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Biomedical subjects

P Joraschky

Publications and source records attributed to P Joraschky.

13 recordsLinked to original sources
PubMed2002

[Evaluation of therapeutic success by patients with anxiety disorders after inpatient psychotherapy].

OBJECTIVE: To identify factors influencing the subjective assessment of patients regarding the outcome of in-patient psychotherapy for anxiety disorders. METHODS: A total of 231 patients were tested at admission, discharge and 1-year follow-up in a multi-center study. Subjective outcome assessment was measured with the revised German version of the Helping Alliance Questionnaire. The use of the term "outcome satisfaction" is discussed. RESULTS: Patient outcome assessment did not correlate with age, sex, or education, or with duration or severity of illness or duration of treatment. Outcome assessment was closely connected with therapy success. Reaching a low symptom level ("clinical significance") had a higher impact than a high pre-post-difference ("statistical significance"). CONCLUSIONS: Anxiety patients give a generally positive assessment of their therapy outcome, which is most determined by symptom-related treatment success. The differentiation of "clinical" and "statistical significance" of success is of importance for the patient's subjective view of the therapy outcome.

Adolescent↗
PubMed2001

The effects of reboxetine on autonomic and cognitive functions in healthy volunteers.

RATIONALE: Though reboxetine, a selective noradrenaline reuptake inhibitor, causes autonomic and cognitive adverse events there is a paucity of appropriately designed studies on the cognitive and autonomic effects of the drug in the literature. OBJECTIVE: To compare the effects of reboxetine on cognitive and autonomic functions with those of placebo in healthy humans. METHOD: A randomised, double-blind, crossover study of 12 healthy male volunteers aged 25 (21-27; median, range) years. Subjects orally received 4 mg reboxetine and placebo twice daily for periods of 14 days each with at least 14 days in between. Vasoconstrictory response of cutaneous vessels (VR) and skin conductance response (SCR) following sudden deep breath were employed as parameters for autonomic function. Quantitative EEG (qEEG) and psychometric tests served as parameters for cognitive function. RESULTS: Reboxetine decreased SCR and prolonged the dilation phase of VR (P<0.05). It did not affect cognitive functions such as flicker fusion frequency, choice reaction, memory and psychomotor coordination but increased slow beta (beta1) power density in the qEEG. Tiredness (n=12), dry mouth (n=9), delayed urination (n=3) and constipation (n=1) were noted with reboxetine. CONCLUSION: Sustained peripheral and/or central sympathetic activation accounts for the prolongation of VR. The decrease of SCR and typical side effects suggest a relevant antimuscarinic drug action. Chronic administration of reboxetine at therapeutic doses causes autonomic dysfunction and subjective sedation but does not impair cognitive and psychomotor abilities in healthy humans.

Adrenergic Uptake Inhibitors↗
PubMed1998

Alterations of autonomic cardiac control in anorexia nervosa.

BACKGROUND: The authors investigated autonomic cardiac function in anorexia nervosa. METHODS: Forty-eight patients, who in the present or past met the DSM-III-R criteria for anorexia nervosa, and 16 normal control subjects participated in a standardized analysis of heart rate variability during supine and standing postures. RESULTS: Several heart rate variability parameters showed an inverse correlation to the present weight of the anorexic subjects. The values of the spectral power analyses were significantly (p < .01) lower in patients (n = 18) weighing less than 75% of ideal weight when compared to the results found in the control group; however, the heart rate variability parameters of anorexic subjects with restored weight (n = 12) did not differ from those of the control subjects. CONCLUSIONS: The obtained results provide evidence for autonomic cardiac dysfunction in acutely ill anorexic patients. Further research is required to elucidate possible clinical consequences of these findings.

Adolescent↗
PubMed1998

Rhythmical changes of the cutaneous blood flow in the forehead region under the condition of hypnoid relaxation.

BACKGROUND: A characteristic and stable blood flow rhythm can be detected for the skin of the forehead and ear lobes with frequencies of approx. 0.15 Hz (9/min), which were primarily not related to the respiratory rhythm. PATIENTS AND METHODS: The perfusion of the skin in the forehead region was investigated non-invasively with laser Doppler fluxmetry in ten healthy subjects before and during Hypnoid Relaxation (HyR). The HyR-state was induced by suggesting formulas regarding to the well known Autgeneous Training. RESULTS: In all test subjects rhythmical fluctuations of bloodflow with a frequency of approx. 0.15 Hz could be observed both, before and during HyR. We found that the amplitude of these fluctuations clearly (> 20% from individual baseline) increased in five of ten test subjects under the condition of HyR. Furthermore, in three of ten cases the spontaneous respiration under HyR adjusted to the frequency of the described bloodflow rhythm, which exists both, before and during HyR. CONCLUSIONS: These phenomena suggest an individually stabil and autonomous rhythm which is effected by alterations in the level of conciousness and which may be caused by the close linkage between the nerval structures for control of respiratory and circulatory systems. May be, this autonomic rhythm could be used as a trigger for breathing therapies or as a parameter for the impact of relaxation techniques on hemodynamics, e.g. in complementary therapy of vascular diseases like systemic sclerosis.

Adolescent↗
PubMed1997

Pseudoseizure "status".

