Zeitschrift für Medizinische Psychologie

This article reviews current research on the conceptualization, epidemiology, and treatment of functional somatic syndromes (FSS). FSS are defined by clusters of medically unexplained symptoms. A variety of diagnostic criteria for a number of FSS exist. Individuals affected by one FSS often fulfill criteria for at least one additional FSS. Also, psychiatric comorbidity with depressive, anxiety, and/or personality disorders is frequently present. The course of these syndromes is often chronic. Use of antidepressants and psychotherapy has been shown to be effective in the management of FSS. Future research on FSS should adopt standardized operationalization of diagnostic criteria as well as report diagnostic procedures. Studies investigating specific risk factors and differential pathophysiological mechanisms in FSS are critical.

Theoretical background and objectives: Stress reducing effects of Taiji practice have been repeatedly reported. The aim of the present study was to investigate which persons benefit the most from Taiji practice in terms of reduced physiological stress reactivity.

Methods: We conducted a secondary data analysis of a randomized controlled Taiji trial that significantly lowered stress reactivity of salivary cortisol and alpha-amylase in a Taiji group (n = 26) compared to a control group (n = 23). By using hierarchical regression analyses potential moderating influences of self-reported trait-mindfulness and trait values of general psychological stress reactivity on stress protective effects of a three months Taiji training were examined. Moderator variables were assessed at the beginning of the study using the Freiburg-Mindfulness-Inventory and the Perceived- Stress-Reactivity-Scale.

Results: The interaction effect “study group x mindfulness” was significant for stress reactivity of salivary alpha-amylase (p = 0.050). Participants in the Taiji group with higher trait-mindfulness showed a lower salivary alpha-amylase stress reactivity, while in the control group higher trait-mindfulness was associated with higher alpha-amylase stress reactivity. In the control group (p = 0.042) but not in the Taiji group (p = 0.69) salivary cortisol stress reactivity was significantly increased in persons with higher trait-mindfulness scores. We could not find moderating effects of general psychological stress reactivity.

Conclusion: Our results suggest that without intervention higher trait-mindfulness is associated with increased physiological stress reactivity. Persons with higher trait-mindfulness seem to benefit the most from practicing Taiji in terms of reduced sympathetic stress reactivity.

In this overview, the common neurologic disease restless legs syndrome (RLS), its diagnosis, the psychosocial impairment and treatment options are presented. The pathophysiology of the disorder has not yet been clarified sufficiently. RLS is associated with a clinically relevant psychosocial impairment. In addition to a reduction in quality of life, increased prevalence of depressive and anxiety disorders are reported. Curative treatments are not yet available. First-line therapies comprise mainly dopamine agonists and levodopa. Anticonvulsants reduce RLS symptoms in the majority of patients, but are off-label in Germany. Opioids also show good efficacy, but have been studied so far only in small populations. Patients may experience a loss of efficacy and a worsening of symptoms during dopaminergic treatment. In patients with insufficient improvement during drug therapy or relevant psychosocial impairments, cognitive behavioral as well as mindfulness and acceptance-based interventions can improve quality of life of the affected patients.

Objectives: The concept of Chemical Coping proposes that patients suffering from chronic pain might utilize their pain medication to ameliorate coexisting distressful emotional states. Primary objective of this study was the preliminary evaluation of the German version of the Chemical Coping Index (CCI-D) in 80 patients with somatoform diseases as well as the development and evaluation of a short-scale.

Methods: The psychometric properties of the CCI-D were tested via item analysis and reliability analysis (Cronbach's coefficient alpha). To evaluate the short-scale of the CCI-D item analysis, reliability analysis, confirmatory factor analysis and concurrent correlation analysis were performed.

Results: The scale structure of the original version of the CCI could not be replicated distinctly. The CCI-D12 was highly reliable (α = 0.92), explained 51% of variance and showed plausible values in confirmatory modell-fit-indices. Chemical Coping was significantly correlated with an increased intake of pain medication (P ≪ 0.01), defiance of medical intake instructions (P ≪ 0.01), and highly associated with experienced withdrawal symptoms (P ≪ 0.001), fear (P ≪ 0.05), hypochondria (P ≪ 0.01), psychosocial distress (P ≪ 0.001), and alexithymia (P ≪ 0.001). Patients did not differ significantly in somatization and pain disability.

Conclusion: The German short-scale CCI-D12 is a reliable and valid instrument assessing patterns of chemical coping and misuse of pain medication.