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Biomedical subjects

W Rief

Publications and source records attributed to W Rief.

35 records · Page 2Linked to original sources
PubMed1995

Somatoform symptoms in depressive and panic syndromes.

Somatoform symptoms are common features of psychological and psychosomatic disorders. This study addresses the question of whether somatoform symptoms differ in patients with panic syndromes. with depressive syndromes, or with somatization syndromes without depression or panic syndromes. We therefore investigated 135 inpatients o f a psychosomatic clinic and identified 64 patients for the depression group, 31 for the panic subgroup, and 18 for the somatization syndrome group. Neither the number of somatization symptoms nor the pattern of somatoform symptoms differed substantially among the 3 groups, except for higher frequencies of palpitations in the panic group and more abdominal pain symptoms in the depressive group. The 3 groups showed nearly identical frequency distributions of the individual somatoform symptoms. All 3 groups showed elevated hypochondriasis scores. In personality dimensions, depressive patients showed the lowest scores for extraversion. The improvements during inpatient treatment on the somatization variables, as well as general psychopathology, were also comparable. We favor the interpretation that the somatization syndrome is a fairly uniform syndrome whether or not it occurs alone or in combination with depressive syndromes or panic syndromes.

Journal Article↗
PubMed1994

Course of multi-impulsive bulimia.

Thirty-two consecutively admitted females with bulimia nervosa (purging type) according to DSM-IV and additional impulsive behaviours (multi-impulsive bulimia (MIB)) and 32 age-matched female controls with DSM-IV bulimia nervosa (purging type) (uni-impulsive bulimia (UIB)) were assessed longitudinally on admission and at discharge following in-patient therapy and at a 2-year follow-up. Multi-impulsive bulimics were defined as presenting at least three of the six of the following impulsive behaviours in their life-time in addition to their bulimic symptoms at admission: (a) suicidal attempts, (b) severe autoaggression, (c) shop lifting (other than food), (d) alcohol abuse, (e) drug abuse, or (f) sexual promiscuity. Multi-impulsive bulimics were more frequently separated or divorced, had less schooling and held less-skilled jobs. Except for interoceptive awareness (EDI), which was more disturbed in multi-impulsive bulimics, there were no differences concerning scales measuring eating disturbances and related areas. Multi-impulsive bulimics showed more general psychopathology--anxiety, depression, anger and hostility, psychoticism--differed in several personality scales from uni-impulsive bulimics (e.g. increased excitability and anger/hostility) and had overall a less favourable course of illness. Multi-impulsive bulimics also received more in- and out-patient therapy previous to the index treatment and during the follow-up period. The data support the notion that 'multi-impulsive bulimia' or 'multi-impulsive disorder' should be classified as a distinct diagnostic group on axis I or that an 'Impulsive Personality Disorder' should be introduced on axis II. The development of more effective treatment for multi-impulsive bulimia is warranted.

Adult↗
PubMed1994

Reliability of self-rated tinnitus distress and association with psychological symptom patterns.

Psychological complaints were investigated in two samples of 60 and 138 in-patients suffering from chronic tinnitus. We administered the Tinnitus Questionnaire (TQ), a 52-item self-rating scale which differentiates between dimensions of emotional and cognitive distress, intrusiveness, auditory perceptual difficulties, sleep disturbances and somatic complaints. The test-retest reliability was .94 for the TQ global score and between .86 and .93 for subscales. Three independent analyses were conducted to estimate the split-half reliability (internal consistency) which was only slightly lower than the test-retest values for scales with a relatively small number of items. Reliability was sufficient also on the level of single items. Low correlation between the TQ and the Hopkins Symptom Checklist (SCL-90-R) indicate a distinct quality of tinnitus-related and general psychological disturbances.

Adult↗
PubMed1994

[When patient and therapist disagree--discrepancies in evaluation of change].

The following study concerns the interaction of different measures for therapeutic change. 1377 inpatients of a psychosomatic hospital were examined. Measures for change were the subjective global rating of the inpatient, the subjective global rating the psychotherapist, and the Symptom-Check-List SCL-90-R. To get additional information for possible predictive variables for discrepant judgements, also personality questionnaires and sociodemographic variables were considered. Results demonstrated only medium correlations between subjective ratings for change of the patient and the psychotherapist, although the same categories were used (R = 0.44). The correlations to measures of change of the self-rating-scales are even lower. Therefore we conclude that these measures focus to different information, because the common part of variance is low. Discrepancies between the judgement of therapists and patients can be found after all when the patient makes a negative rating. Predictive variables for discrepancies of the judgements for change of the psychotherapists and patients are: age, sex, phobic anxiety and bodily complaints. While younger patients tend to make better judgements than their therapists we find the contrary for elder patients. Women tend to make better judgements than their psychotherapists. We find also discrepancies in patients with multiple syndromes, when phobic anxiety and bodily complaints exist and are perhaps not adequately concerned in the psychotherapy.

