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Winfried Rief

Publications and source records attributed to Winfried Rief.

At least 19 recordsLinked to original sources
PubMed2006

Somatization in the population: from mild bodily misperceptions to disabling symptoms.

OBJECTIVE: This study investigates the prevalence of current somatization in the population by taking different levels of symptom severity into account. Somatization is described along a continuum from mild and negligible bodily misperceptions to severe and disabling somatoform symptoms. METHODS: A representative sample of 2.552 persons in Germany was examined with a screening instrument for medically unexplained physical complaints that had occurred during the past 7 days. All 53 symptoms from the ICD-10/DSM-IV sections of somatoform disorders were included. RESULTS: 81.6% reported at least one symptom causing at least mild impairment and 22.1% at least one symptom causing severe impairment. The entire sample had an average of 6.6 symptoms associated with at least mild distress. Somatization of any degree was associated with female gender, age above 45, lower educational level, lower household income and rural area. The most common symptoms with prevalence rates > 20% were various types of pain (back, head, joints, extremities), food intolerance, sexual indifference, painful menstruations and erectile/ejaculatory dysfunction. CONCLUSION: This population survey demonstrates that medically unclear complaints are an everyday phenomenon. About three out of four cases are below clinical relevance with only low level of impairment. Epidemiological correlates are similar between clinical and non-clinical forms of somatization.

Adolescent↗
PubMed2006

The prevalence of body dysmorphic disorder: a population-based survey.

BACKGROUND: Body dysmorphic disorder (BDD) is a highly distressing and impairing disorder characterized by a preoccupation with imagined or slight physical defects in appearance. Well designed studies on its prevalence and on base rates for diagnostic criteria are rare. Therefore this study aimed to reveal prevalence rates of BDD in the general population and to examine clinical features associated with BDD. METHOD: Of 4152 selected participants 2552, aged 14-99 years, participated in this German nationwide survey. Participants were carefully selected to ensure that the sample was representative; they were visited by a study assistant who provided instructions and help if needed. Participation rate was 62.3%. DSM-IV criteria for BDD, as well as subthreshold features (e.g. individuals who consider some part(s) of their body as ugly or disfigured, but do not fulfill all BDD criteria) were examined. We also assessed suicidal ideation associated with the belief of having an ugly body part, as well as the desire for cosmetic surgery. Furthermore, somatization symptoms were assessed. RESULTS: The prevalence of current BDD was 1.7% (CI 1.2-2.1%). Individuals with BDD reported higher rates of suicidal ideation (19% v. 3%) and suicide attempts due to appearance concerns (7% v. 1%) than individuals who did not meet criteria for BDD. Somatization scores were also increased in individuals with BDD, relative to those without. BDD was associated with lower financial income, lower rates of living with a partner, and higher rates of unemployment. CONCLUSIONS: Our study shows that self-reported BDD is relatively common and associated with significant morbidity.

Adolescent↗
PubMed2006

Prevalence, spectrum, and functional characterization of melanocortin-4 receptor gene mutations in a representative population-based sample and obese adults from Germany.

CONTEXT: Autosomal dominant inheritance of mutations in the melanocortin-4 receptor gene (MC4R) is currently regarded as the most relevant genetic cause for extreme obesity and affects 2-4% of extremely obese individuals. OBJECTIVE: Our objective was to assess the relevance of MC4R mutations in a German population-based sample. DESIGN AND SETTING: We conducted a mutation screen of the MC4R gene by capillary electrophoresis-based single-strand conformation polymorphism analysis and denaturing HPLC. PARTICIPANTS: Subjects included 4068 individuals of a German population-based study group [Kooperative Gesundheitsforschung im Raum Augsburg, Survey 4 (KORA-S4); i.e. Cooperative Health Research in the Region of Augsburg] and 1003 German obese adults (body mass index >or= 30 kg/m(2)). MAIN OUTCOME MEASURES: Samples with aberrant capillary electrophoresis-based single-strand conformation polymorphism analysis/denaturing HPLC patterns were resequenced. Functional studies including agonistic receptor stimulation (Nle-D-Phe-alpha-, alpha-, and beta-MSH) and cell surface expression assays were performed. RESULTS: Sixteen (six novel) coding nonsynonymous mutations were detected in 27 heterozygous individuals of KORA-S4. Four of the mutation alleles led to impaired receptor function in vitro; however, none of these six heterozygous mutation carriers was obese (body mass index >or= 30 kg/m(2)). In the obese adults, six coding nonsynonymous and a nonsense mutation were detected in 13 individuals. Only the nonsense mutation allele entailed impaired receptor function. CONCLUSIONS: Our study depicts prevalence, spectrum, and functional characterization of MC4R mutations in the German population-based sample KORA-S4. In this epidemiological study group, individuals heterozygous for nonsynonymous MC4R mutation alleles entailing impaired function were not obese. Furthermore, nonsynonymous MC4R mutations causing impaired receptor function were rare in German obese adults (two in 1003 = 0.2%).

