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Biomedical subjects

R Plassmann

Publications and source records attributed to R Plassmann.

18 recordsLinked to original sources
PubMed1998

[Changes in pensioning and psychosomatic assessment].

Appropriate evaluation of a patient's handicapping or disabling conditions, of his or her capacity for work and gainful activity rank among the recurring tasks in inpatient rehabilitation. Published recently, the Beeinträchtigungsschwere-Score (BSS; a score for determining the severity of a condition) constitutes a highly practicable instrument for these purposes, well suited to the clinical setting. Particular difficulties are encountered in the assessment of patients already in the pension award process, a population where the original disease picture has been superimposed by numerous chronification factors of a psychological, social and economic nature so that a so-called invalidity pensioning career has set in. The article gives an overview of this phenomenon of invalidity pensioning career and the sequence of its various phases, setting out the use of the BSS for social-medical evaluation in an inpatient rehabilitation setting.

Adult↗
PubMed1997

[Psychosomatic disorders in the area of environmental medicine. Environmental medicine--environmental psychology].

In environmental medicine, we frequently see patients who have a very firm, sometimes fixated view of the nature of their disease, and they do not except the correction by the physician but only confirmation. Therefore, we face the task to undertake these patients a careful medical and psychological differential diagnosis. In a major number of cases, the symptoms are caused not by supported environmental effects but by an unknown diagnosis, and recognition and treatment would be impossible in case of an uncritical adoption of the patient's illness theory. Further, psychosomatic syndromes, which are well accessible by treatment procedures of psychosomatic medicine, can be diagnosed in many of those patients. This article demonstrates the different kinds of psychosomatic diseases in the area of environmental medicine and its appropriate therapeutic consequences.

Adult↗
PubMed1995

[Psychoanalysis of self injury].

Psychoanalytic aspects of diseases with self-inflicted mutilation (factitious diseases and Munchhausen syndrome) have been investigated increasingly within the last years in the setting of long term ambulatory and hospital treatments. The author describes in this report how these disease states may also be interpreted as equivalents of remembrance and can be understood as inadequate attempts for self assistance. He outlines possibilities for psychotherapy arising in view of this background.

Adult↗
PubMed1995

[Psychosomatic disorders in the new German states. Findings and background information].

The sociopsychological background and the conceptual problems in understanding the individual experience of the far reaching changes in the living after the remification of Germany is discussed. It is attempted by the analysis of treatment courses from a psychosomatic hospital to identify typical clinical pictures, trigger situations, or pathopsychological features in especially affected patients coming from the new states. From the author's experience, this is not possible. However, it is pointed out that specific health problems in this population are obvious. The decrease in birth-rate, the frequency of notifications of illness, unemployment, and applications for retirement are observed as an example. In a sample case, changes in the values regarding the areas of existence securing, self-realization, and human relationships are discussed in their effect on coping with illness. It is found that taking into account the societal changes and the internal and external weakening caused by these changes eases the coping with individual conflicts and psychosomatic disturbances.

Adaptation, Psychological↗
PubMed1995

[Progress in disability pensions for psychosomatic patients].

Only part of the invalidity pensioning courses seen can be traced to medically substantiated illness and disablement. Another part of these courses, with an extraordinarily high share in particular from the psychosomatic field, consists of a gradual psychosocial down-grading which, though possibly triggered by illness and disablement, essentially is enhanced, or countered, by specifies of individual personality, family, labour market, or medical doctors' behaviour. The matter dealt with only seems to be a dry one. The fates of those affected are oppressive, regardless of whether pensioning ensues or not. Frequently, the entire family is involved by the improvement taking place. At the same time, enormous spending accumulates due to the coverage provided by the statutory health and pension insurance schemes. It is therefore considered appropriate that an invalidity pensioning study be conducted specifically directed at pensioning behaviours, at clarifying the weight of the various factors involved and at investigating the effectiveness of rehabilitative instruments in the various phases. The findings should form the basis also for improved preventive approaches, such as energetic measures to combat meaningless certification of illness or "parking-off" of patients in long-term unemployment, while rehabilitative service provision is totally neglected.

