Psychosomatic Patients Research Articles

A Screening-Tool for Three Dimensions of Work-Related Behavior and Experience Patterns in the Psychosomatic Rehabilitation - A Proposal for a Short-Form of the Occupational Stress and Coping Inventory (AVEM-3D)

Objectives: The assessment of work pressures is of particular importance in psychosomatic rehabilitation. An established questionnaire is the Occupational Stress and Coping Inventory (German abbr. AVEM), but it is quite long and with regard to scoring time-consuming in routine clinical care. It should therefore be tested, whether a shortened version of the AVEM can be developed, which is able to assess the formerly described three second-order factors of the AVEM, namely Working Commitment, Resilience, and Emotions, sufficiently reliable and valid, and which also may be used for screening of patients with prominent work-related behavior and experience patterns. Methods: Data were collected at admission from consecutive samples of three hospitals of psychosomatic rehabilitation (N = 10,635 patients). The sample was randomly divided in two subsamples (design and validation sample). Using exploratory principal component analyses in the design sample, items with the highest factor loadings for the three new scales were selected and evaluated psychometrically using the validation sample. Possible Cut-off values ought to be derived from distribution patterns of scores in the scales. Relationships with sociodemographic, occupational and diagnosis-related characteristics, as well as with patterns of work-related experiences and behaviors are examined. Results: The three performed principal component analyses explained in the design sample on the respective first factor between 31 % and 34 % of the variance. The selected 20 items were assigned to the 3-factor structure in the validation sample as expected. The three new scales are sufficiently reliable with values of Cronbach's α between 0,84 and 0,88. The naming of the three new scales is based on the names of the secondary factors. Cut-off values for the identification of distinctive patient-reported data are proposed. Conclusion: Main advantages of the proposed shortened version AVEM-3D are that with a considerable smaller number of items the three main dimensions of relevant work-related behavior and experience patterns can be reliably measured. The proposed measure is simple and economic to use and interpret. Based on the present sample we provide means and standard deviations as reference at admission of psychosomatic rehabilitation. As a limitation it should be mentioned that further evaluation of reliability, validity and sensitivity to change restricted to the items of the shortened version is necessary. The practicability and validity of the proposed cut-off values cannot yet be conclusively assessed. Finally, the validity of the AVEM-3D in groups of indications other than psychosomatic patients and in healthy persons remains to be examined.

Evaluation of Contextual Factors in Psychosomatic Rehabilitation

Objectives: Although individualized and ICF-oriented implementation of rehabilitation treatment requires knowledge of relevant contextual factors, there is a lack of operationalized documentation and measurement tools to evaluate these factors. Therefore, an ICF-oriented semi-structured interview was designed. Methods: 20 contextual factors were externally assessed whether they negatively affected mental functioning and participation of psychosomatic patients. Additionally, psychometric scales were applied. Results: Six relevant impairing contextual factors were identified. Contextual factors significantly correlated with psychometric scales. Patients with higher contextual impairment showed significantly higher psychological stress levels. Conclusions: Anamnesis of contextual factors at the beginning of psychosomatic rehabilitation yields important information for therapy planning. Further research on contextual factors in medical rehabilitation is needed.

The sense of body boundaries – subjective determinants and implications for body self-relation in people with psychosomatic illnesses

Abstract This article seeks to explore the determinants of the sense of body boundaries and its implications for body self- relation in psychosomatic patients - patients with irritable bowel syndrome (IBS) as well as psoriasis and atopic dermatitis. Stepwise regression analysis and paths analysis were carried out. The most significant condition affecting the strength of the sense of body boundaries among IBS patients is their sensitivity to the violation of self- boundaries in the dimension of the social self. Likewise, among patients with skin diseases, the most important factor is their style of cognitive functioning (field independence). Furthermore, both similarities and differences have been found in the groups involved in the research in terms of determinants of the sense of body boundaries, as well as in comparison with the results from healthy patients. The results which were obtained indicated that the greater the strength of the sense of body boundaries in IBS patients, the greater its positive impact on the assessment of the patients’ own health, their physical attractiveness and comfort from touch, in a similar way to that in healthy people. As far as patients with psoriasis and atopic dermatitis are concerned, the sense of body boundaries was revealed to have a positive impact on the level of health orientation: active involvement with either maintaining or improving the health condition.

