Search

Introduction: In January 2016, 2057 refugees from civil war-torn Syria and Iraq, aged 18.0 to 24.9 years, were first-time entrants into the German unemployment register and thus potentially eligible for the labor market. Civil war and forced migration may affect individuals' mental health. Traumatic experiences in particular are assumed to represent a major barrier, e.g., to labor-market integration. This study aimed to screen the rates of posttraumatic stress disorder (PTSD). Former refugee studies have reported PTSD screening rates between 3% and 44%. Method: A total of 8.5% (N = 175 of 2057) of respondents were randomly interviewed either by telephone or web-based interviews. A total of 84 respondents (48% out of 175 respondents) were screened using the Essen Trauma Inventory (ETI) based on the DSM-IV, and 91 (52%) respondents used the Short Screening Scale for Posttraumatic Stress Disorder (SSS-PSD). All respondents were additionally questioned regarding psychological impairment (Symptom Checklist 10) and health status (Short Form 12). Results: Of the respondents, 59.4% reported at least one traumatic experience. The percentage of positive PTSD screenings obtained using the ETI was 9.5% (N = 84) and 6.6% (N = 91) using the SSS-PSD. The percentage of positive PTSD screenings obtained with both screening instruments was 8% (N = 175; 95%-CI: 3.9% to 12.1%). A total of 19.4% of the subjects were above the SCL-10 cut-off for psychiatric caseness. Discussion: The PTSD rate in this sample was in the average range compared to previous estimates from large samples of refugees. Psychiatric caseness was high. The results should be considered for planning labor-market integration programs and the design of supportive schemes. Keywords: Posttraumatic Stress Disorder, PTSD, Psychopathology, Refugee, Unemployment

Introduction Frailty has been discussed as a predictor of morbidity and mortality for liver cirrhosis. The aim of our study is to evaluate the role of frailty in liver transplantation, particularly for patients with MELD scores < 15. Methods All patients listed for liver transplantation between September 2015 and November 2018 were prospectively included in the study. Frailty was assessed by Fried’s frailty classification. Pre-, intra-, and postoperative data were prospectively recorded. Univariate and multivariate regression analyses were performed. The ethical approval of the institutional board review was obtained for the study. Results There were 114 patients included in the study, and their median MELD score was 16. Of these, 86 patients were defined as frail (75.4%). A total of 62 patients (54.4%) underwent liver transplantation, 11 (17.7%) died postoperatively, and 24 patients (21.0%) died while on the waitlist. All postoperative mortality cases were frail, and only 3 patients (12.5%) were non-frail in the waitlist mortality group. There were 14 patients who had MELD scores of <15 (58.3%). The overall survival of non-frail patients was significantly better than that of frail patients. The multivariate regression analyses identified frailty criteria, including unintended weight loss and low hand grip strength, and platelet count and being married or living in a solid partnership were prognostic factors for survival in all patients. Conclusion The addition of frailty assessment can be beneficial for predicting mortality after liver transplantation, especially in patients with low MELD score. Frail patients on the waitlist have significant risk for mortality even with low MELD score.

INTRODUCTION AND OBJECTIVE:Male to female (MtF) gender affirming surgery (GAS) comprises the resection of the testes and the erectile tissue and formation of a functional and aesthetic vaginal cavi...

This study investigates the role of body image self-appraisal in predicting the outcomes of outpatient psychotherapy in patients with anorexia nervosa (AN). Multiple linear regression analyses and a path-analysis model were applied to test the study hypotheses that body image at baseline predicts treatment outcomes of outpatient psychotherapy in patients with AN at follow-up measurement. The analyses were conducted as secondary analyses in a subgroup (n = 148) of the anorexia nervosa treatment of outpatient-cohort (ANTOP-study) (N = 242) of patients with AN. The results show that Negative Evaluation of the Body at baseline predicts perceived stress during psychotherapy, which in turn predicts depressive symptoms at the end of therapy which in turn predicts the outcomes body mass index and EDI-2 sum score at 12 months follow-up. The results underline the importance of body image disturbance in the course of AN and call for body image as a central target of psychotherapeutic interventions in patients with AN.

