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Abstract
Eating disorders are a common mental disorder during adolescence and young adulthood. While prevalence rates of eating disorders dramatically increased during the second half of the last century, these rates have remained relatively stable over the last 20 years. According to ICD-10 eating disorders are diagnostically categorized as anorexia nervosa, bulimia nervosa and atypical eating disorders or eating disorders not otherwise specified. Concerning the etiology, genetic factors are involved, especially in anorexia nervosa, as well as psychological and sociocultural factors. Evidence-based recommendations are available for the treatment of bulimia nervosa and binge eating disorder and in this context cognitive behavioral therapy is seen as the first choice. In contrast, the state of knowledge concerning the treatment of anorexia nervosa is still limited, especially concerning effective treatments for adults. Recent data only provide evidence for the effectiveness of family therapy for adolescents. Due to the lack of high quality studies, research on therapy for anorexia nervosa is a future challenge.
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Affiliation(s)
- U Voderholzer
- Schön Klinik Roseneck, Am Roseneck 6, 83209, Prien am Chiemsee, Deutschland.
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Greetfeld M, Cuntz U, Voderholzer U. Pharmakotherapie von Anorexia nervosa und Bulimia nervosa: State of the Art. Fortschr Neurol Psychiatr 2011; 80:9-16. [DOI: 10.1055/s-0031-1281845] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
| | - U. Cuntz
- Schön Klinik Roseneck, Prien am Chiemsee
| | - U. Voderholzer
- Schön Klinik Roseneck, Prien am Chiemsee
- Abteilung Psychiatrie und Psychotherapie, Universitätsklinikum Freiburg
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Otto B, Cuntz U, Otto C, Heldwein W, Riepl RL, Tschöp MH. Peptide YY release in anorectic patients after liquid meal. Appetite 2007; 48:301-4. [PMID: 17157959 DOI: 10.1016/j.appet.2006.06.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2005] [Revised: 06/27/2006] [Accepted: 06/28/2006] [Indexed: 12/25/2022]
Abstract
Fasting and postprandial levels of human peptide YY (PYY) were recently found to be lower in obesity. To investigate whether PYY levels are correspondingly high in patients with anorexia nervosa, PYY concentrations were analyzed under basal conditions and in response to a liquid meal. We investigated PYY plasma levels in 16 female anorectic (BMI 15.2+/-0.3 kg/m2) and seven lean subjects (BMI 21.3+/-0.6 kg/m2) before and after ingestion of a liquid meal (250 kcal; 15% protein, 55% carbohydrates, and 30% fat). PYY levels were analyzed using PYY ELISA (DSL, USA). Values are given as mean+/-SEM. Basal PYY levels in anorectic patients (89.0+/-14.4 pg/mL) were not significantly different from lean subjects (64.1+/-12.1 pg/mL). Postprandial PYY levels in healthy volunteers increased significantly after 20 and 60 min (80.4+/-12.7 and 96.0+/-19.9 pg/mL, respectively). In anorectic women PYY was increased at 20 min (137.9+/-19.5 pg/mL) and at 60 min (151.3+/-19.2 pg/mL). No difference was found between both groups. We conclude that basal and postprandial PYY levels in normal weight women are not different from anorectic patients. We could not confirm the recently published blunted postprandial PYY response in anorexia, a finding that merits further study.
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Affiliation(s)
- B Otto
- Medical Department, University Hospital-Innenstadt, Ziemssenstr. 1, D-80336 Munich, Germany.
