Traumatische Ereignisse, posttraumatische Belastungsstörung und Somatisierung bei Patienten der Ambulanz einer psychsomatischen Universitätsklinik

An einer Stichprobe von 483 Patienten der Klinik für Psychosomatische Medizin und Psychotherapie Essen hatte die vorliegende Untersuchung zum Ziel, die Trauma- und Posttraumatische Belastungsstörung (PTSD)-Prävalenzen in unserem Inanspruchnahmeklientel zu identifizieren, und deren Beziehung zur Depressivität, Ängstlichkeit, Kohärenzgefühl und Inanspruchnahmeverhalten zu untersuchen. Des weiteren sollte der Zusammenhang von Trauma, PTSD und Somatisierung genauer untersucht werden. Ferner verfolgten wir das Ziel, Prädiktoren für PTSD zu identifiziert. Die Trauma-Expositionsrate schwankte zwischen 31.1% und 63.1%; diese war abhängig vom Eingangstraumakriterium nach DSM-IV (A1 und A2) für PTSD. Die Resultate dieser Arbeit konnten verdeutlichen, dass es einen Unterschied macht, ob man beide Traumakriterien nach DSM-IV heranzieht oder lediglich eines davon erfüllt sein muss, um von einem psychischen Trauma sprechen zu können. Testpsychometrisch betrug die PTSD-Prävalenz 10.1%, während die behandelnden Therapeuten bei nur 2.9% der Gesamtstichprobe die Diagnose „Posttraumatische Belastungsstörung“ (F43.1 nach ICD-10) stellten. Generell scheinen PTSD-Betroffene unter einer grundsätzlich höheren psychischen Belastung (Depressivität, Ängstlichkeit, Somatisierung) zu leiden als Traumatisierte ohne PTSD und noch mehr gegenüber Nicht-Traumatisierten. Unter gesundheitsökonomischen Aspekten scheint es besonders wichtig zu sein, Menschen mit Traumatisierung einer adäquaten Behandlung unterziehen zu lassen. Sie zeigten in der vorliegenden Untersuchung das höchste Inanspruchnahmeverhalten bezüglich Arztbesuche, Psychotherapie und Psychopharmaka gegenüber Nicht-Traumatisierten. Bemerkenswert sind die Ergebnisse bezüglich der zentralen Hypothesen, zum einen PTSD würde von den behandelnden Therapeuten unterschätzt und zum anderen PTSD und Somatisierung würden in enger Beziehung zueinander stehen. Unsere Befunde stimmen mit anderen empirischen Arbeiten überein, so dass man berechtigterweise die Vermutung äußern kann, es handele sich bei beiden Fällen um ein generelles Phänomen, das settingunspezifisch zu sein scheint. Bezüglich des Zusammenhangs von Somatisierung und PTSD standen insbesondere neurologische und gastrointestinale Beschwerden im Vordergrund. PTSD-Patienten berichteten im Mittel über 20 somatoforme Beschwerden, Nicht-Traumatisierte hingegen hatten im Mittel 9 somatoforme Beschwerden. In der Allgemeinbevölkerung liegt die Prävalenz somatoformer Beschwerden bei 3.4. Unsere Ergebnisse haben auch diagnostische Implikationen. Die PTSD wird häufig von anderen psychischen Störungen überlagert oder stellt sich phänomenologisch in Form anderer Störungen wie Depression oder Angststörung dar, was ihre Diagnose erschwert. Es ist eine gängige klinische Beobachtung, dass sich traumatisierte Patienten mit PTSD mit körperlichen Beschwerden in ärztliche Behandlung begeben (Rückenschmerzen, Schlafstörungen etc.), ohne dass die traumabedingte Genese der Beschwerden zur Sprache kommt. Die vorliegende Studie unterstreicht die Wichtigkeit der differentialdiagnostischen Einbeziehung der PTSD insbesondere bei Patienten mit somatoformen Symptomen bzw. Störungen, um sie einer adäquaten evtl. auch traumaspezifischen Behandlung frühzeitig zuführen zu können

Psychosocial impact of prognostic genetic testing in the care of uveal melanoma patients: protocol of a controlled prospective clinical observational study

Background: Uveal melanoma patients with a poor prognosis can be detected through genetic analysis of the tumor, which has a very high sensitivity. A large number of patients with uveal melanoma decide to receive information about their individual risk and therefore routine prognostic genetic testing is being carried out on a growing number of patients. It is obvious that a positive prediction for recidivism in the future will emotionally burden the respective patients, but research on the psychosocial impact of this innovative method is lacking. The aim of the current study is therefore to investigate the psychosocial impact (psychological distress and quality of life) of prognostic genetic testing in patients with uveal melanoma. Design and methods: This study is a non-randomized controlled prospective clinical observational trial. Subjects are patients with uveal melanoma, in whom genetic testing is possible. Patients who consent to genetic testing are allocated to the intervention group and patients who refuse genetic testing form the observational group. Both groups receive cancer therapy and psycho-oncological intervention when needed. The psychosocial impact of prognostic testing is investigated with the following variables: resilience, social support, fear of tumor progression, depression, general distress, cancer-specific and general health-related quality of life, attitude towards genetic testing, estimation of the perceived risk of metastasis, utilization and satisfaction with psycho-oncological crisis intervention, and sociodemographic data. Data are assessed preoperatively (at initial admission in the clinic) and postoperatively (at discharge from hospital after surgery, 6–12 weeks, 6 and 12 months after initial admission). Genetic test results are communicated 6–12 weeks after initial admission to the clinic. Discussion: We created optimal conditions for investigation of the psychosocial impact of prognostic genetic testing. This study will provide information on the course of disease and psychosocial outcomes after prognostic genetic testing. We expect that empirical data from our study will give a scientific basis for medico-ethical considerations

