Functional neurology after the Second World War: The beginnings of neurology on screen (III).

Treatment of functional symptoms has a long history, and interventions were often used in soldiers returning from battle. On the 75th anniversary of the end of the Second World War, I review the portrayal of neurology in documentary film. Two documentaries were released in 1946 and 1948 (Let There Be Light and Shades of Gray, respectively), which showed a number of soldiers with functional neurology including paralysis, stuttering, muteness, and amnesia. The films showed successful treatments with hypnosis and sodium amytal by psychoanalytic psychiatrists. These documentaries link neurology with psychiatry and are remarkable examples of functional neurology and its treatment on screen.

The importance of individual' mental status for the true value of functional self-reported questionnaires used in medical rehabilitation.

The physical and mental health are inseparable and integral components of one's health and as such should always be addressed during the process of medical rehabilitation. It should be an obvious fact that the state of individual' mental health can influence and even more, modify, the outcomes of medical rehabilitation. Furthermore, the state of mental status has an effect in determining the reliability of functional self-reported questionnaires that are frequently used in medical rehabilitation. In conclusion, the evaluation and assessment of the individual's mental health status need to be incorporated as a regular part of the comprehensive and holistic approach to medical rehabilitation.

[Psychotherapy for patients with fibromyalgia syndrome. Systematic review, meta-analysis and guideline]. / Psychotherapie von Patienten mit Fibromyalgiesyndrom. Systematische Übersicht, Metaanalyse und Leitlinie.

BACKGROUND: The scheduled update to the German S3 guidelines on fibromyalgia syndrome (FMS) by the Association of the Scientific Medical Societies ("Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften", AWMF; registration number 041/004) was planned starting in March 2011. MATERIALS AND METHODS: The development of the guidelines was coordinated by the German Interdisciplinary Association for Pain Therapy ("Deutsche Interdisziplinären Vereinigung für Schmerztherapie", DIVS), 9 scientific medical societies and 2 patient self-help organizations. Eight working groups with a total of 50 members were evenly balanced in terms of gender, medical field, potential conflicts of interest and hierarchical position in the medical and scientific fields. Literature searches were performed using the Medline, PsycInfo, Scopus and Cochrane Library databases (until December 2010). The grading of the strength of the evidence followed the scheme of the Oxford Centre for Evidence-Based Medicine. The recommendations were based on level of evidence, efficacy (meta-analysis of the outcomes pain, sleep, fatigue and health-related quality of life), acceptability (total dropout rate), risks (adverse events) and applicability of treatment modalities in the German health care system. The formulation and grading of recommendations was accomplished using a multi-step, formal consensus process. The guidelines were reviewed by the boards of the participating scientific medical societies. RESULTS AND CONCLUSION: Cognitive behavioral therapy combined with aerobic exercise (multicomponent therapy) is strongly recommended. Relaxation as single therapy should not be applied. The English full-text version of this article is available at SpringerLink (under "Supplemental").

Dermatological rehabilitation.

Chronic and chronically recurring diseases often cannot be treated causally and usually lead to a considerable impairment in social and occupational participation. In order to deal appropriately with such restrictions, a more comprehensive therapeutic approach is required in the sense of a bio-psychosocial model of disease and health which serves as the basis for modern dermatological rehabilitation. Multimodal, quality-controlled dermatological rehabilitation gives patients with chronic skin diseases a treatment option that goes beyond the primarily symptom-oriented outpatient care provided by office-based physicians and the acute care of inpatient facilities. This paper presents the complex opportunities offered by dermatological rehabilitation. The aim of this paper is to put dermatologists working in the practical field in a position to help their patients with chronic skin diseases to realize their statutory right to participate in society. For this purpose, it will impart the understanding of medical rehabilitation that is necessary so that the dermatologist in charge can advise his or her patient competently, in order to successfully arrange for the corresponding care appropriate to the indication and taking into account personal circumstances and insurance-related requirements.

[Desire for early retirement and therapy of chronic back pain: relevance of social medical variables for outpatient psychotherapeutic treatment]. / Rentenbegehren und Therapie chronischer Rückenschmerzen: Die Relevanz sozialmedizinischer Variablen bei ambulanter psychotherapeutischer Behandlung.

