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Biomedical subjects

Wolfgang Hiller

Publications and source records attributed to Wolfgang Hiller.

17 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

Factors influencing tinnitus loudness and annoyance.

OBJECTIVE: To evaluate the 2 major components of tinnitus severity, loudness and annoyance, and their degree of dependence on characteristics of tinnitus manifestation, history, and etiology. DESIGN: Cross-sectional survey performed during the first months of 2004. SETTING: Nonclinical population. PARTICIPANTS: A total of 4995 members of the German Tinnitus League. MAIN OUTCOME MEASURES: Comprehensive screening questionnaire, including the Klockhoff and Lindblom loudness grading system and the miniversion of the Tinnitus Questionnaire. RESULTS: A moderate correlation of 0.45 was found between tinnitus loudness and annoyance. Both factors were generally higher in men, those older than 50 years, those with binaural and centrally perceived tinnitus, those with increased noise sensitivity, and those who had continuous tinnitus without interruptions. Tinnitus that lasted 12 months or less had a stronger influence on annoyance (odds ratio [OR], 1.96) than on loudness (OR, 0.45), whereas the contrary was found for tinnitus of more than 5 years' duration (ORs, 0.72 and 2.11, respectively). Loudness and annoyance were increased in subjects with coexisting hearing loss, vertigo, and hyperacusis. The impact of hyperacusis on annoyance was clearly stronger than on loudness (ORs, 21.91 vs 9.47). CONCLUSIONS: Several clinical factors of tinnitus influence perceived loudness and annoyance. Both are distinguishable components of tinnitus severity.

Adolescent↗
PubMed2006

Cognitive-behavioral therapy and psychodynamic psychotherapy: techniques, efficacy, and indications.

UNLABELLED: In this article, we provide an overview of the techniques and efficacy of the two most commonly used psychotherapeutic treatments of psychiatric disorders in adults: cognitive-behavioral and psychodynamic therapy. Psychotherapeutic techniques, major indications, and empirical evidence will be presented. The focus will be on empirically supported models of treatment. CONTEXT: Cognitive-behavioral therapy and psychodynamic psychotherapy are the most frequently applied methods of psychotherapy in clinical practice. OBJECTIVE: To give an up-to-date description of cognitive-behavioral therapy and psychodynamic psychotherapy and to review empirical evidence for efficacy in specific mental disorders. DATA SOURCES: Systematic reviews of psychotherapy outcome research based on evidence-based methods were used. In order to identify more recent trials, Medline, Psyclnfo, Pubmed, and Current Contents were searched in addition in July 2005 using database-specific keywords. In October 2005, the search was updated. Text books and journal articles were used as well. STUDY SELECTION: The authors reviewed the available systematic surveys and meta-analyses as well as the additionally identified studies using established inclusion criteria. DATA EXTRACTION: Following the evidence-based methods of the Canadian Task Force on Preventive Health Care, an established hierarchy of study designs was applied. Using rigorous criteria, only evidence from randomized controlled trials (Type 1 studies) was included. The authors independently assessed for which mental disorders randomized controlled trials provide evidence for the efficacy of cognitive-behavioral therapy or psychodynamic psychotherapy in specific disorders. DATA SYNTHESIS: The efficacy of cognitive-behavioral in many mental disorders has been demonstrated by a substantial number of randomized controlled trials and several meta-analyses. However, for specific disorders the rates of treatment responders are not yet sufficient. For psychodynamic psychotherapy, clearly less efficacy studies are available. However, the available studies provided evidence that psychodynamic psychotherapy is an effective treatment of specific mental disorders as well. CONCLUSIONS: Although there is substantial evidence for the efficacy of cognitive-behavioral therapy and some evidence for the efficacy of psychodynamic psychotherapy, further studies are required to improve the positive outcome rates of treatment responders in specific mental disorders. For psychodynamic psychotherapy further studies of specific forms of treatment in specific mental disorders are required to corroborate the available results.

Cognitive Behavioral Therapy↗
PubMed2005

Does sound stimulation have additive effects on cognitive-behavioral treatment of chronic tinnitus?

