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1.  Psychodynamic mechanism and weight reduction in obesity group therapy – first observations with different attachment styles 
Objectives: Successful long-term results are extremely rare in non-surgical obesity treatment. Interactional difficulties with the attending physicians and the limited compliance of obese patients are a frequently described dilemma in repeated psychotherapeutic group treatment attempts. The type of relationship initiation and the attachment behavior probably play a central role in this connection but have not yet been systematically investigated.
Methods: This paper focuses on the attachment styles of obese subjects and their effects on psychodynamic group therapy within the context of a weight-reduction program.
Results: The attachment styles are characterized in 107 pre-obese and obese patients, and their effects on patients and therapists in group therapy are described.
Conclusion: The paper surveys the motivational situation, clinical pictures, and repeated group topics.
PMCID: PMC2940216  PMID: 20930928
obesity; attachment styles; psychotherapy; group; therapist
3.  CAM in Psychiatry 
PMCID: PMC3745881  PMID: 23983776
4.  Younger and older chronic somatoform pain patients in psycho-diagnostics, physician-patient relationship and treatment outcome 
Patients with chronic pain are found with highly variable clinical presentation and differing physical complaints. They are seen as a heterogenic group. Based on clinical observations, elderly patients seem to differ from younger patients with chronic pain. We examined whether there were systematic differences between young and old pain patients.
As part of a routine evaluation of university hospital care, a newly developed psychosomatic treatment model for chronic somatoform pain disorders was examined. The basis for treatment efficacy was a target-oriented, specific somatic and psychological intervention that included a stable physician-patient relationship. Particular attention was paid to differences in treatment outcome with regard to changes in both physical and psychopathological symptom levels. We hypothesised that younger pain patients had higher psychological burden and benefitted more from our treatment than older pain patients.
Overall, 179 inpatients (57.5% women) with chronic pain were examined (age between 16 and 79 years). The group as a whole yielded high scores on the somatisation dimension (SCL-90) and showed a considerable amount of psychopathological symptoms, such as depressive mood and anxiety (HADS) and a great emotional instability (FPI-R). Age differences were only found with regards to patients’ degree of aggression (SCl-90): younger patients showed higher aggressive tendencies than older ones (p< 0.05). The treatment offered helped patients in both age groups especially with regard to reduction of depressive mood (HADS, p< 0.01) and anxiety levels (HADS, p< 0.01). Regression analysis showed different age groups and gender as significant predictors of anxiety reduction under therapy (R2=.108; model: p< 0.01).
Discussion and conclusion
Results show that younger chronic pain patients suffer more from a considerable amount of psychological distress than older ones, but our treatment approach was equally effective in both groups. However, age and gender differences, as well as the patient’s baseline level of anxiety influenced the outcome. These factors need to be studied in future research.
PMCID: PMC3573985  PMID: 23379640
Chronic somatoform pain; Age; Psychosomatic in-patient treatment; Attachment style
5.  Attachment style contributes to the outcome of a multimodal lifestyle intervention 
Background & Aims
The long-term success of life-style interventions in the treatment of obesity is limited. Although psychological factors have been suggested to modify therapeutic effects, specifically the implications of attachment styles and the patient-therapist relationship have not been examined in detail yet.
This study included 44 obese patients who participated in a one-year multimodal weight-reduction program. Attachment style was analyzed by the Adult Attachment Prototype Rating (AAPR) inventory and its relation to a one-year weight reduction program was studied. The patient-therapist-relationship was assessed using the Helping Alliance Questionnaire.
Attachment style was secure in 68% of participants and insecure (preoccupied and dismissing) in 32%. Interestingly a significantly higher weight-reduction was found in securely (SAI) compared to insecurely attached individuals (UAI; p < 0.05). This estimation correlated positively also to the quality of helping alliance (p = 0.004).
The frequency of insecure attachment in obese individuals was comparable to that of the normal population. Our data suggest a greater weight-reduction for SAI than for UAI, and the patient-therapist relationship was rated more positively. The conclusion can be drawn that a patient's attachment style plays a role in an interdisciplinary treatment program for obesity and has an influence on the effort to lose weight.
PMCID: PMC3296567  PMID: 22300715
attachment style; obesity; patient-therapist relationship; weight reduction
6.  Somatic comorbidity in anorexia nervosa: First results of a 21-year follow-up study on female inpatients 
Anorexia nervosa is a severe psychosomatic disease with somatic complications in the long-term course and a high mortality rate. Somatic comorbidities independent of anorexia nervosa have rarely been studied, but pose a challenge to clinical practitioners. We investigated somatic comorbidities in an inpatient cohort and compared somatically ill anorexic patients and patients without a somatic comorbidity. In order to evaluate the impact of somatic comorbidity for the long-term course of anorexia nervosa, we monitored survival in a long-term follow-up.
One hundred and sixty-nine female inpatients with anorexia nervosa were treated at the Charité University Medical Centre, Campus Benjamin Franklin, Berlin, between 1979 and 2011. We conducted retrospective analyses using patient's medical and psychological records. Information on survival and mortality were required through the local registration office and was available for one hundred patients. The mean follow-up interval for this subgroup was m = 20.9 years (sd = 4.7, min = 13.3, max = 31.6, range = 18.3). We conducted survival analysis using cox regression and included somatic comorbidity in a multivariate model.
