[Sexual Self-esteem in Trans*People: Development of a New Questionnaire and Clinical Evaluation]. / Sexueller Selbstwert von Trans*Personen: Fragebogenentwicklung und klinische Testung.

AIM OF THE STUDY: Our purpose was to develop a new instrument for the assessment of sexual self-esteem in German and to examine its psychometric properties. Subsequently, we aimed to investigate sexual self-esteem in trans*people. METHODS: The construction and validation of the sexual self-esteem scale was realized in a sample of the general population (N=426; Study 1, online) based on confirmatory factor analysis and statistical item analysis. We then investigated an outpatient sample of trans*people (N=85; study 2) to compare sexual self-esteem with the population sample and to examine the associations between sexual self-esteem, body experience, and psychological and psychosomatic distress. RESULTS: An acceptable model fit and good internal consistency for the final unidimensional 8-item solution of the sexual self-esteem scale (SSES) were confirmed. Sexual self-esteem was moderately associated with global self-esteem in the population sample. Trans*people showed a significantly lower sexual self-esteem compared to the normal population. Results also revealed the expected associations with body experience, but no association with psychological and psychosomatic distress. CONCLUSION: The SSES is the first German-language and gender-neutral instrument to assess sexual self-esteem and provides good psychometric properties. It appears promising for monitoring the course and success of the transition treatment of trans*people as well as for its application in couples and sexual therapy.

Effects of structured patient education in adults with atopic dermatitis: Multicenter randomized controlled trial.

BACKGROUND: Atopic dermatitis (AD) is a chronic relapsing skin disease prevalent in 1% to 3% of adults in Western industrialized countries. OBJECTIVE: We sought to investigate the effectiveness of educational training in an outpatient setting on coping with the disease, quality of life, symptoms, and severity in adults with AD. METHODS: In this German prospective, randomized controlled multicenter study, adult patients with moderate-to-severe AD were educated by referring to a comprehensive 12-hour training manual consented by a multiprofessional study group from different centers (Arbeitsgemeinschaft Neurodermitisschulung für Erwachsene [ARNE]). Patients were randomly allocated to the intervention or waiting control groups. Study visits were performed at baseline and after 1 year (1 year of follow-up). Primary outcomes were defined as a decrease in (1) "catastrophizing cognitions" with respect to itching (Juckreiz-Kognitions-Fragebogen questionnaire), (2) "social anxiety" (Marburger Hautfragebogen questionnaire), (3) subjective burden by symptoms of the disease (Skindex-29 questionnaire), and (4) improvement of disease signs and symptoms assessed by using the SCORAD index at 1 year of follow-up. Data were analyzed on an intention-to-treat basis. RESULTS: At 1 year of follow-up, patients from the intervention group (n = 168) showed a significantly better improvement compared with the waiting group (n = 147) in the following defined primary study outcomes: coping behavior with respect to itching (P < .001), quality of life assessed by using the Skindex-29 questionnaire (P < .001), and the SCORAD index (P < .001). CONCLUSIONS: This is the first randomized, controlled multicenter study on patient education in adult AD. The ARNE training program shows significant beneficial effects on a variety of psychosocial parameters, as well as AD severity.

Association of pain level, health and wound status in patients with chronic leg ulcers.

Pain is a ubiquitous problem in patients with chronic leg wounds. The pain may be caused by the underlying pathology of the leg ulceration, the wound, wound treatment, or complications such as skin irritation around the ulcer. The objectives of this research were to evaluate the level of suffering endured by patients because of their ulcer-related pain, and to evaluate whether and how this pain is treated. In addition, to determine whether this pain influences quality of life and health status. In 2010, data were collected in order to characterize the patients by socio-demographic facts, such as age, gender, co-morbidity, pathogenesis of the wound, wound status of new patients, wound pain, and use of analgesics. In addition, modified EQ-5D questionnaires were distributed with additional questions concerning pain experience, treatment, and general health status. Of 103 patients, 45 were male and 58 female. Mean age was 67.8 years (males 65 years, females 70 years). Up to 69% had leg ulcerations due to vascular disease. Out of the 103 distributed questionnaires, 49 were returned and evaluated. Analysis showed that 82% of these patients reported wound-related pain, and 42% estimated their analgesics as not sufficiently pain relieving (mean value of the visual analogue scale (VAS) 4.9). Mean health status was 50.5 (maximal health status 100). Patients with a pain value ≥ 5 showed a lesser mean health status (42.2) than patients with a pain value < 5 (60.3). The proportion of patients receiving no, or only weak, analgesics was nearly the same for patients with VAS ≥ 5 and with VAS < 5. Further research in pain therapy is of utmost importance to improve the quality of life of patients with chronic wounds.

