Clinical competence of biopsychosocially trained physicians and controls.

Objective: To assess and compare clinical observations and interpretations by physicians trained in biopsychosocial internal medicine (group A) and a control group (C) of physicians with no such special training.

Methods: A verbatim first-interview of a 36-year old woman, seen for consultation by RHA, was presented to both groups (A, trained physicians: n = 30, and C, controls: n = 29). The patient's symptoms included: shaky knees, strange sensations in the abdomen and chest, insecurity and dizziness.

Engel's biopsychosocial model is still relevant today.

In 1977, Engel published the seminal paper, "The Need for a New Medical Model: A Challenge for Biomedicine" [Science 196 (1977) 129-136]. He featured a biopsychosocial (BPS) model based on systems theory and on the hierarchical organization of organisms. In this essay, the model is extended by the introduction of semiotics and constructivism.

Gender and the relationship between traumatic childhood experiences and pain in adulthood.

Objectives And Methods: Gender differences regarding 17 childhood experiences, thought to have traumatising potential (Traumatic Childhood Experiences = TCE), and pain behaviour in adulthood were assessed using a self-administered, anonymously filled-out questionnaire. Patients were consecutively accrued in the offices of practicing physicians. Three research questions were formulated: 1) Are specific TCE reported more frequently in male and female patients with the diagnosis "Pain Associated with Psychological Factors" (PP), compared to patients with "Pain, explained by Organic Processes" (OP), and "Patients with Diseases without Pain" (OD)? 2) Do PP-men and PP-women differ in reporting TCE?; 3) Are specific TCE correlated with Pain Duration, -Intensity and Number of Operations?

Results: 1).

Negative affect states and cardiovascular disorders: a review and the proposal of a unifying biopsychosocial concept.

Aim: The purpose of this review was to study the relationships between negative affect states and cardiovascular disorders.

Procedure: The phenomenology of the negative affect states of depression, helplessness, hopelessness, vital exhaustion and grief is described. Their correlations with morbidity and mortality are analyzed.

Toward an understanding of different manifestations of fatigue.

Background: The aim of this study was to determine if patient narratives and interviewer reactions are specific in groups of somatic (SF) and psychogenic fatigue (PF) patients.

Methods: The interview criteria and criteria of the interviewer reaction are tested against group classification. Over a 2-year period, 51 (22 PF and 29 SF) patients fulfilling the inclusion criteria were interviewed by two trained independent interviewers.

Chronic fatigue syndrome (cfs).

The Chronic Fatigue Syndrome (CFS) is described based on the revision of Fukuda et al. The question "whether CFS can be discussed as a homogenous disorder?" has been reviewed and the answer is "no". Other overlapping syndromes are mentioned.

Hopelessness is associated with decreased heart rate variability during championship chess games.

Objective: Clinical observations suggest that negative affects such as helplessness/hopelessness (HE/HO) may induce autonomic duration; affects were assessed for every move after reconstruction of the games. In all games compiled, 18 situation of intense confidence/optimism and 20 of intense helplessness/hopelessness were observed.

Results: Intense affects of HE/HO were associated with decreasing HF-HRV (Fisher exact test, p =.

The two faces of medical evidence.

The dictionary definition of "evidence" is given. The meaning of evidence in the history of science is described. Clinical examples are presented to illustrate different aspects of evidence, i.

Accuracy of the clinical diagnosis of 'psychogenic disorders' in the presence of physical symptoms suggesting a general medical condition: a 5-year follow-up in 162 patients.

Objective: The range of unnoticed physical disorders in patients diagnosed with a psychogenic disorder varies widely. We investigated the accuracy of the clinical diagnosis of 'psychogenic disorder' where physical symptoms suggesting a somatic condition (PDPS) are present.

Method: All 162 cases of PDPS diagnosed between 01.

The differentiation of organic and psychogenic pain.

The differentiation between the organic and psychogenic origin of pain is often difficult to establish. One helpful characteristic for the detection of the organicity of a pain syndrome is its consistent change in intensity and/or quality as a function of the motoric behavior of the patient, which can be assessed while taking the history. This observation is illustrated by means of four clinical vignettes.