Psychosomatic patients in integrated care: Which treatment mediators do we have to focus on?

The field of psychosomatics has gained increasing significance; it has been struggling to establish its position as either an independent discipline or a subdomain of specific areas such as internal medicine or psychiatry. However, the rise of psychosomatic syndromes and disease patterns as well as an increase of specific integrated psychosomatic wards is a clear indication for the growing importance of interdisciplinary approaches to psychosomatic disorders. The study presents data from an 8-week inpatient treatment at a psychosomatic facility and investigates whether patients improved in their subjective symptom experience. A complex treatment approach, ranging from pharmacological treatment and group and individual psychotherapy to physiotherapy and ergotherapy was integrated into this intervention. In essence, containment of intrapsychic aggression derivatives played a central role in the treatment of psychosomatic symptoms. A significant factor contributing to a successful treatment is the doctor-patient relationship. All these factors were investigated in the present study.

Subjective sleep complaints indicate objective sleep problems in psychosomatic patients: a prospective polysomnographic study.

ObjectiveTo elucidate the relationship between subjective complaints and polysomnographical parameters in psychosomatic patients.MethodA convenience sample of patients from a psychosomatic inpatient unit were classified according to the Pittsburgh Sleep Quality Index (PSQI) as very poor sleepers (PSQI >10, n=80) and good sleepers (PSQI <6, n=19). They then underwent a polysomnography and in the morning rated their previous night’s sleep using a published protocol (Deutschen Gesellschaft für Schlafforschung und Schlafmedizin morning protocol [MP]).ResultsIn the polysomnography, significant differences were found between very poor and good sleepers according to the PSQI with respect to sleep efficiency and time awake after sleep onset. When comparing objective PSG and subjective MP, the polysomnographical sleep onset latency was significantly positively correlated with the corresponding parameters of the MP: the subjective sleep onset latency in minutes and the subjective evaluation of sleep onset latency (very short, short, normal, long, very long) were positively correlated with the sleep latency measured by polysomnography. The polysomnographical time awake after sleep onset (in minutes) was positively correlated with the subjective time awake after sleep onset (in minutes), evaluation of time awake after sleep onset (seldom, normal often), and subjective restfulness. The polysomnographical total sleep time (TST) was positively correlated with the subjective TST. Conversely, the polysomnographical TST was negatively correlated with the evaluation of TST (high polysomnographical TST was correlated with the subjective evaluation of having slept short or normal and vice versa). The polysomnographical sleep efficiency was positively correlated with subjective feeling of current well-being in the morning and subjective TST and negatively with subjective restfulness, subjective sleep onset latency, subjective evaluation of sleep onset latency, and evaluation of time awake after sleep onset.ConclusionThe data suggest that, in general, patients selected from the extremes of reported very poor sleepers and good sleepers have different amounts of sleep when measured in the laboratory, and that in general, the amount and timing of sleep in the laboratory are quite well perceived and reported by these groups. The data came from psychosomatic patients and suggest that even in this patient group, respective sleep complaints are more than just the expression of general somatization or lamenting.

Psychotherapy of somatoform disorders

In Ukraine there is tendency to increased deseaseness and prevalence's of somatoform disorders.The most significant role belongs to the patient's self-evaluation of the influence of the disease on their social status that is an essential past of the self-picture of the disease and the important point of therapeutic rehabilitation intervention.On the basis of the examined 300 patients on somatoform disorders and 200 patients on psychosomatic diseases, we have elaborated a formal test that allows evaluating quantitatively the influents of the disease on various spheres of patients’ social status.It was absolutely unexpectable the common for psychosomatic and somatoform disorders patients rise of significance of personal individual, every day life factors in cases of aggravation of the main disease course. We created the cognitive-behavioral psychotherapy system with suggestive and autosuggestive implementations.Elucidation of peculiarity of personal perception of the disease served as basis of elaboration of purposeful system of psychotherapy, consulting, psychological support for patients with high-effectiveness 1.5–3 years catamnesis in 85% patients.Our experience showed the necessity of the use the target-oriented integrativе models of psychotherapy, parted on stages. On the first stage-sedative-adapting the receptions of cognitive and suggestive psychotherapy are used. There is group therapy on second stage. On the third stage elements of the autogenic training mastered.Disclosure of interestThe author has not supplied his/her declaration of competing interest.

