Therapeutic outcome of adjustable gastric banding in morbid obese patients

We examined 77 obese patients treated with bariatric surgery in order to analyse treatment success, and compare those with a good or a poor outcome. The subjects, who were recruited one year after undergoing adjustable gastric banding, were asked questions concerning their sociodemographic status, postoperative course, past and present weight status, eating behaviours and difficulties in changing eating habits. Furthermore, we also used two body image questionnaires, and considered the patients' evaluations of positive and negative changes, as well as their wishes for the future. There were no preoperative differences between the 71% of patients in the good outcome group and the 29% in the poor outcome group. With regard to the postoperative course, the poor outcome group had more problems in adapting to new eating behaviours, experienced significantly more post-surgical complications, and had a persistently negative body evaluation. Both groups were satisfied with their achieved weight loss achieved, and their improved self-esteem and mobility. Adjustable gastric banding seems to be successful in inducing weight loss and allowing a better quality of life. However, factors such as postoperative complications, the ability and willingness to adopt new eating attitudes, and an improved body image seem to be crucial for therapeutic outcome.

Features in families of boys with hyperkinetic and emotional disorders

Standardized assessment of a family's characteristics (conflict management, cohesion, etc.) is not used routinely, although these variables may play an important role in the course of psychological disorders in children. The present study investigated differences within the features of families of children with hyperkinetic and emotional disorders. Families of 20 boys diagnosed with Attention Deficit Hyperkinetic Disorder and 20 boys with Emotional Disorder (ages 6-12 years) by giving the Mannheim Parents Interview and the teacher's form of the Conners scale were included for evaluation and compared with a matched, healthy control group of 20 boys. Parents were asked to complete a form assessing the family's characteristics ("Familienklima-Testsystem"), including Cohesion, Expressiveness, Conflict Tendency, Individual Independence, Achievement Orientation, Intellectual-Cultural Orientation, Active-Recreational Orientation, Moral-Religious Emphasis, and Organization. Comparison of groups was made by the Kruskal-Wallis test and Mann-Whitney U test. There are significantly more conflicts in families whose children belong to the two disorder groups. Compared with a matched healthy control group, there is low Expressiveness, Independence, and Cultural and Active-Recreational Orientation in the Emotional Disorder group and a significant lack of Organization and Cohesion in the Attention Deficit Hyperkinetic Disorder group. Altogether there seems to be a significant association of Attention Deficit Hyperkinetic Disorder symptoms with the family's Cohesion and Organization. One implication is that therapists focus their efforts not only on the children with disorders but also on their families.

Buprenorphine versus methadone maintenance treatment in an ambulant setting: a health-related quality of life assessment

BACKGROUND

To compare the effects on quality of life (QOL) of oral methadone with sublingual buprenorphine.

METHODS

We performed an open-label, non-randomized, two-site (methadone-buprenorphine) study. During 6 months we assessed the quality of life status of 53 opioid-dependent patients admitted to a methadone or buprenorphine maintenance programme using the German version (Berlin Quality of Life Profile) of the Lancashire Quality of Life Profile. Physical symptoms were measured using the Opioid Withdrawal Scale. Five hundred and thirty urine screening tests were carried out randomly to detect additional consumption.

RESULTS

Sixty-seven opioid-dependent subjects (38 on methadone and 29 on buprenorphine) were enrolled in the study, and 53 completed it (30 subjects treated with buprenorphine and 23 subjects with racemic methadone). The subjects were comparable on all baseline measures. At the first follow-up (week 8), the buprenorphine-maintained group showed significantly less additional consumption of opioids (P = 0.013) compared with the methadone group. Patients retained in the buprenorphine or methadone programme (week 24) showed no significant differences in all quality of life scores. At the end of the study period, the buprenorphine-maintained group showed significantly less additional consumption of opioids (P = 0.001) and cocaine (P = 0.018) compared with the methadone group. The outcome measures for withdrawal symptoms after 24 weeks of treatment with buprenorphine showed slight advantages in stomach cramps, fatigue or tiredness, feelings of coldness and heart pounding.

CONCLUSIONS

These results suggest that buprenorphine treatment is as effective as methadone regarding effects on quality of life and withdrawal symptoms. Buprenorphine has the potential to reduce the harm caused by drug abuse. Further research is needed to determine if buprenorphine is more effective than methadone in particular subgroups of patients.

