Healing beyond the joint: Addressing mental health in periprosthetic joint infection in a prospective longitudinal study.

OBJECTIVE: Periprosthetic joint infection (PJI) is a devastating complication following joint replacement surgeries. While the somatic impacts of PJI have been extensively explored, the influence on mental health remains understudied. This study aimed to longitudinally assess the psychological burden, quality of life, and expectations in individuals undergoing treatment for PJI. METHODS: A prospective study was conducted at a German trauma center between January 2020 and December 2022. Patients diagnosed with PJI (n = 29, mean age 71.4 ± 8.8 years) were assessed at five timepoints, within one week before revision surgery, one month, three, six, and twelve months postoperatively. Outcomes included the ICD-10 symptom-rating (ISR), German Short-Form 36 (SF-36), European Quality of Life 5 Dimensions (EQ-5D), and an expectation questionnaire. RESULTS: Psychological scores exhibited significant upward trends over time. The ISR score increased from 0.55 preoperatively to 0.87 at the 12-month follow-up (p = 0.002), surpassing the clinically relevant threshold. Depression and anxiety scores peaked at 6 months (1.6, p = 0.005) and 12 months (1.12, p = 0.001), respectively. Quality of life, measured by SF-36, showed stable physical component summary scores but declining mental component summary scores. Patients' expectations of returning to normal health consistently decreased (p = 0.009). CONCLUSION: Patients undergoing treatment for PJI experience significant psychological burden, with implications for quality of life and expectations of recovery. The findings underscore the importance of addressing psychological well-being in the management of PJI and emphasize the need for comprehensive care strategies that encompass both somatic and psychological dimensions.

Effect of functional relaxation on the quality of life in patients with periprosthetic joint infection: Protocol for a randomised controlled trial.

INTRODUCTION: Periprosthetic joint infection (PJI) is a devastating complication in orthopaedic and trauma surgery, which puts a high burden on the patients involving recurrent hospitalisation, prolonged courses of antibiotic medication, severe pain and long periods of immobility as well as high levels of psychological distress. Thus, this multicentre study aims at implementing body-oriented psychotherapy in clinical practice and evaluating its therapeutic effect on the quality of life. METHODS AND ANALYSIS: A prospective, parallel two-armed randomised controlled trial with approximately n=270 patients with verified PJI treated surgically with a one-staged exchange, or a two-staged exchange will be conducted. Functional relaxation (FR) therapy will be implemented as a group therapy. FR originally belongs to the psychodynamically based body-oriented psychotherapy. Intervention techniques consist of minute movements of small joints, which are performed during relaxed expiration accompanied by an exploration of differences of body feelings. A group will include 3-8 patients, led by a specialist physiotherapist certified in FR once a week. The participants are consecutively admitted to the class and participate in 12 sessions. The control group will consist of patients receiving an unspecific 'placebo relaxation' intervention for the same duration. The primary efficacy endpoint is the mental component summary and physical component summary of quality of life assessed by the 36-Item Short Form Health Survey (SF-36) after 6 months. Secondary outcomes include SF-36 scores after 12 months, consumption of pain medication, mobility measured by the Parker mobility score and the physical activity measured by daily steps with an accelerometer (actibelt). ETHICS AND DISSEMINATION: Approval from the Ethical Committee of the University Hospital Regensburg was received (file number: 21-2226-101). Written, informed consent to participate will be obtained from all participants. Results will be made available in the form of peer-reviewed publications and presentation in congresses. TRIAL REGISTRATION NUMBER: DRKS00028881; German Clinical Trials Register.

A Multimodal Stress-Prevention Program Supplemented by Telephone-Coaching Sessions to Reduce Perceived Stress among German Farmers: Results from a Randomized Controlled Trial.

