Suicidal Ideation in Adult Patients with Atopic Dermatitis: A German Cross-sectional Study.

A cross-sectional study was performed to assess symptoms of suicidality, depression and anxiety in adult patients with atopic dermatitis. The study describes the relationships between these psychiatric symptoms and skin-specific factors, such as atopic dermatitis severity and skin satisfaction. A sample of 181 German patients with atopic dermatitis was compared with a control group of 64 persons with healthy skin with a similar age and sex distribution. Standardized questionnaires were used to assess suicidality (Pöldinger's Scale), depression and anxiety (Hospital Anxiety and Depression Scale; HADS), quality of life (Dermatology Life Quality Index; DLQI), atopic dermatitis severity (Patient-Oriented Scoring Atopic Dermatitis; PO-SCORAD) and skin satisfaction (Skin Satisfaction Questionnaire; SSQ). The prevalence of suicidal ideation among patients with atopic dermatitis was high (21.3%); 3.9% scored above the cut-off that might be an indicator for acute suicidality. Depression symptoms, high severity of atopic dermatitis, lower age, and little touching within the family were identified as significant factors to predict suicidality in atopic dermatitis. Psychiatric screening in dermatological treatment of atopic dermatitis is discussed.

[The reception of Heinz Kohut in Germany]. / Die Rezeption von Heinz Kohut in Deutschland.

First the discussion of Kohut's new ideas in the United States is sketched as a background. The response to these ideas was divided: on the one hand they were hailed as important innovations of psychoanalytic theory, and a circle of colleagues formed around their author; on the other hand they were violently rejected, and old friends distanced themselves from him. In Germany Kuhut's ideas were initially well received. His visits, lectures and supervisions resulted in a lively exchange and a number of friendships. When the differences between Kohutian and classical theory became evident this led increasingly to disillusionment and retreat. De-emphasizing drive and ego psychology had considerable consequences for psychoanalytic technique as well as for the analyst's Menschenbild, his relationship to the patient and his critical self-reflection. In Germany, too, a circle of colleagues emerged, following and elaborating the ideas of Kohut.

Atopic dermatitis, attachment and partnership: a psychodermatological case-control study of adult patients.

Adult patients with atopic dermatitis were examined from a psychodermatological perspective with respect to attachment attitudes and satisfaction with partnerships. In addition, the correlation between these variables and skin symptoms, as well as the skin-specific quality of life, was also studied. A total of 62 adult patients with atopic dermatitis were compared with a parallel control group with healthy skin (n = 62). There were significant correlations between the patients' attachment characteristics on the one hand and the detriment to skin-specific quality of life on the other. In contrast, partnership satisfaction was not as severely impaired as expected; however, it showed significant correlations with attachment attitudes.

Long-term outcomes of short-term and long-term psychosomatic inpatient treatment and their predictors.

OBJECTIVES: The Clinic for Psychosomatic Medicine and Psychotherapy at the University Giessen, Germany, offers short-term (STT) and long-term inpatient therapy (LTT). METHODS: In a prospective, 3-year follow-up study, we examined therapeutic indication, short- and long-term results, outcome predictors, and the utilization of aftercare for both settings. RESULTS: STT patients were more frequently acutely ill, suffered from stronger symptomatic manifestations, and were more frequently employed. LTT patients had a greater rate of chronic psychosomatic disorders, personality disorders and somatic comorbidity. In both settings, distress strongly declined during inpatient therapy and remained stable for 3 years. Negative predictors of outcome were infantile object relation patterns and interpersonal problems. We found no differences between STT and LTT patients in terms of the utilization of aftercare. CONCLUSION: Duration of psychosomatic inpatient treatment should be differentiated according to the chronicity and nature of the disorder.

[Short-term and long-term inpatient psychotherapy -- indications, results, predictors]. / Stationäre Kurz- und Langzeitpsychotherapie -- Indikationen, Ergebnisse, Prädiktoren.

