Pain and salivary biomarkers of stress in temperomandibular disorders were affected by maxillary splints.

BACKGROUND: Longitudinal intervention studies on treatment options in temporomandibular dysfunction (TMD) including self reports and salivary biomarkers of stress are rare and the exact therapeutic function of occlusal splints widely unknown. METHODS: We examined the therapeutic effects of a Michigan splint with occlusal relevance in patients with TMD using a placebo-controlled, delayed-start design. Two intervention groups received a Michigan splint, while one of them had a placebo palatine splint for the first 3 weeks. We collected pain intensities (at rest and after five occlusal movements), salivary measures associated with stress (cortisol and alpha-amylase) and self-reported psychological distress (stress, anxiety, catastrophizing) at baseline and 3 and 7 weeks after onset of intervention. RESULTS: At baseline, we observed increased pain intensity and psychological distress in TMD patients compared to 11 matched healthy controls. Baseline anxiety was linked to movement pain intensity through stress. Over therapy reductions in pain intensity and morning cortisol were more pronounced in those patients starting immediately with the Michigan splint, while psychological distress decreased similarly in both groups. CONCLUSION: Our results suggest that perceived stress plays a role for the association between anxiety and TMD pain and underlines the need for an interdisciplinary perspective on the pathogenesis and therapy of TMD in a setting where psychotherapeutic knowledge is still scarce or rarely applied.

Sexual dysfunction in psychiatric inpatients the role of antipsychotic medication.

INTRODUCTION: Sexual dysfunction is a common side effect of antipsychotic medication. Although increased prolactin levels caused by antipsychotic agents are believed to play a major role with regard to sexual side effects, the underlying mechanism of antipsychotic agent-induced sexual dysfunction remains poorly understood. METHODS: In a multicentric study 587 psychiatric inpatients were assessed by means of a self-rating sexual questionnaire. Focussing on antipsychotic treatment three subgroups were drawn from the original sample. One group was treated with prolactin-increasing antipsychotics (n=119), the other with prolactin-neutral medication (n=109) and the third patient group was comprised of non-medicated clinical controls (n=105). RESULTS: The majority of all patients (50-75%) reported at least minor sexual dysfunction. On comparison of the subgroups, only female patients treated with prolactin-increasing medication reported more severe sexual dysfunction. However, multiple regression analysis did not confirm an association between the type of treatment and sexual impairment. DISCUSSION: Sexual dysfunction frequently occurs in psychiatric inpatients treated with antipsychotics. Our findings only partly support the assumptions concerning a major role of prolactin-increasing neuroleptics for medication-induced sexual impairment.

Sexual impairment in psychiatric inpatients: focus on depression.

INTRODUCTION: Although sexual side effects are a common reason for noncompliance with medication, information on impairment of sexuality in psychiatric inpatients is scarce. METHODS: In the present multi-center study, data on several aspects of sexual functioning were collected in psychiatric inpatients using a previously validated questionnaire. RESULTS: A high overall prevalence of sexual dysfunction was reported by participants and was highest in depressed subjects. Patients receiving antidepressants suffered from more frequent and more severe impairment of sexuality than did subjects receiving neither antidepressants nor antipsychotics or opioids. DISCUSSION: Judging from this data, sexual impairment appears to be a frequent and underestimated problem in psychiatric inpatients with a high prevalence across all diagnostic groups, particularly in depressed subjects. Female patients attribute this impairment mainly to their mental illness, whereas male patients tend to assign their impairments primarily to their medication.

Effects of client-centered psychotherapy for personality disorders alone and in combination with psychopharmacological treatment. An empirical follow-up study.

BACKGROUND: : There is an increasing interest concerning the treatment of patients with personality disorders (PD) in data on the efficacy of psychotherapeutic strategies especially when combined with medication. METHODS: The efficacy of an inpatient client-centered treatment program (CCT) was studied prospectively in 142 patients with PD and additional depressive, anxiety or eating disorders (ICD-10). RESULTS: Significant improvements in depression, self-esteem and social adjustment were achieved up to discharge, which remained stable at the 1-year follow-up. The efficacy with regard to individual variables or the total result could not be further enhanced by a combination with psychopharmacological treatment (CCT + MED), consisting mainly of antidepressants. Within the subgroups of patients with socially deviant (F60.0-2), emotionally unstable/borderline (F60.3) and histrionic/narcissistic PD (F60.4, F60.8), CCT was significantly superior to CCT + MED in the reduction of depression (Bech-Rafaelsen Melancholia Scale ratings), whereas the response was enhanced by medication in the subgroup of patients with socially dependent 'cluster C' PD (F60.5-7). CONCLUSIONS: The results are discussed with regard to client-centered therapeutic concepts and to the further development of differential combination strategies.