This study compared the effectiveness of a 12-day stress-prevention program (SGS) supplemented by individualized, structured, four-session telephone-coaching to that of an SGS without telephone-coaching in entrepreneurs from the green professions presenting with increased stress levels. All participants went through the SGS before being randomized either to the telephone-coaching group (TC) or to the control group without telephone-coaching (noTC). SGS included four key therapeutic elements: stress-management intervention, relaxation, physical exercise, and balneotherapy. The primary outcome was the current degree of subjectively experienced stress assessed with the Perceived Stress Questionnaire (PSQ) at a 9-month follow-up. Secondary outcomes included burnout symptoms, well-being, health status, sleep disorders, expectation of self-efficacy, depression, anxiety, ability to work, pain, and days of sick leave. Assessments were conducted at baseline, 12 days (end of program), and 1 (start telephone-coaching), 3, 6 (end of telephone-coaching), and 9 months. Data from 103 adults (TC = 51; noTC = 52), mostly fulltime farmers, were available for analysis (mean age: 55.3; 49.1% female). Participants experienced significant immediate improvement in all outcome measurements, which declined somewhat during the first three months after the end of SGS and then remained stable for at least another six months. While within-group changes from baseline to 9 months showed significant improvements at medium to large effect sizes for all target variables (PSQ-total, TC: -13.38 (±14.98); 95%-CI: (-17.68; -9.07); noTC: -11.09 (±14.15); 95%-CI: (-15.11; -7.07)), no statistically significant differences were found between the groups at any time and for any target variable (between-group ANCOVA for PSQ-total at 9 months, parameter estimator for the group: -1.58; 95%-CI: (-7.29; 4.13)). The stress-prevention program SGS is a feasible, effective, and practical way to reduce perceived stress and improve participants' resources. Four subsequent telephone-coaching sessions do not seem to contribute to a further improvement in the results.

[The "popular saint" Therese of Konnersreuth and her stigmata : An historical example for the interaction of psyche and religiosity]. / Die "Volksheilige" Therese Neumann von Konnersreuth und ihre Stigmata : Ein historisches Beispiel zur Wechselwirkung von Psyche und Religiosität.

BACKGROUND: In present times, we see ourselves confronted by the challenge of engaging increasingly diverse views of the world, god and healing in a constructive dialogue. Consequently, it is important to research into the contrary effects of religiosity on the human psyche. METHODS: Original- and literary medical historian research RESULTS: Gottfried Ewald (1888-1963), a psychiatric expert at the Friedrich-Alexander University of Erlangen, was appointed 90 years ago with the task of examining Therese Neumann (1898-1962), colloquially known as Resl of Konnersreuth. In 1927, Ewald retrospectively confirmed the diagnosis of "most severe hysteria with blindness and partial paralysis". Within the context of regular pastoral care, Resl's "hysterical blindness" disappeared on 24.06.1923. This remission might be ascribed to a positive effect of religiosity on mental health. Besides the beneficial effects of religiosity on healing, pathogenic phenomena of religion can also be seen in the case of Resl. During Lent in 1926, Resl experienced ecstatic states as well as blood-stained tears. On Good Friday in 1926, bleeding of the scalp occurred; since Holy Saturday 1927, she experienced stigmata on her hands and the soles of her feet. Ewald assessed the latter as probably being genuine, although he spoke in favor of a clinical observation in hospital to obtain scientifically substantiated findings. DISCUSSION: The story of Resl of Konnersreuth shows the contrary influences of religiosity on mental health in one and the same individual. CONCLUSION: Detailed psychiatric historical and ethical research on the interaction of the psyche and religiosity can provide information about mechanisms that channel the psychic power of religiosity to promote remission. It is further important to take a religious and spiritual history of the patients.

Significant variation in salivation by short-term suggestive intervention: a randomized controlled cross-over clinical study.

INTRODUCTION: Most dental procedures require a dry working environment. Although many evaporative drying methods are available, an additional reduction of salivary flow would often be helpful. METHODS: This prospective randomized cross-over study compares salivary production in 31 volunteers during direct, indirect, and non-suggestive (control group) intervention. Overall, each volunteer underwent four salivation measurements, i.e. two measurements during two different types of hypnotic suggestion (indirect and direct) arranged in random order and two control sections. All four measurements were conducted successively. RESULTS: Both suggestive methods significantly reduced salivary production in comparison to the two control sections (direct suggestion Δ = 1.46 grams per 5 min, p < 0.001, indirect suggestion Δ = 0.94 grams per 5 min, p = 0.039). Direct suggestion showed a significantly higher reduction of salivary production than indirect suggestion (Δ = -0.53 grams per 5 min, p = 0.001). CONCLUSIONS: Hypnotic suggestion represents a simple and inexpensive method to reduce salivation and could thus create a better working environment for more comfortable dental treatments for both patients and dentists.

