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Biomedical subjects

Winfried Rief

Publications and source records attributed to Winfried Rief.

31 records · Page 2Linked to original sources
PubMed2004

Psychobiological aspects of somatoform disorders: contributions of monoaminergic transmitter systems.

OBJECTIVE: To evaluate the possible biological aspects of 'unexplained physical symptoms', this study examined serotonergic and noradrenergic monoamino acids in somatoform disorders and/or depression. METHODS: Blood samples of 150 subjects from 4 groups (somatization syndrome; depression; depression and somatization; controls) were analyzed for amino acids contributing to the serotonergic and noradrenergic system and peripheral muscle energy balance (tryptophan, valine, leucine, isoleucine, phenylalanine and tyrosine). RESULTS: Tryptophan, branched chain amino acids and other serotonergic amino acids were decreased in patients with somatoform symptoms, even when no depression was present. CONCLUSIONS: We conclude that serotonergic amino acids are biological correlates of multiple unexplained symptoms. Ways of action do not only involve brain mechanisms, but also energy metabolism in peripheral muscles.

Adult↗
PubMed2003

Effectiveness of an empirically supported treatment for social phobia in the field.

This study examined the effectiveness of individual exposure combined with cognitive restructuring for social phobia in a clinical setting as well as the influence of sample restriction criteria on the effect size. Participants were 217 unselected patients with a primary diagnosis of social phobia who were treated by 57 therapists in four outpatient clinics of the Christoph-Dornier-Foundation of Clinical Psychology in Germany. Results 6 weeks after the end of therapy showed highly significant reductions in social phobic fears and avoidance as well as in general anxiety and symptoms of depression. However, patients who dropped out during therapy reported a significantly higher degree of depression. Results did not differ between the four outpatient clinics and are comparable with the average effect-sizes reported by meta-analytic studies of controlled efficacy research, using selected patients. Also, restricting the sample according to the selection criteria often applied in research settings did not result in higher effect sizes for the applied outcome measures. We conclude that individual cognitive behavioural therapy for social phobia can be transported from research settings to the field of mental health.

Adolescent↗
PubMed2003

A controlled treatment study of somatoform disorders including analysis of healthcare utilization and cost-effectiveness.

OBJECTIVE: The purpose of this prospective study was to evaluate the effects of cognitive-behavioral treatment (CBT) on mental health status and healthcare utilization in patients with somatoform disorders (SFD) of a specialized tertiary care center. METHODS: According to DSM-IV interviews, 54 patients had somatization disorder (SD), 51 abridged somatization syndrome (SSI-8) and 67 other defined SFD. A clinical non-SFD comparison group consisted of 123 patients. Treatment effects were controlled against the waiting list. Cost calculations for the 2-year periods before and after treatment were based on medical and billing records from health insurance companies. RESULTS: The SFD patients improved significantly with respect to physical symptom distress, health anxieties, dysfunctional beliefs towards body and health, depression and psychosocial functioning. Their outpatient plus inpatient charges during the 2 years prior to treatment were about 2.2-fold higher than for average patients of the health system. At the 2-year follow-up, we found treatment-related cost offset of 382 (-24.5%) for outpatient and 1098 (-36.7%) for inpatient care. Indirect socioeconomic costs due to days lost from work decreased by 6702 (-35.3%). Per patient savings of 32,174 (-63.9%) were found in a subgroup of somatizing high-utilizers. CONCLUSION: The results encourage including treatment strategies to reduce somatoform illness behavior into clinical practice.

Adult↗
PubMed2003

A new approach to assess illness behaviour.

OBJECTIVE: The aim of this study was to develop a scale to assess the different aspects of illness behaviour and to evaluate the measure in depressive and somatising patients. METHODS: The psychometric properties of the scale were assessed in the following diagnostic groups: patients with major depression (n=36), major depressives with an additional somatisation syndrome (n=40), patients with somatisation syndrome (n=37), and a control group (n=37). After multiple test construction procedures and factor analysis, we developed the Scale for the Assessment of Illness Behaviour (SAIB). RESULTS: The scale included 26 items (originally 58 items) and comprised five factors: (1) verification of diagnoses, (2) expression of symptoms, (3) medication, (4) consequences of illness, and (5) scanning. The intercorrelations between these factors were low confirming the multidimensional structure of illness behaviour. Physicians' rating partially confirmed the factors. All patient groups had elevated scores for illness behaviour. Correlational analyses demonstrated that illness behaviour was closely related to anxiety (such as health worries and phobic anxiety), even after controlling for other factors. Somatisation had medium associations with some aspects of illness behaviour. Symptom Checklist (SCL) results revealed that illness behaviour is not associated with the distress of single symptoms, but with the general number of symptoms. CONCLUSION: A suitable instrument to assess illness behaviour has been developed and should be further analysed in subsequent studies.