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Pfluger PT, Kampe J, Castaneda TR, Vahl T, D'Alessio DA, Kruthaupt T, Benoit SC, Cuntz U, Rochlitz HJ, Moehlig M, Pfeiffer AFH, Koebnick C, Weickert MO, Otto B, Spranger J, Tschöp MH. Effect of human body weight changes on circulating levels of peptide YY and peptide YY3-36. J Clin Endocrinol Metab 2007; 92:583-8. [PMID: 17119001 DOI: 10.1210/jc.2006-1425] [Citation(s) in RCA: 147] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Recent findings suggest that low plasma peptide YY (PYY) levels may contribute to diet-induced human obesity and justify PYY replacement therapy. Although the pharmacological value of PYY is controversial, further study of the secretion of the precursor PYY(1-36) and the pharmacologically active PYY(3-36) is indicated to determine the potential role in energy balance regulation. AIM Our objective was to determine the effects of acute and chronic changes in human body weight on circulating levels of the putative satiety hormone peptide YY. DESIGN Total plasma PYY levels (PYY(1-36) + PYY(3-36)) were measured in 66 lean, 18 anorectic, 63 obese, and 16 morbidly obese humans. In addition, total PYY was measured in 17 of the obese patients after weight loss and in the 18 anorectic patients after weight gain. Fasting PYY(3-36) levels were measured in 17 lean and 15 obese individuals. RESULTS Fasting total plasma PYY levels were highest in patients with anorexia nervosa (80.9 +/- 12.9 pg/ml, P < 0.05) compared with lean (52.4 +/- 4.6 pg/ml), obese (43.9 +/- 3.8 pg/ml), or morbidly obese (45.6 +/- 11.2 pg/ml) subjects. In obese patients, weight loss of 5.4% was associated with a 30% decrease in fasting total PYY plasma levels. In anorectic patients, weight gain had no effect on fasting PYY. PYY(3-36) levels did not differ between lean (96.2 +/- 8.6 pg/ml) and obese (91.5 +/- 6.9 pg/ml) subjects. CONCLUSION Our findings do not support a role for abnormal circulating PYY in human obesity. We conclude that circulating PYY levels in humans are significantly elevated in anorexia nervosa and, given the controversially discussed anorectic effect of PYY, could theoretically contribute to that syndrome.
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Affiliation(s)
- P T Pfluger
- Department of Psychiatry, University of Cincinnati, Office E-217, Genome Research Institute, 2170 East Galbraith Road, Cincinnati, Ohio 45237, USA
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Cuntz U, Fichter M. Anorexia nervosa und Diabetes mellitus Typ I–Klinik und stationärer Verlauf in 14 konsekutiven Fällen. Psychother Psych Med 2006. [DOI: 10.1055/s-2006-934239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Otto B, Tschöp M, Frühauf E, Heldwein W, Fichter M, Otto C, Cuntz U. Postprandial ghrelin release in anorectic patients before and after weight gain. Psychoneuroendocrinology 2005; 30:577-81. [PMID: 15808927 DOI: 10.1016/j.psyneuen.2005.01.009] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2004] [Revised: 01/24/2005] [Accepted: 01/26/2005] [Indexed: 12/29/2022]
Abstract
The appetite-modulating hormone ghrelin transmits changes in food intake to the central nervous system. In patients with anorexia nervosa, weight gain reduces elevated fasting ghrelin levels to normal, however, less is known about the effects on postprandial ghrelin levels. In 20 female anorectic in-patients (25.6 +/- 1.0 years; body mass index (BMI) 15.1 +/- 0.3 kg/m2) a standardized test with 250 ml fluid meal (250 kcal: 9.4 g protein, 34.4 g carbohydrates, and 8.3 g fat) was performed at three different times (at admission, after partial weight gain of at least 2 kg, and at discharge) and compared to healthy controls (n = 6; BMI 21.1 +/- 0.7 kg/m2). Plasma ghrelin levels were measured preprandially as well as 20 and 60 min postprandially by a commercially available radioimmunoassay (Phoenix Pharmaceuticals, USA). At admission plasma ghrelin levels significantly decreased postprandially (from 871.9 +/- 124 to 620.3 +/- 80 pg/ml 60 min after meal; P < 0.005). After partial weight gain (2.8 +/- 0.1 kg; BMI 16.1 +/- 0.3 kg/m2) postprandial ghrelin concentrations decreased from 597.0 +/- 79 to 414.7 +/- 39 pg/ml (P < 0.0001), at discharge (weight gain: 7.6 +/- 0.5 kg; BMI 17.9 +/- 0.4 kg/m2) from 570.4 +/- 78 to 395.4 +/- 44 pg/ml (P < 0.0001). Mean postprandial ghrelin decrease was not significantly different between the three tests (29, 25, and 26%, respectively) or to controls (20%). In anorectic patients mean postprandial ghrelin decrease did not change during weight gain. These findings indicate that in anorexia nervosa the suppression of ghrelin release by acute changes of energy balance (feeding) is not disturbed and that it is independent from chronic changes in energy balance (weight gain).