Adolescent↗
PubMed1994

Diagnosis of narcissistic self-esteem regulation in patients with factitious illness (Munchausen syndrome).

A quantitative taxonomy for the identification of patients with narcissistic pathology and with borderline personality disorders based on test results is presented. The quantitative identification of these subgroups was produced using a Q-factor analysis. Based on the correlation of the subjects by means of the 241 questions from the narcissistic inventory of Deneke and Müller [27], three subgroups could be defined. Two of these groups exhibited a pathology of the self-system which corresponded to the pathology described by Kernberg [24] for narcissistic and borderline personality disorders. The third group is characterized by reduced observable self-pathology traits from the narcissistic inventory. By means of the reclassification of these three taxonomical groups with the discriminant analysis, two discriminant functions could be calculated, using the weighting of the single test scales for a classification of new patients. These classification functions were used to examine 18 patients suffering from factitious disorders. The evaluation of test profiles with the reduced narcissistic inventory of Deneke and Müller [11] in order to identify the three taxonomical groups showed that 9 patients (50%) had a borderline personality disorder and 6 patients (33%) a narcissistic personality disorder, while 3 patients (17%) could be assigned to the subgroup without self-pathology. In summary, 83% of the examined patients with factitious disorders exhibited a disorder in self-regulation. The previous clinical observations of self-regulation for patients with factitious disorders could thus be confirmed. It becomes clear that different high levels of disorder in self-regulation (position in the sphere of the discriminant function) correspond to varying degrees of prognostic significance.

Adult↗
PubMed1994

Inpatient and outpatient long-term psychotherapy of patients suffering from factitious disorders.

A favorable therapeutic course is achieved by the combination of an initial clinical psychotherapy and a subsequent analytical long-term treatment implemented as an outpatient therapy or an interval therapy. This form of therapy was offered to all of the patients and was accepted by half of the patient collective, i.e., by 12 out of 24. Only in 1 of these 12 cases, was it possible to dispense with the initial clinical therapy in favor of a primary outpatient therapy. Of these 12 therapies, 2 were terminated by the patients. We were able to continue the other 10 for longer periods, extending up to 4 years. In this setting, a transition from the working phase to the separation phase is possible around the fourth year of therapy. Termination of therapy is almost always based on a negative therapeutic reaction. The patients were generally capable of development, but were not able to take advantage of this opportunity because of the dominance of malignant introjects. In several cases, this pattern has become consolidated on a social as well as an endopsychic level. The therapy is then terminated in favor of a structured mother-child relationship or a similarly structured marriage. In those cases where the therapy was broken off prematurely, the establishment of a sufficiently stable working relationship was prevented by the predominantly negative transference. As a result, it was not possible to conduct a follow-up therapy after the normal end of the clinical psychotherapy, for example. The question remains whether a significant lengthening of the clinical psychotherapy could have changed anything here; in my opinion, this is not the case. In these cases, the inpatient therapy was always terminated by the patients, either by a directly expressed wish or by a symptomatic development making referral or discharge imperative. The 10 cases undergoing long-term therapy all progressed favorably, with a significant, or at least marked, improvement of the symptomatology and the relationship capability. In this context, the results are, in each case, a function of the severity of the illness, the individual capability for growth, and the length of treatment. Even though 6 of the 10 long-term therapies are now in the separation phase, none of them has been finally ended yet. As a result, we have only a small amount of information so far on the possibilities for reaching a final conclusion of the therapy.(ABSTRACT TRUNCATED AT 400 WORDS)

Acting Out↗
PubMed1993

[Organ worlds: basic principles of analytic body psychology].

In this article, the author introduces the expression organ fantasies, pathological zones in the body self and organ world with the intention of formulating an analytical psychology of the body. He presents the view that a person's own body has the significance of a primary object which, under normal circumstances, enables a person to make several important basic experiences, such as the experience of being alive, of having a body, and of being separate from others. On the basis of this work with borderline patients, the author demonstrates that the pathological zones in the body self can be understood by means of a phase model and that the illness-producing effect of a pathological organ world is related to a defective symbolization of experiences. The author suspects that the analytical psychology of the body can be applied to psychosomatic illness as well.

