Search PubMed⌕ Search

Biomedical subjects

W Wöller

Publications and source records attributed to W Wöller.

14 recordsLinked to original sources
PubMed1996

[What is supportive psychotherapy?].

Although supportive psychotherapy is of great importance in psychiatry and psychosomatic medicine, supportive treatment strategies have not been paid much attention so far in literature and training. Clinical indication criteria for supportive techniques are: lack of treatment motivation and introspection, impairment of object relations and impulse control, inadequate modulation of affect and difficulties in establishing a therapeutic working alliance. After reviewing the principles of supportive psychotherapy, special aspects of supportive treatment techniques are discussed.

Humans↗
PubMed1995

[Perceived emotional support of HIV-positive men in relation to the stage of the disease].

Perceived emotional support is considered important in buffering the adverse effects of life-threatening conditions, e.g. AIDS. The aim of the present study was to investigate (1) which aspects of perceived emotional support are associated with depression, anxiety and suicidality in patients with HIV-infection, and (2) whether perception of emotional support is influenced by the stage of disease. 40 male patients with HIV-infection, most of them homosexuals (no drug-addicts, no signs of neuropsychiatric impairment) were investigated. A Perceived Emotional Support Scale, Zung's Self-rating Depression Scale and Spielberger's State-Trait-Anxiety Inventory were administered. To assess suicidality, a clinical interview was carried out. Stage of disease was determined according to CDC-classification and CD4-cell count. The data indicate that (1) aspects of perceived emotional support concerning regulation of self-esteem in relation to a key figure are of greatest importance in predicting depression and state-anxiety and (2) emotional support is perceived significantly better in patients with low CD4-count, i.e. in those patients facing the greatest threat.

Adult↗
PubMed1995

[Trauma of illness--crises in self concept regulation by cancer patients].

Oncological diseases often represent a psychic trauma, which leads affected patients into a narcissistic crisis. Starting from the concept of narcissistic regulation system (Deneke, 1989), the origins of the destabilisation of the self are described, and parallels to persecution trauma will be drawn. The longing of the patients for symbiotic relationships are investigated in their double sense. On the one hand they serve the patient to stabilise his self, on the other hand they involve the danger of traumatisation within an object relation. The consequences for the process of mourning and integration will be discussed.

Adaptation, Psychological↗
PubMed1993

Cortisone image and emotional support by key figures in patients with bronchial asthma. An empirical study.

In a subgroup of patients with bronchial asthma, irrational fears of steroid medication can be observed beyond justified worries about side-effects. A cortisone image which involves overemphasizing the threatening aspects of cortisone often underlies non-compliant illness behaviour. In the present study, cortisone image and the relationship with a key figure was investigated in 62 patients with bronchial asthma, all of whom had participated in a structured asthma treatment and teaching programme (ATTP). The data show that (1) perceiving cortisone as threatening predicts poor adherence to ATTP guidelines how to manage severe attacks, and (2) patients having a supportive relationship with their key figure are less likely to experience threatening aspects of cortisone.

Acute Disease↗
PubMed1993

[Cortisone level and emotional support by key figures in patients with bronchial asthma].

In a subgroup of patients with bronchial asthma, irrational fears of cortisone medication can be observed beyond justified worries about side-effects. A cortisone image which involves overemphasizing the threatening aspects of cortisone, often underlies noncompliant illness behaviour. In the present study, cortisone image and subjectively experienced emotional support by a key figure was investigated in 62 patients, all of whom had participated in the Düsseldorf Asthma treatment and teaching programme (ATTP). The data show that patients having a supportive relationship with their key figures are less likely to experience threatening aspects of cortisone. The findings are discussed in light of psychoanalytic object relations theory.

Adaptation, Psychological↗
PubMed1992

[Negative cortisone attitude in patients with bronchial asthma].

Patients with bronchial asthma often exhibit irrational fears of cortisone medication beyond justified worries about side-effects. A negative cortisone image, which means overemphasizing the damaging and threatening aspects of cortisone, often underlies non-compliant illness behaviour. In the present study, cortisone image was investigated in 54 patients with bronchial asthma before and after participation in the Düsseldorf Asthma treatment and teaching programme (ATTP) and one year later. By participating in ATTP, a significant reduction of the negative cortisone image and thus a more realistic view of cortisone could be achieved in most patients. This effect was also evident at the follow-up examination one year later. On the other hand, persistence of a negative cortisone image in a subgroup of patients turned out to be a potent predictor of later non-compliant illness behaviour. Psychological implications of a persistent negative cortisone image are discussed.

