Biomedical subjects

R D Stieglitz

Publications and source records attributed to R D Stieglitz.

At least 19 recordsLinked to original sources

PubMed2003

[Psychological disorders after severe occupational accidents].

After severe accidents, a significant number of victims develop post-traumatic stress disorder (PTSD) and other psychiatric disorders, which lead to considerable impairment in work and daily life. Few studies exist which deal with the psychological consequences of industrial accidents. The Department of Psychiatry and Psychotherapy (University of Freiburg) in cooperation with the Department of Trauma Surgery (University of Freiburg) have therefore carried out a prospective study on the subject. 56 victims of an industrial accident were assessed immediately after the accident, and again six months later, using different instruments, e.g. structured clinical interviews (e.g. ADIS). The prevalence rates of psychiatric disorders in the follow-up assessment after six months were 12% PTSD, 11% subsyndromal PTSD (not all criteria of PTSD fulfilled) and 11% other psychiatric disorders. The patients with PTSD and subsyndromal PTSD were compared with the patients with other psychiatric disorders. The accidents of patients with PTSD/subsyndromal PTSD were more serious, and their injuries more severe. In addition, these patients reported that they had thought much more about their work before the accident and believed that their work was much more dangerous than that of patients with other psychiatric disorders. As early as the first day after the accident the patients with PTSD/subsyndromal PTSD were afraid of developing physical and work-related problems as a consequence of the accident. They also reported more symptoms of PTSD and depression and anxiety symptoms. Patients with PTSD/subsyndromal PTSD reported more limitations in daily life and that they were unfit for work for a longer period. After their return to work, they had more problems and were less resistant to stress.

Accidents, Occupational↗

PubMed2001

[Development of the Borderline Symptom List].

The categorical diagnosis of borderline personality disorder (BPD) is currently discussed as sufficiently reliable and valid. However, specific standardized instruments to measure the degree of the symptomatology are currently not available. Based on the criteria of DSM-IV, the Diagnostic Interview for Borderlines (DIB-R) and the opinion of clinical experts and borderline-patients, a self-rating scale was developed to quantify the intrapsychic strain of patients with BPD. 308 female borderline-patients scored the 99 items. Factor analyses revealed seven factors: self-image, affect regulation, autoaggression, dysthymia, social isolation, intrusions and hostility. Analyses of reliability and validity revealed promising results.

Adolescent↗

PubMed2001

[Differentiated short- and long-term effects of a "Training of Emotional Intelligence" and of the "Integrated Psychologic Therapy Program" for schizophrenic patients?].

Social cognition was shown as a rate limiting factor for both psychosocial outcome and response to psychosocial intervention in schizophrenia. In a randomized controlled trial a new cognitive-behavioral group treatment for schizophrenic inpatients (the "Training of Emotional Intelligence", TEI) was tested against the well evaluated "Integrated Psychological Therapy Program" (IPT) of H. Brenner. Within the framework of P. Salovey's work the Training of Emotional Intelligence focussed on three domains of deficits in schizophrenia: emotional perception, emotional understanding and emotional management. In the randomized controlled trial with 41 DSM-IV schizophrenic inpatients no differences were found in problem-solving and negative symptoms, both post treatment and in the 12 months-follow up. Additionally there was a better outcome in affect decoding capacity post treatment, and a progess in regulation of negative affects in the follow up. Emotional role taking behavior and social anxiety returned to baseline level, perhaps by reasons of no "booster sessions" in the follow up. Unfortunately in contrast to our hypotheses we failed to show treatment-specific effects, which may be due to an underpowered statistical testing. There was only one exception of this: While the Integrated Psychological Therapy Program showed a greater reduction of global psychopathology after treatment, the Training of Emotional Intelligence reduced psychopathology in the follow up more strongly. Possible reasons for these results are discussed.

Adult↗

PubMed2000

[Cognitive remediation. A new chance in rehabilitation of schizophrenic disorders?].

A critical review of current approaches and principles of cognitive remediation strategies in rehabilitation of schizophrenia is given. Selection of cognitive functions targeted in compensatory training programs could be based on results of neuropsychological predictor research on social and vocational functioning in community and neuropsychological rate limiting factors in rehabilitation. Methodological flaws in data base, missing of task analysis of more complex skills like social perception, social skills and interpersonal problem solving and the lack of evaluation of training generalization on work performance are discussed. Finally the cognitive remediation program developed in the Department of General Psychiatry and Psychotherapy/University of Freiburg, Germany is proposed. The components focused on training in attention, memory, and executive function (decision making, planning). Compensatory strategy building, and computer-mediated automatization are integrated in a group setting.

Cognition Disorders↗

PubMed2000

[The concept of "evidence-based medicine" in psychiatry. A path to a more rational psychiatry?].