Effect of cognitive behavioral stress management program on psychosomatic patients' quality of life.

Background:Level of stress and its management affects the dimensions of psychosomatic patients’ quality of life (QoL), which is an important psychological issue. The present study aimed to investigate the effect of cognitive behavioral stress management program on psychosomatic patients’ QoL. In cognitive behavioral method, patients discover thought and behavioral mistakes and recover them. The criterion to evaluate the success of the present study was measurement of the patients’ QoL and its notable improvement after intervention.Materials and Methods:This is a before-and-after clinical trial with a control group. The study participants comprised 70 psychosomatic patients referred to subspecial psychiatry clinic in Isfahan who were selected through convenient sampling and allocated to the study and control groups. Quality of Life Questionnaire (SF36) was adopted to collect the data. The questionnaire was completed by the participants in three stages of before-and-after up to a month after intervention. Cognitive behavioral stress management program was administrated in study group for eight straight sessions, two month, and a month after intervention. Along with this, conventional medical treatments were conducted for both the groups. Data were analyzed by ANOVA. The significance level was P < 0.001.Results:There was no significant difference in QoL mean scores between the two groups before intervention (44, 43.1), but mean scores of QoL were significantly higher in intervention G (55.7, 59.1), compared to control (39.8, 35.7), after intervention (P < 0.001) and one month after intervention (P < 0.001).Conclusions:Cognitive behavioral stress management, conducted in the present study, had a notable effect on QoL. Therefore, designing psychological interventions based on cognitive behavioral stress management is suggested as an efficient clinical intervention.

Medico-social characteristics of patients at the psycho-somatic department

Over the recent years, there has been an increase in the number of patients with psychosomatic disorders, as well an increase in the number of «masked depressions». High social significance of psychosomatic diseases is predetermined by the fact that it is extremely common among people of working age. The aim of the study was to analyze the medical and social composition of the patients at the psychosomatic department, as well as to show the efficiency of treatment in such department. The analysis of data obtained during the survey department of psychosomatic patients for anxiety and depressive disorders is presented. The survey was conducted by using the Hospital Anxiety and Depression Scale (HADS). The medical documentation of the department was also analyzed. The study found that the social composition of patients was heterogenous. Most of the patients (54.3 %) were in hospital with a diagnosis of organic anxiety disorder. It was revealed that the largest share among the somatic pathology accounted to such pathology as hypertension of the III degree in conjunction with coronary artery disease (20.7 %) and hypertension of the II stage (19.6 %). The efficacy of treatment in this department was proven. By the 20th day of hospitalization, 30 % of patients did not experience anxiety and/or depression. Combined symptoms of anxiety and depression were observed only in 14 % of patients by the 20th day of treatment.

Are there Associations between Embitterment and Clinical as well as Personality Variables by Psychosomatically Ill Inpatients