Adult↗
PubMed1992

[Affective-cognitive coping with attacks and illness behavior in patients with bronchial asthma].

The purpose of this study was to investigate attack-related cognitive coping styles in 80 patients with bronchial asthma and to relate them to outcome parameters of illness behaviour. All patients had participated in a 5-day-lasting asthma treatment and teaching programme (ATTP). Outcome variables to be predicted were: The number of days in hospital due to asthma during the year following the training programme and the patients' adherence to the recommendations of the programme one year later. Independent predictor variables were: pre-training attack frequency, hospitalization due to asthma, medication intensity, pulmonary function, asthma symptom anxiety, trait anxiety and attack-related cognitive coping styles. Multiple regression analyses show the importance of a "minimizing/self-confident" coping style in predicting days in hospital, while a "diverting" style predicts best a poor management of attacks in patients on oral steroids.

Adaptation, Psychological↗
PubMed1990

[Anxiety and illness behavior in bronchial asthma].

In 82 patients attending a one-week asthma self-management education program, asthma symptom anxiety, personality trait anxiety, and attack-related coping styles were correlated with attack frequency, medication regimen and pulmonary function parameters. In 21 patients, asthma symptoms anxiety was shown to influence illness behaviour at follow-up one year later: in patients with severe asthma, greater symptom anxiety was associated with more suitable illness behaviour. Moreover, suitable illness behaviour appears to be related to cognitive coping styles that take into account the asthmatic's feeling of dependency in attacks without denying them.

Adaptation, Psychological↗
PubMed1984

[Borderline--a diagnostic entity?].

In the last years, there has been considerable controversy as to whether the term "borderline" should be introduced into psychiatric diagnostic nomenclature to designate psychiatric disorders not classifiable as psychoses, neuroses or traditional forms of personality disorders. Whereas many psychiatrists, especially those who are psychodynamically oriented, have been using this term for a long time, the more phenomenologically oriented psychiatrists refuse to do so while pointing to its lack of clear-cut definitions and its confusing abundance of meanings. The definitions of the term "borderline" used in the various "borderline" -concepts are reviewed. Some authors (Knight, Kety et al.) consider "borderline schizophrenia" to be a subgroup of schizophrenic psychoses. Others (Klein, Stone) take "borderline" disorders as a heterogeneous group of psychiatric illness encompassing especially some atypical affective disorders. Thirdly the concepts of those authors who conceive "borderline" as a distinct diagnostic entity are reviewed: Kernberg's "Borderline personality organization", Grinker's "Borderline syndrome", Gunderson and Singer's "Borderline personality disorders", Spitzer and Endicott's "Borderline (unstable) personality disorder" and "Schizotypical personality". The "borderline" definitions of all concepts are examined as to whether they fulfil the requirements of a "useful" (according to Kendell) diagnostic category, i.e. whether they yield reliably defined diagnostic criteria, and whether they can be validated by genetic and biological studies, therapy response, and long-term studies. It is pointed out that attempts have been made to establish operationally defined diagnostic criteria for some of the "borderline" concepts, but that research aiming at their validation is still in an initial stage.

Affective Disorders, Psychotic↗
PubMed1983

[Therapeutic measures in tardive dyskinesia].

