[Experience of pregnancy for women with pregnancy-induced hypertension]

BACKGROUND AND OBJECTIVE

The experience of pregnancy for women with pregnancy-induced hypertension (PIH) is compared to the experience of women with a normal pregnancy course in order to gain insights into the development of PIH and possible strategies for prevention and care.

PATIENTS AND METHODS

This study was performed as a retrospective investigation of 21 women - 10 with PIH and as control group 11 with uncomplicated pregnancies - between 5 and 13 months after delivery by means of an interview relating to their experience of pregnancy. The interviews were evaluated by qualitative text analysis with categorisation. The specific categories "planning of pregnancy", "affective complaints", "significant others", "work" and "out-patient care" were compared between cases.

RESULTS

The interviews with women with PIH revealed a significantly more conflict-shaken pregnancy, often unplanned and undesired. Also during pregnancy there were severe conflicts with relevant third persons. A weak expression of their emotions was observed. Additionally, the majority of women reported a rather disturbed relationship with their physicians.

DISCUSSION

Stress and PIH are intertwined. This is presented in the literature available about this subject. Qualitative research produces only contextual and subjective evidence, nevertheless this is the most concrete base that one can obtain. Only a readiness to deal with conflicts developing during pregnancy and the expression of also negative emotions towards relevant third persons would be helpful to cope with one's own negative feelings.

CONCLUSIONS

The practical impact on care for women with PIH is awareness for their underlying conflicts, weak emotional expressivity and provision of an adequate supply of psychological support.

[A favourite adversary: "classic long-term psychoanalysis". Commentary on Rief and Hofmann's "Psychoanalysis should be rescued. By all means?"]

Rief and Hofmann (2009, Nervenarzt 80:593-597) harshly criticise the meta-analysis on the effectiveness of long-term psychodynamic psychotherapy (LTPP) by Leichsenring and Rabung (2008, JAMA 300(13):1551-1565). They find fault with the inclusion of naturalistic studies in addition to randomised clinical trials. Furthermore, they criticise the heterogeneity of the treatments included and the disorders studied. They suspect that a number of RCTs of LTPP with negative results for LTPP have been done and not been published. This paper comments on the following issues: the strict determination of RCTs is scientifically outdated and in order to investigate the effectiveness of psychotherapy naturalistic studies have to be included; the heterogeneity of studies included in meta-analysis as well as the heterogeneity of the patients studied reflect clinical reality, which is the purpose of effectiveness studies. The accusation of repressing results of LTPP RCTs is unsustainable. All in all, the meta-analysis by Leichsenring and Rabung was done accurately, and the results were controlled for by separate analyses of single subgroups. Therefore, their study does provide evidence of the effectiveness of long-term psychodynamic psychotherapy for patients with complex mental disorders.

Living donor liver transplantation and its effect on the donor-recipient relationship--a qualitative interview study with donors

An important aspect in the preoperative evaluation and a legal precondition for an living donor liver transplantation (LDLT) is a family or emotionally close relationship between donor and recipient. We investigated the development of the donor-recipient relationship after LDLT. We conducted semi-structured clinical interviews with 18 donors as part of a regular postoperative follow-up and analyzed them using the method of Grounded Theory. The donation does not lead to any major changes in the donor-recipient relationship, probably due to careful pre-selection. It does however enhance the existing positive or conflicting character of the relationship. Donors sometimes downplay negative aspects in the relationship and emphasize the improvement as a way of dealing with a major life event. A donation cannot fulfill expectations linked to it and it is unfavorable to be used to improve the relationship. Potential misuse or instrumentalization of the donation by the donor are possible. Postoperative feelings of gratitude are an issue after surgery. A good relationship enhances a better management of the postoperative course. The preoperative donor-recipient relationship should be as free of conflict as possible. A thorough preoperative evaluation of the donor-recipient relationship is particularly important to assess the donors' suitability and clarify conflicts and unrealistic expectations.

Counselling versus Selbsthilfemanual bei ambulanten Tinnituspatienten

BACKGROUND

Counselling is a basic psychological intervention for chronic tinnitus the effectiveness of which has not yet been evaluated.

SCIENTIFIC QUESTION

The therapeutic effect of counselling was compared to that of a self-help manual. Outcome was analysed for tinnitus disability, tendency to become chronic, and accompanying psychiatric disorders.

METHODS

A total of 75 tinnitus outpatients were randomly assigned to group counselling (n=35) and self-help (n=40). Tinnitus disability, general psychological disturbances, depression, anxiety, coping and illness beliefs were measured using questionnaires (TQ, SCL-90-R, BDI, BAI, FKV, KKG) administered before and after treatment and at a 6-month follow-up. Psychiatric disorders (DSM-IV) were assessed using the CIDI.

