Current Holistic-medicine News Results

Risk factors at pretreatment predicting treatment-induced nausea and vomiting in Australian cancer patients: a prospective, longitudinal, observational study.

Support Care Cancer. 2010 Sep 3;
Pirri C, Katris P, Trotter J, Bayliss E, Bennett R, Drummond P

PURPOSE: Despite significant advances in antiemetic management, almost 50% of cancer patients still experience nausea and vomiting during treatment. The goal of antiemetic therapy is complete prevention of treatment-induced nausea and/or vomiting (TINV); however, realisation of this goal remains elusive, thus supplementary strategies identifying patients at high risk must be employed in the interim. Consequently, we examined TINV incidence and its risk factors, including patient, clinical and pretreatment quality of life (QOL)/psychological factors. METHODS: Two hundred newly diagnosed cancer patients beginning combined treatment participated in this prospective, longitudinal, observational study. QOL (including TINV), psychological adjustment, and patient/clinical characteristics were examined at pretreatment, on-treatment (8 weeks +/- 1 week) and post-treatment. RESULTS: Overall, 62% of patients experienced TINV, with TIN incidence (60%) doubling that of TIV (27%). Eight independent risk factors predicted 73% of TIN incidence: high premorbid/anticipatory NV, moderately/highly emetogenic chemotherapy (M/HEC), longer treatment (>3 months), female gender, surgery prior to adjuvant chemotherapy +/- radiotherapy, private health insurance and low emotional functioning (pretreatment). Six independent risk factors predicted 77% of TIV incidence: premorbid/anticipatory vomiting, M/HEC, female gender, cancer resection and low role functioning (pretreatment). CONCLUSIONS: TINV still represents a very major concern for patients. Several pretreatment risk factors for the development of TIN and TIV, respectively, were identified. Patients about to undergo cancer treatment, particularly combined treatment involving emetogenic chemotherapy and surgery, should be screened for these factors with a view to modifying standard pretreatment/maintenance antiemetic therapy. Furthermore, and consistent with recent research, it is recommended that more comprehensive interventions combining antiemetics with other effective pharmacological (e.g. anxiolytics) and non-pharmacological approaches (e.g. acupuncture, relaxation techniques) be considered by clinicians in attempts to improve control of TIN and TIV (and overall QOL) for their patients. In this way, optimal holistic care will be ensured for cancer patients by clinicians providing conventional oncology treatment.

Perspectives of African and Brazilian immigrant women on sexual and reproductive health.

Eur J Contracept Reprod Health Care. 2010 Aug; 15(4): 255-63
Dias S, Gama A, Rocha C

Objectives To explore attitudes and experiences related to sexual and reproductive health (SRH) of African and Brazilian immigrant women in Portugal. Methods Focus groups were conducted with 35 immigrant women with low income living in Lisbon, chosen through purposive sampling. Discussions were audio-taped and transcribed, and analysed through content analysis procedure. Results Compared to the Brazilian women, most Africans lacked knowledge and had more negative attitudes toward contraceptive methods, which adversely affected their proper use. African women were also less knowledgeable on sexually transmitted infections (STIs); some of them considered that their vulnerability to STIs was related to their partners' sexual risk behaviours. Nevertheless, a few Africans held less traditional attitudes toward condom use and appeared to have greater control over their sexual behaviour and STI prevention. Focus group discussions brought to light that cultural background often shapes women's desires concerning maternity. The participants' statements highlight the interaction between economic and social factors that affect immigrants and play an important role in their reproductive health. Conclusions This study illustrates the importance of developing holistic and tailored interventions for SRH promotion among immigrant women, whereby the differences and specific needs of each group need to be taken into consideration.

The concept of collaborative health.

