Patients' expressions of complaints as a predictor of the course of acute hepatitis A.

OBJECTIVE: Physical complaints, emotional states, liver, and immune parameters were investigated as possible indicators of the course of hepatitis A. METHODS: Forty-seven patients with hepatitis A were studied by means of the Giessen-Complaint-Inventory (GBB) and the Berlin Mood Questionnaire (BSF), as well as by taking into account their typical liver parameters and the following immune parameters: alphaInterferon (alphaIFN), soluble Interleukin 2 receptor (sIL-2R), Interleukin 6 (IL-6), Interleukin 1 receptor antagonist (IL-1Ra), and Immunoglobulin M or G (IgM, IgG). Two hundred twenty-nine medical students and a representative German sample (n = 1557, Braehler et al.) served as controls. RESULTS: We found that the initial degree of change in permeability of the liver cells, complaints about abdominal symptoms, and extent of depressive mood were able to predict the length of hospital stay. Patients with the initial, more pronounced liver damage, as well as patients who articulated less subjective impairment proved to have a longer course of illness. Those patients who needed a significantly longer time for recovery report, at admission, very few complaints-fewer than even the normal population. We were not, however, able to demonstrate a significant difference in the investigated immune parameters. CONCLUSION: A certain denial tendency seems to be harmful with respect to the recovery process and the immunological competence in the course of hepatitis A.

[Questionnaire of self-efficacy, optimism and pessimism: reconstruction, selection of items and validation of an instrument by means of examinations of clinical samples]. / Fragebogen zu Selbstwirksamkeit, Optimismus und Pessimismus. Restrukturierung, Itemselektion und Validierung eines Instrumentes an Untersuchungen klinischer Stichproben.

Self-efficacy and optimism are considered highly useful parameters in the context of therapeutic indication prognosis, and outcome evaluation. In our study, a combined questionnaire measuring "self-efficacy" (Schwarzer u. Jerusalem 1986) and "optimism" (Scheier u. Carver 1985) was restructured and reduced in length. The resulting instrument was compared with its original version in five different clinical samples comprising n = 726 inpatients. Factor analyses achieved the bidimensionality in the construct "optimism" as postulated by Scheier and Carver, this yielding the two factors "optimism" and "pessimism". The statistical validation resulted in good to optimal values. Factor analyses considering the different clinical groups showed that certain items failed to be invariably approprieted to one factor. Therefore, we decided in favor of an item reduction, resulting in half the original number: 5 items representing "self-efficacy" 2 for "optimism" and 2 for "pessimism". The scale values of the reduced version showed no relevant deviations compared to the original, and hence we conclude that the reduction does not result in a loss of information.

Determinants of the quality of life of patients with diabetes under intensified insulin therapy.

OBJECTIVE: The concept of quality of life (QOL) is understood as a multidimensional construct made up of physiological, psychological, and social aspects, but their particular weightings for the global QOL are rarely investigated. We examined 1) the general QOL of patients with diabetes, 2) the significance of the individual QOL aspects for the overall assessment of QOL, and 3) the modulating function of coping mechanism and particular personality traits. RESEARCH DESIGN AND METHODS: A total of 116 diabetes patients under intensified insulin therapy were studied, as were 107 patients with inflammatory bowel disease, 66 patients with chronic hepatitis C, and 229 students who served as control subjects. The examination was based on eight standardized QOL and personality questionnaires (354 items) and assessed by means of linear structural regression models (AMOS 3.6). RESULTS: The QOL of diabetes patients appears to be higher than the QOL of other chronically ill patients. Social, psychological, and physical aspects contribute to the overall QOL, although physical complaints receive a comparatively low weighting. Coping behavior and particular personality traits covary with all QOL aspects, giving these variables greater significance for the QOL than the existence of secondary illnesses. CONCLUSIONS: The hypothesis that the various factors involved in the multidimensional construct QOL receive different weightings was confirmed, making a simple summary score for the general QOL appear unjustifiable. In addition, all aspects that are commonly understood as parameters of QOL are influenced by external factors, such as coping behavior, based on individual personality characteristics.

[Testing a screening strategy for identifying psychosomatic patients in gynecologic practice]. / Testung einer Screening-Strategie zur Identifizierung psychosomatisch auffälliger Patientinnen einer gynäkologischen Praxis.

In a pilot-study 103 gynecological outpatients answered a gynecological questionnaire (FGB) including items of the (non-gynecological) complaints questionnaire (GBB) and a mood questionnaire (BSF). Cluster analyses of the FGB- and BSF-scores identify four groups. One group, consisting of 26 outpatients (= 25%), has as high GBB- and BSF-scores as a group of 256 psychosomatic in-patients answering these questionnaires at the beginning of their psychosomatic therapy. These 26 outpatients are labeled as high risk patients. Further results show high correlations between all FGB- and GBB-scores among the gynecological outpatients. A significant connection between the four group classification and ten biopsychosocial variables is found only for the variable professional state. The results are seen as a first confirmation of the tested screening-strategy. Moreover they give evidence that further investigations should pay more attention to the connection between job strain and gynecological complaints or disorders.

[Biopsychological relationships and prediction of the course of acute viral hepatitis]. / Biopsychologische Zusammenhänge und Prädiktoren des Krankheitsverlaufs bei der akuten Virushepatitis.

Psychosocial factors are discussed to influence the manifestation and course of infectious diseases. The results of psychoimmunological research during the past two decades have proved that different psychosocial factors can alter a great number of immune functions. Clinical studies on the relevance of such immune alterations are still rare. The course of viral hepatitis is strictly determined by individual immune-competence, and because it is not medically treated in acute stages it offers an ideal biopsychosocial research model. In 87 patients with acute viral hepatitis we measured every week complaints, moods (German adaptation of MACL), liver and immune-function (sIL-2R, alpha IFN, IL-1Ra, IL-6). It was shown that complaints are influenced by immune activity as well as by individual psychological factors. Patients could be differentiated by symptoms ad hospital admission into three groups: 1. with mainly bodily focused symptoms, 2. with predominantly anxious-depressive symptoms and 3. with elevated moods without complaints. In the further course patients in group 2 and 3 showed more often a delayed recovery, and hence we must presumed that the coping-process in group 1 is more likely to support immune functioning, whereas coping mechanisms in groups 2 and 3 are more likely to suppress it.