RESULTS

Counselling and the self-help manual had a significant effect on tinnitus disability, showing most profit for participants with a high level of tinnitus distress. The significant reduction in tinnitus distress was maintained at the 6-month follow-up. There was, however, no difference between the two treatment-groups. Effect-sizes for patients with DSM-IV-diagnoses were smaller.

CONCLUSION

For tinnitus outpatients without psychiatric comorbidity, self-help manuals can be an effective first treatment.

Psychische und somatische Aspekte der Leberlebendspende: Präoperative Evaluation und postoperativer Verlauf

BACKGROUND AND OBJECTIVE

Living donor liver transplantation (LDLT) has been gaining importance in the treatment of end-stage liver disease in adults as a partial solution to the growing organ shortage. Thus far, only few empirical studies have been published on the situation of donors who are faced with the risk of medical complications after resection of the right hepatic lobe.

PATIENTS AND METHODS

87 potential donors were preoperatively assessed in the years 2000 and 2001 at the Charité Berlin. 41 potential donors were excluded, 46 donors (31 women, 15 men, mean age 41 [19 - 67] years) underwent liver surgery and were re-assessed 6 months after the operation. The frequency of postoperative complications and the course of psychosocial parameters were investigated. Donors' moods were analysed with the Berlin Mood Questionnaire, the physical complaints were assessed with the Giessen Complaint Questionnaire. The preoperative interviews of 20 potential donors were analysed according the current social qualitative research methods.

RESULTS

In 11 % (n = 10) of potential donors transplantation was not recommended for psychosocial reasons because they showed a marked ambivalence towards the operation. After operation, 22 % (n = 12) of donors had postoperative complications. Most relevant single causes of severe impairment were temporary and reversible biliary leakages from the cutting edge. There were no long- term complications. 26 % (n = 10) of donors showed postoperative high values for anxious depression and physical complaints.

CONCLUSIONS

The resection of the right hepatic lobe holds promise of a good psychosocial outcome for most donors, irrespective of donation-related complications. The psychosocial impairment and physical complaints of some donors after transplantation are yet not clearly understood. Further psychosocial studies will be necessary to develop criteria for an evidence based medical care of living donors.

Willingness to donate: an interview study before liver transplantation

OBJECTIVES

The introduction of the living donation in organ transplantation introduces important new psychological conflicts and ethical questions in the transplantation process. Operation related risks, as well as dependencies in the family structure, generate considerable pressure on potential donors. The aim of the study was to reconstruct the determinants of willingness to donate before transplantation.

METHODS

Evaluation of 20 taped and transcribed interviews oriented to current approaches in qualitative interview research. The approach used is based on grounded theory, qualitative content analysis, and the concept of the ideal type.

RESULTS

Before surgery, "openly motivated" donors push for an operation, leaving no room for ambivalence in the evaluation process. They idealise the relationship with the recipient, and link their donation with the individual-partly in subconscious expectations and wishes. In contrast, "openly ambivalent" donors formulate their anxieties and express arguments against donation.

CONCLUSIONS

Statements that claim ambivalence towards donation or utterance of arguments against donation indicate earlier coercion. Before transplantation, potential donors should have the opportunity to discuss their emotional situation to help their decision making process.

[The significance of structural dynamics for a theory of neurosis and personality disorders]

Following the psychopathological approach of Janzarik (structural dynamics), this paper develops a two-dimensional theory for the understanding of neuroses and personality disorders. The dynamic dimension serves to describe the symptomatology between the two poles of anxiety and depression. The structural dimension differs according to the maturity of the personal identity between mature neurotic personality organization on the one hand and severe personality disorder on the other.

[Psychiatric disorders caused by global social change. Traumatization among the inhabitants of the former GDR]

More than a decennium after the reunion of East and West Germany, the psychological sequelae of traumatic experiences of East Germans are still evident. There were not only about 300 000 people imprisoned for political reasons in the German Democratic Republic between 1945 and 1989, partly exposed to physical and psychological torture, but also much more people subject of subthreshold traumatic experiences by harassment in public and private life. As a result, under a psychiatric perspective it should be taken into account not only specific post-traumatic stress disorders (PTSD), characterized by relieving of the traumata in intrusive flashbacks, avoidance of circumstances associated with the traumatic experiences, and increased psychological sensitivity and arousal, but also specific Adjustment disorders, or cultural shocks: many people of the former GDR had to deal with adjustment difficulties of different types to the new cultural environment after the reunion, which could be characterized as becoming intimate with post-modern Western culture within a process of identity development. This process encloses different phases or stages discussed under psychopathologic and psychodynamic perspective.