Adult↗
PubMed1992

Lifetime diagnoses in patients with somatoform disorders: which came first?

Thirty inpatients with somatoform disorders were examined with the structured clinical interview SCID for psychiatric lifetime diagnosis. In the present diagnoses, we found a concordance of 63% for somatoform and affective disorders and the lifetime comorbidity of both disorders was 87%. Additionally, patients with somatoform disorders frequently had a history of other psychiatric disorders (for example, anxiety disorders, 40%). For 73% of patients with somatoform disorders and a history of affective disorders, the onset of the somatoform disorder was prior to the onset of another psychiatric disorder. The time interval between the onsets of somatoform disorders and affective disorders was greater than 1 year for most patients; for 46% of the patients with a history of both disorders, the time interval between the two disorders was more than 5 years. The course of illness for somatoform and affective disorders was quite different; while affective disorders tended to episodic periods with interim remissions, the somatoform disorders usually showed long, chronic courses (mean duration of the current somatoform disorder was 11.9 years). Finally, the Symptom Check List SCL-90R demonstrated good discrimination between patients with affective and anxiety disorders. However, the SCL-90R failed to discriminate patients with somatoform disorders from affective- and anxiety-disordered subjects. Therefore, the development of other psychometric scales is necessary for the evaluation of patients with somatoform disorders.

Adult↗
PubMed1992

The Symptom Check List SCL-90-R and its ability to discriminate between dysthymia, anxiety disorders, and anorexia nervosa.

The factorial and discriminative validity of the Hopkins Symptom Check List SCL-90-R were examined in the light of criticism that clinical self-rating scales primarily express a general distress factor. In a population of 899 psychosomatic patients, high intercorrelations were found between the individual dimensions of the SCL-90-R. A subsequent Principal Components Analysis obtained 9 factors which were markedly less interdependent than those in the original version. The ability of the questionnaire to distinguish between patients with dysthymia, anxiety disorders and anorexia nervosa was examined. The average hit rate in the discriminant analysis was 67% using the original version and 74% with the proposed new factorial structure of the SCL-90-R, confirming the discriminative validity of the inventory. The present results as well as earlier studies suggest that the factor 'anxiety' should be included in the factor 'phobic anxiety', the factors 'paranoid ideation' and 'psychoticism' should be reformulated, and a new factor 'sleep disturbances' should be added to the original version of the SCL-90-R.

Adult↗
PubMed1991

Fluoxetine versus placebo: a double-blind study with bulimic inpatients undergoing intensive psychotherapy.

In a double-blind trial 40 patients with bulimia nervosa according to DSM III-R criteria were randomly assigned either to a 60 mg fluoxetine group or to a placebo control group. Fluoxetine or placebo was given over a period of 35 days. Parallel to the drug trial, patients participated in an intensive inpatient behavioral psychotherapy program. There were no dropouts at all in the study. Fluoxetine was well tolerated and had only minor adverse effects. In self-ratings and expert ratings concerning attitudes towards eating, eating behavior, and general psychopathology, significant improvements over time were observed in both groups. Using analysis of variance (ANOVA), however, there were no statistically significant "group by time" differences. Results show that the intensive inpatient-care and psychotherapy program was highly effective in changing eating behavior and attitudes as well as general psychopathology. Fluoxetine showed a significant reduction in body weight, especially during the first three weeks of fluoxetine treatment. It was not possible to demonstrate a statistically significant improvement in eating attitudes, eating behavior, and general psychopathology beyond that elicited by intensive inpatient psychotherapy and general inpatient care. These results can possibly be explained by the existence of a "ceiling effect".

Adult↗
PubMed1991

Visual perceptual organization in schizophrenic patients.