Many of the diagnostic and therapeutic procedures in psychiatry and psychotherapy are based on opinion rather than evidence. The concept of evidence-based medicine aims to bridge the gap between clinical research and clinical decision-making by integrating the best available external evidence with personal expertise. In this article, we demonstrate several examples of the non-evidence-based medicine paradigm. Then we show the usefulness and practicability of the new evidence-based medicine paradigm by using a clinical example. Finally, we discuss the consequences, chances, and limitations of this new model. We also examine the role of the individual clinician's viewpoint as well as the need of institutional re-engineering and the possible restructuring of the entire health care system towards evidence-based methods.

Antidepressive Agents, Tricyclic↗

PubMed1999

Effects of physical activity on the fatigue and psychologic status of cancer patients during chemotherapy.

BACKGROUND: Fatigue is a common and often severe problem in cancer patients undergoing chemotherapy. The authors postulated that physical activity training can reduce the intensity of fatigue in this group of patients. METHODS: A group of cancer patients receiving high dose chemotherapy followed by autologous peripheral blood stem cell transplantation (training group; n = 27) followed an exercise program during hospitalization. The program was comprised of biking on an ergometer in the supine position following an interval training pattern for 30 minutes daily. Patients in the control group (n = 32) did not train. Psychologic distress was assessed at hospital admission and discharge with the Profile of Mood States and Symptom Check List 90. RESULTS: By the time of hospital discharge, fatigue and somatic complaints had increased significantly in the control group (P for both < 0.01) but not in the training group. Furthermore, by the time of hospital discharge, the training group had a significant improvement in several scores of psychologic distress (obsessive-compulsive traits, fear, interpersonal sensitivity, and phobic anxiety) (P value for all scores < 0.05); this outcome was not observed in the control group. CONCLUSIONS: The current study found that aerobic exercise can reduce fatigue and improve psychologic distress in cancer patients undergoing chemotherapy.

Adult↗

PubMed1999

[Quality of life. Construct validation and the development of a modular system].

The construct Quality of Life (QoL) is investigated by metaanalysis of eight (inter)nationally validated questionnaires in a multicenter study. Data have been collected in a mentally healthy (n = 479), a depressed (n = 171) and a schizophrenic (n = 139) sample. Conventional psychometric criteria and a facet analytical methodology have been applied. The resulting questionnaire "Modular System for Quality of Life" (MSQoL) consists of a core module with 47 items (one "G-factor" and six subdimensions), which is sufficiently valid for all three samples. Additionally, there are four specific modules (demography, family, partnership, profession). No specific modules can be identified for the psychopathological subgroups. The validated radex structure for subjective QoL offers the opportunity for a cumulative research design and for adaptations to the actual setting.

Adolescent↗

PubMed1999

The concept of "sense of coherence" and the development of posttraumatic stress disorder in traffic accident victims.

According to the "sense of coherence" concept, those subjects who can give meaning to a traumatic event can comprehend what has happened and have a sense of manageability of the sequelae, are able to cope better with the traumatic event itself. In the present study, this concept was applied to traffic accident victims. Severely injured traffic accident victims were assessed a few days after the accident and at 6-month follow-up. At follow-up, patients filled in the 29-item version of the Sense of Coherence (SOC) self-rating scale. The results show that the SOC total score correlated negatively with the development of: (i) posttraumatic psychopathology; (ii) psychological disorders (i.e., posttraumatic stress disorder after the accident); and (iii) anxious cognitions. The personality trait of neuroticism correlated negatively and extraversion and frustration tolerance correlated positively with SOC total score. Previous hypotheses are supported by our findings.

Accidents, Traffic↗

PubMed1999

On the validity of the Bech-Rafaelsen Melancholia Scale (BRMS).

BACKGROUND: The findings published to date on convergent validity of the BRMS are mainly concerned with the correlation with other observer-rating scales for depression. In many studies on the evaluation of therapeutic interventions self-rating scales are used in connection with observer-rating scales. Therefore, findings on the relations among instruments of both groups are necessary in order to justify the combination of a particular observer-rating scale with a particular self-rating scale. In the ICD-10 three different degrees of severity of depressive episodes are distinguished. No data on the discriminant validity of the BRMS with respect to this new diagnostic classification are available till now. METHODS: 45 depressed inpatients were assessed with two observer-rating scales (BRMS and DEPRES of the AMDP system) and two self-rating scales (BDI and DS). RESULTS: The discriminant validity with reference to the three degrees of severity of depressive episodes as defined in ICD-10 is at r = 0.80 very high. The convergent validity of the BRMS is high at r = 0.70, related to the DEPRES. The correlations between the BRMS and the BDI as well as the DS were clearly lower, at 0.53 and 0.32 each. CONCLUSIONS: The only moderate convergent validity between self-rating and observer-rating scales is a strong argument for a multi-methodological approach in the context of therapy evaluation.

