[Mental disorders in old age]. / Psychische Erkrankungen bei Frauen und Männern im Alter.

Older adults face multiple age-related burdens. Although certain mental disorders are more common in the elderly, mental illness-in contrast to physical disorders-is less frequent than in younger individuals. Some clear differences related to gender have been identified in relation to mental disorders in these patients. Older women tend to suffer more frequently from depression and anxiety disorders, while addiction disorders, in particular alcohol abuse, and suicide are more prevalent in men. The importance of psychotherapy in addition to psychopharmacological medication in the treatment of older adults with mental disease has become increasingly clear. This particular patient group tends to be very motivated to work with their care provider; moreover, previously employed constructive coping strategies, as well as the extensive experience in handling problems can be great assets to the therapeutic process.

Expectations of patients, nurses and physicians in geriatric nursing home emergencies.

OBJECTIVES: To determine contentment with the performance of primary mission emergency care providers. METHODS: A prospective cohort study was conducted using key informant interviews to assess quality of life and self-rated degree of contentment with care in geriatric emergencies. RESULTS: Interviews concerning a total of 152 geriatric emergency cases in nursing homes were conducted with patients in 13 (8.6%) cases, geriatric nurses in 132 (86.8%) cases and emergency physicians in 116 (76.3%) cases within a 3-month period. All responding patients as well as the majority of nurses (96.2%) and physicians (79.4%) were content with the quality of emergency care, but showed less contentment with communication (57.6% of nurses; 22.4% of physicians) and with cooperation on-site (57.6% of nurses; 20.7% of physicians). CONCLUSIONS: Participants perceived a deficit in communication and cooperation on-site. There is a need for intensified education in managing geriatric emergency patients, especially with regard to communication and psychosocial issues.

Long-term outcome after laparoscopic adjustable gastric banding for morbid obesity.

This study was performed to determine the long-term consequences of laparoscopic gastric banding on weight loss, body image, and life quality in morbidly obese patients. After a minimum follow-up of 9 years (mean follow-up 10 years; range 9-12 years) several questionnaires concerning weight loss, body image, and life quality were mailed to 180 morbidly obese patients following laparoscopic adjustable gastric banding. One hundred and twelve (62%) patients (92 females, 20 males) completed and returned the questionnaires. Of the entire sample, 73 (64.9%) patients still had the first band, 17 (15.3%) a second band, and in 22 (19.8%) probands the band had been removed for various reasons. Average weight loss, calculated as change in body mass index, was 13.9 kg/m². Average excess weight loss (EWL) was 30.6%. A total of 10% patients accounted for >50% of EWL. Half of the probands were completely satisfied with their weight loss and about half had reached their planned weight. Lowest post-operative weight was reached at different times, in nearly half of the probands after 2 years, in one-fourth after 4-5 years, and in about 20% at a later time. More than 90% of the probands experienced longer interruptions in weight loss; about half knew why. The findings indicate that overall quality of life was rated good to excellent by two-thirds of the probands, and fair to poor by one-third. A close correlation was seen between extent of weight loss and quality of life and body image. Despite some limitations, laparoscopic adjustable gastric banding is an effective and safe long-term surgical treatment for a majority of morbidly obese individuals, resulting in long-term weight loss and health-related quality of life. However, there is also a minority of morbidly obese subjects who do not benefit enough from this kind of bariatric surgery. Future research should investigate what kind of bariatric surgery is best for the particular obese individual in order to minimize unsatisfying post-operative results.

Morbid obesity: significance of psychological treatment after bariatric surgery.

Conservative interventions for weight reduction are not very effective in many cases of morbid obesity. For this reason, bariatric surgery plays an increasing role in the treatment of these patients. Bariatric surgery, however, is not the solution but an important precondition for successful management of morbid obesity. Psychological evaluation of the weight loss surgery patients is recommended because of the prevalence of psychiatric comorbidities and of eating disorders in individuals with morbid obesity. Morbid obese eating disordered patients with co-morbid psychiatric disorders, especially with personality disorders, show greater difficulties in adapting to the new demands, including the need to cope with stress and other problems in a new way, to relearn how to eat, distress over weight loss plateaus, failure to achieve a normal-looking body etc. Therefore, psychological and/or psychiatric treatment seem to be needed in some obese patients to gain an early postoperative understanding of possible psychological or eating problems. Various kinds of psychological support are available at Innsbruck Medical University Hospital before and after bariatric surgery, such as pharmacotherapy, individual psychotherapy, small-group psychotherapy, and the "Obesity Club". The reasons for the relatively low degree of willingness to take part in psychological treatment programs are demonstrated.