J Interprof Care. 2010 Aug 31;
Sandberg H

Based on empirical research about teamwork in human service organizations in Sweden, the concept of collaborative health (CH) encapsulates the physical, psychological and social health resources the individual uses in teamwork; resources which at the same time are influenced by the teamwork. My argument built on empirical research leading up to identifying and defining the core concept in this article, is that teamwork affects team members' health and this in turn affects the teamwork and its outcome. In this paper collaborative health is viewed from a social constructionism perspective and discussed in relation to earlier concepts developed in social psychology and working life research, including psychosocial stress and burnout. The paper also introduces the concept of functional synergy, which in this context is defined as the simultaneous presence of sharp goal-orientation and synergy in teamwork. The need for a holistic team theory is emphasized as a tool in research on teamwork. Such a theory relies on identifying sound and illuminating constituent concepts. I suggest that collaborative health could be a useful concept for better understanding the complex collaborative and co-operative teamwork of human service organizations of today.

Nutritional treatments for acute myocardial infarction.

Altern Med Rev. 2010 Jun; 15(2): 113-123
Gaby AR

Acute myocardial infarction (MI) is one of the most frequent causes of death in the United States. The evaluation and treatment of acute MI in conventional medicine has focused primarily on anatomical and physiological factors that lead to impaired blood flow. Less attention has been paid to metabolic factors that may influence the vulnerability of the myocardium to ischemia and to various stressors. There is evidence that in some cases inefficient cellular metabolism, rather than the availability of oxygen and other blood-borne nutrients, is an important factor determining whether cardiac pathology will develop. Metabolic dysfunction could result from intracellular deficiencies of magnesium, coenzyme Q10, carnitine, and certain B vitamins, nutrients which play a role in the synthesis of adenosine triphosphate (ATP; the body's main storage form of energy). In addition, increased oxidative stress may contribute to the pathogenesis of both MI-related myocardial damage and reperfusion injury. Consequently, administration of antioxidants might improve outcomes in patients with acute MI. Numerous clinical trials have found parenteral administration of magnesium in the early stages of acute MI can substantially reduce the death rate. In addition, several trials have shown L-carnitine is beneficial in the treatment of acute MI. Other nutrients, such as vitamin C, vitamin E, and various B vitamins, may also be of value.

AHNA: building a community to advance holistic health and nursing.

Beginnings. 2010; 30(3): 12-3
Crawford J

Consent in terminal sedation.

Indian J Med Ethics. 2010 Jul-Sep; 7(3): 161-4
Krishna L

For the majority of patients at the end of life, their symptoms can be relieved through good palliative care. However, for an unfortunate few, these symptoms become intractable despite the best holistic interventions and in such cases terminal sedation is considered. The use of this intervention remains fraught with controversy, particularly around the subject of consent. A clinical scenario is used to propose that under such circumstances, given the physical and psychological stress to which these patients are subject, it is neither useful nor meaningful to ask for the patient's informed consent. Instead, physicians caring for such patients should act in the patient's best interests, in accordance with the Best Interest Principle, to alleviate such suffering.

Sickle Cell Disease: An Opportunity for Palliative Care Across the Life Span.

Nurs Clin North Am. 2010 Sep; 45(3): 375-397
Wilkie DJ, Johnson B, Mack AK, Labotka R, Molokie RE

Sickle cell disease is a chronic illness that affects patients physically and emotionally and can do so at an early age. An ecological model of palliative care that involves improved communication among the health care team, patients, and their families can be beneficial. Open and honest communication regarding advance care planning, disease management, relief of pain and other symptoms, and bereavement and grief are all important for the patient, family, and health care team. Given the multiple acute and chronic complications of sickle cell disease, an approach to care that is holistic and comprehensive may help to improve a patient's biologic function and the perceived health, functional status, and quality of life of the patient and family.

[When guidelines are confronted with health care reality : Purpose of guidelines from the perspective of a psychiatrist.]