Introduction Psychosocial resources like social support or intrapersonal coping skills play an important role in resilience and quality of life (QOL), yet research systematically investigating the availability of different resources and QOL in transgender (trans) women is missing. Aim The present study aimed to systematically investigate the existence of different psychosocial resources and QOL in trans women following gender-affirming surgery (GAS). Methods Using a cross-sectional design, 557 trans women who had received GAS at the local urological department were invited to study participation. Criteria for study inclusion were 18 years and older, diagnosis of transsexualism according to the International Classification of Disease, completion of all sessions of GAS, and given written informed consent to study participation. Main Outcome Measures Psychosocial resources were assessed using the Essen Resource Inventory (ERI), the Sense of Coherence Scale, and the Social Support Scale. QOL was assessed with the Short Form Health Survey. Data from trans women were compared to normative data of healthy non-trans women as reported in the respective test manuals. Results In total, 158 trans women responded and participated in this study. They had received GAS 4 months to 21 years ago. The total sample was divided into 3 subgroups depending on the time interval since the participants’ last GAS procedure (group 1: GAS 0.3−3 years ago (n = 48); group 2: GAS 3.1−10 years ago (n = 62); and group 3: GAS 10.1−21 years ago (n = 41)). Trans women retrospectively indicated their available resources 3 years ago (ERI 3-years) and in the last 4 weeks (ERI 4-weeks). Trans women who had received GAS within the last 3 years (group 1) showed an increase in resources when comparing ERI 3-year scores (presurgery) with ERI 4-week scores (postsurgery). No differences emerged for group 2 and group 3. Compared to normative data from non-trans women, trans women scored significantly lower on the ERI but not in measures of Social Support Scale or Sense of Coherence Scale. Compared to non-trans women, mental QOL was significantly impaired in trans women, whereas no differences in physical QOL emerged. Clinical Implications As this study hints towards reduced psychosocial resources in trans women, the offering of specialized counseling can have high beneficial potential to support the development of resources, thereby enhancing QOL. Strength & Limitations Data of a large sample of trans women is provided who were investigated up to 21 years after GAS. The study is limited by its cross-sectional design and the response rate of 42%. Conclusion This study indicates that psychosocial resources improve around the time of GAS and seem to be improved and sustained in later years following GAS. Still, compared to non-trans women, trans women have a lower availability of resources and a lower mental QOL.

ZusammenfassungDie Kunsttherapie ist eine klinisch anerkannte Therapiemethode, jedoch gibt es immer noch sehr wenige Studien, die sich mit der Wirksamkeit, Wirkfaktoren oder Wirkweisen der Kunsttherapie auseinandersetzen. Insbesondere fehlt bis zum heutigen Zeitpunkt ein speziell für die Kunsttherapie zugeschnittenes und psychometrisch überprüftes Forschungsinstrument, welches Erlebensdimensionen der Kunsttherapiegruppe aus Patientensicht misst. Ein solches Messinstrument könnte Hinweise auf deren Wirksamkeit geben, kunsttherapeutische Gruppenprozesse besser verstehen lassen und zur Qualitätssicherung dienen. Ziel der vorliegenden Untersuchung war die Entwicklung und Validierung des Fragebogens zum Erleben der Kunsttherapiegruppe aus Patientensicht (FEKTP). Dieser Fragebogen basiert auf Grawes und Yaloms Konzepten zu gruppentherapeutischen Wirkfaktoren. Es nahmen 133 Patienten an der Studie teil und beantworteten den FEKTP direkt nach der 6. Kunsttherapiesitzung. Die Patienten bearbeiteten zusätzlich etablierte Symptom- und Erfahrungsfragebögen zu Beginn und zum Ende der Behandlung. Die Faktorenanalysen ergaben eine eindeutige Faktorenstruktur des FEKTP, welche die theoretisch angenommenen Subskalen zum Großteil einordnet. Die testpsychometrischen Hauptgütekriterien des FEKTP (Reliabilität, Validität und Objektivität) lassen sich als gut bis akzeptabel einordnen. Die Kriteriumsvalidität sollte aber in zukünftigen Studien nochmals genauer überprüft werden. Somit liegt nun auch für die Kunsttherapie ein valides Instrument zur systemischen Erfassung von allgemeinen Wirkfaktoren vor. Die Anwendung empfiehlt sich im Forschungs- als auch im Versorgungskontext.