Effectiveness of a multimodal treatment program for somatoform pain disorder.

Chronic pain conditions are highly prevalent, with somatoform pain disorder accounting for a large proportion. However, the psychological forms of treatment currently used achieve only small to medium effect sizes. This retrospective study investigated the effectiveness of a 5-week multimodal pain program for patients with somatoform pain disorder. The diagnosis of somatoform pain disorder was confirmed by a specialist for anesthesiology and pain management and a specialist for psychosomatic medicine. Therapy outcome was evaluated with a Numeric Rating Scale (NRS), the Pain Disability Index (PDI), and the Pain Perception Scale. Within the study sample (n = 100), all parameters showed a significant and clinically relevant improvement at the end of therapy (P values < 0.001). The highest effect sizes (d) were found for reduction in average pain rating (NRS: d = 1.00) and the affective items of the Pain Perception Scale (SES-A: d = 0.07). The lowest effect sizes were found for improvement of pain-related disabilities (PDI: d = 0.42) and sensory items of the Pain Perception Scale (SES-S: d = 0.50). Despite high chronification of pain condition, with average pain duration of greater than 8 years, the multimodal treatment program showed medium to large effect sizes on the outcome of patients with somatoform pain disorder. Compared with previous data with small to moderate effect sizes, a multimodal program seems to be more effective than other interventions to address somatoform pain disorder.

Evaluation of a salutogenetic concept for inpatient psychosomatic treatment.

The increase of psychosomatic disorders due to cultural changes requires enhanced therapeutic models. This study investigated a salutogenetic treatment concept for inpatient psychosomatic treatment, based on data from more than 11000 patients of a psychosomatic clinic in Germany. The clinic aims at supporting patients' health improvement by fostering values such as humanity, community, and mindfulness. Most of patients found these values realized in the clinical environment. Self-assessment questionnaires addressing physical and mental health as well as symptom ratings were available for analysis of pre-post-treatment effects and long-term stability using one-year follow-up data, as well as for a comparison with other clinics. With respect to different diagnoses, symptoms improved in self-ratings with average effect sizes between 0.60 and 0.98. About 80% of positive changes could be sustained as determined in a 1-year follow-up survey. Patients with a lower concordance with the values of the clinic showed less health improvement. Compared to 14 other German psychosomatic clinics, the investigated treatment concept resulted in slightly higher decrease in symptoms (e.g., depression scale) and a higher self-rated mental and physical improvement in health. The data suggest that a successfully implemented salutogenetic clinical treatment concept not only has positive influence on treatment effects but also provides long-term stability.

Primary Prevention Programme for Burnout-Endangered Teachers: Follow-Up Effectiveness of a Combined Group and Individual Intervention of AFA Breathing Therapy.

Background. Early retirement of teachers due to burnout is frequent in Germany. In this study short- and medium-term effects of AFA breathing therapy were evaluated. Methods. This study was designed as a longitudinal controlled intervention design with four points of measurements: before assessment (T1), after intervention (T2), three months (follow up 1) (T3) after intervention, and six months (follow up 2) after intervention (T4). The intervention lasted a total of 11 weeks (weekly group therapy for eight weeks and three weeks of individual breathing session). The effects of intervention were measured with the questionnaire "work-related behaviour and experience Patterns" (AVEM) at four times. Results. In the intervention group 64 teachers and in the self-selected control group 27 teachers were included. The AVEM scales "subjective significance of work" and "professional ambition" changed over time and within both groups (interaction effect). Significant improvements over the four measurements were observed in the intervention group in two AVEM scales: "emotional distancing" (F = 6.3; P < 0.01) and "balance and mental stability" (F = 4.4; P < 0.02). Conclusions. AFA breathing therapy showed short- and medium-term effects in the intervention group over four points of measurements. It may be assumed that breath therapy supports teachers in resisting occupational demand.

[Prevalence and comorbidity of somatoform disorder in psychosomatic inpatients: a multicentre study]. / Pravalenz und Komorbiditat der somatoformen Storung: Eine Multicenter-Studie.