Psychogenic pain, disturbances of gait and stance, sensory symptoms, dizziness, and psychogenic seizures have been found to be the most common conversion symptoms in neurology clinics. A retrospective analysis of 18 patients suffering from pseudoseizure "status" is presented in this study. All of the patients fulfilled the DSM-III-R criteria of conversion disorder. However, 5 of them had concomitant major depression, 6 suffered from bulimia nervosa, and 7 met the criteria for substance abuse. On Axis II, 10 cases of borderline personality disorder, 2 cases of antisocial personality disorder, and 3 cases of histrionic personality disorder were diagnosed. The majority of the patients had attempted suicide and other forms of self-destructive behavior. The findings suggest that patients with pseudoseizure "status" suffer from severe affective imbalances and disturbed impulse control.

Adolescent↗
PubMed1997

Longitudinal development of distress, coping and quality of life in HIV-positive persons.

BACKGROUND: Longitudinal study on burdens, quality of life and coping strategies of HIV-positive persons to identify patterns of successful adaptation to the demands of the infection. METHODS: In a semiprospective multimodal approach, 61 HIV-positive persons in all stages of the infection attending an HIV ambulatorium were assessed by inventories (3 times) and by a half-standardized interview (baseline T1 focussing on first reactions after diagnosis, follow-up T3 1.5 years later). Subjects had a mean age of 35.3 years and 69% were male. Forty-four percent were infected via homosexual intercourse, 46% via intravenous needle sharing and 10% via heterosexual intercourse or an unknown source. RESULTS: Global, psychic and familial distress decreased significantly from the first period after the diagnosis of HIV to the third time of measurement, while somatic complaints increased. Most test persons were able to deal effectively with the demands of the infection and showed a great degree of flexibility in their use of cognitive-actional and emotional-palliative strategies; they achieved a high quality of life. In contrast, highly distressed individuals, mainly drug users, tended to cope in an evasive-regressive way and reported a low quality of life. Correlations between ineffective coping strategies and low quality of life were found to be significant. CONCLUSIONS: After an initial phase of sorrow and lack of orientation regarding their future life, most HIV-positive persons deal effectively with the demands of the HIV infection and report a good quality of life. In contrast, HIV-positive persons with a high degree of distress and an evasive-regressive coping pattern need professional support, such as psychotherapy.

Adaptation, Psychological↗
PubMed1995

[Assessment of curriculum by medical students: comparison of participants and non-participants in voluntary anamnesis groups. An empirical study].

A representative sample of medical students (n = 121) was given a questionnaire to assess parts of their medical education (lectures, seminars, clerkships) and to design a subjectively ideal timetable, which was compared with the real faculty program. Overall traditional lectures received a low rating (n = 0.17) and individual studies with the textbooks a high rating (n = 0.53). The information given in programs in psychiatry and psychosomatics in significantly less motivating than information to be learned in other medical subjects. This is surprising because the ground work for training in the doctor-patient relationship should be in these fields. Students with former group experience (participation in peer groups on history taking (wish to have more practically oriented education compared with the students without group experience. It is not clear whether the important factor is participation in group experience before starting medical school. (64% of the participants had group experience in the first group as opposed to only 45% of the other group). This information should be taken into consideration when reforming medical school programs.

Adult↗
PubMed1991

[Psychological disorders masked as physical symptoms. Problems in the diagnosis of masked depression].

In unclear clinical pictures, the diagnosis "masked depression" is often made, and forms the basis for anxiolytic and antidepressive drug treatment. What is required, however, is a positive diagnosis of a functional syndrome with predominance of a depressive symptomatology. This diagnosis is not simply based on vegetative symptoms, but also has to include psychological and psychodynamic criteria. This consideration of the patient's subjective reality is necessary for a stable therapeutic alliance, especially since therapy is a long-term undertaking.

Affect↗
PubMed1990

[Dysmorphophobia in dentistry].

Patients suffering from dysmorphophobia with symptoms involving the masticatory system, i. e. teeth, mouth and jaws, were subjected to comprehensive examinations in close cooperation with the psychiatric profession. In rare cases the problem underlying the urgent desire for treatment in difficult patients is a disease known as dysmorphophobia. The signs of this disease that become evident in the dental office and the specific personality features of the patients affected are described and demonstrated in three typical case reports. Our experience has shown that irreversible and isolated dental manipulations are to be avoided. An interdisciplinary treatment objective (besser: approach?) integrating dental treatment into a greater therapeutic context is proposed.

Adolescent↗
PubMed1989

[Delusions of parasitic skin infestation in elderly dermatologic patients].

In a study on 21 patients, who had been treated at the Erlangen Dept. Dermat. for delusion of parasitosis during the last 17 years, we compiled catamnestic data, evaluated the personality profiles, and focussed upon the interrelations between the clinical symptoms, the outcome of various psychological tests, and the course of the disease. Our sociographic results agreed well with those of earlier studies (i.e. social isolation, conflicts in or loss of partnership and sexuality). Nearly half of the patients complained about depressive moods which, however, could not be psychometrically proved. In every fifth patient, we detected a propensity to paranoia both clinically and psychopathometrically, indicating the development into paranoic delusion. In general, the patients' aggressiveness was found rather low. Nor were there any hints for organic psychosyndromes in the majority of the patients. We conclude that delusion of parasitosis usually represents a solitary phenomenon of primary psychosis, which can largely be regarded as a monosymptomatic hypochondriac disorder. Successful treatment with neuroleptic drugs depends on a confidential interrelation between patient and physician.

Adult↗