Changes in quality of life for patients with chronic venous insufficiency, present or healed leg ulcers.

BACKGROUND: Patients with chronic leg ulcers are handicapped in daily life, both by physical complaints and social problems. The aim of our study was not only to assess a possible impairment of quality of life (QOL) of leg ulcer patients but also to evaluate if there is a real improvement of QOL after healing of the ulcer. Patients with chronic venous insufficiency served as the control group. We further analyzed if there were significant differences in the response between patients who were and were not performing compression therapy. PATIENTS AND METHOD: We interviewed three groups of patients (active venous leg ulcer, healed venous leg ulcer and patients with chronic venous insufficiency using the "Freiburger Life Quality Assessment für Venenerkrankungen" (FLQAv). RESULTS: Physical problems, daily handicaps and social problems all increased with age. Contrary to our expectations, healing of a leg ulcer did not lead to a significant increase in QOL. Instead, patients with active ulcers did not regard their QOL as lower than those in the other groups. Compression therapy also did not impair QOL in the three groups. CONCLUSION: Even though ulcer healing is an admirable goal, it does not necessarily lead to an improved QOL, probably because of the numerous comorbidities in this patient group. Nonetheless, it is important to control problems associated directly with the wound to allow ulcer patients to participate actively in everyday life and minimize social problems.

[Lifestyle drugs in medicine]. / Lifestyle-Medikamente in der Medizin.

Lifestyle drugs have become an important new group of medications, which are taken by healthy people to increase the individual well-being and quality of life. Nootropics, psychopharmaceuticals, hormones and "ecodrugs" are today the main groups. The wish for eternal youth, beauty and potency is central, and lifestyle medications are also requested to influence cosmetic findings, which are usually simply a result of the natural aging process. Lifestyle drugs seem to be harmless, but the physician must pay attention to possible abuse, side effects, risks and complications. Additionally, however, lifestyle drugs are also frequently used by patients suffering from emotional disorders such as somatoform disorders. Medicalization of physiological life is then expected to solve psychosocial problems, but without success. The use of lifestyle medications in somatoform disorders is contraindicated and psychotherapy or psychopharmacological treatment come first. With this overview article, we would like to make an update of new lifestyle drugs.

[Borderline personality disorder and transsexualism]. / Borderline-Persönlichkeitsstörung und Transsexualität.

OBJECTIVE: The study addresses the question whether, as often assumed, the symptoms of borderline personality disorders occur more frequently in transsexuals or not. METHODS: We examined 164 transsexuals. The subjects completed the following questionnaires: The Borderline-Personality Inventory (BPI), the Freiburg Personality Inventory (FPI) and the Questionnaire for Assessment of One's Own Body (FbeK). RESULTS: In 80 % of all the examined transsexuals, there was evidence of symptoms of neither a borderline personality disorder nor of other personality disorders. If borderline symptoms occurred, they were predictable from the variables depressivity, low composure, low sociability and lack of confidence in relation to the external appearance. CONCLUSIONS: The data obtained refute the often-assumed increased relationship between borderline personality disorders and transsexuality. It should be assumed that a borderline personality disorder is primarily a psychiatric illness, while transsexuality is a disorder of gender identity in which secondary borderline symptoms may arise in some cases.

Psychopharmacological treatment of dermatological patients--when simply talking does not help.

In dermatology, primary emotional disorders with cutaneous manifestations, secondary emotional disorders caused by dermatoses and multifactorial diseases are possible indications for the use of psychopharmaceuticals. Neuroleptics (anti-psychotics) are usually used in psychiatric illnesses, while antidepressants are foremost in treating depression as well as obsessive-compulsive, anxiety and panic disorders. Minor tranquilizers may be used symptomatically. To define the indications for mid- and long-term treatment with psychopharmaceuticals, the unequivocal diagnosis of the main and secondary psychiatric symptoms as well as the primary target symptoms must be designated. At the start of therapy planning, any possible desired and undesired side effects must be taken into account, such as stimulation, sedation, anticholinergic side effects or weight gain. The main antidepressants are the well-tolerated selective serotonin reuptake inhibitors (SSRI) such as sertraline, fluoxetine or citalopram. A clear long-term plan and how to monitor it must be discussed with patient carefully because of the need for individual dose titration and the late onset of action of many of these medications. Good results can be achieved in dermatologic patients requiring psychopharmaceuticals if the indications are carefully assessed and the therapy logically structured.