Eating problems in very low birthweight children are highest during the first year and independent risk factors include duration of invasive ventilation.

AIM: This study aimed to investigate the incidence and time course of eating problems in children born with a very low birthweight (VLBW) and to identify the perinatal risk factors. METHODS: We used a standard eating questionnaire to study 178 VLBW children, born between 1999 and 2005 at a median of 28.6 weeks' gestation and median birthweight of 1058 g, for the first 6 years of life. The control group comprised 74 children born full term. RESULTS: Just under a quarter of the VLBW children (24.7%) had eating problems before the age of one, and by the age of two, the cumulative incidence had increased to 28.6%. The 69 children born between 1999 and 2001 had eating problems up to the age of six, but 76.5% were resolved by the age of four. Independent risk factors were gestational age at birth, and duration of invasive ventilation and eating problems were associated with significantly poor growth. CONCLUSION: The incidence of eating problems in VLBW children was highest during the first year of life. Gestational age and the duration of invasive ventilation were independent risk factors, and eating problems contributed to continued growth failure. Eating problems require early recognition and intervention.

[Alexithymia and specific relationship patterns in a clinical sample]. / Alexithymie und spezifische Beziehungsmuster in einer klinischen Stichprobe.

OBJECTIVES: Alexithymia is characterized by deficits in perceiving, differentiating and regulating affects, both one's own affects and those of others. It is often related to interpersonal problems which are a major reason for seeking psychotherapy. This study assesses the relationship between alexithymia, specific relationship patterns and interpersonal problems in a clinical inpatient sample. METHODS: We evaluated alexithymia (Toronto-Alexithymia-Scale-26: TAS-26), relationship patterns (Relationship Patterns Questionnaire-II; RPQ-II) and interpersonal problems (Inventory of Interpersonal Problems: IIP) in 152 patients with various mental disorders upon admission to an inpatient clinic for psychosomatic medicine and psychotherapy. RESULTS: Alexithymia (TAS-20) was significantly negatively associated with self-assertion (RPQII) and significantly positively associated with overall interpersonal problems (IIP-total score). Specifically, the interpersonal style associated with alexithymia was characterized by cold, socially avoidant, nonassertive and exploitable behavior (IIP-subscales). CONCLUSIONS: Alexithymia in patients with mental disorders is linked to specific relationship patterns and interpersonal problems at the beginning of an inpatient psychotherapy. Because interpersonal problems, and especially the therapeutic alliance, are strong predictors of outcome in individual psychotherapy, specific attention should be paid to this relationship in the treatment of alexithymic patients.

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.

[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.

[The Relationship Patterns Questionnaire (RPQ): a validation using a clinical sample]. / Der Beziehungs-Muster-Fragebogen (BeMus): Validierung anhand einer klinischen Stichprobe.

The Relationship Patterns Questionnaire RPQ was designed to assess the relationship patterns concerning the individual's own behavior as well as the anticipated behavior of an important reference person. In this study, the questionnaire is examined psychometrically by using a sample of psychosomatic inpatients (N = 160). The underlying circumplex structure could be confirmed by means of factorial analyses as well as by the correlations between IIP and RPQ. There were no significant correlations between physical complaints (GBB) and relationship patterns; however, a less affectionate relation was associated with greater psychosocial strains (SCL-90-R) both on the self and on the object level. The pre-post analysis revealed a tendency to a greater ability to assert oneself as well as to be open opposite the reference person, but the effect size was small. Possibilities and limits of the present RPQ version are discussed and conclusions are drawn concerning the further development.

[The relationship patterns questionnaire (RPQ): validation by using a representative sample]. / Der Beziehungs-Muster-Fragebogen (BeMus): Validierung anhand einer repräsentativen Bevölkerungsstichprobe.

In this study the present form of the Relationship Patterns Questionnaire (RePat) will be presented as a successor of the Interpersonal Relationship Patterns Questionnaire (IRQ). Similar to the IRQ the RePat assesses the behavior of relationship concerning both one's own and the anticipated behavior of an important person on the basis of the SASB model and the CCRT method. In contrast to the IRQ, the RePat is much shorter and thus easier to use. The study describes the construction and the psychometric examination of the questionnaire by using a representative study (n = 2007, East = 1015, West = 992). The samples of East and West Germany show structural differences concerning its relationship patterns, which in our opinion are plausible for political and historical reasons. The clinical application and their implications for therapeutic interventions will be demonstrated by a single case using both the patient's and her partner's assessment of their relationship.

[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.

Desenvolvimento da versão em português do Brasil do questionário sobre padrão de relacionamentos Beziehungs-Muster Fragebogen / Development of a Brazilian Portuguese version of the questionnaire on relationships pattern Beziehungs-Muster Fragebogen

INTRODUÇÃO: O desenvolvimento da versão em português do Brasil do Beziehungs-Muster Fragebogen, conhecido na literatura internacional como Relationship Patterns Questionnaire, questionário que avalia o padrão central de relação, visa à introdução, em nosso meio, de uma medida auto-aplicável para implementação de projetos de pesquisa cuja questão envolva o construto transferência. METODOLOGIA: As etapas para o desenvolvimento da versão foram: obtenção da licença dos autores; tradução do instrumento original para o português do Brasil; julgamento e ajuste do material traduzido por profissionais da área da psiquiatria e psicologia; retrotradução; julgamento da equivalência semântica; consenso de profissionais da área da psiquiatria e psicologia sobre a adequação do instrumento à nossa cultura; interlocução com a população-alvo. CONCLUSÃO: O Beziehungs-Muster Fragebogen é uma medida auto-aplicável, para avaliação da transferência ou padrão central da relação, que poderá facilitar a implementação de projetos para investigar os aspectos da relação terapêutica adjuntos à transferência. É um método de fácil aplicação e análise, baixo custo e que dispensa o uso de vídeos ou gravadores na sessão. Estudos investigatórios acerca do padrão de relação poderão fornecer mais resultados sobre a adaptabilidade desse instrumento à nossa cultura.

INTRODUCTION: The Beziehungs-Muster Fragebogen (BeMus-3), known in the international literature as the Relationship Patterns Questionnaire (RPQ), is a questionnaire that evaluates the central pattern of relationship. The development of its Brazilian Portuguese version aims at introducing, in our country, a self-report measurement to implement research projects involving the construct of transference. METHODOLOGY: The development stages of this version were: obtaining permission from the authors; translation of the original instrument into Brazilian Portuguese; evaluation and adjustment of the translated material by psychiatry and psychology professionals; back-translation; evaluation of semantic equivalence; consensus of psychiatry and psychology professionals on the adequacy of the instrument to our culture; interchange with the target population. CONCLUSION: BeMus-3 is a self-report measurement to assess the transference or central pattern of relationship that can facilitate the implementation of projects to investigate the transference-related aspects of therapeutic relationship. This method is easy to apply and analyze, has a low cost and does not require the use of video or voice recorders during the session. Investigative studies on the pattern of relationship may provide further results on the adaptability of this instrument to our culture.