Body Image↗
PubMed1986

[Secret self mutilation, a psychosomatic disease].

The present article contains initial results form systematic psychoanalytic work with patients practicing secret self-mutilation (our term for these is "mimicry patients"). The group we examined was treated on an in-patient basis in a hospital for psychosomatic disorders. The article may be considered as a preliminary report. Up until now the international range of experience is rather limited. We have therefore, made use of this occasion also for developing an applicable clinical definition of the different forms of self-mutilation. This definition is based upon psychological criteria rather than, as has hitherto been the custom, upon the techniques and the morphology of the self-inflicted injuries. Clandestine self-mutilation, in our understanding, is a psychosomatic illness. The self-manipulation has the character of a psychosomatic symptom which, although self-inflicted, is beyond the control of the afflicted individual and is accompanied by extremely reduced consciousness. So far, the experience gained in therapy points to a variety of subconscious conflicts at the back of this symptom, most frequently a severe guilt problem which is not only manifest intrapsychically but also within the family milieu of the patient. On the whole therapeutic results correspond to those observed with other grave psychosomatic disorders accompanied by organic lesions, that is to say improvement sets in slowly after a therapy extending over periods of several months to several years. Initially, a long time before any treatment of the subconscious conflict may be attempted, such therapy must employ supportive ego-consolidating methods and establish a therapeutic alliance. Even so we see no reason for resignation with regard to therapeutic success.

Adult↗
PubMed1985

[Headache and perception].

Attacks of migraine can be caused by a spasmodic overexertion of perception which has neurotic origins. In such cases massive intolerance with regard to depressive episodes and helplessness is observed in the patients. This can be plausibly explained on the background of unsolved infantile conflicts. As an attempt at a solution on the somatic level the patients employ motor and sensor overexertion which may result in overexposure to stimuli and, subsequently, in headache. When this development of symptoms is considered as a general model a perfect analogy to the development of the psychoneuroses becomes apparent.

Arousal↗
PubMed1985

[Borderline structure and painful skin hemorrhages: a case of Gardner-Diamond syndrome].

The Gardner-Diamond Syndrome is an infrequently diagnosed impressive psychosomatosis. The patients (exclusively female) suffering from this disorder are described as "angry young women". They are considered hysterical, masochistic, depressive, hostile and timid. Physically the syndrome is characterized by atypical, painful, apparently spontaneous skin bleeding in young women and these patients look like they have been beaten, injured or are seriously ill. Besides hematoma, renal hemorrhage, uterine hemorrhage, headaches or unconsciousness as well as numerous symptoms of conversion in the narrower sense of the word have been observed, e.g. loss speech, gait deviation, or feelings of discomfort. To this day the pathophysiological peculiarity that enables the patients to transform subconscious psychic events into the specific temporary alteration in the permeability of the capillary walls being a constitutional variant characteristic of females suffering from Gardner-Diamond Syndrome and activated by psychic stimuli. In the case history presented, the problem is the psychic working out of narcissistic injuries in the context of a borderline structure. These injuries turn into physical symptoms analogous to the process of conversion. Since, in this case, there is no question of a defense against oedipal fantasies one would prefer to speak of a "narcissistic conversion". Quite peculiar is the universally described resemblance of the patients to one another. The syndrome, together with the character and psychodynamic features, is repeated in almost a stereotypical manner. An explanation for this phenomenon cannot be expected even from the discovery of a pathophysiological detail in the blood vessels. Rather, we are confronted with one of those extremely rare syndromes where, in a limited field, physical and psychic events are completely blended. The physical events such as affects and defense mechanisms for which they can be substituted at random and without mutual interference. It is as though these disorders had retained a phylogenetically lost unity and primeval capability of interchanging psychic and somatic structures and, so to speak, preserved them in the manner of a museum. These syndromes make us surmise that in processes of somatization a recourse to ancient, long-faded psychosomatic relationships may play a certain role.

Adult↗