BACKGROUND: This study investigated the influence of patients' desire for early retirement on the success of an outpatient cognitive behavioural treatment (CBT) in patients with chronic back pain. Previous studies have shown that the desire for early retirement and social compensation had a negative influence on therapy outcome, e.g. pain intensity and pain disability. This study was conducted to reassess whether these results can be replicated in an outpatient CBT setting. METHOD: Questionnaires assessing pain-related variables were issued to a total of 116 patients at the beginning, at the end of treatment and 6 months after termination of therapy. RESULTS: Overall, the treatment showed significant positive results in the variables assessed. In contrast to other studies, patients with a desire for early retirement also showed improvement during treatment. The success of treatment proved to be stable after termination of therapy. CONCLUSION: CBT in an outpatient setting seems to be an effective treatment for patients with chronic back pain and even patients with a desire for early retirement benefit from treatment.

Diagnosis and distress in Navajo healing.

In contemporary Navajo society, traditional Navajo ceremonies, Native American Church prayer meetings, and Navajo Christian faith healing are all highly sought-after resources in the everyday pursuit of health and well-being. What is the nature of affliction among patients who turn to such forms of religious healing? Are these patients typically afflicted with psychiatric disorder? In this article we discuss 84 Navajo patients who participated in the Navajo Healing Project during a period in which they consulted one of these forms of healing. We present diagnostic results obtained from the Structured Clinical Interview for DSMIV (SCID) administered to these patients. We then present an ethnographically augmented analysis comparing the research diagnosis obtained via the SCID with a clinical diagnosis, with the diagnosis given by religious healers, and with the understanding of their own distress on the part of patients. These analyses demonstrate how a cultural approach contributes to the basic science and clinical understandings of affliction as well as to discussion of the advantages and limitations of DSM categories as descriptors of distress and disorder.

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.

El modelo psicosomático de Pierre Marty / Pierre Marty´s psycho-somatic model

El artículo hace un recorrido por la teoría psicosomática de Pierre Marty y la escuela formada entorno al «lnstitut de Psychosomatique de Paris. (IPSO), que continúa su labor de investigación, desarrollo teórico y difusión. Se aborda, en primer lugar, la descripción del modelo teórico de Marty, según los tres aspectos fundamentales (monista, evolucionista y económico); posteriormente, las principales características del proceso de somatización y las distintas formas de presentarse la enfermedad somática y, por último, algunas consideraciones sobre diagnóstico y tratamiento (AU)

The article traces the developmetn of the psychosomatic theory of Pierre Marty and the school formed by the Institut de psychosomatique de Paris (IPSO), which continues his work in the fields of research, theoretical development and diffusion. Marty´s theoretical model is described according to three main aspects (monistic, evolutionary and economic). The author then considers the main aspects of the process of somatization, the different forms that illness can present, and its diagnosis and treatment (AU)

[Vocal cord dysfunction. An important differential diagnosis to bronchial asthma]. / Vocal Cord Dysfunction. Eine wichtige Differenzialdiagnose zum Asthma bronchiale.

Vocal cord dysfunction (VCD) is described as a functional disorder of the vocal folds which leads to an intermittent, inspiratory 'paradoxical' glottal closure. We report on three women with frequent repetitive shortness of breath attacks caused by VCD. This was diagnosed by transnasal videofiberendoscopy, with glottal closure being seen during inspiration. Because of the different etiologies, one of the patients was treated with breathing and speech therapy, another received Omeprazol for laryngopharyngeal reflux, and the third was treated by intralaryngeal botulinum toxin injections. All three patients showed a reduction in attacks. Clinically, VCD seems to mimic asthma. However, with a thorough patient history and diagnostics, especially with transnasal laryngoscopy during a (triggered) attack, a precise diagnosis seems possible.

["Without song or sound?" Possibilities and effects of music therapy]. / "Sang- und klanglos?" Möglichkeiten und Wirkungen in der Musiktherapie.

Music therapy is still not widely known within everyday medical and psychotherapeutical contexts. Music touches fundamental themes of human existence and is important in preventive as well as in clinical and rehabilitative areas. The highly specialized and technical areas of medicine need to be complemented by artistic therapeutic approaches that recognize the physical and sensory aspects of the suffering person. Active and receptive music therapy and training have evolved in different fields of health care. A theory embracing various approaches is particularly useful. Fundamental attitudes in the music therapy relationship will be differentiated and the importance of music therapy will be presented using examples based on the treatment of cancer patients.

[2-stage group psychotherapy with integrated autogenic training within the scope of a general integrated psychotherapy concept]. / 2-stufige Gruppenpsychotherapie mit integriertem Autogenem Training im Rahmen eines allgemeinen Konzepts der integrierten Psychotherapie.