Background: As findings regarding predictors for good outcome after total joint arthroplasty are highly inconsistent, aim of this study was to investigate the influence of the psychosocial variables sense of coherence and social support as well as mental distress on physical outcome after surgery. It should be investigated if different predictors are important in patients after total hip arthroplasty (THA) compared to patients after total knee arthroplasty (TKA). Methods: In a prospective design, 44 patients undergoing THA and 61 patients undergoing TKA were examined presurgery and 6 and 12 weeks after surgery using WOMAC (disease-specific outcome), SF-36 (health-related quality of life), BSI (psychological distress), SOC-13 (sense of coherence), and F-SozU (social support). Changes over time were calculated by analyses of variance with repeated measures. Stepwise multiple linear regression analyses were computed for each group to predict scores of WOMAC total and all WOMAC subscales 12 weeks postoperatively. Results: THA as well as TKA patients experienced improvements in all parameters (effect sizes for WOMAC scores between η² =.387 and η² =.631) with THA patients showing even better results than TKA patients. WOMAC scores 12 weeks after surgery were predicted predominantly by WOMAC baseline scores in TKA with an amount of explained variance between 9.6 and 19.5%. In THA, 12-weeks WOMAC scores were predicted by baseline measures of psychosocial aspects (anxiety, sense of coherence, social support). In this group, predictors accounted for 17.1 to 31.6% of the variance. Conclusions: Different predictors for outcome after total joint arthroplasty were obtained for THA and TKA patients. Although psychosocial aspects seemed to be less important in TKA patients, preoperatively, distressed patients of both groups should be offered interventions to reduce psychological distress to obtain better outcomes after surgery. CA Lindner

Der Einfluss von Familie, Partnerschaft, Bildung oder beruflicher Situation auf Entstehung und Aufrechterhaltung der Anorexia nervosa (AN) wurde vielfach diskutiert. Bereits in den ersten Beschreibungen der Erkrankung wurde detailliert Bezug zu Dimensionen des Familiensystems genommen. Dennoch ist die Evidenz zur Auswirkung dieser Variablen auf den Verlauf der Krankheit bis heute unklar. Randomisierte, kontrollierte Studien zu den Effekten von Psychotherapie geben wenige Information, wie diese Variablen bei den teilnehmenden Patientinnen verteilt sind, insbesondere auch, welchen Einfluss sie auf das Outcome der Studien haben. Ziel vorliegender Arbeit war es, die Patientinnen aus der Studie „Anorexia Nervosa Treatment of Outpatients“ (ANTOP) – der weltweit grosten ambulanten Therapiestudie zu AN – hinsichtlich der Einflusse von Familie, Partnerschaft und Berufskontext auf den Behandlungserfolg zu untersuchen. Die Ergebnisse zeigen Hinweise, dass Patientinnen in der ANTOP-Studie einen hoheren Bildungsstand als der altersentsprechende Bevolkerungsdurchschnitt haben. Gleichzeitig scheinen sie weniger haufig in einer institutionalisierten Partnerschaft zu sein. Bezuglich der Berufstatigkeit gibt es keine Unterschiede. Erhobene Variablen zu Familie, Partnerschaft, Bildung und beruflicher Situation hatten keinen pradiktiven Wert bezuglich des gewichtsbezogenen Therapie-Outcome in der ANTOP-Studie.

Die Lebensqualitat von Menschen mit psychischen Storungen ist in der Regel stark reduziert und sollte wahrend der Behandlung mit berucksichtigt werden. Der vorliegende Beitrag bietet eine Ubersicht uber Studien zur Effektivitat von psychotherapeutischen Interventionen zur Verbesserung der Lebensqualitat von Betroffenen mit Essstorungen. Eine umfassende elektronische Literaturrecherche ergab 10 Studien, die den Ein- und Ausschlusskriterien unserer Arbeit entsprachen und integriert wurden, 3 davon waren randomisierte Kontrollstudien. Die Art der Interventionen sowie die Messinstrumente zur Erfassung der Lebensqualitat unterschieden sich stark zwischen den Studien. Insgesamt zeigte sich eine signifikante Verbesserung der Lebensqualitat durch psychotherapeutische Behandlung. Jedoch besteht weiterhin die Frage, welche Faktoren in der Psychotherapie zur Verbesserung der Lebensqualitat beitragen. Die Durchfuhrung weiterer randomisierter Kontrollstudien mit standardisierten methodischen Messverfahren wird empfohlen, auch um den Langzeiteffekt von Psychotherapie auf die Lebensqualitat bei Essstorungen zu untersuchen.

