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Kocalevent, Rüya-Daniela; Fliege, Herbert; Rose, Matthias; Walter, Marc; Danzer, Gerhard; Klapp, Burghard F.
doi: 10.1159/000085143pmid: 15947509
Background: The phenomenon ‘autodestructive behaviour’ is becoming an increasingly serious disease and cost factor in a wide range of medical fields. The present paper presents a survey of the literature on autodestructive behaviour, excluding psychotic, substance-induced or organic brain disorders. Starting out with a conceptual overview, the paper goes on to look into the epidemiology of autodestructive behaviour and the forms in which it manifests itself. Method: A literature search was conducted in Medline, Psycinfo and Psyndex using the search terms ‘artifact’, ‘artificially induced’, ‘autodestructive’, ‘self-mutilation’, ‘factitious’, ‘self-harm’, ‘self-induced’, ‘self-inflicted’, ‘self-injuring’ and ‘self-mutilation’ for the period from 1977 to 2003. Results: Five of a total of 18 empirical studies describe the simultaneous occurrence of direct and indirect forms of autodestructive behaviour. Reported prevalence rates range from 0.032% to 9.36%. The ratio of females to males was found to be 2:1 (average age: 31.5 years; SD: 9.3 years); in contrast, the gender ratio was reversed for Munchausen’s syndrome. The case history data presented are patchy and differ in terms of their priorities. We found a large number of codiagnoses, which seems to indicate that personality and dependence disorders, or substance misuse, are characteristic of both direct and indirect forms of autodestructive behaviour. Conclusions: The task at hand is to use a yet-to-be-developed nomenclature and adequately operational diagnostic criteria to work out standardised survey instruments that do justice to the heterogeneity of this disorder complex.
Belaise, Carlotta; Fava, Giovanni A.; Marks, Isaac M.
doi: 10.1159/000085144pmid: 15947510
Background: Psychological debriefing uses brief unsystematic exposure, and is ineffective for posttraumatic stress symptoms and disorder. Systematic exposure alone and cognitive restructuring alone are each effective. Other approaches too may be useful. Methods: The treatment of 3 posttraumatic stress disorder (PTSD) patients is detailed in which there was no exposure to the main traumatic event.There was exposure to related cues in case 1, exposure to related and other cues followed by well-being therapy (WBT) in case 2 and WBT in case 3. Results: The 3 patients improved enduringly, confirming earlier findings that exposure to the main trauma is not essential for PTSD to improve. Conclusions: A study is needed of therapeutic mechanisms in PTSD and of the value of WBT in a randomized controlled trial.
Bazelmans, E.; Prins, J.B.; Lulofs, R.; van der Meer, J.W.M.; Bleijenberg, G.
doi: 10.1159/000085145pmid: 15947511
Background: It has been demonstrated that individual cognitive behaviour therapy is an effective treatment for chronic fatigue syndrome (CFS). The aim of the present study was to investigate the effectiveness of cognitive behaviour group therapy (CBGT) in an unselected group of CFS patients. Additionally, pretreatment characteristics of CFS patients who improve after CBGT were explored. Methods: In a non-randomised waiting list controlled design, 31 patients were allocated to CBGT and 36 to the waiting list condition. CBGT consisted of 12 two-hour sessions during 6 months. Main outcome measures were fatigue (Checklist Individual Strength) and functional impairment (Sickness Impact Profile). Results: A moderate effect on fatigue in favour of CBGT was found. For functional impairment, the effect was opposite to what was expected. Patients who improved after CBGT had less complaints at baseline compared to patients who did not improve. Conclusions: An explanation for the moderate effect might be that during CBGT, rest and relaxation were too much emphasised. Furthermore, an unselected group of CFS patients and therapists inexperienced in CB(G)T for CFS participated. Suggestions to improve CBGT for future research are given.
Berardi, Domenico; Menchetti, Marco; Cevenini, Nadia; Scaini, Sara; Versari, Matteo; de Ronchi, Diana
doi: 10.1159/000085146pmid: 15947512
Background: Underrecognition and undertreatment of depression in primary care has been regarded as a major public health problem. In contrast, some studies found that among patients labeled as depressed by primary-care physicians (PCPs), a relevant proportion do not satisfy international diagnostic criteria for depression. The aims of this study are: (1) to assess disparity between PCP diagnosis and research diagnosis of depression; (2) to compare antidepressant treatment in concordant and discordant cases of depression. Methods: Data are gathered from a national survey on depressive disorders in primary care, conducted with the collaboration of 191 PCPs. Three hundred and sixty-one PCP patients were evaluated, and their psychiatric diagnosis was established by the ‘unaided’ PCPs and by using a research interview for depression. Results: PCPs recognized 79.4% of cases of depression and prescribed antidepressants to 40.9% of them. Yet, 45.0% of patients labeled as depressed by the PCPs were not cases of depression according to ICD-10 criteria; 26.9% of false-positive cases received an antidepressant. Globally, 35% of antidepressants for ‘depression’ were prescribed to false-positive cases. Conclusions: Underrecognition and undertreatment of depression in primary care seem to be less alarming. Conversely, PCP diagnoses of depression appear to be more inclusive than psychiatric diagnostic criteria. A possible consequence of this apparently more inclusive diagnostic threshold may be an excessive use of antidepressants. These changes require a corresponding change in research, toward efficacy and safety of the treatment of milder cases, and in education, toward the distinction between the management of mild and severe cases of depression.