Her2/neu overexpression in differentiated thyroid carcinomas predicts metastatic disease

To investigate the prognostic value of Her2/neu expression in differentiated thyroid carcinomas 103 patients were retrospectively investigated. All of them received surgical and an identical follow-up treatment. The patients with papillary and follicular thyroid cancer were further separated into two groups concerning their clinical development, including one group without distant metastasis (follow-up of minimum 8 years). The second group presented with distant metastases as a sign of an aggressive behaviour. Her2/neu was immunohistochemically detected on sections from formalin-fixed, paraffin-embedded tissues using c-erbB-2/Her-2/neu oncoprotein Ab-17 monoclonal antibody (mAb). In statistical analysis using the Mann-Whitney U-test and chi(2) test, Her2/neu protein overexpression was significantly correlated with prognosis. Both tumour entities without distant metastases showed significantly less cytoplasmic immunostaining than patients with development of metastases. Concerning the clinical outcome, Her2/neu overexpression may be regarded as a prognostic factor in differentiated thyroid carcinomas. Moreover, in addition to standard radio-iodine elimination therapy, application of Herceptin could lead to new successful therapeutic concepts for a number of patients with progressive thyroid cancer.

The impact of blepharospasm and cervical dystonia on health-related quality of life and depression

The aim of the study was to evaluate and compare health-related quality of life (HR-QoL) and depression in essential blepharospasm (BSP) and idiopathic cervical dystonia (CD), to identify the clinical and demographic factors associated with poor HR-QoL in both disorders and to analyse the effect of Botulinum Toxin A (BtxA) therapy. Two hundred-twenty consecutive patients with BSP (N = 89, 62 % women, mean age 64 years, mean disease duration 7 years) and CD (N = 131, 64 % women, mean age 53 years, mean disease duration 8 years) recruited from routine referrals to eight Austrian dystonia clinics were included. HR-QoL was measured by the Short Form 36 (SF-36) and depression by the Beck Depression Inventory (BDI). At baseline, patients with CD and BSP scored significantly worse in all eight SF-36 domains compared with an age-matched community sample. In addition, 47 % of patients with CD and 37 % of those with BSP were depressed. Women with BSP scored significantly lower in all SF-36 domains and were more depressed than male patients. In contrast, there was no significant effect of gender on HR-QoL and depression in CD. Neck pain had a significant impact on all SF-36 domains and represented the main determinant of depression in CD. Although BtxA therapy resulted in a significant improvement of clinical symptoms in BSP and CD, HR-QoL did not improve in BSP and only two of the eight SF-36 domains improved significantly in patients with CD. The present study for the first time demonstrated that BSP has a substantial impact on health status emphasizing the need for psychological support with interventions aimed at treating depression in these patients. Our results provide further evidence for the profound impact of CD on HR-QoL and indicate the importance of an adequate management of neck pain in addition to reducing the severity of dystonia in CD. The mismatch between objective BtxA derived improvement of dystonia and lack of change of HR-QoL as determined by the SF-36 illustrates the need for optimized disease specific quality of life rating scales in patients with craniocervical dystonia.

Pharmacological treatment strategies of residential primary care providers in dementia diseases--results of a representative survey in western Austria

OBJECTIVE

The goal of this study was to investigate pharmacological treatment strategies used by residential primary care providers for patients with dementia.

METHODS

A postal questionnaire survey was sent to all residential primary care providers, internists, neurologists and psychiatrists (n = 689) in the western region of Austria.

RESULTS

The response rate (53 %) was similar in all four physician groups. Acetylcholinesterase inhibitors are considered to have a higher efficacy (p < 0.0005) compared to nootropic drugs. However, the vast majority of primary care providers (95 %) prescribe nootropic drugs. Two thirds (64 %) of the primary care providers prescribe acetylcholinesterase inhibitors. The dementia subtype influences the prescription frequency of acetylcholinesterase inhibitors, but not the specific choice of nootropic compound. Half of the primary care providers (52 %) combine antidementia drugs. Nearly two-thirds (62 %) of all primary care providers frequently prescribe antidepressants. Specific serotonin reuptake inhibitors are applied by the majority of primary care providers (96 %). About one-third (39 %) of primary care providers and internists (29 %) prescribe tricyclic antidepressants. Antipsychotics are applied frequently by around a quarter (29 %) of all physicians. More than half of primary care providers (62 %) and internists (58 %) treat patients with typical antipsychotics. Psychiatrists and neurologists are significantly more reluctant to prescribe tricyclic antidepressants and typical antipsychotics.

