ICD-10 Symptom Rating questionnaire for assessment of psychological comorbidities in patients with chronic tinnitus.

BACKGROUND: Tinnitus frequently occurs alongside psychological comorbidities whose assessment is important for treatment planning and -success. The selection of suitable questionnaires is thus crucial. The present study aims to investigate the ICD-10 Symptom Rating (ISR) to this regard. METHODS: The current study investigated tinnitus burden and psychological comorbidities in a sample of N = 311 patients with chronic tinnitus. All participants completed an intensive 7­day multimodal tinnitus-specific therapy. Tinnitus burden was measured using the German version of the Tinnitus Questionnaire (TQ). Psychological comorbidities were measured using the ISR (total score, depressive disorder, anxiety disorder, obsessive-compulsive disorder, somatoform disorder, and eating disorder), the Perceived Stress Questionnaire (PSQ; total score, tension, worries, joy, and demands), and the General Depression Scale (Allgemeine Depressionsskala, ADS). RESULTS: Sixty-five percent of participants suffered from psychological comorbidities. Treatment response comprised improvements in the TQ, ISQ, PSQ and ADS. At baseline, tinnitus-burden correlated with the ISR-total, ISR-obsessive-compulsive disorder and PSQ-tension scores. Post treatment, the-now reduced-tinnitus burden was additionally predicted by ISR-depressive and eating disorder scores. CONCLUSION: The ISR is a useful tool for measuring psychological comorbidities in patients with chronic tinnitus as well as short-term treatment response. Therapeutic approaches for chronic tinnitus should address stress-related tension, depressive symptomatology and coping strategies such as maladaptive eating behaviours.

[The ICD-10 Symptom Rating questionnaire for assessment of psychological comorbidities in chronic tinnitus patients]. / ICD-10-Symptom-Rating-Fragebogen zur Beurteilung psychischer Komorbiditäten bei Patienten mit chronischem Tinnitus.

BACKGROUND: Psychological comorbidities are frequent in tinnitus patients and their diagnosis is important for both interventions as well as treatment success. The selection of suitable questionnaires is thus crucial. The present study aimed to investigate the ICD-10 Symptom Rating (ISR) questionnaire for the diagnosis of psychological comorbidities. METHODS: The current study investigated tinnitus burden and psychological comorbidities in a sample of n = 311 patients with chronic tinnitus. All participants completed an intensive 7­day multimodal tinnitus-specific therapy. Tinnitus burden was measured using the German version of the Tinnitus Questionnaire (TQ). Psychological comorbidities were measured using the ISR (total score, depressive disorder, anxiety disorder, obsessive-compulsive disorder, somatoform disorder, and eating disorder), the Perceived Stress Questionnaire (PSQ; total score, tension, worries, joy, and demands), and the General Depression Scale (Allgemeine Depressionsskala, ADS). RESULTS: Psychological comorbidities were suffered by 65% of participants. Treatment response comprised improvements in TQ, ISR, PSQ, and ADS. At baseline, tinnitus burden correlated with the ISR total, ISR obsessive-compulsive disorder, and PSQ tension scores. Post-treatment, the now reduced tinnitus burden was also predicted by the ISR depressive and eating disorder scores. CONCLUSION: The ISR is a useful tool for measuring psychological comorbidities in patients with chronic tinnitus as well as for assessing short-term treatment response. Therapeutic approaches for chronic tinnitus should also consider stress-related tension, depressive symptomatology, and coping strategies such as maladaptive eating behaviors.

Analysis of mental disorders in tinnitus patients performed with Composite International Diagnostic Interview.

PURPOSE: Known association between tinnitus and psychological distress prompted us to examine patients with chronic tinnitus by using the Composite International Diagnostic Interview (CIDI), which is a standardized and reliable method used for the diagnosis of mental disorders. METHODS: One hundred patients with chronic tinnitus admitted to the Tinnitus Center, Charité-Universitätsmedizin Berlin, were included in this study. Data were collected between February 2008 and February 2009. Besides CIDI, the Tinnitus Questionnaire according to Goebel and Hiller, the Hospital Anxiety Depression Scale, and the General Anxiety Disorder-7 were used. RESULTS: Using CIDI, we have identified one or more mental disorders in 46 tinnitus patients. In that group, we found persistent affective disorders (37 %), anxiety disorders (32 %), and somatoform disorders (27 %). Those patients who had affective or anxiety disorders were more distressed by tinnitus and were more anxious and more depressed than tinnitus patients without mental disorders. Psychological impairment positively correlated with tinnitus distress: Patients with decompensated tinnitus had significantly more affective and anxiety disorders than patients with compensated tinnitus. CONCLUSIONS: In the present study, we have detected a high rate (almost half of the cases) of psychological disorders occurring in patients with chronic tinnitus. The patients diagnosed with psychological disorders were predominantly affected by affective and anxiety disorders. Psychological disorders were associated with severity of tinnitus distress. Our findings imply a need for routine comprehensive screening of mental disorders in patients with chronic tinnitus.