Nervenarzt. 2010 Aug 28;
Mönter N

The National Health Care guidelines on unipolar depression play a leading role regarding the multitude of players providing general care services, regarding scientific research and, last but not least, regarding common etiologic and therapeutic concepts as perceived by affected people and their relatives. In terms of health care, depression as a universal disorder comprises qualitative and quantitative aspects. For practicing neurologists/psychiatrists the guidelines provides many suggestions for different forms of treatment of the many kinds of depressive patients. When using a comprehensive approach, the criteria of evidence-based medicine are particularly important for practicing psychiatrists regarding the knowledge based on medical experience and patients preferences. It is important to point out that the hitherto fervently debated treatment dichotomy of psychotherapy versus pharmacotherapy is beginning to diminish. This is also reflected by the holistic perception of diseases and treatment approaches prevailing among established psychiatrists and the apparent development of health care quality towards individualized medicine.

What does it mean to be an oncology nurse? Reexamining the life cycle concepts.

Oncol Nurs Forum. 2010 Sep 1; 37(5): 561-70
Cohen MZ, Ferrell BR, Vrabel M, Visovsky C, Schaefer B

Purpose/Objectives: To summarize the current research pertaining to the concepts initially examined by the Oncology Nursing Society Life Cycle of the Oncology Nurse Task Force and related projects completed in 1994.Data Sources: Published articles on the 21 concepts from the Oncology Nursing Society Life Cycle of the Oncology Nurse Task Force work. Research published in English from 1995-2009 was obtained from PubMed, CINAHL(R), PsycINFO, ISI Science, and EBSCO Health Source(R): Nursing/Academic Edition databases.Data Synthesis: Most of the concepts identified from the Oncology Nursing Society Life Cycle of the Oncology Nurse Task Force have been examined in the literature. Relationships and witnessing suffering were common concepts among studies of the meaning of oncology nursing. Nurses provide holistic care, and not surprisingly, holistic interventions have been found useful to support nurses. Interventions included storytelling, clinical support of nurses, workshops to find balance in lives, and dream work. Additional support comes from mentoring.Conclusions: The research identified was primarily descriptive, with very few interventions reported. Findings have been consistent over time in diverse countries.Implications for Nursing: This review indicates that although the healthcare system has changed significantly in 15 years, nurses' experiences of providing care to patients with cancer have remained consistent. The need for interventions to support nurses remains.

Medical Professionalism: Conflicting Values for Tomorrow's Doctors.

J Gen Intern Med. 2010 Aug 26;
Borgstrom E, Cohn S, Barclay S

BACKGROUND: New values and practices associated with medical professionalism have created an increased interest in the concept. In the United Kingdom, it is a current concern in medical education and in the development of doctor appraisal and revalidation. OBJECTIVE: To investigate how final year medical students experience and interpret new values of professionalism as they emerge in relation to confronting dying patients and as they potentially conflict with older values that emerge through hidden dimensions of the curriculum. METHODS: Qualitative study using interpretative discourse analysis of anonymized student reflective portfolios. One hundred twenty-three final year undergraduate medical students (64 male and 59 female) from the University of Cambridge School of Clinical Medicine supplied 116 portfolios from general practice and 118 from hospital settings about patients receiving palliative or end of life care. RESULTS: Professional values were prevalent in all the portfolios. Students emphasised patient-centered, holistic care, synonymous with a more contemporary idea of professionalism, in conjunction with values associated with the 'old' model of professionalism that had not be directly taught to them. Integrating 'new' professional values was at times problematic. Three main areas of potential conflict were identified: ethical considerations, doctor-patient interaction and subjective boundaries. Students explicitly and implicitly discussed several tensions and described strategies to resolve them. CONCLUSIONS: The conflicts outlined arise from the mix of values associated with different models of professionalism. Analysis indicates that 'new' models are not simply replacing existing elements. Whilst this analysis is of accounts from students within one UK medical school, the experience of conflict between different notions of professionalism and the three broad domains in which this conflict arises are relevant in other areas of medicine and in different national contexts.

Current quality of life and its determinants among opiate-dependent individuals five years after starting methadone treatment.