[Conflict-centered individual therapy or integration of psychotherapy methods. Process of change in client-centered psychotherapy with and without behavioral exposure therapy in agoraphobia with panic disorder]. / Konfliktzentrierte Monotherapie oder Methodenintegration? Veränderungsprozesse von Gesprächspsychotherapie mit und ohne verhaltenstherapeutische Reizkonfrontation bei Agoraphobie mit Panikstörung.

The mechanisms of change due to different psychotherapeutic treatments of anxiety disorders are the subject of the present study. Sixty-eight patients with agoraphobia and panic (DSM III R No. 300.21, ICD 10 No. F 40.01) were included, exclusively treated with client-centered treatment (n = 28) or with additional behavioral exposure treatment (n = 40) in an inpatient setting. The patients were examined on admission, at discharge, and at 6 and 12 months follow-ups with the Structured Clinical Interview for DSM III R (SKID), the Freiburg Personality Inventory (FPI R), and the Giessen Test (GIESS). Both treatment modalities significantly reduced panic and avoidance. Differences were found in personality scales. The support of autonomy was superior by client-centered treatment alone: client-centered treated (CCT) patients felt less dependent on the expectations of others, less under stress, and had fewer psychosomatic complaints. Patients with additional exposure treatment feel accepted by their social environment earlier. The results are discussed with regard to open questions of therapy integration and different mechanisms of change.

[Psychotherapy research in psychiatry. Results of a survey of psychiatric clinics]. / Psychotherapieforschung in der Psychiatrie. Ergebnisse einer Erhebung an psychiatrischen Kliniken.

This paper concerns advances in the integration of psychotherapy in psychiatric education and clinical practice and whether they go along with increasing research activities. To find answers, a survey on psychotherapy research was carried out in all German psychiatric hospitals and departments by means of a questionnaire. The results indicate that psychotherapy research is done nearly exclusively in university hospitals. About half of them had already published psychotherapy studies and two thirds of them are presently carrying out studies, mostly including prospective, randomized clinical trials. These studies cover the whole spectrum of psychiatric disorders: substance abuse, schizophrenic and affective disorders, anxiety, and obsessive compulsive and personality disorders. To improve psychotherapy research conditions further, efforts are necessary to increase scientific exchange, financial support, and the integration of institutions outside the universities.

[Effects of inpatient client-centered psychotherapy in various illness: 1-year follow-up]. / Effekte stationärer Gesprächspsychotherapie bei verschiedenen Krankheitsbildern: 1-Jahres-Katamnese.

The long-term effect (1-year-follow-up) of an inpatient client-centred psychotherapy programme was evaluated in 202 severe and chronically disturbed patients with a bread diagnose range (ICD-10 F1-F6). These 202 patients represented 74% of a total of 272 patients who had originally been examined and tested at admission and had now been re-identified after a follow-up of one year. Patients were investigated via Clinical Global Impressions (CGI), Bech-Rafaelsen-Melancholia-Scale (BRMES) and the Personality Inventory (Giessen-Test). Severity of illness, depressivity and self-and-other acceptance improved significantly; social incompetence was especially reduced in patients who had personality disorders. The range of effects reached from good to very good improvement: the magnitude of effect on social variables is probably even under estimated due to high pre-therapy variance. At follow-up 68% of the patients were in occupation or professional education. 32% needed no further treatment. Readmission rate was 14%. Results are discussed with regard to specific client-centred therapy.

The benefit of an insight-oriented and experiential approach on panic and agoraphobia symptoms. Results of a controlled comparison of client-centered therapy alone and in combination with behavioral exposure.

BACKGROUND: It is a common view that psychodynamic treatment does not help much to ameliorate the symptoms of panic and agoraphobia. The effects of an insight-oriented treatment on central anxiety symptoms are the subject of the present controlled study. METHODS: Forty patients with severe panic and agoraphobia were admitted to an inpatient anxiety treatment program. Most of the patients had been treated by pharmacological means unsuccessfully. The patients were randomly assigned to pure client-centered therapy or to additional behavioral exposure treatment. Client-centered and behavioral agoraphobia manuals were used. The patients were examined on admission, at discharge and at 3, 6, and 12 months follow-up for panic (Structured Clinical Interview for DSM III-R--SCID), anxiety (Hamilton Anxiety Scale), agoraphobia (SCID, Fear Survey Schedule), and depressive (Hamilton Depression Scale) symptoms. RESULTS: Both client-centered treatment and a combination with exposure treatment reduced panic, avoidance and depressive symptoms significantly. For a short period the combined treatment was superior in patients' coping actively with anxiety and improving agoraphobic symptoms. However, at 1-year follow-up there was no further difference in the reduction of anxiety and depressive symptoms. CONCLUSIONS: The results are discussed with regard to the combination of these forms of therapy and to widespread skepticism about the efficacy of insight-oriented treatment.