Adult↗
PubMedDate not supplied

Validity of the Brief Patient Health Questionnaire Mood Scale (PHQ-9) in the general population.

OBJECTIVE: The aim of this study was to assess the validity of the Patient Health Questionnaire depression module (PHQ-9). It has been subject to studies in medical settings, but its validity as a screening for depression in the general population is unknown. METHOD: A representative population sample (2,066 subjects, 14-93 years) filled in the PHQ-9 for diagnosis [major depressive disorder, other depressive disorder, depression screen-positive (DS+) and depression screen-negative (DS-)] and other measures for distress (GHQ-12), depression (Brief-BDI) and subjective health perception (EuroQOL; SF-36). RESULTS: A prevalence rate of 9.2% of a current PHQ depressive disorder (major depression 3.8%, subthreshold other depressive disorder 5.4%) was identified. The two depression groups had higher Brief-BDI and GHQ-12 scores, and reported lower health status (EuroQOL) and health-related quality of life (SF-36) than did the DS- group (P's < .001). Strong associations between PHQ-9 depression severity and convergent variables were found (with BDI r = .73, with GHQ-12 r = .59). CONCLUSION: The results support the construct validity of the PHQ depression scale, which seems to be a useful tool to recognize not only major depression but also subthreshold depressive disorder in the general population.

Adolescent↗
PubMedDate not supplied

Specific effects of depression, panic, and somatic symptoms on illness behavior.

OBJECTIVE: In terms of restricted financial resources, the contribution of mental disorders to health care use and illness behavior is highly relevant. However, the specific contributions of panic disorder, depression, and somatic complaints to illness behavior in unselected samples is unclear. METHODS: A representative sample of 2507 inhabitants of Germany was selected and grouped into people with panic disorder (30), somatic syndrome (102), major depression (24), depressive syndrome (77), and controls (2269). Assessment instruments were the complete version of the Patient Health Questionnaire (PHQ), the Scale for the Assessment of Illness Behavior (SAIB) as well as measures of health care use. RESULTS: Although all clinical groups showed increased illness behavior, their impact was independent and specific. Subjects fulfilling the criteria of panic disorder showed the highest scores for illness behavior and health care use. People with mental disorders showed a greater increase in visits to general practitioners and medical specialists than to psychiatrists or psychologists. Regression analysis revealed that somatic complaints and depression have independent associations with illness behavior and health care use. CONCLUSIONS: Different mental and psychosomatic disorders contribute independently to health care use and other aspects of illness behavior.

Adaptation, Psychological↗
PubMedDate not supplied

Psychophysiologic treatment of chronic tinnitus: a randomized clinical trial.

BACKGROUND: Tinnitus seems to be associated with psychophysiological over-activation (e.g., of head and shoulder muscles). Therefore we aimed to develop and evaluate a new intervention program including a psychophysiological approach. METHODS: Forty-three tinnitus sufferers were randomized to 2 groups, one receiving a psychophysiologically oriented intervention lasting 7 intervention sessions (plus 2 assessment sessions), whereas the other group waited for a comparable time period. Afterward, patients on the waiting list also received the intervention. Physiological variables were muscle activity of head and shoulders and electrodermal activity. Psychological assessments took place at pretreatment, post-treatment, and 6 months later. Follow-up data were available from 95% of participants. Major outcome variables were self-rating scales (e.g., tinnitus annoyance assessed by the Tinnitus Questionnaire), and diary data (self-control, daily time of perceiving the tinnitus). RESULTS: On most tinnitus specific variables, patients in the treatment group improved significantly more than patients on the waiting list. Main effect sizes for tinnitus-specific variables were up to 0.89. Muscle reactivity of head muscles at the beginning predicted significant treatment effects. CONCLUSION: Compared with meta-analytical reviews of psychological interventions for tinnitus sufferers, the presented treatment is brief and in the upper range of effectiveness.

Cognitive Behavioral Therapy↗
PubMedDate not supplied

Worries about modernity predict symptom complaints after environmental pesticide spraying.