Eating Disorders, Trauma, PTSD, and Psychosocial Resources

The frequency of traumatic events and comorbid post-traumatic stress disorder (PTSD) in women with eating disorders (EDs) was assessed. Also, patients with anorexia nervosa (AN) and bulimia nervosa (BN) were compared with regard to post-traumatic symptomatology and the role of psychosocial resources was analyzed. 103 ED patients (29.1±10.5 years) were studied through the use of standardized questionnaires. 23.1% of AN and 25.5% of BN patients fulfilled the study definition for a current diagnosis of PTSD. Cumulative traumatization led to more severe symptomatology. Psychosocial resources were found to have strong associations with symptomatology. These findings provide additional support for the association between traumatization and ED. Clinical interventions for traumatized ED patients may benefit from a focus on post-traumatic stress symptomatology and personal resources

Emotional Expression Predicts Treatment Outcome in Focal Psychodynamic and Cognitive Behavioural Therapy for Anorexia Nervosa: Findings from the ANTOP Study

Emotional Expression Predicts Treatment Outcome in Focal Psychodynamic and Cognitive Behavioural Therapy for Anorexia Nervosa: Findings from the ANTOP Stud

Use of Assistive Technology and Need for Social Support for Elderly With Physical Disabilities

Objectives: The purpose of this study is to examine the use of assistive technology, social support in everyday life and psychological existential orientation for individuals with physical disabilities.  Methods: Forty-six elderly persons with physical disabilities (aged 73.7±10.6 years, range 53-93 years) were examined with regard to the use of assistive technology, social support in everyday life and psychological existential orientation by an extensive questionnaire set (questionnaire for assistive technology (AT-24), questionnaire for social support (F-SOZU-K-22) and Brief Symptom Inventory (BSI)).  Results: The subjects stated that they needed aid and social support in order to carry out their daily indoor/outdoor activities (for e.g. dressing, having a bath / shower, using toilet, eating, going up / down the stairs, shopping, or going out). The most commonly used mobility aid was the walking frame that accounted for 61.9%, followed by the walking stick with 40.5% and a bathtub lift with 21.4%. The results also showed the psychopathological symptoms in the sample.  Discussion: Assistive technologies together with the support of relatives and care services help people to cope with a variety of activities in their daily lives with fewer restrictions. The effectiveness of the aids differs between participants because it depends on several factors such as health, knowledge, and information about aids, as well as the appropriate selection of aids

Psychosocial predictors for outcome after total joint arthroplasty: a prospective comparison of hip and knee arthroplasty

Abstract Background As findings regarding predictors for good outcome after total joint arthroplasty are highly inconsistent, aim of this study was to investigate the influence of the psychosocial variables sense of coherence and social support as well as mental distress on physical outcome after surgery. It should be investigated if different predictors are important in patients after total hip arthroplasty (THA) compared to patients after total knee arthroplasty (TKA). Methods In a prospective design, 44 patients undergoing THA and 61 patients undergoing TKA were examined presurgery and 6 and 12 weeks after surgery using WOMAC (disease-specific outcome), SF-36 (health-related quality of life), BSI (psychological distress), SOC-13 (sense of coherence), and F-SozU (social support). Changes over time were calculated by analyses of variance with repeated measures. Stepwise multiple linear regression analyses were computed for each group to predict scores of WOMAC total and all WOMAC subscales 12 weeks postoperatively. Results THA as well as TKA patients experienced improvements in all parameters (effect sizes for WOMAC scores between η2 = .387 and η2 = .631) with THA patients showing even better results than TKA patients. WOMAC scores 12 weeks after surgery were predicted predominantly by WOMAC baseline scores in TKA with an amount of explained variance between 9.6 and 19.5%. In THA, 12-weeks WOMAC scores were predicted by baseline measures of psychosocial aspects (anxiety, sense of coherence, social support). In this group, predictors accounted for 17.1 to 31.6% of the variance. Conclusions Different predictors for outcome after total joint arthroplasty were obtained for THA and TKA patients. Although psychosocial aspects seemed to be less important in TKA patients, preoperatively, distressed patients of both groups should be offered interventions to reduce psychological distress to obtain better outcomes after surgery