Psychological comorbidity in patients with chronic tinnitus: analysis and comparison with chronic pain, asthma or atopic dermatitis patients.

PURPOSE: To determine the prevalence and severity of psychological comorbidity in patients with chronic tinnitus in comparison with other chronic illnesses, namely chronic pain, chronic asthma and atopic dermatitis. METHODS: Psychological diagnoses were done according to ICD-10 Chapter V(F). Subjective impairment was evaluated using 5 psychometric questionnaires: tinnitus questionnaire, Berlin mood questionnaire, sense of coherence (SOC-L9) and perceived stress questionnaire. Sleep disturbance was measured by the subdomain 'exhaustion' of the Giessen physical complaints inventory. RESULTS: Somatoform or affective disorders were most frequent in all disease groups. Patients with chronic tinnitus had a stronger SOC and better subjective mood, stronger commitment, and less anger and anxious depression than the patients with chronic pain, chronic asthma or atopic dermatitis. However, in patients with higher tinnitus annoyance, psychological comorbidity was similar to that found in patients with other chronic diseases. CONCLUSIONS: Besides collecting medical and social history, special psychometric instruments should be used for the diagnosis of tinnitus patients. Based on relative high frequency of psychological comorbidity, we recommend interdisciplinary cooperation between otorhinolaryngologists and other specialists (psychosomatic medicine, psychology or psychiatry) during the treatment of tinnitus patients, especially when high degree of tinnitus annoyance is involved.

[Psychometric instruments for the diagnosis of tinnitus]. / Psychometrische Testverfahren in der Tinnitusdiagnostik.

Tinnitus is a very complex phenomenon with various mechanisms of origin. Multimodal and interdisciplinary treatment is the most effective form of treatment for patients with chronic tinnitus. In order to assess existing comorbidity in tinnitus patients as well as to treat the patients individually, a comprehensive and differentiated diagnosis is needed. Since standardized guidelines for the use of relevant instruments in the diagnosis of tinnitus have been lacking hitherto, we present here psychometric questionnaires which have already been used effectively in the research, diagnosis and therapy of tinnitus in the present article. The questionnaires measure the severity of tinnitus, depression and anxiety, the perceived stress, personal resources as well as the quality of life of patients.

[Integrated intensive treatment of tinnitus: decrease of the tinnitus-related distress during a one-year follow-up study]. / Integrierte Tinnitusintensivbehandlung: Verringerung der tinnitusbedingten Belastung während einer 1-Jahres-Katamnese.

AIM OF THE STUDY: The therapy of the chronic tinnitus is aimed at improving the way patients cope with their tinnitus and at reducing the tinnitus-related distress. The present study investigated the changes of psychometric parameters that occurred in patients with chronic tinnitus after 7-days outpatient multidisciplinary therapy. The changes were monitored for up to 1 year in order to evaluate the long-term efficiency. METHODS: Main emphasis of the intensive tinnitus therapy applied was placed on tinnitus habituation and on teaching the patients how to apply coping strategies. The main elements of the multimodal concept included progressive muscle relaxation according to Jacobson, physiotherapy, educative seminars, training of selective attention and, lastly, the change of judgment, attitude and behaviour towards tinnitus. Psychometric parameters and tinnitus-related distress were assessed prior to and after the therapy (at 3, 6 and 12 months) using the tinnitus questionnaire (TQ) according to Goebel and Hiller. Furthermore, subjects waiting for therapy (waiting list) were recruited to the control group and compared with the therapy group which had received therapy 3 months earlier. RESULTS: The therapy group showed a significant reduction of the TQ total score after 3 months as compared to the control group. Moreover, we observed a long-term, progressive positive outcome during the one-year follow-up. The TQ total score was reduced by 10.9 points. There was an obvious decrease of the emotional and cognitive distress as well as of the intrusiveness of tinnitus, as per evaluation of TQ subscales. CONCLUSIONS: The outpatient intensive multidisciplinary tinnitus therapy with long-term aftercare has proved to be an effective method in the treatment of patients with chronic tinnitus. The outpatient setting enables the instant implementation of strategies learned during therapy in the patients' everyday life.

[Group therapeutic concept for chronic tinnitus]. / Gruppentherapeutische Ansätze bei chronischem Tinnitus.

The aim of this article is to show an established group therapeutic concept for chronic tinnitus. The treatment of chronic tinnitus is intended to improve the way patients cope with tinnitus but it does not eliminate it. It means that patients learn how to reduce the impairment they are experiencing. Patients with tinnitus are supported in the process of habituation through the treatment. Multimodal cognitive behavioral therapeutic interventions in a group setting are particularly helpful because they may demonstrate differences in the influence of cognitive processes on the emotional perception of the tinnitus between the patients. Psychological factors like emotional support through other patients and learning from other examples can ease the process of internalizing coping strategies. Psychological processes seem to be of particular importance. Those processes can have an effect on concentration, appraisal, and coping with the tinnitus. Progressive muscle relaxation using Jacobson's technique, physical therapy, education via lectures, training of selective attention and change of appraisal, mental attitude and behavior concerning the tinnitus are the main factors in tinnitus therapy and can enable tinnitus patients to decrease their psychological strain.