OBJECTIVES: This epidemiological multicenter study investigates the prevalence and comorbidity of somatoform disorder in psychosomatic inpatients. METHODS: Twenty psychosomatic hospitals collected the diagnoses of all treated patients in the years 1998 to 2007. The data were analysed at the "Institute for Quality Assurance in Psychotherapy and Psychosomatic Medicine" (IQP),Munich. RESULTS: Of the 100,607 patients surveyed, 18,492 (18.4 %) fulfilled the ICD-10 criteria for a somatoform disorder. 91.9 % of patients with somatoform disorder have at least one, on average 2.8 additional psychiatric disorders. The mean duration of the symptoms before current treatment was 62.6 months. CONCLUSIONS: The prevalence of somatoform disorder in psychosomatic inpatients is comparable to that found in data from internal or general medicine patients. However, there are major differences in the distribution of the diagnostic subgroups of somatoform disorder.

Effects of functional relaxation and guided imagery on IgE in dust-mite allergic adult asthmatics: a randomized, controlled clinical trial.

Although relaxation and imagination techniques have repeatedly proven their effectiveness in asthma, nothing is known about the immunological effects of these complementary interventions. Therefore, the aim of this study is to investigate the effects of the brief relaxation technique of functional relaxation (FR) with guided imagery (GI) on serum IgE in adult patients with dust mite allergic asthma in a randomized, controlled trial. Sixty-four patients were treated over a 4-week period and assessed at baseline, after treatment and after 4 months for follow-up. Due to its significant role in the pathophysiology of allergic asthma, the serum IgE was employed as outcome measure in this investigation. Participation in FR, GI, and FR/GI led to decreases in serum IgE (IU/mL) of -54.7 +/- 67.1, -49.5 +/- 93.4, and -28.4 +/- 93.9 compared with an increase of 27.7 +/- 43.2 in CI. Our study confirmed a positive and clinically relevant effect of FR and GI on total serum IgE levels.

Functional relaxation as complementary therapy in irritable bowel syndrome: a randomized, controlled clinical trial.

OBJECTIVES: Irritable bowel syndrome (IBS) is a frequently disabling and almost invariably distressing disease with a high overall prevalence. Numerous trials identified the importance of psychogenic and emotional etiological factors, and this is obvious in clinical practice. Although relaxation techniques are frequently recommended, there is still a lack of evidence for their efficacy in the management of IBS. This study therefore aims to determine the efficacy of functional relaxation (FR) in IBS. SUBJECTS: The subjects were 80 patients with IBS. INTERVENTIONS: Participants were randomly allocated either to FR or to enhanced medical care (EMC: treatment as usual plus two counseling interviews) as control intervention with 2 weekly sessions over the 5-week trial each. Thirty-nine (39) patients completed FR and 39 received EMC. OUTCOME MEASURES: An impairment-severity score (IS) was employed as the primary outcome parameter with assessment at baseline, after treatment, and again after 3-month follow-up. RESULTS: FR was significantly superior to EMC with a standardized effect size of 0.85. The achieved effects through FR remained stable in terms of psychic and bodily impairment after 3-month follow-up. CONCLUSIONS: The results of our trial suggest a positive effect of FR training on subjective functional impairment in the IS, if provided in addition to treatment as usual (TAU). There appears to be a clinically relevant long-term benefit of FR as a nonpharmacological and complementary therapy approach in IBS.

[AFA breathing therapy to prevent burnout for teachers]. / Die AFA-Atemtherapie als Burnout-Prophylaxe bei Lehrerinnen und Lehrern.

BACKGROUND: AFA breathing therapy has been shown to have positive effects on burnout-associated work-related patterns of behavior and experience. OBJECTIVE: To assess the effects of AFA breathing therapy on teachers. METHODS: Volunteers without relevant psychopathology (excluded by VDS90 screening) were included in the study. Evaluation was based on the 'Fragebogen zur Erfassung des arbeitsbezogenen Verhaltens- und Erlebensmusters (AVEM)' - 'Questionnaire for the assessment of work-related patterns of behavior and experience'. The AVEM comprises 11 scales like subjective relevance of work, readiness to exert oneself, perfectionism, ability to detach from work, calmness and mental equilibrium, and perceived social support. RESULTS: In most scales, mean scores improved significantly over the course of the treatment. Furthermore, in 9 out of 11 AVEM-scales, mean intra-individual differences improved significantly more in the course of the treatment phase than in the course of the control phase. CONCLUSION: AFA breathing therapy could prove effective for burnout prevention.