CONCLUSIONS

Despite the lack of scientific evidence, residential primary care providers combine antidementia drugs very frequently. Therefore, controlled studies on combination therapies are urgently needed; in contrast to neurologists and psychiatrists, primary care providers and internists frequently prescribe tricyclic antidepressants and typical antipsychotics. The reasons for this should be clarified in further studies.

The impact of hemoglobin levels on fatigue and quality of life in cancer patients

BACKGROUND

Although fatigue is a commonly reported symptom in cancer patients its etiology is still poorly understood. The objective of the present study was to investigate the relationship between hemoglobin (Hb) levels and the subjective experience of fatigue and quality of life in cancer patients with mild or no anemia undergoing chemotherapy.

PATIENTS AND METHODS

Sixty-eight cancer patients (25 colorectal, 26 lung and 17 ovarian cancer) presently undergoing chemotherapy participated in the study. Fatigue was measured with the Multidimesional Fatigue Inventory (MFI-20), quality of life with The European Organization for Research and Treatment of Cancer QLQ-C30. In order to provide normative data for fatigue levels, the MFI-20 was also completed by a sex- and age-matched sample of 120 healthy controls.

RESULTS

Compared with healthy subjects, cancer patients experienced significantly higher levels of subjective fatigue. Correlations between Hb values and subscales of the MFI-20 were moderate with a tendency to increase during chemotherapy. Hb values alone, however, do not fully account for the observed fatigue. Other symptoms, especially pain, dyspnea and sleep disturbances, also showed an association with perceived fatigue.

CONCLUSIONS

Despite significant correlations, these results indicate that Hb values only partially explain subjectively experienced fatigue and quality of life in cancer patients. It is suggested therefore that the treatment of fatigue must be multidimensional and involve all areas which contribute to the syndrome.

Multidimensional scaling as a tool for analysing quality of life data

Multidimensional scaling (MDS) is introduced and discussed as a graphical method to complement conventional descriptive and confirmatory methods in the validation and analysis of quality of life (QOL) data. An outline of M DS as a statistical technique is given, and its application in the context of QOL research is described. The use of MDS is then illustrated in an example based on a study of 300 cancer survivors who completed the functional assessment of cancer therapy-general (FACT-G) and the EORTC core quality of life questionnaire (QLQ-C30). The correlational structure of the two widely used QOL instruments is investigated by means of MDS, and differences between the two questionnaires are elaborated. Finally, the merits and drawbacks of MDS are discussed in the specific context of the example and in the general framework of QOL research.

Quality of life measurement in oncology--a matter of the assessment instrument?

Two widely used quality of life questionnaires, European Organization for Research and Treatment of Cancer Core (EORTC QLQ-C30) & Functional Assessment of Cancer Therapy-General (FACT-G), were examined for their comparability using four different groups of cancer patients. During a follow-up investigation, 418 cancer patients (Hodgkin's disease, breast cancer, bone marrow transplantation (BMT), chronic lymphatic leukaemia (CLL)) completed both the EORTC QLC-C30 and the FACT-G during the same session. For an illustration of the differences between the two Quality of Life (QoL) instruments, pairs of diagnostic groups were formed and their QoL scores using the EORTC QLQ-C30 and FACT-G compared. The corresponding subscales of the EORTC-QLC-C30 and the FACT-G show only low to moderate intercorrelations across all four groups of cancer patients studied. In particular, a comparison of pairs, namely Hodgkin's disease versus breast cancer patients and BMT versus CLL patients, highlights substantial differences in the corresponding subscales of the EORTC QLQ-C30 and the FACT-G. The results of the QoL investigations should not be interpreted independently of the instrument used and an interpretation of results must be based on the contents of items of the respective questionnaires.

[Subjective wellbeing and somatic markers in methadone substitution. Evaluation of 61 heroin addicts]

AIM

In 61 patients with the ICD-10 diagnosis "heroin dependence" an evaluation of subjective well-being with consideration given to coexisting symptoms prior to and 4 months after initiation of methadone maintenance.

METHOD

The Lancashire Quality of Life Profile and, for the clinical physical side effects, the opioid withdrawal scale proposed by Bradley and Seldenburg, were used. Additionally, urinalysis was performed.