Psychological and physiological habituation are major goals in the treatment of patients suffering from chronic tinnitus. This study evaluates whether sound stimulation provided by use of low level white noise generators (NG) enhances the effects of cognitive-behavioral treatment (CBT). 124 outpatients with tinnitus of >6 months received manualized group treatment and were randomly assigned to the NG/no NG conditions. Those with moderate tinnitus-related distress obtained four sessions focusing on education, while severely distressed subjects were treated according to a full 10-session CBT program. Outcome was assessed at post-treatment and at 6- and 18-month follow-up. No additive effects due to the NGs could be demonstrated. All groups improved significantly on measures of tinnitus-related distress, dysfunctional cognitions, general psychopathology, depression, hypochondriasis and psychosocial functioning. Beneficial effects of the NGs were only observed for patients with concurrent tinnitus and hyperacusis. As systematic physical stimulation of the auditory system does not further improve the effects of CBT, the importance and strength of psychological interventions are emphasized. The clinical relevance of recently developed "retraining" approaches accentuating physical stimulation should be reconsidered.

Acoustic Stimulation↗
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↗
PubMed2004

High utilizers of medical care: a crucial subgroup among somatizing patients.

OBJECTIVE: Patients with somatoform disorders (SFD) are likely to overutilize healthcare services. This study investigates (a) whether extraordinarily high medical costs can be predicted from patient characteristics or psychopathology, and (b) whether high-utilizing patients respond differently to cognitive-behavioral treatment. METHODS: We compared 42 SFD high utilizers with 53 SFD average utilizers and 29 patients suffering from other than SFD mental disorders. High utilization was defined by healthcare expenditures of > or = 2500 euros during the past 2 years. Costs were computed from medical and billing records of health insurance companies. Somatization distress, hypochondriasis, depression, dysfunctional cognitions related to bodily symptoms, general psychopathology, personality profiles, and psychosocial disabilities were assessed before treatment. RESULTS: High utilizers had higher levels of self- and observer-rated illness behavior, self-perceived bodily weakness, and psychosocial disabilities. Although they did not report more somatization symptoms, their subjective symptom distress was higher. There were no differences between high and average utilizers concerning general psychopathology, DSM-IV comorbidity, and personality profiles. Treatment improvements were similar. CONCLUSION: High- and average-utilizing somatizers represent distinguishable subgroups. The results emphasize the importance of mechanisms specifically related to SFD and may enhance the early detection of patients who are likely to develop overutilization.

Cognitive Behavioral Therapy↗
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

Studies on high-temperature amination reactions of aromatic chlorides using discrete palladium-N-heterocyclic carbene (NHC) complexes and in situ palladium/imidazolium salt protocols.

The palladium catalysed coupling of aryl chlorides and amines can be readily achieved with short reaction times when carried out at high temperatures under thermal or microwave conditions. These coupling protocols are successful using two co-ordinate palladium-N-heterocyclic carbene complexes, or imidazolium salt protocols.

Catalysis↗
PubMed2002

Inter- and intramolecular spin transfer in molecular magnetic materials. Solid-state NMR spectroscopy of paramagnetic metallocenium ions.