Efficacy of functional relaxation and patient education in the treatment of somatoform heart disorders: a randomized, controlled clinical investigation.

BACKGROUND: Recurrent heart problems and, especially, chest pain in the absence of somatic heart disease is a common finding, although challenging to treat. OBJECTIVE: The authors assessed a body-oriented approach to the somatic fixation frequently seen in these patients. METHOD: They conducted a controlled study to assess the effect of functional relaxation in 22 patients with non-specific chest pain. The primary outcome measures were self-reported changes on the subscales Somatization and Anxiety of the Symptom Checklist of Derogatis, as well as the subscale Cardiovascular Complaints of the Giessen Inventory of Complaints. RESULTS: Significant improvements of the primary outcome measures were observed in patients treated with functional relaxation, whereas no significant improvements could be seen in the control group. CONCLUSION: Functional relaxation appears to be a safe and effective, non-pharmacological approach in the treatment of non-specific chest pain.

Brief relaxation versus music distraction in the treatment of dental anxiety: a randomized controlled clinical trial.

BACKGROUND: Dental anxiety is a significant cause of poor dental health. Because patients often prefer nonpharmacological interventions, the clinical effectiveness of clearly structured approaches is of particular interest. METHODS: This prospective randomized controlled study compares a brief relaxation method (BR) with music distraction (MD) and with a control group (C). The authors randomly assigned 90 patients with dental anxiety to BR, MD or C groups. They assessed the outcomes by means of the state anxiety subscale of the State-Trait Anxiety Inventory. RESULTS: Both BR and MD reduced dental anxiety significantly. In contrast, patients in the C group did not exhibit a significant change in their anxiety level. BR was significantly superior to MD. Stratification according to the patient's general level of dental anxiety revealed that BR also was particularly effective in highly anxious subjects, whereas MD did not have a clinically relevant effect on these subjects. CONCLUSIONS: BR appears to be a safe, economically sound and effective nonpharmacological approach to the short-term reduction of dental anxiety. Additional investigations are needed to validate these findings in a larger clinical trial and to determine the long-term effects of this intervention. CLINICAL IMPLICATIONS: Relaxation techniques are a pragmatic, effective and cost-saving method of facilitating dental treatment in anxious patients.

Promoting mindfulness in psychotherapists in training influences the treatment results of their patients: a randomized, double-blind, controlled study.

BACKGROUND: All therapists direct their attention in some manner during psychotherapy. A special form of directing attention, 'mindfulness', is recommended. This study aimed to examine whether, and to what extent, promoting mindfulness in psychotherapists in training (PiT) influences the treatment results of their patients. METHODS: The therapeutic course and treatment results of 124 inpatients, who were treated for 9 weeks by 18 PiTs, were compared. The PiTs were randomly assigned to 1 of 2 groups: (i) those practicing Zen meditation (MED; n = 9 or (ii) control group, which did not perform meditation (noMED; n = 9). The results of treatment (according to the intent-to-treat principle) were examined using the Session Questionnaire for General and Differential Individual Psychotherapy (STEP), the Questionnaire of Changes in Experience and Behavior (VEV) and the Symptom Checklist (SCL-90-R). RESULTS: Compared to the noMED group (n = 61), the patients of PiTs from the MED group (n = 63) had significantly higher evaluations (according to the intent-to-treat principle) for individual therapy on 2 STEP scales, clarification and problem-solving perspectives. Their evaluations were also significantly higher for the entire therapeutic result on the VEV. Furthermore, the MED group showed greater symptom reduction than the noMED group on the Global Severity Index and 8 SCL-90-R scales, including Somatization, Insecurity in Social Contact, Obsessiveness, Anxiety, Anger/Hostility, Phobic Anxiety, Paranoid Thinking and Psychoticism. CONCLUSIONS: This study indicates that promoting mindfulness in PiTs could positively influence the therapeutic course and treatment results in their patients.

Promotion of mindfulness in psychotherapists in training: preliminary study.

This study examined whether the promotion of mindfulness in psychotherapists in training can influence the treatment results of their patients. The therapeutic course and treatment results of 196 inpatients, who were treated during a nine week period by nine psychotherapists in training, were compared: in the first phase of the study, the treatment group without (CG, historical control group, n=55), and in the second phase the treatment group with, (MFG, n=58) therapists who were currently practicing Zen meditation. The results of treatment were examined (according to the intent-to-treat principle) with the Session Questionnaire for General and Differential Individual Psychotherapy (STEP), the Questionnaire of Changes in Experience and Behaviour (VEV) and the Symptom Checklist (SCL-90-R), and showed significantly better results in the MFG.