Adult↗
PubMed2006

Medication-attributed adverse effects in placebo groups: implications for assessment of adverse effects.

Medication-attributed adverse effects are a frequent reason for poor compliance in practice and in clinical studies and are also common in patients receiving placebo. The occurrence of adverse effects in placebo groups can clarify the assessment of adverse event reporting. We analyzed data from randomized, placebo-controlled trials of statin drugs published since 1992 with sample sizes larger than 100 subjects. Reports of adverse effects and discontinuation rates in placebo groups were evaluated. We compared data on adverse effect profiles in placebo groups between trials and with expected rates from population-based studies. We also sought to determine the range of adverse effect ascertainment methods used in different studies. Methods of ascertainment of adverse events varied widely across studies. Overall, 4% to 26% of patients in the control groups of large trials of statin drugs discontinued placebo use because of perceived adverse effects. The symptom rate in placebo groups varied substantially across trials (up to a ratio of 13:1 for possibly drug-related symptoms, eg, headache, 0.2%-2.7%, or abdominal pain, 0.9%-3.9%) and were often markedly lower than those found in the general population (eg, fatigue, 1.9%-3.4%) in trials of statin drugs vs 17.7% in the general population. In conclusion, the widely varying rates of adverse effects reported by patients taking placebo and the high prevalence of such symptoms in the general population should be considered by both trialists and clinicians. In addition, variability of adverse effect ascertainment is considerable and suggests the need for better standardization in research.

Adverse Drug Reaction Reporting Systems↗
PubMed2006

What determines well-being in obesity? Associations with BMI, social skills, and social support.

OBJECTIVE: Theory and research suggest that the stigma associated with obesity has an impact on the development of social skills and social relationships which may be related to subjective well-being. The main objective was to clarify the associations between BMI (kg/m2), social skills, social support and subjective well-being in a sample of obese subjects. METHODS: Cross-sectional study of 226 obese adults (75 females and 151 males) from the general population between the ages of 19 and 74 [mean (SD), 46.9 (13.7) years]. Mean (SD) BMI of the subjects was 36 (5.3). OUTCOME MEASURES: subjective well-being was measured by the Satisfaction With Life Scale (SWLS) and by the Positive And Negative Affect Scales (PANAS). Social support was assessed with scales of the Social Support Questionnaire F-SozU and social skills with a short form of the German Insecurity Questionnaire U-24. RESULTS: Hierarchical regression analysis showed that social support and social skill measures are relevant predictors of subjective well-being (with both independent and shared influences), while BMI is not. The obese people in our study neither differed from other comparison groups in their subjective well-being, nor did they report greater impairments in social skills or social support. CONCLUSION: BMI does not seem to be the major determinant of low subjective well-being in obesity. As in healthy controls, subjective well-being is principally associated with social skills and social support.

Adult↗
PubMed2006

Dimensionality of the Whiteley Index: assessment of hypochondriasis in an Australian sample of primary care patients.