RESULTS

Statistically appreciable differences were found between the two groups in terms of drug-specific side effects, somatic satisfaction scales, and consumption of medications and co-use of addictive drugs. Further statistically evident inter-group differences were seen with regard to mental well-being.

CONCLUSION

Overall, methadone maintenance leads to a rapid improvement in subjective well-being and to a relevant reduction in concurrent physical symptoms.

[Schizophrenia and violence. Results of a comprehensive inquiry in an Austrian providence]

The question as to whether schizophrenics have an increased potential for delinquency and violent behavior has given rise to much controversy. During the past few years, a large number of epidemiological studies have demonstrated a moderate but reliable relation between schizophrenic disorders and violence. In the present study, a new approach at investigation was used by evaluating the overall rate of convictions and commitments to psychiatric institutions for general delinquency, violence, and homicide among schizophrenics. The most outstanding results demonstrated that the treatment of schizophrenic offenders was only insufficiently covered by the psychiatric care system, showed the lack of compliance in the study group, and demonstrated the high significance of coexisting acute and chronic alcohol and drug abuse. The risk of delinquency and violent behavior was much higher in schizophrenics than in the general population. It is indicated, however, that mentally ill delinquents are only of minor importance within the overall group of offenders and that better preventive and therapeutic measures present opportunities for prevention.

Association of olanzapine-induced weight gain with an increase in body fat

OBJECTIVE

The goal of this study was to explore the pathophysiology of weight gain during treatment with olanzapine for schizophrenia.

METHOD

The authors used a prospective, controlled, open study comparing body weight, body mass index, and related biological measures in mentally and physically healthy volunteers and olanzapine-treated patients with schizophrenia. Weight, eating behavior, leptin serum levels, body mass index, and body composition were assessed over an 8-week observation period.

RESULTS

A significant increase in body weight, leptin serum levels, and percentage of body fat was seen in patients treated with olanzapine, but the drug-free comparison group did not show any significant changes. The weight gain during antipsychotic treatment with olanzapine was mainly attributable to an increase in body fat; patients' lean body mass did not change.

CONCLUSIONS

In addition to the original finding that an increase in body fat is mainly responsible for olanzapine-induced weight gain, these findings confirm results obtained in other studies showing increases in body weight and serum leptin levels during treatment with second-generation antipsychotics.

Use of alternative/complementary therapy in breast cancer patients--a psychological perspective

The objectives of this study were to assess the additional use of alternative (complementary) therapies in patients with breast cancer who were receiving conventional treatment and to compare patients using alternative therapies with patients receiving only conventional treatment with special reference to psychological adaptation, causal attribution and quality of life. A sample of 117 female out-patients with a diagnosis of breast cancer filled in the following assessment instruments: FQCI (Freiburg Questionnaire for Coping with Illness), PUK (Causal Attribution Questionnaire), EORTC QLQ-C30 (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire), POMS (Profile of Mood States), and a self-developed questionnaire on alternative therapies. Nearly half the patients (47%, n = 55) reported that they had used alternative therapies in addition to conventional treatment. The methods applied most frequently were nutrition-related measures (special drinks, vitamin preparations and whole-foods - each applied by about 50% of users), mistletoe preparations (49%), trace elements (47%), and homeopathy (31%). Compared with patients receiving only conventional treatment, the users of alternative therapy were younger and better educated. Users developed a more active style of illness coping than nonusers and showed more religious involvement. Patients using a large number of alternative therapies (>3) tended to adopt a more depressive coping style than those using only a small number (< or =3). For a substantial proportion of cancer patients alternative therapies apparently fulfil an important psychological need. However, a subgroup of patients using many alternative therapies seem to have considerable adjustment problems. In dealing with cancer patients the treatment team should be aware of both these groups.

Risk profile of SSrIs in elderly depressive patients with co-morbid physical illness

BACKGROUND

So far, most studies on treatment strategies in elderly depressive patients have included only patients in good physical health, thereby excluding and neglecting somatic co-morbidity, which is very prevalent and relevant in geriatric psychiatry.

METHOD

40 elderly depressive inpatients at the Department of Internal Medicine in Hochzirl who had started on SSRI monotherapy were allocated to this prospective post-marketing surveillance study. A stable medication for their physical illness for at least six months was a prerequisite. A Mini Mental State Exam (MMSE) score of >24 was required for study entry. The four-week study consisted of one baseline and four follow-up examinations, including psychiatric and medical history, as well as ratings for psychopathology and treatment-related adverse events. The antidepressants administered were paroxetine (20 mg/d), citalopram (20 mg/d), fluoxetine (20 mg/d) and sertraline (50 mg/d). Depression was rated using the 21-item Hamilton Depression Scale (HAMD); side effects were evaluated by the UKU Side Effect Rating Scale, and we used the Hillside Akathisia Scale (HAS) to record the incidence of SSRI-induced akathisia.