Understanding of bitterness ranges from a negative general human emotion to a destructive complex affekt due to a non adequate processed affront or resentment. Relevant associations between kinds of bitterness and clinical as well as personality-related variables in hospitalized psychosomatic patients were examined. Prospective naturalistic study over 14 months of consecutive admitted psychosomatic patients without exclusion criteria (N=166). General bitterness and 4 subscales were investigated on the basis of the Berner Verbitterungs-Inventar (BVI), personality traits on the basis of BFI-10, and clinical variables mainly on the basis of validated instruments (HoNOS, BDI, HADS, GAF, CGI, IIP-D, BSCL, comorbidity, duration of illness and structure as well as conflict-load according to OPD-2). Differences among levels of bitterness were examined with ANOVA tests, relationships between bitterness and clinical as well as personality-related variables using multivariate linear and multinomial regression models. The general bitterness falls within the average range. ANOVA models show higher scores for neuroticism, IIP, BDI, HADS, and BSCL when bitterness is above-average. In multivariate regression analyses, BDI, BSCL and neuroticism are positively associated with bitterness, whereas GAF, illness duration, and conscientiousness are negatively associated with bitterness. Diagnoses, severity of disease and burden of conflicts as well as level of organization of personality are not associated with bitterness. Models explain 11-39% of variance of bitterness. Bitterness in psychosomatic patients is hardly associated with personality variables, diagnoses, and psychopathological burden with the exception of depressiveness and neuroticism. Burden of interpersonal concerns may better explain bitterness than psychopathology or personality. Bitterness could be interpreted as a theoretical construct widely independent from severity of disease, personality, and diagnosis, showing importance in clinical practice.

Alteration of consciousness via diverse photo-acoustic stimulatory patterns. Phenomenology and effect on salivary flow rate, alpha-amylase and total protein levels

Long-term photo-acoustic stimulation is used for the induction of altered states of consciousness for both therapeutic and experimental purposes. Long-term photo-acoustic stimulation also leads to changes in the composition of saliva which have a key contribution to the efficiency of this technique in easing mucosal symptoms of oral psychosomatic patients. The aim of this study is to find out whether there is any cumulative effect of repeated stimulation and whether there are any detectable differences between diverse stimulatory patterns of long lasting photo-acoustic stimulation on the phenomenology of the appearing trance state and on salivary secretion. There was significant cumulative effect in relation with the appearance of day dreaming as phenomenological parameter, and in relation with protein output and amylase/protein ratio as salivary parameter. Pattern specific effect was detectable in relation with salivary flow rate only. Although our results clearly indicate the existence of certain cumulative and stimulation-pattern specific effects of repeated photo-acoustic stimulation, the absolute values of all these effects were relatively small in this study. Therefore, in spite of their theoretical importance there are no direct clinical consequences of these findings. However, our data do not exclude at all the possibility that repeated stimulation with other stimulatory parameters may lead to more pronounced effects. Further studies are needed to make clear conclusion in this respect.

Self-reported workplace perception as indicators of work anxieties.

Work anxiety is a potentially disabling mental health problem, which can cause (long-term) sickness absence. In many cases patients do not openly report their anxieties and tend to give externalizing explanations of inner problems. Therefore people with work anxiety may perceive their workplace more negatively than those without such anxiety. To investigate the relation between subjective work description and work anxiety. Work anxiety was investigated with a standardized interview in a sample of employed psychosomatic rehabilitation inpatients suffering from common mental disorders. We assessed their subjective perception and evaluation of workplace conditions with the 'Short Questionnaire for Job Analysis' (KFZA) and compared their results with those from a sample of employees in the general population. There were 148 inpatient participants and 8015 general population controls. Patients with work anxiety described their workplace significantly more negatively than patients without work anxiety and employees in the general population, with no differences in workplace descriptions between psychosomatic patients without work anxiety and the general population sample. The type of complaint about work conditions was related to the specific type of work anxiety. Reports about workplace burdens can be indicative of work anxiety and should prompt further in-depth assessments. The content of complaints about work conditions may point to the type of underlying work anxiety.

Subjective experience of relaxation – induced by vibroacoustic stimulation by a Body Monochord or CD music – a randomised, controlled study in patients with psychosomatic disorders