OBJECTIVE: The Whiteley Index (WI) is a widely used instrument for measuring hypochondriacal worries and beliefs. Several studies explored the structural validity of the WI obtaining contrary results concerning the number of factors as well as the item composition. The main aim of this study is to compare factor solutions from previous studies to draw conclusions about the most valid scale model of the WI for administration in primary care. METHODS: Weighted least squares (WLS) confirmatory factor analyses of the WI were conducted. The sample in study consisted of 1800 patients from primary care practices. Seven different models were compared, including single- and three-factor conceptualisations. RESULTS: A seven-item, single-factor model best described the data, while three-factor models were clearly inadequate. CONCLUSIONS: Results support a one-dimensional conceptualisation of the WI and suggest a certain subscale of the WI, the WI-7, to constitute the most psychometrically sound scale for use as a screening instrument for hypochondriasis in primary care. In addition to psychometric considerations, the brevity and simplicity of the WI-7 also make it attractive as a screening tool in the context of primary care. A cutoff score of 2/3, calculated on the basis of general practitioners' diagnoses, yielded the best balance of sensitivity and specificity in the present study.

Adolescent↗
PubMed2006

[Discrepancy between ideal and real body image: does it affect body-dysmorphic disorder symptoms?].

Body dysmorphic symptoms are characterized by a distressing and impairing preoccupation with an imagined or slight defect in appearance. It is assumed that a discrepancy between ideal and real body image is associated with body dysmorphic disorder symptoms. On the basis of a nationwide survey participants were analysed in terms of their body dysmorphic symptoms and specific aspects of their body image. The ideal and real body image differed significantly in both sexes and in age groups. On closer examination it was apparent that there were different factors for men and women which predicted the occurrence of body dysmorphic symptoms. The results are discussed against the background of existing body ideals and in terms of their gender specific relevance.

Adult↗
PubMed2006

Recent trends in behavioral medicine.

PURPOSE OF REVIEW: Behavioral medicine is an interdisciplinary field, integrating research from a variety of disciplines. This review focuses on recent advances and developments in behavioral medicine. RECENT FINDINGS: Stress, as well as having a role in the etiology and maintenance of somatic disease and somatoform disorders, is an important factor in the behavioral medicine literature. Consequentially, recent advances in psychological interventions targeting these conditions were developed. Furthermore, a variety of psychobiological mechanistic studies investigating the dysregulations of stress axes in conditions relevant to behavioral medicine have been undertaken. SUMMARY: Studies investigating factors and processes relevant to health and illness clearly demonstrate the impact of psychosocial factors such as stress. The biopsychosocial perspective becomes increasingly sophisticated, focusing on specific disease processes and empirically tested and effective interventions.

Behavioral Medicine↗
PubMed2006

Why reassurance fails in patients with unexplained symptoms--an experimental investigation of remembered probabilities.

BACKGROUND: Providing reassurance is one of physicians' most frequently used verbal interventions. However, medical reassurance can fail or even have negative effects. This is frequently the case in patients with medically unexplained symptoms. It is hypothesized that these patients are more likely than patients from other groups to incorrectly recall the likelihoods of medical explanations provided by doctors. METHODS AND FINDINGS: Thirty-three patients with medically unexplained symptoms, 22 patients with major depression, and 30 healthy controls listened to an audiotaped medical report, as well as to two control reports. After listening to the reports, participants were asked to rate what the doctor thinks the likelihood is that the complaints are caused by a specific medical condition. Although the doctor rejected most of the medical explanations for the symptoms in his verbal report, the patients with medically unexplained complaints remembered a higher likelihood for medical explanations for their symptoms. No differences were found between patients in the other groups, and for the control conditions. When asked to imagine that the reports were applicable to themselves, patients with multiple medical complaints reported more concerns about their health state than individuals in the other groups. CONCLUSIONS: Physicians should be aware that patients with medically unexplained symptoms recall the likelihood of medical causes for their complaints incorrectly. Therefore, physicians should verify correct understanding by using check-back questions and asking for summaries, to improve the effect of reassurance.

Adult↗
PubMed2005

Lack of support for the association between GAD2 polymorphisms and severe human obesity.