RESULTS AND CONCLUSION

Our results suggest that SSRls are effective and reasonably safe in elderly depressive patients with co-morbid physical illness. Adverse effects are more common, but generally tolerable, than in younger and physically healthy patients. The risk profile of SSRls in this population can be considered favorable.

Quality of life in breast cancer patients--not enough attention for long-term survivors?

In a study of breast cancer survivors, the authors used the European Organization for Research and Treatment of Cancer core questionnaire + breast module (EORTC QLQ-C30/+BR23) and the Functional Assessment of Cancer Therapy-Breast (FACT-B)for the assessment of quality of life (QoL). The main focus of this study was to look at the effect of time elapsed since initial treatment on the patients' QoL. Eighty-seven female patients (average age of 53.9 +/- 8.7 years) were included in the study. All women had received curative cancer therapy. The average time elapsed since start of initial treatment was 4.7 +/- 4.3 years. Reduced QoL, especially in the areas of emotional, social, and sexual functioning, was found not only after initial treatment (1-2 years) but also after long posttreatment survival (> 5 years). From these findings, needs for specific psycho-oncological interventions are derived. The findings imply that besides recovering from the acute consequences of cancer therapy, long-term survivors of breast cancer (> 5 years after initial treatment) still may have a special need for psycho-oncological support.

Life after cystectomy and orthotopic neobladder versus ileal conduit urinary diversion

Patients frequently complain about changes in their everyday life after radical cystectomy and urinary diversion. The aim of this study was to compare subjective morbidity of ileal neobladder to the urethra versus ileal conduit urinary diversion and to elucidate its influence on quality of life. A total of 102 patients who underwent radical cystectomy due to a bladder malignancy were included in the study: 69 patients (67.6%) with an orthotopic neobladder and 33 patients (32.4%) with an ileal conduit. The compliance was 99% and mean follow-up was 37 months. All patients completed two retrospective quality-of-life questionnaires, namely the QLQ-C30 and a questionnaire developed at our institution to elucidate specific items regarding urinary diversion. The questioning was performed by a nonurologist. The results obtained from the validated (QLQ-C30) and our self-designed questionnaire clearly demonstrate that patients with an orthotopic neobladder better adapt to the new situation than patients with an ileal conduit. In addition, neobladder to the urethra improves quality of life due to a better self-confidence, better rehabilitation as well as restoration of leisure, professional, traveling, and social activities, and reduced risk of inadvertent loss of urine. For example, 74.6% of neobladder patients felt absolutely safe with the urinary diversion in contrast to 33.3% in the ileal conduit group. Only 1.5% of neobladder patients had wet clothes caused by urine leakage during day versus 48.5% of ileal conduit patients; 92.8% of neobladder patients felt not handicapped at all; and 87% felt not sickly or ill in contrast to 51.5% and 66.7% of ileal conduit patients, respectively. Moreover, 97% of our neobladder patients would recommend the same urinary diversion to a friend suffering from the same disease in contrast to only 36% of ileal conduit patients. The results obtained by this study demonstrate that quality of life is preserved in a higher degree after orthotopic neobladder than after ileal conduit urinary diversion.

[A pilot study of fathers on parental leave in Tirol.]

The current study examines fathers in parental leave in Tirol. The authors have come to realise that systematic reflections concerning fathers on leave of their work are rare. The authors attempt to answer the following question: does parental leave have implications on child/father attachment? The pilot study examines a small sample of 15 father/child couples. The description and analysis of father/child interactions was elaborated with the Child Adult Relationship Index (CARE-Index) designed by Crittenden (1988, 2000).

Body image and psychopathology in male bodybuilders

BACKGROUND

To compare male bodybuilders to men with eating disorders and control men regarding body image, psychopathology and sexual history.

METHOD

We compared 28 male bodybuilders, 30 men with eating disorders (anorexia nervosa, bulimia or binge eating disorder defined by DSM-IV), and 30 controls, using a battery of questionnaires covering weight history, eating behavior, body image, lifetime history of psychiatric disorders, and sexuality. Eating-disordered and control men were recruited from a college student population and studied during the course of an earlier investigation.