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Affiliation(s)
- B Otto
- Department of Medicine, University Hospital Innenstadt, Ziemssenstr. 1, 80336 Munich, Germany.
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Otto B, Rochlitz H, Möhlig M, Burget L, Kampe J, Pfluger P, Castenada T, Krishna R, Bodani U, Mehta K, Cuntz U, Tschöp M, Bidlingmaier M, Pfeiffer A, Spranger J. Circulating Concentrations of Human Peptide YY: Influence of Acute and Chronic Energy Balance Changes. Exp Clin Endocrinol Diabetes 2005. [DOI: 10.1055/s-2005-862856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Otto B, Tschöp M, Cuntz U. Letter to the Editor: Similar fasting ghrelin levels in binge eating/purging anorexia nervosa and restrictive anorexia nervosa. Psychoneuroendocrinology 2004; 29:692-3. [PMID: 15041090 DOI: 10.1016/j.psyneuen.2004.01.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2003] [Accepted: 01/07/2004] [Indexed: 12/12/2022]
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Wilhelm M, Strütt-Neeb P, Opielka C, Cuntz U. Verhaltenstherapeutische Ernährungstherapie für Adipositaspatienten. Verhaltenstherapie 2003. [DOI: 10.1159/000069215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Otto B, Cuntz U, Fruehauf E, Wawarta R, Folwaczny C, Riepl RL, Heiman ML, Lehnert P, Fichter M, Tschöp M. Weight gain decreases elevated plasma ghrelin concentrations of patients with anorexia nervosa. Eur J Endocrinol 2001; 145:669-73. [PMID: 11720888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
OBJECTIVE Ghrelin is a new gastric hormone that has been identified as an endogenous ligand for the growth hormone (GH) secretagogue receptor subtype 1a (GHS-R1a). Ghrelin administration however not only stimulates GH secretion but also induces adiposity in rodents by increasing food intake and decreasing fat utilization. We hypothesized that impaired ghrelin secretion in anorexia nervosa may be involved in the pathogenesis of this eating disorder. To examine this hypothesis and to further investigate the role for ghrelin in regulating energy homeostasis, we analyzed circulating ghrelin levels in patients with anorexia nervosa and examined possible correlations with clinical parameters before and after weight gain. METHODS Plasma ghrelin levels were measured in overnight fasting plasma samples from 36 female patients with anorexia nervosa (age: 25.0+/-1.2 years, BMI: 15.2+/-0.2 kg/m(2)) before and after weight gain following psychotherapeutic treatment intervention in a psychosomatic institution. Plasma ghrelin levels were also measured in fasting plasma samples from 24 age-matched female controls (31+/-1.4 years, BMI: 22.9+/-0.45 kg/m(2)). For quantification of ghrelin levels a commercially available radioimmunoassay (Phoenix Pharmaceuticals, USA) was used. RESULTS Fasting plasma ghrelin levels in anorectic patients were significantly higher (1057+/-95 pg/ml) than in normal age-matched female controls (514+/-63 pg/ml n=24, P=0.02). Therapeutic intervention in a psychosomatic institution caused an BMI increase of 14% (P<0.001) leading to a significant decrease in circulating ghrelin levels of 25%, (P=0.001). A significant negative correlation between Deltaghrelin and DeltaBMI was observed (correlation coefficient: -0.47, P=0.005, n=36). CONCLUSION We show for the first time that fasting plasma levels of the novel appetite-modulating hormone ghrelin are elevated in anorexia nervosa and return to normal levels after partial weight recovery. These observations suggest the possible existence of ghrelin resistance in cachectic states such as caused by eating disorders. Future studies are necessary to investigate putative mechanisms of ghrelin resistance such as a possible impairment of intracellular ghrelin receptor signaling in pathophysiological states presenting with cachexia.