Place & Gilmore (1980) proposed that schizophrenic patients are deficient in the perceptual organization of visual stimuli. According to their theory, the patients should be less influenced by global characteristics of visual displays. In the present experimental approach, 24 schizophrenics, 12 alcoholics and 24 healthy controls were asked to identify the number of lines presented for 23 ms on a video screen. In one condition, the stimuli were identical to those used by Place & Gilmore: up to six lines were shown at the corners of an imaginary hexagon; all lines were either in the same direction ('homogeneous') or differed in orientation ('heterogeneous'). In another condition the lines appeared at 10 different positions within the same field. The results of Place & Gilmore were not replicated; schizophrenics were only less influenced than the control group by different directions of the lines when three lines were presented. When more lines were presented, schizophrenics had the same advantage from homogeneity as the controls. If the basic configuration was a hexagon and six lines were presented, schizophrenics were able to profit very strongly from the global Gestalt. In summary, global characteristics of the visual displays do not facilitate visual information processing by schizophrenics as they do in the case of controls. However, if the basic Gestalt properties are strong enough, schizophrenics can take advantage of it. Thus the deficit of schizophrenics described by Place & Gilmore is relative and not absolute.

Adult↗
PubMedDate not supplied

A two-year follow-up study of patients with somatoform disorders.

Thirty inpatients with multiple somatoform symptoms admitted to a psychosomatic hospital were diagnosed using the Structured Clinical Interview for DSM-III-R and questionnaires. Two years later, a reexamination by interview and a follow-up questionnaire took place. The authors found high comorbidity rates not only for affective disorders (lifetime 86%), but also for anxiety disorders (lifetime 43%). Comorbidity is of high prognostic relevance: whereas patients with only somatoform disorders at first assessment may remit until second assessment, in those patients with comorbidity with other psychiatric disorders, some somatoform symptoms still remain. The rate of misdiagnosed organic disorders is estimated at lower than 10%.

Adult↗
PubMedDate not supplied

Further evidence for a broader concept of somatization disorder using the somatic symptom index.

Somatization syndromes were defined in a sample of 102 psychosomatic inpatients according to the restrictive criteria of DSM-III-R somatization disorder and the broader diagnostic concept of the Somatic Symptom Index (SSI). Both groups showed a qualitatively similar pattern of psychopathological comorbidity and had elevated scores on measures of depression, hypochondriasis, and anxiety. A good discrimination between mild and severe forms of somatization was found by using the SSI criterion. SSI use accounted for a substantial amount of comorbidity variance, with rates of 15%-20% for depression, 16% for hypochondriasis, and 13% for anxiety. The results provide further evidence for the validity of the SSI concept, which reflects the clinical relevance of somatization in addition to the narrow definition of somatization disorder.

Adult↗
PubMedDate not supplied

Elevated levels of psychophysiological arousal and cortisol in patients with somatization syndrome.

OBJECTIVE: This study investigates psychological and psychobiological processes in patients with somatization syndrome. METHOD: We compared physiological measures (heart rate, finger pulse volume, electrodermal activity, electromyography), cortisol levels, and subjective well-being during rest and during a mental stress task as well as selective attention and memory for illness-related words in 58 patients with somatization syndrome and 21 healthy controls. RESULTS: The somatization group had higher morning salivary cortisol concentrations, higher heart rates, and lower levels of finger pulse volume. During the mental stress task, patients with somatization syndrome felt more distressed and had higher heart rates, whereas controls showed habituation to the experimental situation. We were unable to demonstrate an attention or memory bias specific for somatization. CONCLUSIONS: The results point to several psychological, psychophysiological, and psychobiological mechanisms that might be involved in the maintenance of somatization syndrome. These results are discussed from a cognitive-psychobiological perspective.

Adolescent↗
PubMedDate not supplied

Somatization symptoms and hypochondriacal features in the general population.

OBJECTIVE: The principal goal of this study is to examine the base rates of somatoform symptoms and of hypochondriacal features in the general population. METHODS: A representative sample of 2050 persons in Germany was examined by use of screening for somatoform symptoms and the Whiteley Index. RESULTS: The most frequent somatoform symptoms were back pain, joint pain, pain in extremities, and headache, as well as abdominal symptoms (bloating or intolerance of several foods) and cardiovascular symptoms (palpitation). People reported a mean of two somatization symptoms of DSM-IV somatization disorder (SD) during the prior 2 years. Strong age and medium gender effects were found for most somatoform symptoms, as well as for composite indices. However, the sex ratio suggested in DSM-IV for SD seems to be an overestimation. Hypochondriacal features showed only small sex differences but, again, pronounced age effects. In contrast to low rates for SD, the base rates for somatization and hypochondriacal features were high and represented the health care relevance of subthreshold syndromes. CONCLUSION: We present base rates of hypochondriacal and somatization features that may be important facets in the development of classification criteria and in the interpretation of health care expenditure.