BackgroundAnorexia nervosa (AN) is a serious illness leading to substantial morbidity and mortality. The treatment of AN very often is protracted; repeated hospitalizations and lost productivity generate substantial economic costs in the health care system. Therefore, this study aimed to determine the differential cost-effectiveness of out-patient focal psychodynamic psychotherapy (FPT), enhanced cognitive–behavioural therapy (CBT-E), and optimized treatment as usual (TAU-O) in the treatment of adult women with AN.MethodThe analysis was conducted alongside the randomized controlled Anorexia Nervosa Treatment of OutPatients (ANTOP) study. Cost-effectiveness was determined using direct costs per recovery at 22 months post-randomization (n = 156). Unadjusted incremental cost-effectiveness ratios (ICERs) were calculated. To derive cost-effectiveness acceptability curves (CEACs) adjusted net-benefit regressions were applied assuming different values for the maximum willingness to pay (WTP) per additional recovery. Cost–utility and assumptions underlying the base case were investigated in exploratory analyses.ResultsCosts of in-patient treatment and the percentage of patients who required in-patient treatment were considerably lower in both intervention groups. The unadjusted ICERs indicated FPT and CBT-E to be dominant compared with TAU-O. Moreover, FPT was dominant compared with CBT-E. CEACs showed that the probability for cost-effectiveness of FTP compared with TAU-O and CBT-E was ⩾95% if the WTP per recovery was ⩾€9825 and ⩾€24 550, respectively. Comparing CBT-E with TAU-O, the probability of being cost-effective remained ConclusionsDepending on the WTP, FPT proved cost-effective in the treatment of adult AN.

Eine valide Diagnostik zahlt zu den wesentlichen Grundlagen der erfolgreichen psychotherapeutischen Behandlung. Gerade bei den Traumafolgestorungen ist das nicht immer erfullt, insbesondere dann, wenn Fragebogen zum Einsatz kommen, die die Kriterien einer Traumafolgestorung gemas der Klassifikationssysteme Diagnostic and Statistical Manual of Mental Disorders(DSM)-IV und International Statistical Classification of Diseases and Related Health Problems(ICD)-10 nicht vollstandig berucksichtigen. In der vorliegenden Ubersichtsarbeit werden haufig verwendete Traumafragebogen im deutschen Sprachraum fur Erwachsene sowie fur Kinder und Jugendliche mit ihren Besonderheiten vorgestellt und kritisch diskutiert. Abschliesend werden Empfehlungen fur die Diagnostik von Traumafolgestorungen mithilfe von Fragebogen vorgenommen.

Summary Background Health-related quality of life (HRQOL) is a marker of disease severity. Data on the relative impairment of HRQOL in chronic liver disease (CLD) and functional gastrointestinal disorders are lacking and no studies have assessed the link between impairment of HRQOL and psychosocial factors yet. Aim To assess predictors for, and the impairment of, HRQOL in CLD and FD. Methods In 181 functional dyspepsia (FD) patients, 204 CLD patients and 337 healthy blood donors, HRQOL was assessed with the Short Form-36 (mental and physical component), and anxiety and depression utilizing the Hospital Anxiety and Depression Scale. Results Compared with HC, HRQOL is significantly lower in FD and CLD (P-value for all

The protection of the donors from physical or emotional harm has been a fundamental principle in living-donor liver donation from the beginning. Psychosomatic donor evaluation aims at the selection of eligible donors and the screening and exclusion of psychiatrically vulnerable donors. As clinical interviews may include subjective biases, efforts should be made to establish objective criteria for donor assessment. In recent research, protective factors have been reported to be a significant force behind healthy adjustment to life stresses and can be investigated as possible predictors of donors' eligibility. Being the central construct of Antonovsky's theory of salutogenesis, the sense of coherence is one of the most surveyed protective factors and a good predictor of individuals' stability when experiencing stress. Furthermore, family support has been shown to be a valuable protective resource in coping with stress. This study surveyed whether sense of coherence and social support predict donors' emotional strain prior to transplantation. Seventy-one donor candidates were included in the study during the donor evaluation prior to living-donor liver transplantation. Sense of coherence proved to be a significant predictor for all criterion variables, namely anxiety, depression and mental quality of life. In addition to this, donor candidates who were classified as eligible for donation in the psychosomatic interview had significantly higher values on sense of coherence total scores compared with rejected donors. In a multiple regression analysis, sense of coherence and social support together yielded a prediction of depression with an explained variance of 22% (R(2) = 0.22). Sense of coherence and social support can be implemented as self-rating instruments in the psychosomatic selection of donors and would help to further objectify donors' eligibility.