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Affiliation(s)
- B Otto
- Medical Department, Innenstadt, University Hospital, Ziemssenstrasse 1, D-80336 Munich, Germany.
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Hillert A, Staedtke D, Cuntz U, Hafen K. [Therapeutic programmes focusing on job related problems - which psychosomatic patients should participate?]. Rehabilitation (Stuttg) 2001; 40:200-7. [PMID: 11505297 DOI: 10.1055/s-2001-15986] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The necessity to offer special therapeutic programmes focusing on job related problems in psychosomatic rehabilitation has become increasingly evident. Which patients should participate in such programmes? This question has not yet been discussed with regard to its theoretical and methodological implications. In clinical practice the decision has been based on the therapists evaluation. 105 patients, consecutively admitted in a psychosomatic hospital were interviewed with a screening questionnaire about their job related strains and the perceived interaction between symptomatology and job. According to the literature guidelines for inclusion of psychosomatic patients to a special work hardening programme were used. Therapists were asked to independently assign their patients to the programme. The overlap between the two procedures was small. While the guidelines focussed on a high level of job strain and the patient's motivation for a job-related therapeutic approach, the therapists' decision was based on duration of inability to work, impairments at work due to the symptoms, conflicts with colleagues at work and the patient's ability to perceive problems in a differentiated manner. Considering the problem of inclusion-criteria for a work hardening programme, the highly complex constellations behind routine therapeutic decisions in psychosomatic rehabilitation became evident. To integrate medical diagnosis, symptomatology, psychological models, job strain, the patient's social situation and values, is a neglected but important goal of rehabilitation sciences and should be a base for a concept guiding the development, evaluation and establishment of work related therapeutic programmes.
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Affiliation(s)
- A Hillert
- Medizinisch-Psychosomatische Kinik Roseneck, Prien am Chiemsee, Germany
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Abstract
OBJECTIVE The goal of the present study was to identify covariates and predictors of post-treatment weight reduction. To clarify the impact of the individual factors, we compared "winners" (losing more than 2 BMI-points in the follow-up period) with "losers" (gaining more than 2 BMI-points in the same time). DESIGN In a questionnaire based study, we evaluated the psychological impact on eating behavior, general psychopathology and depressive symptoms at three points in time: three months prior to admission (T0), at the beginning (T1) and at the end of in-patient treatment (T2) as well as 6, 12, and 18 months after treatment (T3-T5). SUBJECTS One hundred and thirty eight obese patients (BMI<30 kg/m(2)) were recruited to the study. All patients participated in a multimodal in-patient treatment program over a period of 10 weeks. Treatment elements were cognitive behavioral therapy, movement therapy, and nutritional counseling. The aim of treatment was to regulate food intake, to minimize dysfunctional emotional influences on eating behavior, to enhance physical exercise and to treat comorbid psychiatric disorders. Twenty nine patients (13%) of the initial sample dropped out or were excluded during the treatment and post-treatment period. RESULTS During in-patient treatment eating behavior improved and body weight decreased considerably in all patients. The weight reduction continued slightly in the follow-up period. Moreover, general psychopathology, depressive symptoms and eating behavior improved and remained stable during follow-up. These benefits were closely related to weight reduction. Neither eating behavior, nor eating related cognition nor psychopathology measured at T0 and T1 predicted long term success at T5. "Winners" as compared to "losers" at follow-up showed less psychopathology, less depressive symptoms and a less disturbed eating behavior. Already at discharge (T2), winners were less prone to eating triggered by external stimuli and reported fewer feelings of hunger. These differences predicted post-treatment weight reduction (T3-T5). CONCLUSION Reported feelings of hunger and the tendency to disinhibited eating behavior measured at discharge were able to predict post-treatment weight reduction in our sample. Patients suffering from a feeling of hunger during in-patient treatment were less likely to show further weight reduction in the follow-up period. Similarly, reduction of "disinhibition" during treatment is a precondition for post-treatment weight loss.