The demonstration of association between common genetic variants and chronic human diseases such as obesity could have profound implications for the prediction, prevention, and treatment of these conditions. Unequivocal proof of such an association, however, requires independent replication of initial positive findings. Recently, three (-243 A>G, +61450 C>A, and +83897 T>A) single nucleotide polymorphisms (SNPs) within glutamate decarboxylase 2 (GAD2) were found to be associated with class III obesity (body mass index > 40 kg/m2). The association was observed among 188 families (612 individuals) segregating the condition, and a case-control study of 575 cases and 646 lean controls. Functional data supporting a pathophysiological role for one of the SNPs (-243 A>G) were also presented. The gene GAD2 encodes the 65-kDa subunit of glutamic acid decarboxylase-GAD65. In the present study, we attempted to replicate this association in larger groups of individuals, and to extend the functional studies of the -243 A>G SNP. Among 2,359 individuals comprising 693 German nuclear families with severe, early-onset obesity, we found no evidence for a relationship between the three GAD2 SNPs and obesity, whether SNPs were studied individually or as haplotypes. In two independent case-control studies (a total of 680 class III obesity cases and 1,186 lean controls), there was no significant relationship between the -243 A>G SNP and obesity (OR = 0.99, 95% CI 0.83-1.18, p = 0.89) in the pooled sample. These negative findings were recapitulated in a meta-analysis, incorporating all published data for the association between the -243G allele and class III obesity, which yielded an OR of 1.11 (95% CI 0.90-1.36, p = 0.28) in a total sample of 1,252 class III obese cases and 1,800 lean controls. Moreover, analysis of common haplotypes encompassing the GAD2 locus revealed no association with severe obesity in families with the condition. We also obtained functional data for the -243 A>G SNP that does not support a pathophysiological role for this variant in obesity. Potential confounding variables in association studies involving common variants and complex diseases (low power to detect modest genetic effects, overinterpretation of marginal data, population stratification, and biological plausibility) are also discussed in the context of GAD2 and severe obesity.

Adolescent↗
PubMed2005

Differentiating hypochondriasis from panic disorder.

Hypochondriasis and panic disorder are both characterized by prevalent health anxieties and illness beliefs. Therefore, the question as to whether they represent distinct nosological entities has been raised. This study examines how clinical characteristics can be used to differentiate both disorders, taking the possibility of mixed symptomatologies (comorbidity) into account. We compared 46 patients with hypochondriasis, 45 with panic disorder, and 21 with comorbid hypochondriasis plus panic disorder. While panic patients had more comorbidity with agoraphobia, hypochondriasis was more closely associated with somatization. Patients with panic disorder were less pathological than hypochondriacal patients on all subscales of the Whiteley Index (WI) and the Illness Attitude Scales (IAS) except for illness behavior. These differences were independent of somatization. Patients with hypochondriasis plus panic had higher levels of anxiety, more somatization, more general psychopathology and a trend towards increased health care utilization. Clinicians were able to distinguish between patient groups based upon the tendency of hypochondriacal patients to demand unnecessary medical treatments. These results confirm that hypochondriasis and panic disorder are distinguishable clinical conditions, characterized by generally more psychopathology and distress in hypochondriasis.

Agoraphobia↗
PubMed2005

Psychobiological perspectives on somatoform disorders.

Common physical symptoms such as abdominal pain, headache, back pain and dizziness play a major role for the health care system. Existing models for the development and maintenance of these symptoms emphasize a vicious circle with cognitive-perceptual, behavioral, and psychobiological components. In this manuscript, we present examples of psychobiological factors that might contribute to somatoform disorders. We emphasize that somatoform symptoms are not strictly mental events, but are associated with a diversity of biological processes. The possible role of the endocrine and immune system, amino acids and neurotransmitters, but also physiological activation and cerebral activity is exemplified. These approaches are categorized using a model of perception and filtering of bodily signals. Studies are needed that combine the investigation of different biological systems with assessments of psychological variables in longitudinal trials, but also experimental investigations in humans examining the interaction of behavior changes, biological variations, and body perception are still rare.

Animals↗
PubMed2004

Base rates for panic and depression according to the Brief Patient Health Questionnaire: a population-based study.