We aim to assess the prevalence and severity of posttraumatic stress disorder (PTSD) in patients who receive long-term hemodialysis (HD) and investigate its correlation with depression, anxiety, health-related quality of life, and service utilization.In a cross-sectional study, we recruited 144 HD patients (age, 63.1 +/- 14.2 years; 50.7% men) from 5 dialysis units.PTSD, defined in accordance with criteria of the Impact of Event Scale-Revised and Posttraumatic Stress Diagnostic Scale.Physical health, mental health, depression, anxiety, life satisfaction, service utilization.Impact of Event Scale-Revised, Posttraumatic Stress Diagnostic Scale, Hospital Anxiety and Depression Scale, Short-Form Health Survey.77.8% of HD patients reported at least 1 traumatic event. The lifetime prevalence for PTSD, independent from trauma type, was 17%. PTSD prevalence only with regard to HD as a potential traumatic event was 10.4%. Women reported more helplessness and more intensive experiences of fear or horror than men with respect to the stressor A criterion. Patients with PTSD showed substantial decreases in mental health in comparison to patients without PTSD (P0.01). Additionally, greater depression, anxiety, less life satisfaction, and more service utilization were associated with greater posttraumatic symptoms. There was no correlation of physical health with posttraumatic symptoms. In partial correlation analyses adjusting for depression, associations between posttraumatic symptoms, mental health, and anxiety remained robust.Generalizability to other settings, absence of control group, study power.PTSD is common in HD patients, but little work has been done to explore the variables associated with PTSD. Data suggest that PTSD is underdiagnosed and undertreated in HD patients. Interventions should target these patients with the goal to improve well-being and quality of life.

SUMMARY Aim In a prospective randomized, controlled trial, to compare the long-term outcome of intensive medical therapy (with or without cognitive-behavioural or muscle relaxation therapy) vs. standard medical therapy in patients with refractory functional dyspepsia (FD), referred to a tertiary referral medical center. Methods A total of 100 consecutive FD patients were allocated to a standardized symptom-oriented 4 month therapy (SMT, n = 24), intensive medical therapy (IMT, medical therapy with testing-for and targeting-of abnormalities of motor-and-sensory function, n = 28) or IMT plus psychological interventions (either progressive-muscle relaxation (IMT-MR, n = 20) or cognitive-behavioural therapy (IMT-CBT, n = 28). The symptom intensity (SI) and health-related quality-of-life (HRQoL) after 12 months were prespecified primary outcome parameters. Results After 12 months, significantly greater improvement of SI occurred in patients with IMT-all (with or without psychological interventions) compared with SMT (P

Zusammenfassung Hintergrund: Depressivitat und Angstlichkeit zahlen bei Patienten mit Schilddrusenkarzinom (DTC) zu den haufigsten Befindlichkeitssymptomen mit einem wichtigen Einfluss auf die Lebensqualitat. In der vorliegenden Studie wurde das Ziel verfolgt, protektive Faktoren fur Depression und Angst bei DTC-Patienten zu identifizieren. Methodik: In einer konsekutiven Querschnittstudie wurden 230 DTC-Patienten mit der Hospital Anxiety and Depression Scale (HADS-D), der Sense of Coherence Skala (SOC) und dem Fragebogen zu Sozialer Unterstutzung (F-SOZU) untersucht. Ergebnisse: Eine hoch signifikante Korrelation zeigte sich zwischen Depression und Angstlichkeit (r = .633, p = 0,001). Soziale Unterstutzung und Sense of Coherence hingegen korrelierten sehr signifikant negativ sowohl mit Depression als auch mit Angstlichkeit (beide p 0,001). Geringer, dennoch signifikant, fiel die Korrelation zwischen Alter und Angstlichkeit aus (r = -.19; p 0,005). Der TSH-Spiegel als Mas fur die Auspragung der Hypothyreo...

