[Contribution of psychosomatic medicine to relationship medicine: a catalog of claims in times of crisis]. / Der Beitrag der Psychosomatik zu einer Beziehungsmedizin: ein Forderungskatalog in Zeiten der Krise.

The medical ideology being based on structure instead of function (specifically on the cgs-logic--centimetre, gram, second) instead of a patient-orientation, the patient's resources are rarely ever even touched. This is the basis for operating difficulties in self- and patient-management. Changes of this uneconomic approach should centre on training, focusing especially on how to increase the professional's sensitivity for the relationship with his patient. Unfortunately, Austria's situation is characterized by deficitary psychosomatic competence in medical professionals. In addition, the absence of universitary or other structures centering on psychosomatic training and co-ordination is to be criticized. An interuniversitary-psychosomatic structure in Austria is proposed as a starting-point to overcome these serious short-comings.

[Fourier analysis of pupil oscillations for measuring central activation in psychosomatic patients]. / Fourieranalyse der Pupillenoszillationen zur Messung der zentralen Aktiviertheit bei psychosomatischen Patienten.

The aim of the study was to answer the question if there are any differences in the central activation of different groups of psychosomatic patients and patients with eating disorders, which was measured by means of Fourier analysis of pupillary oscillations. A total of 132 patients (110 f, 22 m) with a mean age of 29.69 years (standard deviation: 9.9) participated in the study. In anorectic and bulimic patients high central activation was observed. Different groups of psychosomatic patients showed significant differences in their central nervous activation. In the group of subjects with the ICD-10 diagnosis F 41.3 (mixed anxiety disorders) the highest amplitudes was observed not only in the particular frequency bands but also in the total spectrum (power), which reflects high central activation. Reduced activation was found in subjects with somatoform autonomic function disorder of the upper and lower gastrointestinal tract (F 45.3). The measurement of central activation in psychosomatic disorders could have consequences for therapeutic interventions.

Psychological health, self-reported physical health and health service use. Risk differential observed after one year of unemployment.

One year after the closure of a furniture factory the health consequences of long-term unemployment were studied among the 215 former employees and an interviewer-administered questionnaire was used to measure psychological health, self-perceived physical health and health service use. Those remaining unemployed 12 months after the closure were found to be 8 times more likely to report poor psychological health than were the re-employed (Odds ratio (OR): 8.5; 95% CI: 4.2-17.0). Self-reported physical ill-health was generally thought be respondents to be due to former work (56 percent of all disorders were related by subjects to former work history) and was also found to be associated with current employment status (OR 5.6; 95% CI: 2.7-11.5). Health services were over-utilized by the unemployed (OR 2.2; 95% CI: 1.2-4.1) and this differential was demonstrated to be even greater for the older and those reporting more diseases. Given the increasing proportion of long term unemployed in many Western countries this health service over-utilization will impose a substantial burden on public health expenditures unless other means of psychological and social support are provided.

[Psychosomatic aspects in otorhinolaryngology exemplified by the "globus" sensation]. / Psychosomatische Aspekte in der Otorhinolaryngologie am Beispiel "Globus".

The term "psychosomatic" is defined by means of the "globe" sign in its clinical use. Psychosomatic anamnesis is introduced as a mode to establish the somatic and psychic status. In this diagnostic therapeutic process the psychosomatically oriented ENT specialist assesses the pattern of these frequent psychophysical disturbances. The therapy of psychosomatic disorders is based on the multiplex aetiology of these diseases; therefore, psychosocial factors of distress must be considered with the same attention as the somatic signs and symptoms. To meet this challenge the specialist has to consider the therapeutic dialogue, psychodynamics and distress coping, effective relaxation techniques and the use of psychotropic drugs.

[Pathologic psychosomatic reaction pattern in aging patients: epidemiologic, diagnostic, preventive and therapeutic remarks]. / Das Pathologische Psychosomatische Reaktionsmuster beim Alternden: Epidemiologische, diagnostische, präventive und therapeutische Bemerkungen.

Somatic, psychic, and social factors influence the Pathological Psychosomatic Reaction Pattern (PPSRP) in the elderly. Some administrative epidemiological, and differential-diagnostical data of the Viennese Psychosomatic Department comment on and extend previous findings. Because of the specificity of PPSRP in the elderly, specific preventive and therapeutic strategies are proposed.

[What does psychotherapy accomplish in the treatment of psychosomatic disorders?]. / Was bewirkt Psychotherapie in der Behandlung psychosomatischer Erkrankungen?