BACKGROUND: Recently published studies analyzing sensitivity and specificity scores have demonstrated that the brief version of the Patient Health Questionnaire (PHQ [J. Am. Med. Assoc. 282 (1999) 1734]) is a useful tool for the detection of panic disorder and depression. METHODS: We aimed to get normative data for the brief PHQ in a representative population-based sample. Sociodemographic data and PHQ data from 2066 subjects were included. RESULTS: Base rates for PHQ criteria of major depression were 3.8% with the typical 1:2 ratio between males and females (frequency of minor depressive forms: 9.2%). Normative data for the depression total scores were reported. Marital status, education and family income were significantly associated with depression, even after controlling for age and sex. For panic disorder, base rates were 1.8%; age, gender, and marital status were significant predictors. Frequency for panic attacks as a less restrictively defined version were 4.5%. CONCLUSIONS: The normative data provide a framework for the interpretation of depression and panic scores of the PHQ.

Adolescent↗
PubMed2004

Causal illness attributions in somatoform disorders: associations with comorbidity and illness behavior.

OBJECTIVE: To compare causal illness beliefs between patients with unexplained physical symptoms and different comorbid disorders and to assess the association of causal illness beliefs with illness behavior. METHODS: We examined a sample of 233 patients attending treatment in primary care. Inclusion criteria were "unexplained physical symptoms." All patients were investigated using structured interviews and self-rating scales [Screening for Somatoform Symptoms (SOMS), Beck Depression Inventory (BDI), Beck Anxiety Inventory, and a 12-item instrument to assess causal attributions]. By means of factor analysis, the following illness attributions were considered: vulnerability to infection and environmental factors, psychological factors, organic causes including genetic and aging factors, and distress (including exhaustion and time pressure). RESULTS: Most patients reported multiple illness attributions. The more somatoform symptoms patients had, the more explanations in general they considered. Especially for vulnerability and organic illness beliefs, patients with somatoform symptoms had increased scores. Comorbidity with depression and with anxiety disorders was associated with more psychological attributions. Even when the influence of somatization, depression, and anxiety is controlled for, illness beliefs still showed associations with illness behavior. Organic causal beliefs and vulnerability attributions were associated with a need for medical diagnostic examinations, increased expression of symptoms, increased illness consequences, and bodily scanning. CONCLUSIONS: Multiple causal attributions can coexist demonstrating different associations with comorbid depression and illness behavior.

Adolescent↗
PubMed2004

Cognitive-behavioural therapy for patients with multiple somatoform symptoms--a randomised controlled trial in tertiary care.

OBJECTIVE: (a) To evaluate the effect of a cognitive-behavioural inpatient treatment and (b) to analyse the differential efficacy of an additional ("soma") group management training of somatisation. METHODS: The final sample consisted of 191 patients with somatisation syndrome (patients with at least eight DSM-IV somatoform symptoms). Patients were randomly assigned to (I) "standard treatment + soma" or (II) "standard treatment + relaxation training." A waiting control group consisted of 34 patients. All patients were diagnosed with a structured clinical interview for DSM-IV and received an interview on medical consulting behaviour and questionnaires concerning somatoform symptoms, general psychopathology, subjective health status, and life satisfaction. RESULTS: Results show high impairment of the sample prior to treatment. At the 1-year follow-up, all outcome criteria were significantly reduced. The differential effect of the additional soma treatment was significant only for a reduction of visits to the doctor. Greatest longitudinal effect sizes were found for the reduction of somatoform symptoms. CONCLUSION: Considering the subjects' high initial impairment, the outcome results are encouraging. The specific effect on health care use highlights the socioeconomic relevance.

Adult↗
PubMed2004

How much do sample characteristics affect the effect size? An investigation of studies testing the treatment effects for social phobia.

In spite of the success of cognitive behavioral therapy for social phobia in research studies, it remains unclear whether interventions will remain successful in the routine of clinical practice, where patients might differ from those in research samples. This study investigates the possibility that higher effect sizes are achieved under typical research conditions. Thirty studies testing treatment effects for social phobia are re-examined by categorizing them according to the quality and amount of applied sample restriction and laboratory study characteristics. The results indicate that even accumulation of sample restriction, such as excluding patients with comorbid disorders or being outside a certain age range, does not have any predictive value for treatment effect. However, there was a relevant tendency for studies applying a row of laboratory treatment conditions, such as recruiting patients by advertisements, applying treatment in university settings, and using specifically trained therapists, to achieve higher effect sizes.

Cognitive Behavioral Therapy↗