Hintergrund: Das Ziel der vorliegenden Arbeit war die Validierung des Essener Lebensqualitats-Index (ELI), eines kurzen storungsspezifischen Fragebogens zur Erfassung der Lebensqualitat bei Personen mit Essstorungen. Die Gesamtstichprobe setzte sich aus n=182 aktuellen und ehemaligen Essstorungspatientinnen sowie n=87 gesunden Kontrollpersonen zusammen. Alle Probandinnen beantworteten den ELI sowie andere testtheoretisch gut abgesicherte Instrumente (EDQOL, SF-12, EDI-2, FKB-20, SEED, BSI, IIP-D und SOC-13). Zusatzlich wurde eine Teilstichprobe von n=46 Essstorungspatientinnen nach Beendigung der Therapie erneut mit den genannten Instrumenten untersucht. Fur die Gesamtstichprobe zeigte sich ein sehr guter Reliabilitatskennwert von α=0,96. Erwartungskonform ergab sich ein Hauptfaktor mit einer hohen Varianzaufklarung von 71,25%. Es zeigten sich Hinweise auf eine sehr gute Konstruktvaliditat und Veranderungssensitivitat. Der ELI kann somit als okonomischer, reliabler und valider Fragebogen zur Messung der storungsspezifischen Lebensqualitat von Betroffenen mit Essstorungen eingesetzt werden. Seine Anwendung empfiehlt sich sowohl im Forschungs- als auch im Versorgungskontext.

Zusammenfassung Fragestellung: Bei Patienten mit alkoholtoxischer Leberzirrhose, die Probleme mit der Einhaltung der Abstinenz hatten, wurde in der Organwartezeit vor der Transplantation eine manualisierte, sechsmonatige, psychoedukative Intervention durchgefuhrt. In einem naturalistischen Design wurde untersucht, ob die Alkoholabstinenz durch die beschriebene Intervention stabilisiert werden kann. Methode: Zwischen Januar 2002 und November 2003 wurden 72 Patienten rekrutiert, von denen 48 an der Gruppe teilnahmen. Die gesundheitsbezogene Lebensqualitat (SF-12), Angst und Depressivitat (HADS-D), Symptombelastung (BSI) sowie die soziale Unterstutzung (F-SOZU) wurden gemessen. Zur Uberprufung der Abstinenz wurde bei den Teilnehmern in jeder Gruppensitzung die Alkoholkonzentration in der Ausatemluft bestimmt. Ergebnisse: Die Patienten wiesen sowohl zu Beginn als auch zum Ende der Gruppe subklinische Scores bezuglich Angst und Depressivitat sowie eine geringe psychiatrische Symptombelastung auf. Die korperlic...

Objectives: We examined the relationships among physical complaints, health-related quality of life (HRQL), anxiety and depression in differentiated thyroid cancer (DTC) patients under short-term hypothyroidism. Methods: We conducted a cross-sectional study in 136 patients hypothyroid on thyroid hormone withdrawal (THW) hospitalized for radioiodine administration. Patients were assessed using Short Form SF-36 (SF-36), Hospital Anxiety and Depression Scale (HADS), Profile of Mood States (POMS), Beck Depression Inventory (BDI), and physical complaints. Results: Compared to the German general population, hypothyroid patients had significantly impaired HRQL. Surprisingly, the prevalence of anxiety (62.5%), but not depression (17.9%) was much higher in hypothyroid DTC patients than in the general population. In multivariate analysis, depression and age were independently associated with the physical health score (R 2 = 0.21), but only psychological variables (depression, mood disturbance, and anxiety) were associated with the mental health score (R 2 = 0.43), on the SF-36 HRQL instrument. Conclusions: HRQL is severely impaired in DTC patients under short-term hypothyroidism. As potential predictors of generic HRQL impairment, depression, anxiety, and mood disturbance could be used to preselect the patients most needing psychiatric care. The high frequency of anxiety should be considered in the aftercare of thyroid cancer patients.