RESULTS

Bodybuilders exhibited a pattern of eating and exercising as obsessive as that of subjects with eating disorders, but with a 'reverse' focus of gaining muscle as opposed to losing fat. Bodybuilders displayed rates of psychiatric disorders intermediate between men with eating disorders and control men. In measures of body image, the bodybuilders closely resembled the men with eating disorders, but significantly differed from the control men, with the former two groups consistently displaying greater dissatisfaction than the latter. Sexual functioning did not distinguish the three groups except for the item 'lack of sexual desire' which was reported significantly more often by both bodybuilders and men with eating disorders.

CONCLUSION

On measures of body image and eating behavior, bodybuilders share many features of individuals with eating disorders.

Preoperative expectations and postoperative quality of life in liver transplant survivors

OBJECTIVE

To assess normalization in the lives of liver transplant patients and the impact of preoperative expectations on postoperative quality of life (QOL).

DESIGN

A semistructured interview, 2 QOL questionnaires, and chart reviews of medical histories.

SETTING

Internal medicine department at Innsbruck university hospital, Austria.

PARTICIPANTS

Fifty-five patients (32 men, 23 women) with liver transplants.

INTERVENTIONS

The Sickness Impact Profile (SIP) and Functional Assessment of Cancer Therapy-General.

RESULTS

Patients' preoperative expectations of a normal life style posttransplantation were predominantly optimistic (60%), but postoperatively only 40% thought that their expectations had been realized. The patients' SIP values showed significant impairments in nearly every area of life when compared with the values of a healthy control group. Only "complications during the hospitalized phase" had a statistically significant impact among the sociodemographic and clinical parameters on postoperative QOL. The lowest QOL scores were found among patients whose expectations of a return to normal life style had not been realized.

CONCLUSION

Unmet life-style expectations after liver transplantation may lead to increased stress, which affects QOL long term. This finding is of clinical relevance; therapeutic measures, particularly professional pretransplant counseling, are indicated.

[Quality of life of patients with eating disorders. A catamnestic study]

OBJECTIVE

To assess the eating behaviour, quality of life and changes in life style in 46 female patients with eating disorders, discharged from our psychosomatic unit at least six month ago.

METHODS

Patients meeting the criteria for DSM-IV anorexia nervosa or bulimia nervosa completed the "Lancashire Quality of Life Profile" [16] and a questionnaire covering demographic aspects, eating behaviour and changes in life style.

RESULTS

Positive changes in eating behaviour correlated with higher quality of life scores in many of the domains assessed, including leisure, financial situation and perceived mental health. These changes also correlated with positive changes in life style in several domains, in particular family situation and leisure activities.

CONCLUSIONS

Results show that various connections between eating behaviour and quality of life as well as life style exist, suggesting a treatment concept that emphasizes both clinical symptoms and psycho-social conflicts.

["...not dangerous, but nevertheless frightening". A program against stigmatization of schizophrenia in schools]

OBJECTIVE

Evaluation of a brief school programme providing information about schizophrenia to high school students. It was investigated whether the programme changed the students' attitude towards this target group and whether information given by a patient affects the results.

METHODS

114 high school students (6 school classes) took part in the programme: 57 students were informed by a psychiatrist and an afflicted person (group A), the other 57 were informed by a psychiatrist and a social worker (group B). The students' attitude towards schizophrenics was assessed using a vignette of a fictitious class-mate suffering from schizophrenia (according to DSM criteria) and by questionnaires assessing the students' emotional and cognitive reactions and their social distance towards the person described by the vignette.

RESULTS

Only in group A (psychiatrist and afflicted) there was a significant improvement regarding the emotional reaction (reduction of fear, increase in positive emotions) and a significant decrease in social distance. Moreover, students no longer associated psychiatric illness with being "crazy". In group B (psychiatrist and social worker) these changes could not be observed. There was even a significant increase in describing patients with schizophrenia as dangerous.

CONCLUSION

As high school students themselves consider their level of knowledge about psychiatric illness as low, information about this topic should be given more attention than is currently done (also from a preventive point of view). For such information to be effective and to affect students' attitudes positively, it appears necessary that students have the opportunity to get in contact with a person affected by psychiatric illness. For changing attitudes it is also essential how information is presented.