Bioenergetic exercises in inpatient treatment of Turkish immigrants with chronic somatoform disorders: a randomized, controlled study.

OBJECTIVE: The aim of this study was to examine whether bioenergetic exercises (BE) significantly influence the inpatient psychotherapeutic treatment results for Turkish immigrants with chronic somatoform disorders. METHOD: In a 6-week randomized, prospective, controlled trial, we treated a sample of 128 Turkish patients: 64 were randomly assigned to BE and 64 participated in gymnastic exercises in lieu of BE. The Symptom Checklist (SCL-90-R) and State-Trait Anger Expression Inventory (STAXI) were employed. RESULTS: According to the intent-to-treat principle, the bioenergetic analysis group achieved significantly better treatment results on most of the SCL-90-R and STAXI scales. CONCLUSIONS: BE appears to improve symptoms of somatization, social insecurity, depressiveness, anxiety, and hostility in the inpatient therapy of subjects with chronic somatoform disorders. Reduction of the anger level and reduction in directing anger inwards, with a simultaneous increase of spontaneous outward emotional expression, could be expected.

[Implementation of the multi-center basis documentation CL-BaDo for conciliar and liaison services: generating data for internal quality management and cost calculation]. / Implementierung der multizentrischen Basisdokumentation CL-BaDo für den Konsiliarund Liaisondienst: Generierung von Daten für internes Qualitätsmanagement und Kostenkalkulation.

In the German DRG system the funding of CL services is not ensured. The documentation of psychiatric comorbidity and CL care delivery is a pre-condition to the development of funding models for CL-services. A task force of several German psychosomatic associations (German College of Psychosomatic Medicine, German Society of Psychosomatic Medicine and Psychotherapy, General Medical Society for Psychotherapy) developed a new documentation form for CL-services (CL-BaDo). The pilot study explored the multicenter implementation of CL-BaDo and the use of the documentation form for quality management and cost calculation. Over a period of at least three months, participating CL-services documented all CL cases consecutively with the CL-BaDo. One site applied full electronic data processing. 2116 CL cases from eight psychosomatic CL-services were analysed. The CL-BaDo is a time-efficient, feasible and acceptable documentation form for CL-service delivery. The full electronic data processing enables networking with a hospital information system to produce higher data quality. The data of CL-BaDo can be used locally for quality management, development of management strategies and communication with consultants, as well as nationwide for health policy questions and research.

[A documentation form for the consultation-liaison service: development of the CL-BaDo]. / Basisdokumentation für den Konsilar-Liaison-Dienst: Entwicklung der CL-BaDo.

OBJECTIVES: In consultation liaison (CL) psychiatry and psychosomatics a multicenter documentation form for the assessment of clinical characteristics of patients and CL service delivery is urgently needed for health care planning and future mental health research. METHODS: In several steps a joint working party of the psychosomatic and psycho-therapeutic societies in Germany (German College for Psychosomatic Medicine, German Society of Psychosomatic Medicine and Psychotherapy, General Medical Society for Psychotherapy) developed a documentation form for C-L service (CL-BaDo). The goals and quality criteria of the patient registration form are defined in an extended consensus process of C-L experts. A pool of formerly 60 items was reduced to 36 items collecting data concerning sociodemographic characteristics, referral information, anamneses, actual psychiatric and somatic status and diagnoses, C-L interventions and treatment recommendations. To enable comparisons, the formulation of items are adapted to existing inpatient and outpatient documentation forms (Psy-BaDo,EuroQA-CL). A special manual guides the coding of the CL-BaDo. RESULTS: 16 CL services in Germany and Austria participated in the testing and pilot study of six months demonstrating the comprehensibility and fast completion of CL-BaDo and consultants' high acceptance of the form. A time-saving and user-friendly electronic version for data entry and data analyses was developed using hand-held technology. CONCLUSION: The data of the CL-BaDo can be used for 1) quality management and communication purposes with referring departments and 2) for multicenter collaborative studies, mental health care management and care planning.