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Affiliation(s)
- U Cuntz
- Medizinisch-Psychosomatische Klinik Roseneck, Am Roseneck 6, 83209 Prien am Chiemsee, Germany.
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Rief W, Cuntz U, Fichter MM. [Diagnosis and treatment of somatoform disorders (functional physical complaints)]. Versicherungsmedizin 2001; 53:12-7. [PMID: 11256014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
In modern classification systems, unexplained physical symptoms without an organic origin are labelled "somatoform disorders". This syndrome is very frequent and causes a lot of treatment costs as well as indirect costs (such as workers' compensation and others). In the past, effective treatment strategies were lacking. However, consideration of modern scientific results has made it possible to develop treatment approaches which find the acceptance of the patients and which are highly effective. A hierarchical approach is presented suggesting the following steps: a) Primary care: The consideration of management rules in primary care can prevent the chronicity of somatoform symptoms. b) Brief psychological and psychopharmacological treatments: Modern cognitive-behavioural approaches can help to cope with the symptoms and to improve the subjective well-being. First results for pharmacological treatments are encouraging. c) Integrative inpatient treatment including intense psychotherapeutic and psychosomatic ingredients. Experts' judgements of course and prognosis in somatoform disorders should consider the following features: Duration and multiplicity of the complaints; comorbidity with other psychiatric and physical disorders; disability in different areas of life such as at work, family, leisure time; individual coping strategies; treatment approaches in the past.
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Affiliation(s)
- W Rief
- Medizinisch-Psychosomatischen Klinik Roseneck, Prien am Chiemsee
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Abstract
The authors examined whether patients suffering from functional gastrointestinal symptoms constitute a separate group within the broader concept of the somatoform disorders. The authors compared 103 patients with a severe gastrointestinal syndrome, 220 patients with a somatization syndrome according to DSM-IV, and 250 clinical control subjects with nonsomatoform mental disorders. The gastrointestinal group showed more catastrophizing thinking, complained more about autonomic sensations, felt bodily weaker, was less tolerant towards bodily discomfort, had developed more hypochondriacal fears and behaviors, was more depressed, and was more severely disabled in different areas of psychosocial functioning than the other groups. These differences, however, disappeared when general somatization was controlled for by analysis of covariance. Only a small effect related to dysfunctional cognitions remained specific to the gastrointestinal syndrome. Because these results do not confirm the idea of an independent gastrointestinal syndrome, general mechanisms of somatization seem to play the dominant role.
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Affiliation(s)
- W Hiller
- Roseneck Center of Behavioral Medicine, Prien, Germany.
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Abstract
OBJECTIVE Starvation severely affects normal pancreatic function in children suffering from Kwashiorkor and in animals undergoing food deprivation. This study examines whether pancreatic size, as determined by ultrasound, is dependent on starvation or on eating patterns in patients with eating disorders. METHOD In 109 inpatients with eating disorders, 86 with anorexia nervosa and 23 with bulimia nervosa, we determined the pancreatic size by means of abdominal ultrasonography before increase in weight. Twenty-four inpatients with other psychiatric disorders served as controls. Pancreatic size was defined by the maximal diameter and the length of the head, the diameter of the head at the confluence of the splenic and mesenteric veins, and the diameters of the body and tail. In 41 eating disorder patients, pancreatic size was also measured during the course of therapy and increase in weight. RESULTS Pancreatic size correlates highly with body mass index (BMI). Counteracting actions such as purging do not seem to influence this pathophysiologic finding. Dystrophy of the pancreas is reversible in a short period of time. The increase in pancreatic size after maintenance of a normal eating pattern, however, exceeded the size expected by regression equation with an increase in the BMI. Pancreatic size seems to correlate with the actual amount of digested food. The increase in BMI is only an indicator of food intake. DISCUSSION Pancreatic size might therefore be useful for the assessment of normalization of the eating pattern. Future research is necessary to investigate the impairment of pancreatic function resulting from dystrophy, the impact of possible pancreatic malfunction on the course of eating disorders, and the regulatory mechanisms responsible for the change of pancreatic size.
