High-utilizing Crohn's disease patients under psychosomatic therapy*

<p>Abstract</p> <p>Objective</p> <p>Few studies have been published on health care utilization in Crohn's disease and the influence of psychological treatment on high utilizers.</p> <p>Methods</p> <p>The present sub study of a prospective multi center investigation conducted in 87 of 488 consecutive Crohn's disease (CD) patients was designed to investigate the influence of the course of Crohn's disease on health care utilization (hospital days (HD) and sick leave days (SLD) collected by German insurance companies) and to examine the conditions of high-utilizing patients. Predictors of health care utilization should be selected. Based on a standardized somatic treatment, high health care utilizing patients of the psychotherapy and control groups should be compared before and after a one-year treatment.</p> <p>Results</p> <p>Multivariate regression analysis identified disease activity at randomization as an important predictor of the clinical course (r²= 0.28, p < 0.01). Health care utilization correlated with duration of disease (p < 0.04), but the model was not significant (r²= 0.15, p = 0.09). The patients' level of anxiety, depression and lack of control at randomization predicted their health-related quality of life at the end of the study (r²= 0.51, p < 0.00001). Interestingly, steroid intake and depression (t1) predicted the combined outcome measure (clinical course, HRQL, health care utilization) of Crohn's disease at the end of the study (r²= 0.22, p < 0.001).</p> <p>Among high utilizers, a significantly greater drop in HD (p < 0.03) and in mean in SLD were found in the treatment compared to the control group.</p> <p>Conclusion</p> <p>The course of Crohn's disease is influenced by psychological as well as somatic factors; especially depression seems important here. A significant drop of health care utilization demonstrates the benefit of psychological treatment in the subgroup of high-utilizing CD patients. Further studies are needed to replicate the findings of the clinical outcome in this CD subgroup.</p

Ein systematischer Literaturessay: (Besprechung des Sammelbandes von Eike von Savigny und Oliver Scholz "Wittgenstein über die Seele"

"Wittgenstein wird in immer höherem Maße ein Philosoph der Vergangenheit. (...) Dies ist kein Grund zur Klage, sondern zur besonnenen Inaugenscheinnahme dessen, was Wittgenstein gesagt hat. Mit dieser Beschreibung bestimmt J. Schulte nicht nur den gegenwärtigen Stand der Wittgensteinrezeption sehr genau, ihm gelingt damit auch eine treffliche Kennzeichnung des jüngst von Eike von Savigny und Oliver Scholz herausgegebenen Sammelbandes "WITTGENSTEIN ÜBER DIE SEELE". Endlich, so kann man sagen, wird einem Bereich der sehr späten Philosophie Wittgensteins wieder eine deutschsprachige Publikation gewidmet

Destruieren als Philosophieren: Buchbesprechung zu: Matthias Kroß: Klarheit als Selbstzweck

Klarheit sei für ihn Selbstzweck, notierte Wittgenstein 1930 (Vermischte Bemerkungen, S. 459). *1* Das Motiv der Klarheit(Philosophische UNtersuchungen, § 133) bildet den Leitfaden der Wittgensteininterpretation "Klarheit als Selbstzweck" von Matthias Kroß (Berlin, 1993). Diese widmet sich den im Vergleich zu Fragen der Bedeutungs- oder Sprachtheorie von den Interpreten Wittgensteins weniger ausgearbeiteten Themen der Religion, Ethik und Gewißheit, die für Wittgenstein von erheblicher Bedeutung waren. Der Autor versucht, die oft bestrittene Kontinuität des Wittgensteinschen Denkens, die sich an Ausdrücken wie Wittgenstein I und II zeigt, an diesen Themen exemplarisch darzulegen. Am Leitmotiv der Klarheit als Selbstzweck verfolgt Kroß diese Themen in der Früh- und Spätphilosophie Wittgensteins. Die Darstellung sieht sich dabei selbst dem Ideal der Klarheit verpflichtet. Die Aufklärung des Lesers vollzieht sich dabei in sieben Kapiteln, die gleich den sieben Hauptsätzen des Tractatus aufeinander verweisen, aber selbständig für sich verstanden werden können

Wittgenstein über sehen und sehen-als.