Schleicher, Holly; Alonso, Carmen; Shirtcliff, Elizabeth A.; Muller, Daniel; Loevinger, Barbara L.; Coe, Christopher L.
doi: 10.1159/000085147pmid: 15947513
Background: Few studies have examined the potentially beneficial role of positive psychological functioning in individuals with chronic pain. This study examined the relationship of psychological well-being (PWB) to pain and disability in women with fibromyalgia (FM) as compared to women with rheumatoid arthritis (RA) and healthy controls (HC). We targeted several domains of PWB that have been associated with health, and also tested whether PWB was related to the women’s social network. Methods: PWB, pain, and disability were assessed in 125 women (57 with FM, 20 with RA, and 48 HC) on two occasions. Results: Women with FM reported lower overall PWB than did RA and HC women. Further, greater PWB was associated with less disability and fatigue, but not pain in women with FM. Self-acceptance, environmental mastery, purpose in life, and positive relations with others emerged as four important constructs in the association between PWB and disability. In addition, PWB mediated the relationship between social network size and disability. Conclusions: This assessment of PWB provides insight into those psychological domains that should be emphasized in treatments aimed at reducing the disabling aspects of FM.
Spitzer, Carsten; Siebel-Jürges, Ute; Barnow, Sven; Grabe, Hans Joergen; Freyberger, Harald J.
doi: 10.1159/000085148pmid: 15947514
Background: Interpersonal relationships are substantially codetermined by nonverbal communication, e.g. facial affect. Given the deficits of nonverbal affect recognition and expression in alexithymia, we hypothesized that alexithymics had more interpersonal problems than nonalexithymic individuals, and that the various facets of the alexithymia construct are differentially related to interpersonal problems. Method: 149 subjects participating in an inpatient group psychotherapy program completed the Toronto Alexithymia Scale (TAS-20) and the Inventory of Interpersonal Problems (IIP-C) at the beginning of the treatment. The IIP-C was also administered to a subgroup at the end of the treatment. Results: Based on the alexithymia scores, patients were classified as low- (TAS-20 score ≤51), moderate- or high-alexithymic (TAS-20 score ≧61). High-alexithymic patients had significantly more interpersonal problems than low alexithymics, particularly in the IIP-C scales indicating hostility and social avoidance. The TAS-20 subscale difficulty describing feelings showed the highest correlations with interpersonal problems (r between 0.23 and 0.55). At the end of the treatment, the high alexithymics still scored highest on the IIP-C, but the magnitude of change in interpersonal problems did not differ across the groups. Conclusions: Our findings suggest that the interpersonal style of alexithymic individuals is characterized by a cold and socially avoidant behavior, corresponding to the predominantly insecure attachment pattern found in alexithymia. Additionally, our results indicate that group psychotherapy is as helpful for alexithymic as for nonalexithymic subjects with respect to interpersonal problems. Finally, we propose that alexithymia involves a reduced capacity to use social interactions for affect regulation.
Mangweth, Barbara; Hausmann, Armand; Danzl, Claudia; Walch, Thomas; Rupp, Claudia I.; Biebl, Wilfried; Hudson, James I.; Pope Jr., Harrison G.
doi: 10.1159/000085149pmid: 15947515
Background: The risk factors for adolescent eating disorders are poorly understood. It is generally agreed, however, that interactions with one’s body and interactions with others are two important features in the development of anorexia and bulimia nervosa. Therefore, we assessed a variety of childhood body-focused behaviors and childhood social behaviors in eating-disordered patients as compared to non-eating-disordered subjects. Method: We compared 50 female inpatients with eating disorders (anorexia or bulimia nervosa), 50 female inpatients with polysubstance dependence, and 50 nonpatient female control subjects with no history of eating or substance abuse disorders (all defined by DSM-IV criteria), using a semi-structured interview of our own design. We asked questions about (1) childhood body-focused behaviors (e.g. thumb-sucking) and body-focused family experiences (e.g. bodily caresses), and (2) childhood social behaviors (e.g. numbers of close friends) and family social styles (e.g. authoritarian upbringing). Results: Many body-focused measures, such as feeding problems, auto-aggressive behavior, lack of maternal caresses, and family taboos regarding nudity and sexuality, characterized eating-disordered patients as opposed to both comparison groups, as did several social behaviors, such as adjustment problems at school and lack of close friends. However, nail-biting, insecure parental bonding, and childhood physical and sexual abuse were equally elevated in both psychiatric groups. Conclusion: It appears that eating-disordered patients, as compared to substance-dependent patients and healthy controls, show a distinct pattern of body-focused and social behaviors during childhood, characterized by self-harm, a rigid and ‘body-denying’ family climate, and lack of intimacy.
doi: 10.1159/000085150pmid: 15947516
Background: Patients with treated episodes of depression are at high risk of relapse and recurrence. This study describes the clinical course of patients who had received cognitive-behavioral group intervention for relapse prevention. Method: Forty-four remitted unipolar depressed patients with recently treated episodes of illness participated in a 16-week group program, the ‘Coping with Depression Course’ (CWD). The majority of patients had suffered from multiple episodes of depression and nearly half of them were only partially remitted when they started the program. Assessments took place throughout the intervention and 17–23 months after the pretest. Descriptive analyses included proportions of reliable and clinically significant improvements, and cumulative relapse rates were estimated using survival analysis. Results: At posttest, residual depression and dysfunctional attitudes had significantly decreased. Improvements were similar in patients with and those without parallel antidepressant medication. Two thirds of patients starting within a dysfunctional depression range showed a clinically significant improvement at the end of the intervention. The estimated cumulative relapse rates at 6, 12, 17, and 23 months after pretest were 13.6, 30.0, 37.0 and 44.9%. Conclusions: Participants appeared to be protected from relapse during active intervention, but a substantial proportion suffered relapses in the postintervention period. Further research into the CWD is needed within the framework of randomized controlled trials.
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