Adolescent↗
PubMedDate not supplied

Cognitive behavior therapy in panic disorder and comorbid major depression. A naturalistic study.

BACKGROUND: There is a lack of evidence about the effectiveness of cognitive behavior therapies (CBT) in settings of routine clinical care as well as in the treatment of panic and comorbid disorders. METHODS: We investigated a group-oriented CBT approach for 80 patients with panic disorder including 35 patients with current comorbid major depression. Assessments took place 6 months before treatment, at the beginning and end of treatment, and 1 year later. Structured interviews and multiple clinical self-rating scales were used. RESULTS: Panic patients with comorbid major depression showed higher anxiety-specific and nonspecific pathology. The most striking benefits were in reducing avoidance behavior, while improvements concerning catastrophic beliefs were smaller, but still significant. For most self-rating scale results, patients with and without comorbid depression improved to a comparable degree. However, the end-state functioning of patients with panic disorder and current comorbid depression at admission is significantly lower than for patients with panic disorder alone. CONCLUSIONS: The results point to the necessity to develop and improve treatment approaches for patients with comorbidity of panic disorder and current major depression.

Adult↗
PubMedDate not supplied

Searching for a gastrointestinal subgroup within the somatoform disorders.

The authors examined whether patients suffering from functional gastrointestinal symptoms constitute a separate group within the broader concept of the somatoform disorders. The authors compared 103 patients with a severe gastrointestinal syndrome, 220 patients with a somatization syndrome according to DSM-IV, and 250 clinical control subjects with nonsomatoform mental disorders. The gastrointestinal group showed more catastrophizing thinking, complained more about autonomic sensations, felt bodily weaker, was less tolerant towards bodily discomfort, had developed more hypochondriacal fears and behaviors, was more depressed, and was more severely disabled in different areas of psychosocial functioning than the other groups. These differences, however, disappeared when general somatization was controlled for by analysis of covariance. Only a small effect related to dysfunctional cognitions remained specific to the gastrointestinal syndrome. Because these results do not confirm the idea of an independent gastrointestinal syndrome, general mechanisms of somatization seem to play the dominant role.

Adolescent↗
PubMedDate not supplied

[New aspects of complex chronic tinnitus. I: Assessment of a multi-modality behavioral medicine treatment concept].

"Complex tinnitus" is a diagnostic term denoting a disturbance pattern where the patient hears highly annoying and painful noises or sounds that do not originate from a recognisable external source and can be described only by the patient himself. It seems that the suffering mainly depends upon the extent to which the tinnitus is experienced as a phenomenon that is beyond control. Part I reports on an examination of the treatment success achieved with 28 consecutive patients who had been treated according to an integrative multimodal behavioural medicine concept. This resulted--despite continual loudness--in a decrease in the degree of unpleasantness of the tinnitus, by 17% (p less than 0.01) with corresponding normalisation of decisive symptom factors in Hopkins Symptom-Check-List (SCL-90-R) and Freiburg Personality-Inventary (FPI-R). On the whole, 19 out of the total of 28 patients showed essential to marked improvement of the disturbance pattern. Part II presents a multidimensional tinnitus model and the essential psychotherapeutic focal points of a multimodal psychotherapy concept in complex chronic tinnitus, as well as the parallel phenomena in the chronic pain syndrome.

Adult↗
PubMedDate not supplied

[New aspects of complex chronic tinnitus. II: The lost silence: effects and psychotherapeutic possibilities in complex chronic tinnitus].

"Complex tinnitus" is a diagnostic term denoting a disturbance pattern where the patient hears highly annoying and painful noises or sounds that do not originate from a recognisable external source and can be described only by the patient himself. It seems that the suffering mainly depends upon the extent to which the tinnitus is experienced as a phenomenon that is beyond control. Part I reports on an examination of the treatment success achieved with 28 consecutive patients who had been treated according to an integrative multimodal behavioural medicine concept. This resulted--despite continual loudness--in a decrease in the degree of unpleasantness of the tinnitus, by 17% (p less than 0.01) with corresponding normalisation of decisive symptom factors in Hopkins-Symptom-Check-List (SCL-90-R) and Freiburg Personality-Inventary (FPI-R). On the whole, 19 out of the total of 28 patients showed essential to marked improvement of the disturbance pattern. Part II presents a multidimensional tinnitus model and the essential psychotherapeutic focal points of a multimodal psychotherapy concept in complex chronic tinnitus, as well as the parallel phenomena in the chronic pain syndrome.

Behavior Therapy↗