[Not Available]

Endometriosis is one of the most frequent gynecological disorders in the reproductive age. Discrepancies between clinical findings and subjective Symptoms cause the question of the determing factors for the subjective experience. In the present study an hermeneutic, sense-orientated approach was employed by using qualitative methods of research. Eleven interviews with endometriosis patients were recorded on tape and transcribed, followed by an individual-case and a comparative analysis in partly deductively and inductively defined categories. The psychosexual development has been found as negatively influenced. Endometriosis patients show conflicting concepts of their sex-specific role. A found aggression conflict manifests itself in the pain Sensation, at an intrapsychic land an interpersonnel level: it influences the relations with other persons, in particular, the doctor-patient relationship. Changes of sense in the doctor-patient-relationship and recent concepts of psychosomatic disorders are discussed.

Psychopathologic and zoological aspects of acarophobia

Acarophobia represents a nosologically inconsistent psychiatric clinical picture which is exceptional in that it is noticed among the clientele of those in charge of pest control, hygienists, health department medical officers and dermatologists rather than in psychiatric practice or mental hospitals. Apart from acarophobia in the course of schizophrenic, affective and organic psychoses as well as cases in which the phobia was induced by another individual, roughly half of the cases were 'pure' forms, i.e. monosymptomatic psychoses mainly occurring at advanced age and in females. Putative parasitisation relates not only to the subject's skin, but also to the premises where the person affected is living. Social isolation appears to rank high among essential causes. Four cases from a pest controller's practice are reported which could not be properly treated because of the subjects' lack of insight into their condition. In this light, it was the aim of the present study to focus the attention of pest controllers and hygienists on interdisciplinary co-operation with psychiatrists as well as with public health departments.

Qualitative research in diagnostic processes

Social sciences, in general, and psychotherapy, in particular, have been informed by two fundamentally distinct methodologies of description and explanation: firstly, causal nomology based on operationalized data, and secondly, empirical hermeneutics focused on the meaningful context of intentions, experiences and actions. The paper deals with the second of these two methodologies in the context of research on psychotherapeutic diagnosis. This paradigm is a methodology for evaluating certain aspects of quality of life which deal with the subjective and interpersonal meaning of symptoms.

[Max Weber's disease. Research on the disease and therapeutic management at the turn of the century]

This article on the German economist and sociologist Max Weber (1864-1920) continues our pathographic and psychohistoric studies on the interrelations between his life, his illness, and his work on "Protestantic Ethics and the Spirit of Capitalism". In a former paper (Frommer u. Frommer, 1993) we focussed on Weber's definition of modern society as an "iron cage" determined by Western rationalism. His theory, which shows that this cultural background demands a great amount of role conformity from the individual, converges with current psychopathological approaches on the personality of depressed patients. In the second article we report on results of our research on further personal documents, and some medical certificates by Weber's physicians. These documents demonstrate the diagnosis of a severe depression in a narcisstic and hypernomic personality.

[From hysteria to nervousness. Comments on Willy Hellpach's sociopathologic prognoses for the 20th century]

The very rich, extensive, and complex work of the psychologist, doctor of medicine, and politician Willy Hellpach (1877-1955) is largely forgotten today. Our article sheds light upon his contribution to the nosology of neuroses, which emphasizes the impact of history, society, and culture on the neurotic syndromes. Hellpach states that during the process of civilisation hysteria is more and more replaced by nervousness. In contemporary nosology this hypothesis leads to the discussion how the relationship of neuroses with depressive symptomatology on the one hand and neuroses with panic attacks and phobia on the other should be conceptualised.

[New approaches for understanding borderline personality disorder]

The concept of Borderline Personality Disorders was developed from North-American psychiatric and psychoanalytic thought. During recent years different contributions on this disorder emerged from several psychological paradigms. Four current trains of research are reviewed: Approaches based upon the five-factor-model of personality, Linehan's behavioristic approach, interpersonal concepts as shown by Benjamin and a self-developed subject-centered approach focussing on the patients' subjective theories of illness. These models converge into a concept which interprets Borderline Personality Disorders as disturbances of personal identity. The patients fail when attempting to overcome the tension between being a person and being a subject in their interpretation of the world and themselves. At the end of the article consequences for therapy are highlighted.

[Music therapy single case research--a qualitative approach]

A qualitative approach for describing music psychotherapy treatment is developed. For this purpose we employ the methodological principle of triangulation of perspectives (patient, therapist, independent observers, composers). Our approach is based on the concept of the resonator function describing the perceptive capacity of all participants for effective and relationship-referred significance of the work produced during the treatment. The qualitative method importing and extending the knowledge of the inner context of the case is illustrated by two musical improvisations from the treatment of a female patient suffering from chronic migraine.