Quality of life after cystectomy and orthotopic neobladder versus ileal conduit urinary diversion

The impact of bladder removal and urinary diversion for patients' everyday life is largely unknown. The aims of this study were to compare subjective morbidity of ileal neobladder to the urethra versus ileal conduit urinary diversion and to elucidate its influence on quality of life. A total of 102 patients who underwent cystectomy due to a bladder malignancy were included in the study. In 69 patients (67.6%) an orthotopic neobladder and in 33 patients (32.4%) an ileal conduit was performed as urinary diversion. The compliance was 99% and mean follow-up was 37 months. All patients completed two retrospective quality of life questionnaires, namely the QLQ-C30 and a questionnaire developed at our institution to ask for urinary diversion specific items. The questioning and assessment was performed by non-urologists. The results obtained from the validated (QLQ-C30) and our own specially compiled questionnaire clearly demonstrate that patients with an orthotopic neobladder are more able to adapt to the new situation than patients with an ileal conduit. In addition, neobladder to the urethra improves the quality of life because it improves self-confidence, causes better rehabilitation as well as the restoration of leisure, professional, travelling, and social activities, and reduced risk of inadvertent loss of urine. For example, 92.8% of neobladder patients did not feel handicapped at all, and 87% did not feel sick or ill, in contrast to 51.5% and 66.7% of ileal conduit patients, respectively. Of the neobladder patients, 74.6% felt absolutely safe with the urinary diversion in contrast to 33.3% in the ileal conduit group. Only 1.5% of neobladder patients had wet clothes caused by urine leakage during the day, versus 48.5% of ileal conduit patients. Moreover, 97% of our neobladder patients would recommend the same urinary diversion to a friend suffering from the same disease, but only 36% of ileal conduit patients would do so. These results demonstrate that the quality of life is preserved to a higher degree after orthotopic neobladder than after ileal conduit urinary diversion.

EORTC QLQ-C30 and FACT-BMT for the measurement of quality of life in bone marrow transplant recipients: a comparison

The purpose of the study was to compare two different quality-of-life self-rating instruments, namely the EORTC QLQ-C30, developed by the quality-of-life study group of the European Organisation for Research and Treatment of Cancer, and the FACT-BMT (version 3), the Functional Assessment of Cancer Therapy - Bone Marrow Transplantation scale, which is the FACT-G(eneral measure) in combination with a module developed specifically for evaluating quality of life of bone marrow transplant (BMT) patients. Fifty-six BMT recipients completed both the EORTC QLQ-C30 and the FACT-BMT (German language version) during the same session. Questionnaire data were analyzed on a subscale basis using correlation analysis and multiple linear regression. Correlations between corresponding subscales of EORTC QLQ-C30 and the FACT-BMT ranged from r=0.30 for the emotional domain (poor agreement) to r=0.77 for global QOL (good agreement). This suggests that the instruments, despite considerable overlap, possibly focus on different aspects of QOL, in particular in addressing emotional and social issues of BMT patients. It appears that the FACT-BMT gives a more comprehensive overview regarding the multidimensional construct of quality of life. The EORTC QLQ-C30 gives more insight into the physical aspects of quality of life and helps to identify symptoms which effectively decrease quality of life from the patient's perspective. The QLQ-C30 might be improved by the incorporation of a BMT-specific module currently under development. We therefore conclude that neither of the two instruments can be replaced by the other in the assessment of QOL of BMT patients and that a direct comparison of results obtained with the two instruments is likely to be misleading.

The weeping behavior in anorexic and bulimic females

BACKGROUND

The aim of the study was to examine the proneness, the functions and triggering situations of weeping in anorexic and bulimic women.

METHODS

Participants were 36 anorexic and 31 bulimic female patients and 56 age-matched female controls. All women completed the Questionnaire on Adult Crying. We limited our study to results on 'crying proneness', 'functions of crying' and 'determining factors of crying'.

RESULTS

Bulimic patients reported to have cried significantly more often in the last 4 weeks, to be more likely to cry in situations of distress and to have used weeping significantly more often as a manipulative behavior than control women. Anorexic patients rated their tendency to cry significantly lower and experienced weeping as significantly more negative than controls.

CONCLUSIONS

Compared to control women, anorexic patients associated weeping with negative feelings as opposed to bulimic patients who appeared to use weeping on an intentional basis. These deviations from control women seem to mirror the introvert character of anorexic patients and the extrovert impulsive personality of patients with bulimia nervosa, respectively.