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Affiliation(s)
- U Cuntz
- Klinik Roseneck, Center for Behavioral Medicine, Prien am Chiemsee, Germany.
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Cuntz U, Welt J, Ruppert E, Zillessen E. [Determination of subjective burden from chronic inflammatory bowel disease and its psychosocial consequences. Results from a study of 200 patients]. Psychother Psychosom Med Psychol 1999; 49:494-500. [PMID: 10634068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
Somatic symptoms of chronic organic diseases do not sufficiently explain the degree to which the individual's daily life is impaired. Quality of life questionnaires are increasingly used to measure long term effects of therapy and rehabilitation. The present study is concerned with determining factors associated with the quality of life of patients suffering from inflammatory bowel disease (IBS). We investigated 200 consecutive inpatients with IBS (Crohn's disease 119, ulcerative colitis 81; 142 males, females; mean age 36.8 years) of the Niederrhein Clinic, a centre for gastroenterologic diseases and metabolic disorders. We assessed sociodemographic data of the last three years, the results of all recent clinical examinations (pattern and extension of inflammatory lesions) CDAI and CAI to determine the activity of the disease, expert ratings of disease severity as well as impact on family, partnership, social environment and leisure activities, psychometric data concerning anxiety (STAI), depression (Paranoid-Depressivitätsskala), and coping (FKV). The subjective impairment was measured by structured interviews. The inflammatory activity of IBS and the intensity of symptoms correlated only insignificantly with the subjective impairment. Depression (as measured by the Paranoid-Depressivitätsskala) and a depressive style of coping (FKV) revealed to be the best predictors for subjective impairment. For patients with a mild to moderate degree of IBS quality of life does not significantly depend on the degree and severity of disease. A depressive coping style seems to be a crucial target of rehabilitation and psychotherapy in IBS.
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Affiliation(s)
- U Cuntz
- Medizinisch-psychosomatische Klinik Roseneck, Prien/Chiemsee
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Cuntz U. Patienten mit Somatisierungssymptomen in der Arztpraxis – zwischen der Gefahr der Chronifizierung und der Chance zur Besserung. Verhaltenstherapie 1998. [DOI: 10.1159/000030633] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Cuntz U, Pollmann H, Enck P. [Behavior therapy in gastrointestinal functional disorders]. Z Gastroenterol 1992; 30:24-34. [PMID: 1557923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Almost all functions of the gastrointestinal tract have been shown to be under central nervous control and to respond to environmental factors such as stress. It is, therefore, not surprising that disturbed gastrointestinal functions may be altered through psychological therapy approaches. For motor dysfunctions of the esophagus and functional dyspepsia, there is a lack of behavioral therapy studies, while controlled studies utilizing relaxation techniques, stress management strategies and anxiety treatment have been shown to improve symptoms and prevent recurrence in reflux esophagitis and peptic ulcer disease despite the wide use of effective medication. Most studies have treated patients with symptoms of the irritable bowel syndrome: This approach usually combined conventional medical treatment with psychotherapy. Psychological management usually consisted of relaxation training, stress management and patient information. Additional behavioral modification, e.g. of eating and defecation behavior, is superior to pharmacological and dietary management alone. The role of biofeedback therapy in these patients remains to be clarified in the future. It is, however, therapy of choice in some patients with constipation due to spastic pelvic floor syndrome and in fecal incontinence, if the external anal sphincter is insufficient to maintain continence. There ist a systematic lack of treatment opportunities as compared to the number of patients seeking health care for functional bowel disorders.
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Affiliation(s)
- U Cuntz
- Klinik Niederrhein, Bad Neuenahr
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