Qual Life Res. 2010 Aug 26;
De Maeyer J, Vanderplasschen W, Lammertyn J, van Nieuwenhuizen C, Sabbe B, Broekaert E

PURPOSE: This study explores the current QoL of opiate-dependent individuals who started outpatient methadone treatment at least 5 years ago and assesses the influence of demographic, psychosocial, drug and health-related variables on individuals' QoL. METHODS: Participants (n = 159) were interviewed about their current QoL, psychological distress and severity of drug-related problems, using the Lancashire Quality of Life Profile, the Brief Symptom Inventory and the Addiction Severity Index. Potential determinants of QoL were assessed in a multiple linear regression analysis. RESULTS: Five years after the start of methadone treatment, opiate-dependent individuals report low QoL scores on various domains. No association was found between drug-related variables and QoL, but a significant negative impact of psychological distress was identified. Severity of psychological distress, taking medication for psychological problems and the inability to change one's living situation were associated with lower QoL. Having at least one good friend and a structured daily activity had a significant, positive impact on QoL. CONCLUSIONS: Opiate-dependent individuals' QoL is mainly determined by their psychological well-being and a number of psychosocial variables. These findings highlight the importance of a holistic approach to treatment and support in methadone maintenance treatment, which goes beyond fixing the negative physical consequences of opiate dependence.

Skin cancers in albinos in a teaching Hospital in eastern Nigeria - presentation and challenges of care.

World J Surg Oncol. 2010 Aug 25; 8(1): 73
Opara KO, Jiburum BC

ABSTRACT: BACKGROUND: Albinism is a genetic disorder characterized by lack of skin pigmentation. It has a worldwide distribution, but is commoner in areas close to the equator like Nigeria. Skin cancers are a major risk associated with albinism and are thought to be a major cause of death in African albinos. Challenges faced in the care of these patients need to be highlighted, in order to develop a holistic management approach, with significant public health impact. The aim of the study was to determine the pattern of skin cancers seen in Albinos, and to highlight problems encountered in their management. METHOD: Case records of albinos managed in Imo state University teaching Hospital from June 2007 to May 2009 were reviewed. The data obtained were analyzed using descriptive statistics. RESULTS AND DISCUSSION: In the period under review, albinos accounted for 67% of patients managed for primary skin cancers. There were twenty patients, with thirty eight (38) lesions. Sixty one percent of the patients were below 40 years. Average duration of symptoms at presentation was 26 months. The commonest reason for late presentation was lack of funds. Squamous cell carcinoma was the commonest histologic variant. Most patients were unable to complete treatment due to lack of funds. CONCLUSION: Albinism appears to be the most important risk factor in the development of skin cancers in our environment. Late presentation and poor rate of completion of treatment due to poverty are major challenges.

The Irish Traveller community: social capital and drug use.

J Ethn Subst Abuse. 2010 Jul; 9(3): 186-205
Van Hout MC

The Irish Traveller community experiences severe marginalization, poverty, discrimination, and compromised health. Research indicates a distinct lack of structural understanding of Traveller negotiation of conflict within dominant sedentarist societal norms and values. Gender-based focus groups (n = 12) of Travellers (n = 57) were conducted as part of a large scale regional needs analysis for Travellers and substance use in Ireland and analyzed thematically using the social capital framework in terms of Traveller experiences within settled communities, exposure to drugs, and drug using contexts. Discriminatory experiences, low levels of institutional trust, and an influx of drug activity in Traveller communities are contributing to the neutralization of drug taking risk and the development of normative and reciprocal relationships in drug activities. A holistic, inter-governmental approach is needed to address social exclusion factors by reducing marginalization, preserving the Traveller ethnic identity, minimizing racist and discriminatory instances, understanding the Traveller risk environment, and fostering inclusive relationships with settled communities.

Novel Approaches for Analysing Gut Microbes and Dietary Polyphenols, Challenges and Opportunities.