Group-therapy and autogenic training in combination show mutual potentiation. Our results have proved the hypothesis to be true and we have also been able to explain it by an analysis of the neurophysiological and psychological findings concerning both methods. Our "model" has proved to be very economical in time and can be easily applied. It needs basic psychotherapeutical education but no special additive schooling. It is particularly well employed in rehabilitation patients, elderly patients and geronto-rehabilitation patients. As numbers of such patients are steadily increasing, it could soon become highly important, and in the technically dominated medicine of today, the particularly communicative component that we postulate in integrated psychotherapy could also grow in importance. By combining the two methods, it is not method that is at the centre of our endeavours but the patient.

[Partial inpatient treatment as a responsibility in psychosomatic rehabilitation]. / Teilstationäre Behandlung als Aufgabe der psychosomatischen Rehabilitation.

Day clinic rehabilitation is part of the development of the medical rehabilitation system. Psychosomatic rehabilitation faces the task of developing a concept of day treatment and of collecting experiences with such models in clinical practice. The basis of this task consists in regulations laid down by the social security insurance authorities which serve as a frame for the development. The main points of these regulations are presented and their relevance for psychosomatic rehabilitation is outlined. The institutional and conceptual establishment of day treatment presents psychosomatic rehabilitation with a number of problems that are particular in this area and which are discussed in detail. Besides that, consequent elaboration of day treatment could stimulate further development of psychosomatic rehabilitation in general and help to overcome prevailing shortcomings of this part of the rehabilitation system.

[Psychosomatic disorders in dermatology--incidence and need for added psychosomatic treatment]. / Psychosomatische Störungen in der Dermatologie--Häufigkeiten und psychosomatischer Mitbehandlungsbedarf.

In a cooperative study involving the Department of Dermatology and the Department of Psychosomatic Medicine/Psychotherapy of the University of Düsseldorf, 187 patients were evaluated for psychosomatic disease and indenient psychological testing. The distribution of skin diseases and psychosomatic ICD 10 diagnoses are presented. It was found that patient evaluation-(symptom-complaint-questionnaire) and expert evaluation correlate positive. It therefore seems worthwhile examining dermatology in-patient's for psychosomatic problems in order to facilitate combined dermatological and psychosomatic approach not only in the hospital but also during the post-discharge ambulatory treatment.

Psychiatric aspects of cardiovascular disease.

The co-occurrence of psychiatric and cardiac disease in many patients exemplifies the complexity of psychosomatic medicine, with both psychosomatic and somatopsychic effects. Psychological factors including depression, anxiety, and hostility influence the development, clinical expression, and prognosis of coronary heart disease. Depression and anxiety are especially common problems complicating cardiac disease. The physician must approach the patient with an appreciation of the confounding aspects of diagnosis and a readiness to think flexibly about the nature of the problems encountered. SSRIs play an increasingly prominent role in psychopharmacotherapy of this population. Innovative treatments in cardiology, such as heart transplantation, defibrillators and mechanical ventricular assist devices are associated with characteristic psychiatric problems for which psychiatrists must devise treatment strategies.

[Expert assessment of chronic fatigue syndrome]. / Begutachtung des Chronic-Fatigue-Syndroms.

The Chronic-Fatigue-Syndrome (CFS) has been first described in 1988 and has been also in Germany recently more frequently diagnosed. It is similar to a lot of other terms, especially to "neurasthenia", which has been introduced 1869 from Beard and is now again content of ICD-10. CFS is defined by primary and secondary criteria, which are however largely subjective. There are no objective signs. It is unknown if this syndrome represents a disease entity of its own. The explanation is either exclusive organic based on immunological and virological findings or exclusive psychogenic as a special form of anxiety psychosis. Possibly are both factors involved as part of "psycho-neuro-immunology". CFS is increased subject of medical certification. It has been tried to give a practical guidance to the assessment of CFS.

Brief interventions for psychophysiological symptoms in hospitalized addicted patients.

The problem of psychosomatic complaints in newly sober substance abusers is longstanding. While somatic symptoms are common in withdrawal generally, some patients experience symptoms which prevail to the point of distracting from the treatment of the addiction. This paper illustrates brief, collaborative interventions conducted in a treatment hospital for three such patients who had significant, persistent, and common psychosomatic difficulties: migraine, insomnia, and hypertension. The importance and utility of holistic, multimodal treatment of the patient is emphasized.