ABSTRACTVibroacoustic stimulation via a Body Monochord can induce states of relaxation and subjective well-being. Sometimes unpleasant experiences such as fear, loss of control and unpleasant imagery can occur. Previous results were mainly deduced from investigations in healthy subjects.In this study, we examined psychosomatic patients’ subjective experiences during a single treatment with a Body Monochord in comparison to a listening session of relaxation music via audio CD. Diagnosed disorders were anxiety disorders n = 14, depressive disorders n = 18, adjustment disorder n = 27 and somatoform disorders n = 6. Each of the two treatments took approximately 20 minutes and was presented to the patients in random order. Subjective experiences were recorded via a shortened version of the Phenomenology of Consciousness Inventory. Neither clinical disorders nor psychometric scales for depressiveness and anxiety showed any influence on the emotional experience of the Body Monochord. However, patients with higher depression and anxiety scores showed a tendency to experience the CD music as less emotionally positive. The experience of relaxation induced by the Body Monochord is characterised to a greater extent by release of control (paired t-test: p = .003, effect size Cohen’s d = .54). Contrary to listening sessions of the CD music, the intensity of imagery during the treatment with the Body Monochord was not related to positive emotional feelings. Possibly during treatment with the Body Monochord psychological defence mechanisms of subjects are more reduced; this may make it easier for unconscious or preconscious contents to appear.

Slow respiring supported by a periodical mechanic haptic stimulus reduces situative anxiety in psychosomatic patients. A randomized controlled trial

Slow respiring supported by a periodical mechanic haptic stimulus reduces situative anxiety in psychosomatic patients. A randomized controlled trial

Feeling Through the Body: Alexithymia and Eating Disorders

Introduction Alexithymia is characterized by difficulties identifying and communicating feelings, and problems differentiating between feelings and bodily sensations; its concrete cognitive style focused on the external environment is typical of psychosomatic patients. Patients with eating disorders (EDs) have high levels of alexithymia, particularly difficulties identifying and describing their feelings. Objective The aims of our study are (1) to assess the alexythimia, emotional empathy, facial emotion identification skills and social inference abilities in a sample of ED patients; (2) to compare these variables between ED patients and healthy controls (HC); and (3) to correlate levels of alexithymia with the severity of the ED as measured by the Eating Disorder Inventory-3 (EDI-3) EDRC score in the ED group. Methods ED (N=42) and HC (N=42) were tested with the Toronto Alexithymia Scale (TAS-20), Eating Disorder Inventory (EDI-3), Facial Emotion Identification Test (FEIT), The Awareness of Social Inference Test (TASIT) and Interpersonal Reactivity Index (IRI). Results Data collection is being completed and the results’ analysis is ongoing. We expect the ED sample to show greater alexythimia and a poorer performance at FEIT and TASIT than HCs. We expect to find a linear correlation between the TAS-20 and EDRC score. Conclusion A better understanding of the role of alexithymia in ED etiology and maintenance might allow the development of targeted treatment approaches to help patients improve their skills in identifying and expressing emotions.

Хронопсихологічне прогнозування перебігу психосоматичних захворювань

The theoretical and practical concept of chronopsychological prognosis of the course of diseases in psychosomatic patients is justified. The practical development of the overall algorithm of psychosomatics prediction, the course of disease and the treatment effectiveness is made. The model of chronopsychological personality profile of patients is developed

大阪歯科大学附属病院における口腔心身症患者の動態調査

We conducted an investigation for 4 years from January 2008 to December 2011 to evaluate the oral psychosomatic patients who visited the Osaka Dental University Hospital.The number of patients diagnosed during the 4-year period was 245. We examined the gender, age, address, date of consultation, clinical department, diagnosis, and dosage of the patients.As a result, we found the following.1. The male-female ratio was 1 : 3.4.2. It took 2.5 months on average before the diagnosis.3. The number of new patients tended to be small in May and large in December.4. There were regional differences in the distribution of patients. The population density was also higher in two areas where there were many patients.

Measuring changes in health over time using the EQ-5D 3L and 5L: a head-to-head comparison of measurement properties and sensitivity to change in a German inpatient rehabilitation sample