To shed light on the interaction in molecule-based magnetic materials, the decamethylmetallocenium hexafluorophosphates, [(C(5)Me(5))(2)M](+) [PF(6)](-) with M = Cr, Mn, Fe, Co, and Ni, as well as the tetracyanoethenides, [(C(5)Me(5))(2)M](+) [TCNE](-) with M = Cr, Mn, Fe, and Co, have been investigated in the solid state by using (1)H, (13)C, (19)F, and (31)P NMR spectroscopy under magic angle spinning (MAS). The isotropic (13)C and (1)H NMR signals cover ranges of about 1300 and 500 ppm, respectively. From the shift anisotropies of the ring carbon signal of the [(C(5)Me(5))(2)M](+) cations, the total unpaired electron spin density in the ligand pi orbitals has been calculated; it amounts up to 36% (M = Ni) and is negative for M = Cr, Mn, and Fe. The radical anion of [(C(5)Me(5))(2)M](+) [TCNE](-) shifts the (13)C NMR signals of all [(C(5)Me(5))(2)M](+) cations to high frequency, which establishes transfer of positive spin density from the anions to the cations. The (19)F and (31)P NMR signals of the paramagnetic salts [(C(5)Me(5))(2)M](+) [PF(6)](-) are shifted up to 13.5 ppm relative to diamagnetic [(C(5)Me(5))(2)Co](+) [PF(6)](-). The signs of these shifts are the same as those of the pi spin density in [(C(5)Me(5))(2)M](+). After consideration of interionic ligand- and metal-centered dipolar shifts, this establishes cation-anion spin delocalization. The mixed crystals [(C(5)Me(5))(2)M(x)Co(1-x)](+)[PF(6)](-) have been prepared for M = Cr and Ni. They are isostructural with [(C(5)Me(5))(2)Co](+) [PF(6)](-) whose single-crystal structure has been determined by X-ray diffraction. The (13)C, (19)F, and (31)P MAS NMR spectra of the mixed crystals show that the respective two closest paramagnetic ions in the lattice delocalize spin density to [(C(5)Me(5))(2)Co](+), [(C(5)Me(5))(2)Ni](+), and [PF(6)](-). In [(C(5)Me(5))(2)M](+), about 10(-4) au per carbon atom are transferred.

Journal Article↗
PubMed2002

25 years experience of the surgical treatment of phaeochromocytoma.

OBJECTIVE: To assess the outcome of the surgical treatment of patients who had adrenalectomy for phaeochromocytoma. DESIGN: Retrospective clinical study. SETTINGS: University hospital, Germany. SUBJECTS: 87 consecutive patients with phaeochromocytoma who were operated on. INTERVENTIONS: 29 flank and 58 transabdominal adrenalectomies between 1974 and 2000. RESULTS: The mean tumour diameter was 5 cm (range 2-13), and the mean weight 91 g (range 7-550). The postoperative hospital stay was 11 days. The flank incision entailed the shortest operating time (95 minutes). Two of the phaeochromocytomas were malignant. There were two wound infections but no deaths. With a correct selection of patients, a flank incision is safe. Endoscopic retroperitoneal adrenalectomies should be preferred.

Adolescent↗
PubMed2002

Assessment of functional gastrointestinal disorders using the Gastro-Questionnaire.

The purpose was to investigate the reliability and factorial structure of the Gastro-Questionnaire for the screening and psychometric measurement of functional gastrointestinal disorders (FGDs). The questionnaire contains 27 gastrointestinal symptom items drawn from the Rome-II criteria, which are rated by frequency and severity, as well as some items to exclude organic diseases. The questionnaire was administered to 259 normal participants and to 69 participants of the annual German meeting of patients with irritable bowel syndrome. Reliability was good (Cronbach's alpha for frequency and severity items: alpha = .86 and alpha = .87). Factor analysis yielded a six-factor solution explaining 60.7% of the variance. Diagnostic frequencies ranged from 32.8% to 100% for FGDs in general, from 1.3% to 76.8% for irritable bowel syndrome, and from 7.0% to 100% for functional dyspepsia, depending on samples and symptom definitions. The Gastro-Questionnaire is a very economic, reliable, and content-valid instrument for the assessment of FGDs.

Adult↗
PubMedDate not supplied

Rapid assessment of tinnitus-related psychological distress using the Mini-TQ.

The aim of this study was to develop an abridged version of the Tinnitus Questionnaire (TQ) to be used as a quick tool for the assessment of tinnitus-related psychological distress. Data from 351 inpatients and 122 outpatients with chronic tinnitus were used to analyse item statistics and psychometric properties. Twelve items with an optimal combination of high item-total correlations, reliability and sensitivity in assessing changes were selected for the Mini-TQ. Correlation with the full TQ was >0.90, and test-retest reliability was 0.89. Validity was confirmed by associations with general psychological symptom patterns. Treatment effects indicated by the Mini-TQ were slightly greater than those indicated by the full TQ. The Mini-TQ is recommended as a psychometrically approved and solid tool for rapid and economical assessment of subjective tinnitus distress.

Adolescent↗
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↗