Studies on the treatments for neuroleptic-induced tardive dyskinesia published in the literature are reviewed. The great number of different treatments and the controversial results of most studies show that there is as yet no specific and safe treatment for tardive dyskinesia. Suggestions for well-designed treatment studies are given: Placebo-controlled double-blind design, larger patient populations, clear diagnostic and standard observing and rating conditions using different assessment methods and videotapes, withdrawal of neuroleptics and antiparkinsonian drugs to discover reversible tardive dyskinesia. If this procedure is not feasible, neuroleptics and other drugs should be maintained at a stable dose level. Longer term studies of some months are necessary to study the prolonged efficacy of different drugs. The effect of dopamine-antagonists such as neuroleptics and of dopamine-depleting agents such as reserpine and oxypertine is of limited duration. Dopamine-agonists such as L-Dopa, bromocriptine and amantadine help only few patients and may even aggravate the symptoms of tardive dyskinesia. In some double-blind studies cholinergic drugs such as lecithin and deanol have improved tardive dyskinesia, but further controlled studies are needed. Anticholinergic drugs such as antiparkinsonian agents should not be prescribed because they may aggravate tardive dyskinesia. Some patients respond to GABA-ergic agents such as baclofen, sodium valproate and the benzodiazepines, but further studies are needed before the value of GABA-ergic agents in the treatment of tardive dyskinesia can be properly assessed. After withdrawal of neuroleptics the average of remission rates within a year is 20%-30%. Elderly patients are more likely to have persistent dyskinesias. A progressive stepwise diminution of the neuroleptic dose and of the antiparkinsonian agents is recommended. When a patient's psychosis is exacerbated after withdrawal of the neuroleptics and tardive dyskinesia is also present, small doses of thioridazine, clozapine or tiapride can be administered. If this practice is not successful cholinergic or GABA-ergic agents may be useful. Because no currently available therapeutic agents satisfies the criteria of safety, marked effectiveness and prolonged efficacy in the treatment of tardive dyskinesia, prevention becomes more important. Prolonged use of a neuroleptic medication requires careful evaluation of indications and risks. The doses of neuroleptic drugs during the maintenance treatment of schizophrenia should be as small as possible.

Age Factors↗
PubMed1983

[Classification of schizophrenic psychoses].

There is a substantial need, based on the heuristic principle, to arrive at a valid classification of schizophrenic psychoses. According to the modern theory of science bases on critical rationalism, nosological classifications in psychiatry are regarded as "useful" conventions requiring precise operational definitions. There are several methods of classification, typological classifications having gained widest acceptance in nosology. The multiaxial classification approach allows to document separately data from different levels of data collection, such as symptomatological, etiological, psychosocial and family data, as well as personality factors. However, it is always necessary to render any classification empirically valid by verifying it by means of empirically observed data. In this review, some frequently used classifications of schizophrenic psychoses are evaluated regarding their "usefulness". Usefulness of a classification is assumed if its sub-grouping of data on one level of data collection is validated by data from another level, or if there is sufficient evidence that this classification can generate hypotheses which lend themselves to empirical testing. The traditional sub-classification of schizophrenias into hebephrenic, paranoid, catatonic, and simple forms lacks clear rules for allocating patients to one of the sub-groups; moreover, these sub-groups have not proved reliable. Some authors have tried to classify schizophrenic psychoses via the course of the illness. Methodological difficulties are considerable, and hence most of these classification still await validation. On the other hand, the course of premorbid personality development has been shown to be very important for the sub-grouping of schizophrenics: Good vs. poor premorbid adaptation dichotomy has been validated by prognostic and psychophysiological studies, by therapy response and by family data. Any distinction between acute and chronic types is bound to be of rather questionable value. Symptom criteria have also been proposed for differentiating between schizophrenic psychoses. Paranoid vs. nonparanoid dichotomy has been supported by several biochemical, psychophysiological, familial and therapy response studies. There is a great deal of evidence from prognostic and genetic studies that the presence of a valid sub-group of schizophrenic psychoses. Sub-grouping schizophrenics according to narrowly defined symptom criteria such as Schneider's first-rank symptoms and Langfeldt's, Feighner's and Spitzer's research symptom criteria is of limited value for a valid sub-classification. An approach to classification based on the distinction between the predominance of positive vs. negative schizophrenic symptomatology is of heuristic usefulness in that it generates biochemical and pathophysiological hypotheses which can be tested empirically.

Acute Disease↗
PubMedDate not supplied

[Determinants of high risk illness behavior in patients with bronchial asthma].

The aim of this study was to identify factors influencing high-risk illness behaviour in patients with bronchial asthma. High-risk illness behaviour was defined as 1. non-compliance with antiasthmatic medication and 2. delaying or avoiding medical help when facing airways deterioration or severe attacks. 150 patients with bronchial asthma were investigated; 60 of them had participated in the structured Asthma Treatment and Teaching Programme (ATTP), 90 had not taken part in such a programme by then. Using structural equation models, lack of emotional support by a key figure, poor doctor-patient relationship, and a negative cortisone image were identified as predictors of high-risk illness behaviour in patients who had attended ATTP, while in patients without participation in a treatment and teaching programme, only a negative cortisone image was predictive of this criterion.

Adolescent↗