OBJECTIVE: Concerns about environmental and technological changes affecting health have been shown to be associated with symptom reports in cross-sectional studies. We aimed to investigate how worries about modernity affecting health, negative affectivity, and prior symptom complaints influence health complaints after environmental spraying in a prospective study. METHODS: Two hundred ninety-two residents of West Auckland completed questionnaires measuring recent symptoms, negative affect, and concerns about the effects of modernity on health before aerial spraying of their neighborhood with Foray 48B. After spraying, 181 residents (62%) returned a follow-up questionnaire measuring symptoms, spray-avoidance behavior, and the perceived effect of the spray program on health. RESULTS: The number of symptoms reported after the spray was most closely related to the number of symptoms reported at baseline (beta = 0.40, p = .0001). Higher levels of modern health worries (beta = 0.23, p = .001) and baseline symptoms (beta = 0.17, p < .05) were associated with a higher number of symptoms being attributed to the spray program. Modern health worries also predicted avoidance behavior during the spraying times (beta = 0.32, p = .001) and the belief that the health of participants and the health of their children and pets was affected by the spray (all p < .01). CONCLUSION: Worries about aspects of modern life affecting health can strongly influence the attribution of symptoms and beliefs about health effects after environmental incidents.

Adult↗
PubMedDate not supplied

Predictors of course and outcome in hypochondriasis after cognitive-behavioral treatment.

BACKGROUND: Predictors of treatment outcome were evaluated in a clinical sample suffering from hypochondriasis. METHODS: The sample consisted of 96 patients with hypochondriacal disorder according to DSM-IV or high syndrome scores on the Illness Attitude Scales (IAS) or Whiteley Index (WI). After intense inpatient cognitive-behavioral treatment (CBT), 60% of the patients were classified as responders because of substantial improvements or recovery from hypochondriacal symptomatology. RESULTS: Non-responders were characterized by a higher degree of pre-treatment hypochondriasis, more somatization symptoms and general psychopathology (SCL-90R), more dysfunctional cognitions related to bodily functioning, higher levels of psychosocial impairments, and more utilization of the health care system as indicated by the number of hospital days and costs for inpatient treatments and medication. No predictive value was found for sociodemographic variables, comorbidity with other mental disorders and chronicity. Multiple linear regression showed that pre-treatment variables significantly predicted IAS scores at post-treatment (R(2) = 0.59), changes during treatment (0.10), IAS scores at follow-up two years later (0.41) and changes between baseline and follow-up (0.25). CONCLUSIONS: The results demonstrate the relevance of various psychopathological variables and health care utilization as important indicators for outcome and further course of clinical hypochondriasis.

Adult↗
PubMedDate not supplied

A new approach to the assessment of the treatment effects of somatoform disorders.

A new 53-item instrument for the evaluation of treatment effects in somatoform disorders, the Screening for Somatoform Symptoms-7 (SOMS-7), is presented. It covers all somatic symptoms mentioned as occurring in somatization disorder, according to DSM-IV and ICD-10. A group of 325 patients was assessed at the beginning and end of treatment to compute scores of reliability and validity. The new scale showed high internal consistency (alpha=0.92) and revealed two composite indices: somatization symptom count and somatization severity index. These indices discriminated patients fulfilling complete criteria for somatoform disorders, patients with somatization syndrome, and patients with other mental and psychosomatic disorders. The instrument confirmed symptom reductions between admission and discharge, while in another group composed of wait-listed patients, no significant decrease in symptoms was observed. In sum, the SOMS-7 seems to be a comprehensive, reliable, and valid instrument for the evaluation of treatment effects in patients with somatoform disorders.

Adult↗
PubMedDate not supplied

Evaluation of general practitioners' training: how to manage patients with unexplained physical symptoms.

Patients with unexplained physical symptoms ("somatoform disorders") tend to overuse the healthcare system. Therefore, the authors aimed to assess whether a training session for general practitioners (GPs) on managing patients with unexplained physical symptoms would be acceptable to GPs and lead to improvements in patient care. In a randomized clinical trial (GPs randomized), GPs got a 1-day training session and additional materials. Included were 26 GP offices in primary care and 295 patients with unexplained physical symptoms (minimum of two symptoms required). Outcome measures were healthcare utilization (number of doctor visits) 6 months before and 6 months after the index visit to the GP, somatization severity, depression, and hypochondriacal fears at the index visit to the GP's office and 6 months later. Training GPs to manage these patients led to significant reductions in healthcare utilization; patients of untrained GPs showed comparable attendance rates in the 6 months before and after the index visit. Differences in depression, somatization, and hypochondriacal fears, however, could not be attributed to the GP training. GPs rated the training as being highly relevant for their everyday practices, underlining the need for and acceptance of the training. Training GPs in managing patients with unexplained physical symptoms seems to be helpful for the reduction of excessive healthcare utilization. These 1-day workshops have high acceptability, so this approach could be a good model for empirically-validated continuing-education programs.

Adult↗