In a cross-sectional study, 483 patients (age: 35.8 +/- 13.2 years) of an outpatient psychosomatic university clinic were investigated using a standardized disorder-specific set of tests. 63.1 % of the patients reported to have experienced at least one traumatic event in their life. Test-psychometrically, a posttraumatic stress disorder (PTSD) could be assumed in 10.1 %. Compared to non-traumatized patients, patients with a PTSD reported significantly more frequently somatoform symptoms; even the comparison of traumatized patients with and without PTSD demonstrated a pronounced tendency to somatize in PTSD patients. Neurologic, gastrointestinal and cardiopulmonary symptoms, as well as pain sensations and sexual dysfunctioning were predominantly reported as somatoform complaints. The results emphasize the close connection between somatization and PTSD symptoms; this should be increasingly taken into consideration in the diagnostic process within psychotraumatology.

Objective: Growing evidence supports a link between obesity and inflammation. Current research is focused on the role of adipokines such as adiponectin and immune cells, especially macrophages, in adipose tissue. Our aim was to examine the role of inflammation not in tissue but in the peripheral blood of healthy overweight and obese subjects. We especially investigated the role of neutrophils and their possible regulation by adiponectin. Methods: In healthy normal-weight, overweight, and obese human subjects (n = 32) the peripheral blood concentrations of adipokines, satiety hormones, apoptosis markers, and cytokines as well as the blood count were related to inflammation and neutrophils, at 3 independent days of examination. The response of neutrophils to stimulation by adiponectin was also investigated in vitro. Results: In obese and by tendency already in overweight subjects, inflammation was increased showing a higher neutrophil-to-lymphocyte ratio, elevated high-sensitivity C-reactive protein, increased chemokines (CXCL8, CCL3, CCL5), increased apoptosis markers (M30 and M65), and changes in hormone levels in the peripheral blood. LPS- and fMLP-induced production of CXCL8 by neutrophils was elevated in overweight and obese subjects. High plasma levels of adiponectin were associated with reduced CXCL8 production in peripheral blood neutrophils. In vitro, production of CXCL8 by neutrophils was inhibited by adiponectin. Conclusion: Reduced adiponectin and enhanced apoptosis may occur already in the peripheral blood of healthy overweight subjects. This process seems to further enhance neutrophil activity in overweight and obese.

Brain and immune system are linked by bidirectional pathways so that changes of the central nervous system may influence various immune functions. The olfactory system may be involved in this interaction. In most odor studies subjects are aware of an odor exposure, using frequently high odor concentrations or long-term exposures without controls. In this pilot study, the potential immune effects of short-term odor exposure were examined in 32 blinded subjects (16 male, 16 female). Subjects were exposed without their knowledge either to a stimulant essential oil (grapefruit, fennel, pepper), a no-odor control or a relaxant essential oil (lavender, patchouli, rose) during a set of psychological questionnaires for 30 min at three separate visits. Activity of neutrophil granulocytes (CXCL8 release, CD16) and peripheral blood concentrations of mainly neutrophil-related immunological markers were measured. We tested the triple of stimulant odor, control and relaxant odor for every subject in a model which assumed opposite effects of the stimulant and the relaxant odor. This hypothesis was falsified by our experimental data, as no significant effect was observed for the parameters tested. The human immune functions tested in our study are not modulated by short-term odor exposure in blinded subjects. Further studies should directly dissect possible differences between long-term and short-term exposures of non-blinded subjects versus blinded subjects.