Preoperative stress and anxiety in day-care patients and inpatients undergoing fast-track surgery.

BACKGROUND: To investigate preoperative levels of stress and anxiety in day-care patients and inpatients undergoing surgical interventions. METHODS: Before induction of anaesthesia, the degree of stress and anxiety was assessed in 135 patients using stress and anxiety questionnaires, bio-feedback, physiological measures, and serum levels for stress variables. Questionnaire responses and physiological measures such as arterial pressure, heart rate, skin conductance, cortisol, and catecholamine levels were compared for day-care patients and inpatients. RESULTS: Significant preoperative anxiety was reported by 34 (45.3%) inpatients and 23 (38.3%) day-care patients. Personal responses in stress and anxiety questionnaires and mean values of arterial pressure and heart rate did not differ significantly in day-care patients when compared with inpatients. Correlation between deviations in plasma cortisol concentrations from normal diurnal distribution and anxiety scores and stress scores was also similar, and the relative increase in preoperative stress variables and measures observed in day-care patients and inpatients was also comparable. Bio-feedback measurements revealed significantly higher preoperative skin conductance (P<0.001) in day-care patients than in inpatients, indicating increased vegetative stress responses. CONCLUSIONS: Preoperative anxiety and stress are common in surgical patients. Questionnaires and bio-feedback measurements may help to assess the degree of patients' burdens. Surgeons should be aware of the personal anxiety of patients and consider patient preferences when deciding who should undergo fast-track surgery in day-care.

[The hands--means of expression for relationship, creativity and coping]. / Die Hand--Ausdrucksorgan für Beziehung, Kreativität und Bewältigung.

The hand is an important active sense organ. Hands help human beings to organise and change the environment, and most developments of mankind would not have been possible without hands. The hands also made a great contribution to the high degree of brain development. The hands are an important characteristic feature of identity and identification and sign of individuality as well. Human hands have a long history as an instrument of social interaction and as an object of social attention. The language of hands offers many kinds of expression and gestures help to underline the words.

Family background and sexual abuse associated with eating disorders.

OBJECTIVE: The authors examined the possible relationship of negative early familial experiences and childhood sexual abuse to the later development of eating disorders. METHODS: Three anonymous questionnaires--a sexual abuse screening checklist, the Biographic Inventory for Diagnosis of Behavioral Disturbances, and the Eating Disorder Inventory--were distributed to 350 female university students. RESULTS: Of the 202 women who completed the questionnaires, 44 (21.8%) were victims of childhood sexual abuse. There were no significant differences in the total or the subscale scores on the Eating Disorder Inventory among women with no, one, or repeated incidents of sexual abuse. However, women who reported an adverse family background displayed significantly higher Eating Disorder Inventory total and subscale scores than did women who assessed family background as a secure base. CONCLUSIONS: The data in this nonclinical female cohort suggest that childhood sexual abuse is neither necessary nor sufficient for the later development of an eating disorder, while an adverse family background may be an important etiological factor.

Psychosocial consequences of weight loss following gastric banding for morbid obesity.

BACKGROUND: This study was performed to determine what consequences surgery for morbid obesity has on weight loss, problems in eating behavior, quality of life, physical appearance and mental state. METHOD: After a minimum follow-up of > 8 months (median follow-up 21 months, range 8-48 months), a questionnaire concerning extent of, satisfaction with and consequences of weight loss was mailed to 250 morbidly obese patients after laparoscopic Swedish adjustable gastric banding (SAGB). In addition, the partner's opinion regarding the operation was evaluated as well as the consequences of weight loss for partnership and sexual relationship. RESULTS: 160 patients (64%) completed and returned the questionnaire. Most patients (87%) were happy with the extent of weight loss. Weight loss, however, was connected with negative consequences for the body such as flabby skin (53%), abdominal skin overhang (47%) and pendulous breasts (42%). Patients who were satisfied with their postoperative physical appearance showed significantly less weight loss than did patients who were unhappy with their appearance (38 vs 54 kg). Most of the partners (91%) believed that the decision for SAGB was right. An improvement in partnership was reported by more than half of the partners (59%), and an improved sexual relationship by 45%. CONCLUSION: Laparoscopic SAGB is an effective surgical treatment for morbid obesity. However, the consequences of excess and rapid weight loss for physical appearance are negative in many cases. Well-directed information about the consequences of excess weight loss before SAGB and the possibilities and limits of plastic surgery must be given preoperatively to offset high and often unrealistic expectations.