[Defenses in rating scales and therapy success]. / Abwehr in Rating-Skalen und Therapieerfolg.

Evaluation of psychotherapeutic or psychopharmacological treatment frequently uses rating scales without regard for patient's defensiveness. This study demonstrates on 309 psychotherapy patients treated with inpatient client-centered therapy and followed-up 1 year after treatment that defensiveness, measured with validity scales of personality inventories MMPI-K, FPI-R and Giessen-Test, influences ratings (scales CGI, HAMA, HAMD, BRMES) before and after therapy. Patients who deny psychopathology on admission do so at discharge and to some extent at follow-up. The extent of effect is significantly diminished with an increase in frankness in these patients, indicated by the significant improvement in validity scales. Inpatient client-centered psychotherapy improved defensiveness in the case of initial self-criticism and diminished it in the case of initial retentiveness.

[Psychotherapy in the psychiatric clinic--an empirical study of the expectations of patients]. / Psychotherapie in der psychiatrischen Klinik--eine empirische Untersuchung über die Erwartungen der Patienten.

Before admission to in-patient psychotherapeutic treatment 202 patients with schizophrenic or neurotic orders, partly with secondary alcohol or substance addiction, were investigated with a questionnaire concerning patients' expectations of psychotherapy: targets, expectations of therapeutic attitude and technique as well as therapeutic procedure (individuals or group therapy). The results are correlated with sociodemographic data and psychiatric disorders and compared with the patients who were not admitted to therapy and the results after discharge. Conclusions are made with regard to indication and adaptive patient-centered therapeutic proceeding.

Different patterns of sexual dysfunctions associated with psychiatric disorders and psychopharmacological treatment. Results of an investigation by semistructured interview of schizophrenic and neurotic patients and methadone-substituted opiate addicts.

Little is known about sexual dysfunctions associated with psychiatric disorders and psychopharmacological treatment. In the present study schizophrenic patients (n = 45, mostly under neuroleptic treatment), neurotic patients (n = 50, mostly treated without medication), methadone-substituted opiate addicts (n = 37), and normal controls (n = 41) were included. They were interviewed with the aid of a sex-differentiated semistructured questionnaire on sexual function. All the methadone-substituted opiate addicts and nearly all the schizophrenic patients suffered from dysfunctions in at least one criterion. The three clinical groups differed significantly from the controls in sexual interest, emotional arousal, physiological arousal (erectile function/vaginal lubrication), performance (ejaculatory function/vaginism, dyspareunia), and orgasm satisfaction. Characteristic patterns of dysfunction were found in the male patients. The schizophrenic patients had significantly more dysfunctions of interest, physiological arousal, performance, and orgasm than the controls. Emotional arousal, erectile and ejaculatory functions, and orgasm satisfaction were impaired more frequently in the male schizophrenics than in the neurotic patients. Reduced sexual interest, emotional arousal, and orgasm satisfaction were reported more frequently by the methadone-substituted opiate addicts than by the neurotic men. Emotional arousal was even more frequently reduced than in the schizophrenic men. There was no correlation between sexual dysfunction and particular neuroleptics or neuroleptic or methadone dosage. The results are compared with the literature and suggestions made for further investigations.

[History of sexual abuse. Consequences for psychotherapy]. / Sexueller Missbrauch in der Vorgeschichte. Konsequenzen für die psychotherapeutische Arbeit.

The definition of sexual abuse and the frequency of its occurrence in the history of psychiatric patients as known by psychiatric literature are discussed. Then, a survey is reported on 10 medical psychotherapists about their male and female patients under in-patient individual and group therapy. Among 57 patients there were 11 of 32 females and 4 of 25 men with a history of sexual abuse, most of them over months or years. Consequences on personality development and vulnerability are outlined. A differential concept how to form the therapeutic relationship and how to handle with experience of sexual abuse is described.

[How can acceptance by psychiatric patients of group psychotherapy be improved? An empirical study of the effect of combined individual and group psychotherapy on attitude to group psychotherapy]. / Wie lässt sich die Bereitschaft psychiatrischer Patienten zur Gruppenpsychotherapie verbessern? Eine empirische Studie zum Einfluss eines kombinierten einzel- und gruppenpsychotherapeutischen Programms auf die Einstellung zur Gruppenpsychotherapie.