Adolescent↗

PubMed1999

[Pharmacologic and cognitive therapy treatment strategies in in persistent negative schizophrenic symptoms].

Negative symptoms are a cofeature of schizophrenia which constitute a severe burden on relatives as well as on the patient himself. Novel (atypical) antipsychotic drugs unlike conventional antipsychotics cause substantial progress in the treatment of negative symptoms. Methodological flaws in recent studies which evaluate the effectiveness of neuroleptics in negative symptoms are being discussed critically. Especially the needs for differentiation of primary and secondary negative symptoms are underlined. Cognitive behavioural rehabilitation strategies are also reviewed. A newly developed cognitive behavioural approach in the treatment of negative symptoms developed by the "Research Group for Rehabilitation in Schizophrenia" of the Department of Psychiatry at the Freiburg University is proposed. A framework is discussed in which neuroleptic treatment optimalization and enhancement of coping strategies by psychosocial approaches are integrated. The need for integrating the patient in rehabilitation and treatment planning is underlined. Despite the limitations of methodology of most studies the findings of research reviewed here could be able to stimulate the optimalization of rehabilitation with these patients. It is necessary to ensure that all patients--especially those with high risk for deteriorating outcome--receive optimal treatment at the earliest possible stage in the course of their schizophrenic disorder. Progress in early intervention strategies [42] are therefore of outstanding interest. Main barriers to effective treatment have to be considered: noncompliance (and side-effects) of medication, repeated relapse, "treatment resistance", negative symptoms, and neurocognitive deficits. These factors indicate the need to favour integrated treatment approaches in which drugs and psychosocial strategies can be combined in a manner that maximizes the potential synergism.

Antipsychotic Agents↗

PubMed1998

[Inpatient treatment of depressed patents. Conceptual considerations and results of a pilot project for quality assurance in Baden-Württemberg].

Quality-assurance activities will become more important in psychiatry during the next few years. In relation to other medical disciplines, some special aspects concerning structure, process and outcome quality as well as practical realization and methodologic aspects must be considered. These specific issues were the focus of a study dealing with the treatment of depressed inpatients. The experiences and results as well as considerations concerning future quality-assurance projects are discussed.

Adult↗

PubMed1998

[Follow-up assessment of mood in depressive patients].

Three short, respectively promising self-rating scales used for the assessment of emotional states, especially depression, were examined: a visual analogue scale with only five items, a short version of the so-called "adjectives list" and a differentiated scale for recording current emotions, possible susceptibility to them and the ability to express them. We checked statistical parameters of item analysis, reliability, validity and time course measurement. This study was carried out with depressive inpatients (n = 35) at the time of admission and 4 weeks later in beginning remission. All three scales proved to be reliable (Cronbach-alpha between 0.48 and 0.97) and partially very valid instruments (concurrent validity between 0.04 and 0.87). In order to improve the documentation of a beginning response to therapeutic efforts, separate recordings of depressive subsyndromes such as "impetus" or "positive emotionality" seem to be quite promising approaches.

Adult↗

PubMed1998

Prediction of posttraumatic stress disorder by immediate reactions to trauma: a prospective study in road traffic accident victims.

Road traffic accidents often cause serious physical and psychological sequelae. Specialists of various medical faculties are involved in the treatment of accident victims. Little is known about the factors which might predict psychiatric disorders, e.g. Posttraumatic Stress Disorder (PTSD) after accidents and how psychological problems influence physical treatment. In a prospective study 179 unselected, consecutively admitted road traffic accident victims were assessed a few days after the accident for psychiatric diagnoses, severity of injury and psychopathology. All were inpatients and had to be treated for bone fractures. At 6-months follow-up assessment 152 (85%) of the patients were interviewed again. Of the patients, 18.4% fulfilled the criteria for Posttraumatic Stress Disorder (DSM-III-R) within 6 months after the accident. Patients who developed PTSD were injured more severely and showed more symptoms of anxiety, depression and PTSD a few days after the accident than patients with no psychiatric diagnosis. Patients with PTSD stayed significantly longer in the hospital than the other patients. Multiple regression analysis revealed that the length of hospitalization was due mainly to a diversity of factors such as severity of injury, severity of accident, premorbid personality and psychopathology. Posttraumatic stress disorder is common after road traffic accidents. Patients with PTSD at follow-up can be identified by findings from early assessment. Untreated psychological sequelae such as PTSD cause longer hospitalization and therefore more costs than in non-PTSD patients.

Accidents, Traffic↗

PubMed1998

Adaptation and psychometric properties of the German version of the Dissociative Experience Scale.