Partnership, sexuality, and sexual disorders in morbidly obese women: consequences of weight loss after gastric banding.

BACKGROUND: A study was performed to determine what consequences surgery for morbid obesity has on sexual attitudes and partnership in obese female patients. METHOD: Semi-structured interviews concerning sociodemographic data, sexuality and relationship were conducted on 82 female patients preoperatively and at least 1 year postoperatively. RESULTS: Physical appearance played the main role in the decision to undergo weight reduction surgery in only 17% of the study patients. Postoperatively, half of the patients were satisfied with their physical appearance 1 year after surgery, the other half not. Preoperatively, 44% of the patients stated that sexuality with their partners was satisfying and the frequency of sexual intercourse was regular. Postoperatively, 63% of the patients stated that they enjoyed sex more, compared with 12% of the patients who enjoyed sex less than before surgery. Postoperatively, 20% of the patients reported that partnership had changed positively, 10% negatively. CONCLUSIONS: The results indicate that many of the sexual problems in obese individuals are the result of an underlying lack of self-esteem, unsatisfactory relationships, or collective stigmatization of obese individuals. Binge eating, often found in morbidly obese patients, seems to be less the result of or compensation for sexual problems but is more likely to stem from other psychosocial or psychological problems.

Denial of pregnancy: obstetrical aspects.

Between 1987 and 1990 27 women were observed who professed they did not know they were pregnant until term or until premature contractions set in. The aim of this study was to evaluate obstetric history and pregnancy outcomes and assess defence mechanisms and coping strategies which contribute to negation of pregnancy. In 11 women pregnancy was denied until delivery, five of these had breech presentations. In nine women denial ended between 27 and 36 weeks and in seven women between 21 and 26 weeks of gestation. Three of the four fetal deaths that occurred and two of the three cases of prematurity occurred in the last group. There was no infanticide but one woman delivered her infant alone and concealed. Most women reported irregular, sometimes menstruation-like bleedings during pregnancy, three women had taken oral contraceptives during pregnancy. Few women reported actual symptoms of pregnancy, such as nausea and weight gain. Denial of pregnancy is a heterogeneous condition with different meanings and different psychiatric diagnoses in different women. Stressors (e.g. separation from partner, interpersonal problems etc.) do play an important role as precipitating factors for the development of an adjustment disorder with maladaptive denial of pregnancy. There is a fluid transition between conscious coping strategies and unconscious defence mechanisms.

Long-term effects of incest: life events triggering mental disorders in female patients with sexual abuse in childhood.

The authors studied several psychosocial, psychosomatic, and psychodynamic factors in 33 female psychiatric patients who had been victims of incest. Abuse was almost exclusively severe and prolonged. Three quarters of the female patients had been abused by their biological fathers or stepfathers. Sexual abuse experiences in childhood are connected with feelings of anxiety, helplessness, and powerlessness. Together with a lack of support on the part of the mother, these experiences lead to ego weakness, an autoplastic mode of coping with aggression and to patterns of objectal relationships which predispose them to object loss. The links between a girl's traumatic experiences in relationships and her vulnerability to separation in later life and their importance for the incidence of mental disorders will be discussed on the basis of Bowlby's attachment theory.

Sexual dysfunctions: relationship to childhood sexual abuse and early family experiences in a nonclinical sample.

Studies investigating a possible relationship between childhood sexual abuse and adult sexual dysfunction have reported highly discrepant results. The purpose of the present study was to examine 202 female university students for early familial experience and childhood sexual abuse in relation to adult sexual disorders. Each student was asked to complete three questionnaires on victimization, sexual dysfunction, early familial experiences. Results indicated that: (a) victims of multiple CSA more frequently reported sexual desire disorders and orgasm disorders than did single-incident victims and nonvictims; (b) single-incident victims and nonvictims reported no significantly different rates for any kind of sexual dysfunction; (c) negative early familial experiences were significantly related to any kind of sexual disorder; and (d) women who reported orgasm disorders more often reported an inadequate sex education than did women with another or no sexual dysfunction. The data suggest that both family dysfunction and sexual victimization contribute to sexual disorders in adulthood, and that later sexual disorders are to a large extent the result of sexual abuse-related factors in particular and family dysfunction in general.