OBJECTIVES: This study investigated differences between patients in both short-term and long-term inpatient psychotherapy. Results for both settings as well as predictors of treatment outcomes were determined. METHODS: Consecutive patients of the Giessen University Clinic for Psychosomatics and Psychotherapy, who were treated during a two-year period in both short- and long-term treatment settings, were studied prospectively (N = 166; return-rate 70 %). Standardized questionnaires were applied for distress (SCL-90 R), physical complaints (GBB 24) and interpersonal problems (IIP-D) as well as for object relationships (IPO). RESULTS: In concordance with treatment concepts, patients in short-term psychotherapy had a more acute onset of symptoms, were more highly distressed and better occupationally integrated; patients in long-term treatment suffered more frequently from chronic psychosomatic disorders, personality disorders and comorbid somatic conditions. In both treatment settings distress and physical complaints decreased considerably and remained quite stable during follow-up. Concurring predictors of outcome were more adaptive patterns of object and interpersonal relationships as well as social resources. No differences were seen between the short-term and long-term treatment for utilization of ambulatory psychotherapy after discharge. DISCUSSION: The study shows that a differentiation between short- and long-term treatments, even within one psychosomatic hospital unit, allows for differential indication and treatment concepts.

[Separation during inpatient psychotherapy and its impact on the regulation of blood glucose in a patient with Brittle Diabetes]. / Der Einfluss von Trennungserfahrungen während stationärer Psychotherapie auf die Blutzuckerregulation eines Patienten mit Brittle Diabetes.

OBJECTIVES: During the inpatient psychotherapy of a 21-year-old male patient with Brittle Diabetes, psychic reactions and changes of blood glucose after separation were studied. METHODS: The patient was interviewed using the Adult Attachment Interview (AAI). Specific attachment-related stress factors were elaborated. During the course of therapy, blood glucose, body symptoms and mood ratings were recorded daily and statistically evaluated by time series analysis. The statistical analysis allowed testing of critical instances (separation) and psychic determinants of blood glucose control. RESULTS: Significant predictors for the average blood glucose were as follows: the therapist's vacation (p < 0.02) and the announcement of discharge from the hospital (p < 0.01). A significant predictor for the daily blood glucose variation was mood (p < 0.01); the trend of the blood glucose variation was negative (p < 0.01). CONCLUSION: Toward the end of the treatment the blood glucose was stabilized. This result suggests the benefit of psychotherapy for these patients. Further empirical studies are necessary to confirm the findings.

[Integrative treatment of instable diabetes mellitus: education or psychotherapy?]. / Zur integrativen Behandlung des instabilen Diabetes mellitus im Jugendalter: Schulung oder Psychotherapie?

The term "brittle diabetes" describes a subtype of instable type-I diabetes, characterized by high variations of blood sugar without any evident cause and despite careful clinical management. Clear guidelines for a precise definition of the condition are still lacking; this fosters insecurities concerning diagnosis and therapy of the disease. Psychosocial influences, triggering these conditions, were discussed. The patient-doctor-relationship appears to be tensed due to an often missing compliance. Using a paradigmatic case study as background, the specific diagnostic and therapeutic problems in brittle diabetes were presented. Brittle diabetes advocates a close cooperation between internal and psychosomatic medicine units and a combination of patient education and psychotherapy. Seen under a psychosomatic paradigm, brittle diabetes can be detected early and effective treatment may avoid further complications in these young patients.

[Patterns of neuronal activity related to emotional stimulation in alexithymia]. / Neuronale Aktivitätsmuster auf affektinduktive Reize bei Alexithymie.

In alexithymia a frontal dysfunction is supposed to be a neurobiological correlate. This study focuses on distorted patterns of neuronal activity evoked by emotional stimuli in alexithymics and controls. Out of hospitalised patients with psychosomatic diseases 8 patients with a high score (HA) and 8 with a low one (NA) on the TAS-20 were investigated with fMRI during emotional stimulation which included pictures evoking anxiety and disgust as well as neutral illustrations. As response to negative affect arousing visual stimulation HA in comparison to NA showed a lower activation in the right medial prefrontal cortex and in the right amygdala. The results were significant for the emotion disgust. The results support the existence of a complex central feedback circuit consisting of regions of the prefrontal cortex and limbic structures to process negative affects. Hypothetically a fundamental factor for the emergence of alexithymic traits is an inhibiting process between affect processing (e. g. medial prefrontal cortex, anterior cingulum) and affect generating structures (e. g. amygdala). Furthermore our findings confirm the hypothesis that alexithymia is a disorder of higher cerebral function.