Wittgensteins späte Überlegungen zu den Wahrnehmungsbegriffen gehen zurück auf seine Beschäftigung mit den Wahrnehmungstheorien von W. James, W. Köhler sowie der Sinnesdatentheorie G. E. Moores und B. Russells; und sie werden vor diesem Hintergrund erst richtig deutlich. Diese drei Konzepte der Wahrnehmung werde ich in einem ersten Schritt grob skizzieren, um dann zu zeigen, wie sich Wittgenstein von ihnen absetzt. Hier wird der Begriff des Aspektsehens eine wichtige Rolle spielen und dazu führen, mit Wittgenstein einen umfassendenBegriff des Sehens zu entfalten sowie den Begriff des Sehen-als zu profilieren

The INSPIRE study: are different personality traits related to disease-specific quality of life (IBDQ) in distressed patients with ulcerative colitis and Crohn's disease?

BACKGROUND: To explore the relationship between personality and disease-specific quality of life [Inflammatory Bowel Disease Questionnaire (IBDQ)] in distressed [Perceived Stress Questionnaire (PSQ)] patients with ulcerative colitis (UC) and Crohn's disease (CD). METHODS: Included in the study were 56 patients with UC and 54 patients with CD ranging in age from 18 to 60 years with a relapse in the previous 18 months, a UC or CD activity index 4, a PSQ 60, and without serious mental or other serious medical condition. The patients completed the Buss-Perry Aggression Questionnaire, the Neuroticism and Lie (social conformity/desirability) scales of the Eysenck Personality Questionnaire, the Multidimensional Health Locus of Control (LOC) Scale [Internal (I), Powerful Other (PO), Chance (C)], the Toronto Alexithymia Scale, and the IBDQ. RESULTS: In linear regression controlling for sex, education (years), and clinical disease activity (AI) in separate analyses of UC and CD patients, higher IBDQ score was related to less social conformity in CD and less neuroticism in UC; higher emotional function score was related to less neuroticism in both CD and UC and less PO-LOC in UC. Higher social function score was related to less social conformity in CD and lower I-LOC and PO-LOC in UC. Bowel function and systemic symptoms were unrelated to personality in either UC or CD. CONCLUSIONS: Although the emotional function subscale was related to neuroticism in both UC and CD, the social function subscale and total IBDQ were related to different personality traits in UC and CD. Personality traits should be taken into account when using IBDQ in studies

The INSPIRE study: do personality traits predict general quality of life (Short form-36) in distressed patients with ulcerative colitis and Crohn's disease?

OBJECTIVE: To assess the role of personality as a predictor of Short form-36 (SF-36) in distressed patients (perceived stress questionnaire, PSQ) with ulcerative colitis (UC) and Crohn's disease (CD). MATERIAL AND METHODS: Fifty-four patients with CD and 55 with UC (age 18-60 years) who had relapsed in the previous 18 months, i.e. with an activity index (AI) for UC or CD&gt; or =4, PSQ&gt; or =60, and without severe mental or other major medical conditions, completed the Buss-Perry Aggression Questionnaire (BPA), the Neuroticism and Lie scales of the Eysenck Personality Questionnaire (EPQ-N and -L), the Multidimensional Health Locus of Control Scale (LOC) (Internal (I), Powerful Other (PO), Chance (C)), the Toronto Alexithymia Scale (TAS) and the SF-36. RESULTS: Multiple linear regression analyses controlling for gender, age and clinical disease activity (AI) in separate analyses for UC and CD showed that the mental and vitality subscales were predicted by neuroticism in both UC and CD. The highest explained variance was 43.8% on the "mental" subscale in UC. The social function subscale was related to alexithymia only in UC, while the role limitation and pain subscales were related to personality in CD only. The physical function subscale related differently to personality in UC and CD. CONCLUSIONS: While mental and vitality subscales were predicted by neuroticism in both UC and CD, other subscales had different relationships to personality, suggesting different psychobiological interactions in UC and CD