Microbiology. 2010 Aug 19;
Kemperman RA, Bolca S, Roger LC, Vaughan EE

Polyphenols, ubiquitously present in the food we consume, may modify gut microbial composition and/or activity, and moreover, be converted by the colonic microbiota to bioactive compounds that influence host health. The polyphenol content of fruit and vegetables and derived products is implicated in some of the health benefits bestowed on eating fruit and vegetables. Elucidating the mechanisms behind polyphenol metabolism is an important step in understanding their health effects. Yet, this is no trivial assignment due to the diversity encountered in both polyphenols as well as gut microbial composition, which is further confounded by the interactions with the host. Only a limited number of studies have investigated the impact of dietary polyphenols on the complex human gut microbiota and these were mainly focused on single polyphenol molecules and selected bacterial populations. Our knowledge of gut microbial genes and pathways for polyphenol bioconversion and interactions is poor. Application of specific in vitro or in vivo models mimicking the human gut environment is required to analyse these diverse interactions. A particular benefit can now be gained from next-generation analytical tools such as metagenomics and metatranscriptomics allowing a wider, more holistic approach to the analysis of polyphenol metabolism. Understanding the polyphenol-gut microbiota interactions and gut microbial bioconversion capacity will facilitate studies on bioavailability of polyphenols in the host, provide more insight on health effects of polyphenols, and potentially open avenues for modulation of polyphenol bioactivity for host health.

GP Proceduralists: 'the hidden heart' of rural and regional health in Australia.

Rural Remote Health. 2010 Jul-Sep; 10(3): 1402
Robinson M, Slaney GM, Jones GI, Robinson JB

INTRODUCTION: General practitioner proceduralists are a distinct and highly trained cohort of doctors who provide procedural services in hospitals and emergency rooms throughout Australia. However, their value is not well recognised in the wider system of primary health care. Consequently, an understanding of the landscape of GP procedural practice is an essential element of health service planning now and in the future. Therefore, empirical data from a 2008 study of GP procedural medicine in the Bogong region of north-east Victoria and southern New South Wales is presented. The implications of shifting trends in the demand for and supply of the GP procedural workforce on future health services is examined. A comprehensive literature review established past and future trends in procedural medicine and provided a context for three research questions: (1) What procedures are being performed by GP proceduralists in the Bogong region? (2) What procedures are no longer performed and why? (3) What is the likely future of GP procedural practice in the next 5 to 10 years? METHOD: A qualitative case study methodology was chosen to explore the factors that influence the nature of GP procedural medicine. A population of 70 GPs were initially identified as practising obstetric, surgical or anaesthetic procedures. Of these, 38 participated in structured interviews, 21 were electronically surveyed and 11 were excluded from the study. Combined interview and survey responses gave a response rate of 81%. Five health service executives and a senior Department of Human Services manager were interviewed to gather their perspectives about the research questions. Content and thematic analysis revealed key issues of importance. Data-sets were examined to analyse themes associated with trends in GP procedural medicine over time. RESULTS: General practitioner proceduralists are attracted by diversity, challenge and passion for procedural work. However, there has been a gradual but sustained decline in the volume and complexity of procedural work due, in part, to shifts in community demography, changing medical practices, the rise of specialisation, the centralisation of services, infrastructure and other costs, and fear of litigation. Moreover, an ageing workforce and a shift in the demographic profile of GPs and the pressures of procedural life have contributed to a decline in GP proceduralist numbers. Nevertheless, there remains a substantial demand for GP procedural medicine in rural communities. CONCLUSIONS: Rural towns are dependent upon GP proceduralists to ensure the continuing health and sustainability of local communities. However, the existence of a viable and robust workforce of GP proceduralists is at a 'breaking point'. Until GP proceduralists are recognised and counted as a distinct cohort of valued and highly trained medical practitioners they will remain the 'hidden heart' of primary care in rural and regional Australia. An holistic approach must be adopted to attract, train, maintain and recognise the GP proceduralists' unique place in rural health. With the Australian health system under government review, there are opportunities to revitalise GP procedural practice as a long term, viable and challenging career choice and ensure on-going support for rural in-patient and emergency department services.

Federal agency support for healthy homes.