This study investigates whether the sceptic attitude of many psychiatric patients to group therapy can be improved by a combined individual and group therapy program. The investigation was made on 50 patients, most of them with neurotic disorders, partly with secondary alcohol or substance abuse as well as some schizophrenic patients. Before admittance to the psychotherapy program enquiries were made by means of a questionnaire, about what subject they would like to speak in the individual or group therapy sessions. The results differ significantly dependent on sociodemographic and illness related factors. A second examination after discharge reveals an ameliorated attitude concerning group therapy in nearly all central themes. Thus, one of the important goals of in-patient psychotherapy has been achieved to improve patients ability to receive out-patient group therapy.

[Demands and reality in the rehabilitation of psychiatric patients. Results of a follow-up study in established need for rehabilitation with reference to the housing and/or vocational sphere]. / Anspruch und Wirklichkeit der Rehabilitation psychiatrischer Patienten. Ergebnisse einer Verlaufsuntersuchung bei festgestelltem Rehabilitationsbedarf auf der Wohn- und/oder Arbeitsachse.

At an index day all 166 patients of the Department of General Psychiatry were asked whether changes of working or housing condition were considered necessary and which definite steps had to be done. In 85 (51.2%) of 166 patients changes were considered necessary. What measures had been initiated or carried out? Concerning the housing situation age and disease (psychiatric diagnosis) proved to be important factors; concerning the working situation age, sex, socioeconomic status and length of unemployment were important.

The rate of blood flow through the inverted yolk sac placenta of the anesthetized guinea-pig.

The rate of blood flow through the yolk sac placenta of late gestation guinea-pig fetuses was estimated by an indirect approach: radionuclide-labelled microspheres were injected in a saphenous vein and the ratio of radioactivity in the yolk sac to that in one of several reference organs was calculated. The ratio was then multiplied by a constant derived from separate experiments in which blood flows to the fetal abdominal organs and chorioallantoic placenta were determined. Stomach blood flow was positively correlated to arterial oxygen content (r = 0.74, P < 0.05), as was the weight-specific splenic blood flow (r = 0.66, P < 0.05). Perfusion of the small and large bowel, kidneys and chorioallantoic placenta was not related to arterial pH or oxygen content and these organs were used as references for the estimation of vitelline blood flow. A positive correlation was found between yolk sac blood flow and arterial oxygen content (r = 0.91, P < 0.01). In normoxaemic guinea-pig fetuses, yolk sac blood flow is 100-300 microliters per min.

[What is the result of an inpatient treatment program with client-centered psychotherapy emphasis in patients with agoraphobia and/or panic? Results of a 1-year follow-up]. / Was bewirkt ein stationäres Behandlungsprogramm mit gesprächspsychotherapeutischem Schwerpunkt bei Patienten mit Agoraphobie und/oder Panik? Ergebnis einer 1-Jahres-Katamnese.

29 of 31 patients with agoraphobia and/or panic-disorder (DSM-III R), treated with an inpatient therapy program with client-centered foundation, could be investigated on a one-year follow up. The investigation was performed by means of the Angst-Katamnese-Fragebogen (AKF), Clinical Global Impressions (CGI), Freiburger Persönlichkeits Inventar (FPI) and Fear Survey Schedule (FSS). On the whole about 2/3 of the patients had a good or very good outcome concerning central anxiety symptoms (panic and agoraphobia). In most of the cases favourable changes of the mental state, interpersonal relationship and personality development were found. The results indicate that an insight orientated and experiential client-centered therapy program helps to reduce anxiety symptoms and to diminish the risk of negative consequences (alcohol and drug abuse).

[Treatment terminations and transfers of schizophrenic patients in inpatient treatment with psychotherapeutic emphasis. A systematic study]. / Behandlungsabbrüche und Verlegungen schizophrener Patienten im Verlauf der stationären Behandlung mit psychotherapeutischem Schwerpunkt. Eine systematische Untersuchung.

The study presented here concerns the multidimensional inpatient treatment of schizophrenics with client centered psychotherapeutic emphasis. All cases that occurred in the course of one year are analysed where treatment had been discontinued during the first thirty days or who had to be transferred to an acute cases ward because of exacerbation of the psychotic pattern of symptoms and/or suicidal tendencies. There was a massed occurrence of treatment complications if the patients were particularly young, if they were of the male sex, if the duration of disease was relatively short and if the directly preceding inpatient pretreatment had lasted for a particularly long time. Another unfavourable factor was a particularly marked acuity of the diseases or if minus symptoms were most conspicuous, if neuroleptic medication had to be effected at high level, and especially if this medication was rapidly cut down at the time treatment was changed and also if motivation of treatment was poor or lacking. It is the aim of this study to give a more precise indication for inpatient rehabilitation treatment with emphasis on psychotherapy, to point out its limitations and to recognise and help to avoid treatment errors.