[The role of stress in the pathogenesis of tinnitus and in the ability to cope with it]. / Stress bei der Tinnitusentstehung und -verarbeitung.

Besides the impairment of somatic functions, other factors including stress, and psychological and social characteristics are known to be important factors in the pathogenesis of tinnitus and the ability to cope with it. Existing coping strategies and psychosocial factors may have an influence on the degree of stress perceived through tinnitus. In the case of missing habituation, serious psychological, neurological and immunological responses to tinnitus are possible. In order to reduce the cognitive and emotional tinnitus-distress associated with this, there should be a focus on providing functional coping strategies combined with cognitive behavioural elements.

[Integrated intensive treatment of tinnitus: method and initial results]. / Integrierte Tinnitusintensivbehandlung: Konzept und erste praktische Erfahrungen.

In recent years, no major advances have been made in understanding the mechanisms underlying the development of tinnitus. Hence, the present therapeutic strategies aim at decoupling the subconscious from the perception of tinnitus. Mindful of the lessons drawn from existing tinnitus retraining and desensitisation therapies, a new integrated day hospital strategy of treatment lasting 7-14 days has been developed at the Charité Hospital and is presented in the present paper. The strategy for treating tinnitus in the proximity of patient domicile is designed for patients who feel disturbed in their world of perception and their efficiency due to tinnitus and give evidence of mental and physical strain. In view of the etiologically non-uniform and multiple events connected with tinnitus, consideration was also given to the fact that somatic and psychosocial factors are equally involved. Therefore, therapy should aim at diagnosing and therapeutically influencing those psychosocial factors that reduce the hearing impression to such an extent that the affected persons suffer from strain. The first results of therapy-dependent changes of 46 patients suffering from chronic tinnitus are presented. The data were evaluated before and after 7 days of treatment and 6 months after the end of treatment. Immediately after the treatment, the scores of both the tinnitus questionnaire (Goebel and Hiller) and the subscales improved significantly. These results were maintained during the 6-month post-treatment period and even improved.

Potential health risks of complementary alternative medicines in cancer patients.

Many cancer patients use complementary alternative medicines (CAMs) but may not be aware of the potential risks. There are no studies quantifying such risks, but there is some evidence of patient risk from case reports in the literature. A cross-sectional survey of patients attending the outpatient department at a specialist cancer centre was carried out to establish a pattern of herbal remedy or supplement use and to identify potential adverse side effects or drug interactions with conventional medicines. If potential risks were identified, a health warning was issued by a pharmacist. A total of 318 patients participated in the study. Of these, 164 (51.6%) took CAMs, and 133 different combinations were recorded. Of these, 10.4% only took herbal remedies, 42.1% only supplements and 47.6% a combination of both. In all, 18 (11.0%) reported supplements in higher than recommended doses. Health warnings were issued to 20 (12.2%) patients. Most warnings concerned echinacea in patients with lymphoma. Further warnings were issued for cod liver/fish oil, evening primrose oil, gingko, garlic, ginseng, kava kava and beta-carotene. In conclusion, medical practitioners need to be able to identify the potential risks of CAMs. Equally, patients should be encouraged to disclose their use. Also, more research is needed to quantify the actual health risks.

High functioning fragile X males: demonstration of an unmethylated fully expanded FMR-1 mutation associated with protein expression.

Fragile X (fra(X)) males with a standardized IQ score of 70 or higher represent a high functioning (HF) or nonretarded fra(X) male group. This group, which does not include nonpenetrant males, has received little research attention to date. Of 221 fra(X) males who had been evaluated through The Children's Hospital in Denver since 1981 and had completed cognitive or developmental testing, 29 (13%) were high functioning by the above definition. We found that HF males on the whole had a lower cytogenetic score and were younger than retarded fra(X) males, but there was no difference between these two groups in the number of typical fra(X) physical manifestations present. FMR-1 DNA testing was performed on 134 fra(X) males and methylation status was determined for 51 of these. A greater percentage of HF males had a mosaic pattern or an incompletely methylated full mutation than did retarded males. A unique DNA pattern, an unmethylated fully expanded mutation, was discovered in 3 of the highest functioning fra(X) males. Protein studies performed on 2 of these males demonstrated the presence of FMR-1 protein, albeit at lower levels than normal. FMR-1 protein was not present in retarded fra(X) males. Significant FMR-1 protein expression may be responsible for higher cognitive functioning in the 2 males with unmethylated fully expanded mutations compared to retarded fra(X) males.