To compare measurement properties and sensitivity to change of the standard version of the EQ-5D (3L) with a newly developed 5-level version (5L) in a multicenter sample of German rehabilitation inpatients (n = 230). Rehabilitation patients (n = 114 orthopedic, n = 54 psychosomatic, n = 62 rheumatic) were asked to complete both versions of the EQ-5D and several other questionnaires at the beginning of, the end of and 3 month after inpatient rehabilitation. 3L and 5L were compared regarding missing values, ceiling effects, redistribution properties, informativity and sensitivity to change. There were nearly no missing values in both questionnaires. Ceiling effects were 1.6 % points to 16.4 % points lower on average for the 5L. For psychosomatic patients, ceiling effects for 5L were as high as in the general German population. Absolute informativity (mean 5L: 1.76, 3L: 1.06) and relative informativity (5L: 0.76, 3L: 0.67) were both higher for 5L. 5L could better detect both positive and negative health changes in most dimensions and patient samples. Overall, patients made better use of the response levels of the 5L. Average proportion of inconsistent responses between 3L and 5L was 6.1 %. Cross-sectionally and longitudinally, 5L was associated with an improved ability to detect health changes over time, reduced ceiling effects, and improved discriminatory power. Overall, these findings were in line with previous study outcomes, although differing in magnitude. Since the sample size is moderate and generalizability of the reported results is unclear, further comparisons in other patient populations will be informative and should be encouraged.

Descriptors and predictors of rehabilitation goals of medical rehabilitation patients

Commonly agreed aims make rehabilitation treatment processes more individual, patient-centred and participatory. Since treatment needs of patients can be highly individual, it is to assume that aims also vary considerably. The article examines which aims orthopedic, oncological and psychosomatic patients set for themselves prior to the rehabilitation and to what extent differences in aims can be explained by personal characteristics. The analyses based on the intervention arm of a randomized controlled study (N=1 342) showed that the most common aims are comparable with similar results of other studies. Differences in aims could be attributed to demographic, diagnostic and health-related characteristics. Further studies should examine whether patients with demonstrably worse treatment prognosis for success have different aims than patients with a favourable prognosis.

Der Fragebogen zur sozialen Integration (FSI) - Psychometrische Testung und Akzeptanz bei Patienten mit hämatologischen Neoplasien

The "Fragebogen zur Sozialen Integration (FSI)" is the German adaption of the "Social Adjustment Scale (SAS-SR)". So far, there is no validation of the FSI with regard to patients with cancer. The scales leisure time, relatives and partnership of the FSI were test-statistically analyzed in hemato-oncological patients. Concordant validity was examined referring to the German version of the "Social Support Questionnaire (F-Sozu)" and one scale of the "EORTC QLQ-C30". In N = 184 participants, we observed in 1% - 20% missing values for several items. Ceiling effects could be observed for the scales relatives (1.22-2.20), whereby for the scales leisure time (1.27-2.95) and partnership (1.51-3.91) the range was substantially higher. Internal consistency averaged about 0.75 (leisure time, partnership), respectively, 0.69 (relatives). Analyses for validity showed values of -0.23 to -0.50 (F-Sozu) as well as -0.29 to -0.40 (EORTC QLQ-C30), respectively. The FSI is a reliable questionnaire to assess social adjustment within hemato-oncological cancer patients. However, psychometric properties in previous studies with psychosomatic patients were better. The high amount of missing values on several items in our study suggests a partial revision of the this instrument would be advisable for use in oncology.

EPA-1194 – Comparative study of static and dynamic family representations in psychosomatic families. case study

A well-functioning family system is able to change over time, while a dysfunctional one rigidly insists on its behaviour patterns well accustomed to. Thus all the family members become essential parts of this unfavourable condition. The aim of our study was to explore the psychosomatic family members’ static and dynamic mental representations about their family. There were altogether three families in our study, one of them with an asthmatic person and the other one with a young adult with panic disorder. The members of the third family were healthy people. Gehring's (2010) Family System Test (FAST) - a figural technique - was used to explore the individuals’ family representations. Later the dynamic form of the test was also applied. The results showed more rigid family structure in the cases of the psychosomatic patients. While the family members’ static representations were more comparable in the typical and ideal situations in the family with an asthmatic young person, the panic patient's typical and conflict family representations demonstrated more similarity. In addition, this representation rather reflected the healthy family members’ mental representation in the family with a panic patient, while in the other case the joint representation of the family members was influenced by the asthmatic young man to a greater extent. The observed types of the family structure confirm the different static representations and cognitive processes by the family members, which raises the significance of the effect of the analysed psychosomatic disorders on the given family system.