J Public Health Manag Pract. 2010 Sep-Oct; 16(5 Suppl): S90-3
Brown MJ, Ammon M, Grevatt P

Numerous studies have demonstrated that housing interventions such as addressing structural deficiencies or lack of safety devices improve health. These successes, coupled with reports by health care and housing professionals of other health and safety issues in homes that they were unable to address, have renewed interest in promoting health by addressing unhealthy housing conditions--but with a holistic approach. The Centers for Disease Control and Prevention, US Department of Housing and Urban Development, and US Environmental Protection Agency fund programs to improve indoor air and drinking water quality and prevent childhood lead poisoning. All of these programs offer valuable lessons for designing more integrated programs. The federal agencies and their grantees have demonstrated that interagency collaboration is essential for successful outcomes. However, the Department of Housing and Urban Development, the Environmental Protection Agency, and the Centers for Disease Control recognize that no individual agency has all of the necessary resources or expertise to formulate national programs and policies and implement a national healthy homes agenda. Thus, they have come together with the US Department of Health and Human Services, the Department of Energy, the US Department of Agriculture, the National Institute of Standards and Technology, the National Institute of Environmental Health Sciences, and the Office of the Surgeon General to form an interagency working group to ensure that vigorous, healthy homes policies are implemented at federal, national, and community levels.

Systems level studies of mammalian metabolomes: the roles of mass spectrometry and nuclear magnetic resonance spectroscopy.

Chem Soc Rev. 2010 Aug 17;
Dunn WB, Broadhurst DI, Atherton HJ, Goodacre R, Griffin JL

The study of biological systems in a holistic manner (systems biology) is increasingly being viewed as a necessity to provide qualitative and quantitative descriptions of the emergent properties of the complete system. Systems biology performs studies focussed on the complex interactions of system components; emphasising the whole system rather than the individual parts. Many perturbations to mammalian systems (diet, disease, drugs) are multi-factorial and the study of small parts of the system is insufficient to understand the complete phenotypic changes induced. Metabolomics is one functional level tool being employed to investigate the complex interactions of metabolites with other metabolites (metabolism) but also the regulatory role metabolites provide through interaction with genes, transcripts and proteins (e.g. allosteric regulation). Technological developments are the driving force behind advances in scientific knowledge. Recent advances in the two analytical platforms of mass spectrometry (MS) and nuclear magnetic resonance (NMR) spectroscopy have driven forward the discipline of metabolomics. In this critical review, an introduction to metabolites, metabolomes, metabolomics and the role of MS and NMR spectroscopy will be provided. The applications of metabolomics in mammalian systems biology for the study of the health-disease continuum, drug efficacy and toxicity and dietary effects on mammalian health will be reviewed. The current limitations and future goals of metabolomics in systems biology will also be discussed (374 references).

Ingenuity pathways analysis of urine metabonomics phenotypes toxicity of gentamicin in multiple organs.

Mol Biosyst. 2010 Aug 11;
Lv H, Liu L, Zhang Y, Song T, Lu J, Chen X

We introduce the use of Ingenuity Pathway Analysis to analyzing global metabonomics in order to characterize phenotypically biochemical perturbations and the potential mechanisms of the gentamicin-induced toxicity in multiple organs. A single dose of gentamicin was administered to Sprague Dawley rats (200 mg/kg, n = 6) and urine samples were collected at -24-0 h pre-dosage, 0-24, 24-48, 48-72 and 72-96 h post-dosage of gentamicin. The urine metabonomics analysis was performed by UPLC/MS, and the mass spectra signals of the detected metabolites were systematically deconvoluted and analyzed by pattern recognition analyses (Heatmap, PCA and PLS-DA), revealing a time-dependency of the biochemical perturbations induced by gentamicin toxicity. As result, the holistic metabolome change induced by gentamicin toxicity in the animal's organisms was characterized. Several metabolites involved in amino acid metabolism were identified in urine, and it was confirmed that gentamicin biochemical perturbations can be foreseen from these biomarkers. Notoriously, it was found that gentamicin induced toxicity in multiple organs system in the laboratory rats. The proof-of-knowledge based Ingenuity Pathway Analysis revealed gentamicin induced liver and heart toxicity, along with the previously known toxicity in kidney. The metabolites creatine, nicotinic acid, prostaglandin E2, and cholic acid were identified and validated as phenotypic biomarkers of gentamicin induced toxicity. Altogether, the significance of the use of metabonomics analyses in the assessment of drug toxicity is highlighted once more; furthermore, this work demonstrated the powerful predictive potential of the Ingenuity Pathway Analysis to study of drug toxicity and its valuable complementation for metabonomics based assessment of the drug toxicity.

