No abstract

Knowledge on the reliability of family history information is essential for every family study. However, systematic analyses of interinformant reliability of family history information on individual relatives have not yet been published. Consequently, family history information on 1306 first-degree relatives and spouses of patients and of control subjects was collected from at least two other family members using questionnaires. Interinformant reliability was acceptable for dementia [Kappa = 0.58, 95% confidence interval (CI) = 0.48-0.68], but less so for alcoholism (Kappa = 0.41, CI = 0.23-0.59), depression (Kappa = 0.26, CI = 0.14-0.38) and anxiety disorders (Kappa = 0.19, CI = 0.05-0.43). Demographic variables of subjects and informants and their familial relationship did not influence diagnostic agreement on the diagnosis of dementia. Diagnostic agreement on depression was significantly reduced when information from siblings of index subjects was compared with information from spouses of index subjects. The interinformant agreement for the diagnosis of depression was higher in younger than in older subjects (relative risk for disagreement 1.08/additional year, CI = 1.02-1.15). Siblings of index subjects seem to provide different, but not necessarily less relevant, family history information in comparison with other relatives. Researchers should be aware of the problem that depression in the elderly can be easily missed by family history. It seems more important for the diagnosis of depression than for a diagnosis of dementia to get information from multiple informants.

The increasing prevalence of stress‐related disorders such as burnout urges the need for specialized treatment approaches. Programmes combining psychotherapy and regenerative interventions emerge to be the most successful. However, evaluated therapy programmes are scarce and usually involve subjective symptom quantification without consideration of physiologic parameters. The aim of the present exploratory, single‐group study was the multimodal investigation of the effectiveness of a specialized holistic therapy programme by assessing symptoms and biological markers of chronic stress. Seventy‐one in‐patients (39 men/32 women; age 46.8 ± 9.9 years) of a specialized burnout ward with the additional diagnosis of burnout (Z73.0) in conjunction with a main diagnosis of depressive disorder (F32 or F33) according to the International Classification of Diseases (ICD)‐10 were included in the study. In addition to symptomatology, the stress‐responsive biomarkers heart rate variability (HRV) and serum brain‐derived neurotrophic factor (BDNF) were measured in patients at admittance to and discharge from the burnout ward applying a 6‐week specialized treatment programme. At discharge, patients showed a significant reduction of symptom burden and a significant increase in serum BDNF, while HRV remained unchanged. The findings implicate that the therapy programme may have beneficial effects on symptomatology and neuroplasticity of patients with burnout. As therapy was often supplemented by psychopharmacological treatment, a relevant influence of antidepressant medication especially on BDNF has to be considered.

Zusammenfassung. Vor dem Hintergrund neuer neurobiologischer und epigenetischer Erkenntnisse erfolgt eine genauere Darstellung des (fachlich oft missverstandenen) «bio-psycho-sozialen» Schmerzverständnisses und seiner Bedeutung für das Verständnis stressinduzierter Schmerzzustände als Grundlage einer individualisierten («personenbezogenen») Schmerztherapie. Daraus werden die Konsequenzen für die Diagnostik bei stressbedingten Schmerzzuständen (z.B. Fibromyalgie-Syndrom, nicht-radikuläre Rückenschmerzen, kraniomandibuläre Dysfunktion, Spannungskopfschmerz) abgeleitet. Vor diesem Hintergrund werden die Prinzipien eines hoch wirksamen bio-psycho-sozialen Therapiekonzept skizziert.

No abstract