[Course of neurogenic bladder dysfunction in patients with spinal cord injury under homeopathic treatment]. / Verlauf der neurogenen Blasenfunktionsstörung bei Patienten mit Rückenmarkschädigung unter klassisch homöopathischer Therapie.

BACKGROUND: Nearly all patients with spinal cord injury (SCI) suffer from neurogenic lower urinary tract dysfunction (NLUTD). Untreated NLUTD is a risk factor for renal damage and can significantly affect quality of life (QoL). Patients with SCI frequently use complementary medicine to alleviate symptoms, namely for urologic problems. OBJECTIVES: We evaluated whether homeopathic treatment influences objective urodynamic parameters. MATERIALS AND METHODS: In a retrospective study, urodynamic data of patients with NLUTD due to SCI who received constitutional homeopathic treatment by the consultants of our hospital were evaluated before initiation of homeopathic treatment and at the most recent follow-up. Modifications in urologic treatment were taken into account. RESULTS: Urodynamic results from 35 patients who underwent homeopathic treatment (14 women, 21 men, median age 46 years, tetraplegia: n = 14; paraplegia: n = 21) were available at both time points and could therefore be evaluated. In all, 20 patients used intermittent catheterization, 6 persons had an indwelling catheter, and 9 persons emptied their bladders without a catheter. There were no significant differences in the urodynamic parameters before and during treatment. Changes in urologic therapy correlated with significant improvement in urodynamic findings. CONCLUSIONS: As all patients were under urologic surveillance, and immediate urologic treatment was established if necessary, a retrospective study design proved not to be suitable to detect possible influences of homeopathic treatment on urodynamic parameters in patients with SCI. Thus, a prospective randomized study is essential.

Disease variables and depression affecting the process of coping in families with a somatically ill parent.

AIM AND METHODS: Based on the investigation of 134 families with a seriously ill parent and 214 offspring, we compared--by means of semistructured psychiatric interviews--the capacity of the ill and the healthy parent and their children to cope with various diseases. We evaluated how disease characteristics such as duration and severity of the disease (assessed by the Karnofsky Index) and associated depression [measured by the Beck Depression Inventory for parents and the Depression Inventory for Children and Adolescents (Depressions-Inventar für Kinder und Jugendliche) for children] influence the coping capacity of all family members. RESULTS: The coping capacity of patients with organic disease (cancer, multiple sclerosis, other somatic diseases) is significantly higher than that of patients with somatization disorder, whereas the depression score of patients with organic disease is significantly lower than that of patients with somatization disorders. The depression of the patient negatively influences his/her coping capacity. Children's coping capacity does not differ with respect to the parental illness and is not influenced by their own depression. There are significant correlations between the coping capacity of children and their healthy and ill parents affected by organic disease (multiple sclerosis, other somatic diseases, cancer), but not between children and healthy and ill parents with somatization disorders. Multivariate regression analysis shows the mutual influence of coping capacities between the parental couple as well as between the parents and their children. The better the patient (partner) is able to cope with a severe disease, the higher are the values of the coping capacity of the partner (patient). Children older than 6 years with a severely ill, nondepressed and well-coping parent cope well. These results do not apply to parents with somatization disorders. CONCLUSIONS: Patients with organic disease cope better and are less depressed, whereas patients with somatization disorders have a lower coping capacity and a higher depression score. Children older than six years cope better. Comprehensive care of a patient with a severe illness has to include his/her family in order to evaluate coping capacities of all family members, particularly of small children, and to assess and treat associated parental depression.