We introduce the 'Fragebogen zu Dissoziativen Symptomen' (FDS), a German adaptation of the Dissociative Experience Scale (DES) which was developed to screen for dissociation within an ICD-10 framework. In addition to the original 28 DES items, the FDS contains 16 items covering dissociative phenomena included in the ICD-10, particularly pseudoneurological conversion symptoms. The psychometric properties of the FDS were studied in 927 clinical and nonclinical subjects from different diagnostic groups and compared to results of American studies. The scale had good test-retest reliability of .88, high internal consistency (split-half = .90, Cronbach's alpha = .94) and good construct validity. These results indicate that the FDS may be a valuable screen for dissociative psychopathology in German-speaking countries.

Adult↗

PubMed1998

Psychopathological assessment and diagnosis. A study of specificity of single symptoms.

The importance of single symptoms in the diagnostic process has not been adequately studied, mainly because of the complexity of the information involved. The aim of the present study is to investigate the interconnection between psychopathological assessment and diagnostic classification, with the aid of a nonparametric, inductive pattern recognition method. Using the concept of inductive logic and a theory of inductive knowledge acquisition, a model has been developed to describe psychopathological assessment and diagnostic classification. Based on a comprehensive psychopathological assessment in 837 patients with 14 different diagnoses, classification values were calculated for specific symptoms in different diagnostic groups. Furthermore, nonparametric statistical procedures have advantages over discriminant analytic approaches: more information is utilized in differentiating the groups and differentiations can be made between more groups, whereby the rate of correctly classified cases is comparable with discriminant analytic approaches. The pattern recognition method appears to illustrate the multidimensional, medical decision-making in a comprehensible way.

Adult↗

PubMed1998

[Children of mentally ill parents. A study of problem awareness in clinical routine practice].

The risk of developing clinically relevant psychiatric disorders in the lifetime course is significantly greater among children of mentally ill parents. A child-adapted programme of information concerning the nature and symptomatology of parental illness is considered to be an important preventive factor, and lies within the domain of the psychiatrist's or therapist's responsibilities. During the developmental phase of a prevention project at Freiburg University's Department of Psychiatry and Psychotherapy, both clinical practice and the level of problem awareness among patients and the therapists were evaluated. Over a period of one year, consecutive interviews involving 114 patients with children under 18 years of age, as well as their respective therapists, were conducted. The results showed that: scarcely any exchanges between children and therapists took place; the extent to which children are informed about parental illness must be considered as small; a high percentage of such children are already evaluated by their parents as disturbed, and the pressing need for support exists.

Adolescent↗

PubMed1998

[Questionnaire on dissociative symptoms. German adaptation, reliability and validity of the American Dissociative Experience Scale (DES)].

The "Fragebogen zu dissoziativen Symptomen (FDS)" represents the authorised German translation and adaptation of the "Dissociative Experience Scale" (DES; Bernstein and Putnam 1986). The original scale comprises 28 items covering dissociative experiences with regard to memory, identity, awareness and cognition according to DSM-III-R and DSM-IV. For the German version, 16 items were added to cover dissociative phenomena according to ICD-10, mainly pseudoneurological conversion symptoms. Reliability and validity of the German version were studied in a total sample of 813 persons and were compared to the results of the original version. Test-retest reliability of the FDS was rtt = 0.88 and Cronbach's consistency coefficient was alpha = 0.93, which is comparable to the results of the DES. The instrument differentiates between different samples (healthy control subjects, students, unselected neurological and psychiatric inpatients, neurological and psychiatric patients with a dissociative disorder and schizophrenics). The FDS is an easily applicable, reliable and valid measure to quantify dissociative experiences.

Dissociative Disorders↗

PubMed1997

Correlation between physical performance and fatigue in cancer patients.

BACKGROUND: Fatigue and a reduction in physical ability are common and often severe problems of cancer patients regardless of disease stage and modality of treatment. However, while physical performance can be assessed objectively with laboratory tests, fatigue is a subjective phenomenon whose perception is influenced by past experience and expectations for the future. PATIENTS AND METHODS: To evaluate the correlation between fatigue and physical impairment, we assessed maximal physical performance with a treadmill test, and mental state with two questionnaires, the Profile of Mood States (POMS) and the Symptom Check List (SCL-90-R), in a successive series of 78 cancer patients with solid tumors or hematological malignancies. RESULTS: A weak association between fatigue and maximal physical performance was found (r = -0.30; P < 0.01). However, intensity of fatigue showed a strong correlation with several indicators of psychological distress such as depression (r = 0.68), somatization (r = 0.64) and anxiety (r = 0.63; P for all < 0.001). Furthermore, patients with lower levels of physical performance had significantly higher scores for depression (P = 0.005), somatization (P = 0.03) and anxiety (P = 0.08), and significantly lower scores for vigor (P = 0.05) than their counterparts whose physical performance was higher. CONCLUSIONS: We conclude that fatigue in cancer patients may be related to mood disturbance but appears to be independent of physical performance. Moreover, low physical performance can be viewed as an independent predictor of mental distress in cancer patients.

Adolescent↗