Psychosomatic disorders are epidemiologically so frequent as often accompanied by psychic (anxiety), vegetative, and psychiatric (depression) symptoms. Efficient psychotherapy of psychosomatic disorders must therefore influence vegetative (peripheric) and central arousal as well as deficient coping strategies. The latter trigger pathologic psychosomatic reaction patterns in (mostly) specific distressfull situations. Psychotherapy of psychosomatic disorders effects: Relaxation of the overactivated and stimulation of the desactivated, a shift of the patient's exclusively somatic attribution of the disease to a psychosomatic one, more efficient coping strategies, a break-up of the pattern "conflict - emotion - vegetative irritation - physiologic reaction".

[Computer-assisted static and light-evoked dynamic pupillometry in psychosomatic patients]. / Computerassistierte "statische" und lichtevozierte "dynamische" Pupillometrie bei psychosomatischen Patienten.

Microprocessor-assisted pupillometry was used in this psychophysiological study to investigate the pupillary diameter (static pupillometry) and visual-evoked pupillary reactions (dynamic pupillometry) in psychosomatic patients (duodenal ulcers, ulcerative colitis, cardiac phobia, anorexia nervosa, bronchial asthma) as compared with age-and sex-matched normal controls. Statistical analyses including multivariate methods demonstrated interesting differences between psychosomatic patients and normal controls, as well as between various subtypes of psychosomatic disorders and elucidated also the influence of a 6 weeks' course of psychotherapy. The data give valuable clues to symptom/syndrome-specific psychophysiological reaction types, which may be of considerable relevance for the characterization of psychosomatic diseases.

Ulcerative colitis: a cyclothymic disorder?

While psychogenic aspects in ulcerative colitis have been comprehensively studied, much less attention has been given to sequence and interaction of psychic and somatic factors in psychopathological description. Onset of schizoaffective and cyclothymic symptomatology in 20 ulcerative colitis patients proved to occur only after somatic manifestation. As later on organic and psychic relapse never occurred simultaneously, further discussion should be centered on two points: Does schizoaffective cyclothymic axial syndrome occur separately from ulcerative colitis manifestation? Or is there a common etiological, pathogenic base for both somatic and psychic symptoms?

[Duration of spiral after-effects in psychosomatic patients (a psychophysiologic study and analysis of data using multivariate procedures)]. / Spiralnacheffektdauer bei psychosomatischen Patienten (Eine psychophysiologische Untersuchung und Datenanalyse mittels multivariater Verfahren).

In a psychophysiological study the spiral after-effect, as measured by means of the Archimedes spiral, was investigated in 182 patients with psychosomatic disorders including duodenal ulcers, ulcerative colitis, anorexia nervosa, asthma and heart neurosis and compared with the results obtained in a control group of healthy volunteers (n = 30). Using multivariate data analysis it was possible to divide the total group of psychosomatic patients into various different subgroups which parallelled the subdivision from the clinical point of view. Moreover, the objectivation of the influence of psychotherapy lasting for 6 weeks on the duration of the after-effect was shown by this technique. These results suggest that the determination of the duration of the spiral after-effect may be of value in clinical psychodiagnostics.

[Contribution to the objective evaluation of the personality features of the colitis patient (author's transl)]. / Colitis ulcerosa - eine Studie zur Objektivierung der Persönlichkeitsmerkmale des Kolitispatienten.

Before becoming in-patients in the psychosomatic department 26 patients (male and female) with ulcerative colitis were subjected to a series of personality tests (MMPI, FPI, GT, EPI) and compared with a normal control group. According to these tests and in psychopathological aspects the colitis patients deviated from the normal control group. The colitis patients showed more anxiousness and neuroticism and a tendency to introversion. The psychological results established by the tests and the psychopathological findings coincided especially in respect to the depressiveness. In connection with the inhibited depressiveness the question arises, whether the aggressive modalities, which can be substantiated by internal aspects but not optimally by the tests, can be objectively evaluated.

[Is chronic recurrent urticaria a psychosomatic disease?]. / Ist die chronische Urticaria eine psychosomatische Erkrankung?

A random group of 37 patients with chronic recurrent urticaria, 26 female and 11 male, was subjected to multidimensional personality tests (Freiburg personality inventory, FPI, Freiburg aggression test, FAF) whereas, deviating from establishing standards, introversion, nervousness, psychosomatic disturbance were more pronounced in the urticaria group, the following traits in deviation from normal standards were not noted: depression, irritability, sociability, emotional instability, composure. Nevertheless, this group appeared to be less communicative, more inhibited, compliant, and less dominant and aggressive. Neither did they show signs of socially accepted expression of negative and annoyed emotions nor socially desirable signs of assertiveness. A high rate of coincidence with other psychosomatic disorders such as frequent headache (18/37), chronic gastritis (19 of 37) and ulcus duodeni (5 of 37) and migraineous headache (6 of 37) was also found in this group. In all cases explorable latent conflictive situations (frequent ambivalence) and negative childhood experience are further indicative of psychosomatic diseases.