N = 41 patients (24.3%) showed a somatic comorbidity, n = 13 patients (7.7%) showed somatic comorbidities related to anorexia nervosa and n = 26 patients (15.4%) showed somatic comorbidities independent of anorexia nervosa, n = 2 patients showed somatic complications related to other psychiatric disorders. Patients with a somatic comorbidity were significantly older (m = 29.5, sd = 10.3 vs m = 25.0, sd = 8.7; p = .006), showed a later anorexia nervosa onset (m = 24.8, sd = 9.9 vs. m = 18.6, sd = 5.1; p < .000) and a longer duration of treatment in our clinic (m = 66.6, sd = 50.3 vs. m = 50.0, sd = 47; p = .05) than inpatients without somatic comorbidity. Out of 100 patients, 9 patients (9%) had died, on average at age of m = 37 years (sd = 9.5). Mortality was more common among inpatients with somatic comorbidity (n = 6, 66.7%) than among inpatients without a somatic disease (n = 3, 33.3%; p = .03). Somatic comorbidity was a significant coefficient in a multivariate survival model (B = 2.32, p = .04).
Somatic comorbidity seems to be an important factor for anorexia nervosa outcome and should be included in multivariate analyses on the long-term course of anorexia nervosa as an independent variable. Further investigations are needed in order to understand in which way anorexia nervosa and a somatic disease can interact.
PMCID: PMC3299644  PMID: 22300749
anorexia nervosa; long-term course; somatic comorbidity; mortality
7.  Psychosocial interventions for patients with chronic disease 
Treatment of patients with chronic diseases will be one of the main challenges of medicine in the future. This paper presents an overview of different origins, mechanism, and symptoms necessary for understanding new and different interventions that include a psychosomatic view.
In a psychosomatic therapeutic intervention there are very different targets, such as psychological symptoms, personality traits, attitudes toward disease and life, risk behaviour, and social isolation and as biological targets the change of autonomic imbalance and of the effects of the psycho-endocrinological or psycho-immunological stress responses. And there are also different psychosomatic measures that influence the individual biological, psychological and sociological targets. There is a need to give different answer to different questions in the field of psychosomatic and behavioral medicine. Comparative effectiveness research is an important strategy for solving some methodological issues. What is the target of treatment for different diseases: Symptom reduction, healing, or limiting progression to the worst case - the death of patients. We know that, the patient-physician relationship is important for every medical/therapeutic action for patients with chronic diseases.
This volume of BioPsychoSocial Medicine will present four different psychosomatic treatment studies from the clinical field in the sense of phase 2 studies: Reports of patients with obesity, anorexia nervosa, chronic somatoform pain and coronary artery disease were presented
PMCID: PMC3299618  PMID: 22293471
psycho social intervention; concepts; mechanism; efficiacy; eating disorders; pain; coronary artery disease
8.  Depressive Symptoms and Heart Rate Variability in Younger Women after an Acute Coronary Event 
We investigated associations between depressive symptoms and reduced heart rate variability (HRV) in women aged 30-65 years after an acute coronary event.
Younger women have an increased mortality after myocardial infarction compared to men of similar age. Depression was hypothesized to contribute to the poor prognosis, possibly mediated by increased susceptibility to arrhythmias.
The Stockholm Female Coronary Risk study comprised 292 women aged 30 - 65 years who were consecutively admitted for myocardial infarction or unstable angina pectoris during a 3-year period. Depressive symptoms were assessed by means of a 9-item questionnaire. Women with no or only one depressive symptom were classified as low depression subjects, those with two or more depressive symptoms as high depression subjects. HRV data were calculated from 24-hour ambulatory electrocardiographic recordings 3 to 6 months after the initial event.
Reliable HRV data were obtained from 266 patients. 70 women were low depression subjects, and 196 women were high depression subjects. In univariate analyses, the index of standard deviations of RR-intervals, very low frequency power, low frequency power and high frequency power of HRV were lower in the high depression subjects. After controlling for potential confounders (diabetes, hypertension, systolic blood pressure, body mass index and β-blocker medication), a significant difference between low and high depression subjects was maintained for all indices except for high frequency power.
The presence of 2 or more depressive symptoms was associated with reduced HRV in a high-risk group of younger women after an acute coronary event.
PMCID: PMC2946964  PMID: 20305564
9.  High-utilizing Crohn's disease patients under psychosomatic therapy* 
Few studies have been published on health care utilization in Crohn's disease and the influence of psychological treatment on high utilizers.
The present sub study of a prospective multi center investigation conducted in 87 of 488 consecutive Crohn's disease (CD) patients was designed to investigate the influence of the course of Crohn's disease on health care utilization (hospital days (HD) and sick leave days (SLD) collected by German insurance companies) and to examine the conditions of high-utilizing patients. Predictors of health care utilization should be selected. Based on a standardized somatic treatment, high health care utilizing patients of the psychotherapy and control groups should be compared before and after a one-year treatment.
Multivariate regression analysis identified disease activity at randomization as an important predictor of the clinical course (r2 = 0.28, p < 0.01). Health care utilization correlated with duration of disease (p < 0.04), but the model was not significant (r2 = 0.15, p = 0.09). The patients' level of anxiety, depression and lack of control at randomization predicted their health-related quality of life at the end of the study (r2 = 0.51, p < 0.00001). Interestingly, steroid intake and depression (t1) predicted the combined outcome measure (clinical course, HRQL, health care utilization) of Crohn's disease at the end of the study (r2 = 0.22, p < 0.001).
Among high utilizers, a significantly greater drop in HD (p < 0.03) and in mean in SLD were found in the treatment compared to the control group.
The course of Crohn's disease is influenced by psychological as well as somatic factors; especially depression seems important here. A significant drop of health care utilization demonstrates the benefit of psychological treatment in the subgroup of high-utilizing CD patients. Further studies are needed to replicate the findings of the clinical outcome in this CD subgroup.
PMCID: PMC2579292  PMID: 18851749

Results 1-9 (9)