Fragestellung: Angesichts der klinischen und wissenschaftlichen Bedeutung traumatischer Ereignisse und posttraumatischer Störungen hatte unsere Studie die Entwicklung und Überprüfung des Essener Trauma-Inventars für Kinder und Jugendliche (ETI-KJ) zum Ziel. Das neue Instrument erfasst ein breites Spektrum an potenziell traumatischen Ereignissen und soll ein geeignetes Screeningverfahren zur Identifikation der beiden Traumafolgestörungen Akute Belastungsstörung und Posttraumatische Belastungsstörung nach DSM-IV darstellen. Methodik: Das ETI-KJ wurde an einer Stichprobe von 276 Kindern und Jugendlichen zwischen 12 und 17 Jahren im Hinblick auf seine psychometrischen Kennwerte an klinischen und nicht klinischen Gruppen überprüft. Ergebnisse: Es fanden sich gute bis sehr gute Reliabilitätskennwerte, insbesondere für die Gesamtskala des ETI-KJ ergab sich eine sehr hohe interne Konsistenz. Die a priori angenommene Vier-Faktoren-Struktur (Intrusion, Vermeidung, Hyperarousal, Dissoziation) fand empirische Bestätigung. Hinweise auf eine sehr gute Konstruktvalidität zeigten sich durch signifikante Korrelationen des ETI-KJ mit weiteren Traumaskalen, Maßen der psychischen Befindlichkeit und der Ressourcenausstattung. Schlussfolgerungen: Mit dem ETI-KJ liegt im deutschen Sprachraum erstmals ein ökonomisches, reliables und valides Screeninginstrument zur differenzierten Erfassung traumatischer Ereignisse und posttraumatischer Störungen vor, dessen Einsatz sich sowohl im Forschungs- als auch im klinischen Kontext empfiehlt.

Background Most studies investigating the effects of chronic hepatitis C (HCV) infection on the central nervous system have focused on cognitive impairment or on the health-related quality of life, but only few on depression. Objectives This study investigated depression in HCV-infected people. Sense of coherence and social support were surveyed as protective factors of mental health. Methods In a cross-sectional study-design, 81 HCV-infected people with mild liver disease, who were not receiving antiviral therapy, were surveyed by validated measures. Anxiety (HADS), depression (BDI), psychopathological symptoms (SCL-90-R), social support (F-SozU) and resilience (SOC) were assessed. Results Higher levels of depression than normal controls ( p =.001) and a wide range of psychological symptoms were associated with HCV infection. Women, single participants, and persons with a shorter interval after first diagnosis exhibited significantly higher scores of depression. Gender and sense of coherence predicted depression scores in HCV people ( R 2 =.42, p Conclusions The expression of depression in HCV-infected people is modulated not only by biological but also by psychological factors of mental health. Sense of coherence as a protective factor has a significant impact on the degree of depression. Furthermore, the high prevalence of depression and anxiety among persons not receiving antiviral therapy justifies psychosocial screening and support for HCV people independent of antiviral therapy.

OBJECTIVES The current study assessed the correlation between the trauma "death of important relatives" and the prevalence of the posttraumatic stress disorder (PTSD). METHODS In a cross-sectional study, 317 subjects (age 37.4; SD 12.6) were examined with the Essen Trauma Inventory (ETI). RESULTS The PTSD point-prevalence was 13.1%. The death of important relatives was the second common traumatic event in the investigated sample (44.6%; N=139). This event was most frequently reported as being the worst trauma (25.4%). About 15.1% of those who reported death of important relatives as their worst traumatic event, fulfilled our study criteria for a PTSD. However, in comparison with other traumas this traumatic event was associated with a low probability of PTSD (4% in the total sample). Women and men did not differ with regard to PTSD prevalence. However, men evaluated the trauma "death of important relatives" more often as the worst event in their life than women (chi2=7.24; p

Objective: Very few previous studies have compared the degree of health-related quality of life (HRQL), depression and anxiety of differentiated thyroid cancer patients (DTC) under short-term hypothyroid-ism and levothyroxine treatment. Methods: Using patient-completed instruments, we examined the frequency of physical complaints, HRQL, anxiety and depression in 130 DTC patients hospitalized for radioiodine therapy or whole-body diagnostics (age 52 years, female 71%) under short-term hypothyroidism (4 weeks of levothyroxine withdrawal; DTC-H) and in 100 DTC out-patients under TSH-suppressive doses of levothyroxine subsequent to radioiodine therapy (DTC-L; age 49 years, female 81%). Results: Compared with the German general population, DTC-H as well as DTC-L patients had significantly impaired HRQL. Notably, the decrease in HRQL was significantly higher in DTC-H than in DTC-L patients. Surprisingly, the prevalence of anxiety (44.6%) but not depression (17.7%) was much higher in the DTC-H patients than in the general population. In contrast to expectations, similar results for anxiety (44.0%) and depression (17.6%) were observed in the DTC-L patients. Conclusions: This mounting evidence suggests that a consistent pattern of HRQL impairment is experienced by patients with DTC. The high frequency of anxiety and the significantly reduced HRQL should be considered in the aftercare of DTC patients.