Assessment and management of nutrition in older people and its importance to health.

Clin Interv Aging. 2010; 5: 207-16
Ahmed T, Haboubi N

Nutrition is an important element of health in the older population and affects the aging process. The prevalence of malnutrition is increasing in this population and is associated with a decline in: functional status, impaired muscle function, decreased bone mass, immune dysfunction, anemia, reduced cognitive function, poor wound healing, delayed recovery from surgery, higher hospital readmission rates, and mortality. Older people often have reduced appetite and energy expenditure, which, coupled with a decline in biological and physiological functions such as reduced lean body mass, changes in cytokine and hormonal level, and changes in fluid electrolyte regulation, delay gastric emptying and diminish senses of smell and taste. In addition pathologic changes of aging such as chronic diseases and psychological illness all play a role in the complex etiology of malnutrition in older people. Nutritional assessment is important to identify and treat patients at risk, the Malnutrition Universal Screening Tool being commonly used in clinical practice. Management requires a holistic approach, and underlying causes such as chronic illness, depression, medication and social isolation must be treated. Patients with physical or cognitive impairment require special care and attention. Oral supplements or enteral feeding should be considered in patients at high risk or in patients unable to meet daily requirements.

[Psychosomatic symptoms in somatic diseases - open-angle glaucoma for example]

Klin Monbl Augenheilkd. 2010 Aug; 227(8): 638-45
Emmerich GM

Psychological aspects exist in somatic diseases like tumours and even fractures, not only in the beginning but also in the management of disease. Somatic diseases give rise to signs of a special constellation of life and management of these diseases is important for the psychological constellation of the individual. Studies on open-angle glaucoma have shown that many patients suffering from this disease are anxious, hypochondric, perfectionist and emotional instable. Chronic diseases are demanding processes of flexibility and defense, and define how the individual can deal with the diseases and what place in life the disease will occupy in the future. In the holistic view of medicine even psychological conflicts should be treated. In many situations, these conflicts are not consciously experienced by the individual. Therapeutically, 2 different tools can be used: symbolic stories can bring forces to manage the conflict and to solve the conflict (2 examples in the text). The method of positive psychotherapy describes the reasons for psychosomatic diseases in three parts: psychosomatic in the traditional understanding, in further and comprehensive understanding. Especially the psychosomatic effects in comprehensive understanding are embedded in the individual's sociocultural environment and provide tips on reasons for the diseases in those parts of life. The "positive balance model" gives an example of life-management and conflict-therapy. In ophthalmology, fear is often more important for the patient than pain. To avoid this, the patients develop techniques to deny, to cover or to suppress the fear. In the article questions are presented like those the ophthalmologist should be able to ask patients in the office concerning open-angle glaucoma. Tips for the therapy and management for neurotic stress are offered and some special anamnestic questions for the ophthalmologist are presented. Unsolved conflicts and denied desires as neurotic symptoms can be focused in symptoms of eye diseases. Macrotraumata and microtraumata may be reason for changes of the hormonal situation and subsequent destabilisation of the metabolism, hypertonic disease and variation of the intraocular pressure. This article gives an example of the therapeutic possibilities in somatic diseases, to discuss the psychic situation with the patient and to be able to give tips for self-help. Finally, the therapeutic procedere in patients with somatic and psychosomatic diseases is discussed and a 5-step model is presented.