Sexual dysfunction in males: significance of adverse childhood experiences.

This paper examines the impact of childhood sexual victimization, physical abuse, and dysfunctional family background on sexual dysfunctions in adulthood in a nonclinical male student sample. The current analysis is based on data from a survey by questionnaire from 301 males. Our findings show that (a) occasional sexual dysfunctions, especially premature ejaculation and sexual desire disorder, are frequent in young male adults; and (b) long-lasting adverse familial relationship to attachment figures are more influential to later sexual dysfunction than are childhood sexual abuse experiences.

The professional image anticipated by anaesthesiologists.

The perspective of anaesthesiologists regarding their professional image in the eyes of colleagues and the public was assessed. A self-reporting questionnaire (Instrument for Stress-related Job Analysis) was completed by 125 anaesthesiologists. Respondents' self-image and presumed image in the eyes of colleagues do not give a bright picture of the anaesthesiologist's role. The anticipated image showed significantly more anaesthesiologists who presumed low professional recognition by their colleagues from other specialties (P = 0.002) and the lay public (P = 0.015) than those who assumed high marks. Presumed colleague opinion correlated significantly with characteristics of job satisfaction including the possibility to co-determine sequence of operations (P = 0.006), recognition of suggestions and ideas (P = 0.007) and fellow support (P = 0.001). Regarding working conditions the possibility to actively control operational procedures also significantly correlated with colleague opinion (P = 0.003). The authors conclude that the possibility to actively influence quality and pace of work on a par with surgical colleagues could help boost self-esteem and self-confidence in anaesthesiologists. Furthermore, positive image promotion in cooperating medical professions and the public could help focus more attention on the important contribution of anaesthesiology to modern medicine.

Differences between patients and medical professionals in the evaluation of aesthetic outcome following breast reconstruction with implants.

BACKGROUND AND AIM: Most studies on breast reconstruction evaluate different surgical techniques, types of implant or time of reconstruction. Moreover, evaluations are usually performed either by surgeons or by patients, but are rarely compared. We conducted a study on aesthetic outcome following breast reconstruction with implants comparing the evaluation by patients versus medical professionals. METHODS: Forty-seven patients, who had a breast reconstruction with implants between 2001 and 2010 (median follow-up 71 months), underwent a clinical examination, standardized photo documentation and filled out a questionnaire to evaluate their aesthetic result (rate 1 very good to 5 very poor). Photo documentation was independently evaluated by 18 medical professionals using the same evaluation instrument and the results were compared. Gender and patient aspects were taken into account. RESULTS: We found statistically significant differences between patients and medical professional ratings. The patient evaluation was better through all categories as compared to the evaluation by medical personnel. The degree of medical education or gender aspects did not significantly affect the professional ratings. Age at reconstruction, length of follow-up or primary versus secondary reconstruction did not seem to make a difference in the evaluations of the patients versus the medical professionals.. CONCLUSION: The differences between patient and expert opinion in rating of aesthetic results indicate that patient satisfaction is influenced by multiple factors and not only by good aesthetic outcome. Patient evaluation should therefore be carefully considered in treatment and outcome studies of breast reconstruction..

Fully developed burnout and burnout risk in intensive care personnel at a university hospital.

We assessed the prevalence of fully developed burnout, burnout risk and the influence of work and employment related factors in five intensive care units at a university hospital. A cross-sectional study was conducted using self-reporting questionnaires for the evaluation of the frequency and intensity of burnout syndrome (Maslach Burnout Inventory) and work and employment related factors. From a total of 320 eligible intensive care personnel, 33 physicians and 150 nurses participated in the study (59% response rate). Applying the process model for burnout, 63 participants (34.4%) were at risk for burnout and another 11 respondents (6.0%) revealed evidence of fully developed burnout (emotional exhaustion > or =4.0 and lack of personal accomplishment < or =4.0). No statistically significant difference in prevalence of fully developed burnout or burnout risk was detected in sub-groups according to age, gender level of training, years of employment and family status. The desire to choose the same profession again was significantly less in respondents with fully developed burnout (P=0.006). The opportunity to regularly attend facilitation was significantly lower for participants with fully developed burnout (P=0.002) compared to participants with no burnout. Fully developed burnout and burnout risk are common in intensive care personnel. Support from facilitators appeared to be an important preventive factor