Prevalence of suicidal ideation in German psychotherapy outpatients: A large multicenter assessment.

BACKGROUND: Suicidal ideation is a major concern in clinical practice. Yet, little is known about prevalence rates of suicidal ideation in patients undergoing outpatient psychotherapeutic treatment. Therefore, the aim of the current study is to assess the prevalence of suicidal ideation in a large sample of psychotherapy outpatients in Germany. The data analyzed in this study is taken from the KODAP-project on the coordination of data collection and analysis at German university-based research and training outpatient clinics for psychotherapy. METHODS: A total of N = 10,357 adult outpatients (64.4 % female; age: M(SD) = 35.94 (13.54), range: 18-92 years of age) starting cognitive-behavioral therapy at one of 27 outpatient clinics in Germany were included in the current study. Prevalence of suicidal ideation was assessed with the Suicide Item (Item 9) of the Beck-Depression Inventory II. RESULTS: Suicidal ideation was reported by 36.7 % (n = 3795) of the participants. Borderline Personality Disorder, Posttraumatic Stress Disorder, and recurrent Major Depression were the diagnoses most strongly associated with the presence and severity of suicidal ideation. LIMITATION: Suicide ideation was assessed only with the respective item of the Beck Depression Inventory II. CONCLUSION: Suicidal ideation is very common among adult patients who start psychotherapy in Germany. A well-founded knowledge of risk assessment in suicidal patients and suicide-specific treatment options is therefore highly relevant.

[Which schizophrenic patients improve under work therapy, which ones don't?]. / Welche schizophrenen Patienten verbessern sich unter Arbeitstherapie, welche nicht? Ein Beitrag zur differenziellen Wirksamkeitsprüfung.

This investigation is part of a multicenter study, where only small effects and no superiority compared to creative ergotherapy was found for four weeks of inpatient work therapy. The criteria were three scales of the Osnabrück-Working Capabilities Profile (O-AFP) assessing basic learning ability, social communication ability and adaptation at the work place. The goal of this investigation is to identify subgroups of patients within the work therapy group, which differ in their course of ability level during the intervention. Three subgroups were identified for each scale. Subgroups with improvements comprise 24 % (learning ability) and 15 % (social communication) of the sample. Adaptation level decreases in a group of 9 % of the patients. The remaining clusters show constancy of abilities at different levels. Comparison of the clusters with neurocognitive, symptom and motivational variables shows that for learning ability mainly neurocognitive variables yield salient differences, whereas for social communication abilities, symptoms and motivation, together with a specific aspect of memory, seem to be characteristic. Only positive symptoms are related to adaptation. Also, there are hints for variables that specifically characterize patients with improvement of ability level. The discussion deals with issues of assessment and prognosis in rehabilitation, contributions to the neurocognitive theory of schizophrenia and to the development of person-centered interventions.

Attentional characteristics of schizophrenia patients differing in learning proficiency on the Wisconsin Card Sorting Test.

The Wisconsin Card Sorting Test (WCST), a test of concept formation, was given to 49 schizophrenia inpatients in three blocks of 64 cards each with the second block comprising special instructions and trial-by-trial feedback. With the help of a psychometric algorithm based on linear regression analysis, the patients were classified according to their response to these specific interventions. Results yielded 15 high scorers, 23 learners, and 11 nonlearners. This a priori classification was confirmed by cluster analysis. Next, these groups were further analyzed with the Degraded Stimulus Continuous Performance Test (DS-CPT), a test of target discrimination, and the Test of Attentional Style (TAS), which assesses habitual, subjectively experienced attentional problems. A significant difference between high scorers and nonlearners was found for discriminative sensitivity (d'), with the learners achieving intermediate scores. Results for only the DS-CPT response criterion (beta) and a TAS subscale (Distractibility) tended to be significant. Discriminant analysis also revealed that d' is the most powerful variable for discriminating among the subgroups. The article also addresses baseline versus dynamic assessment, specific rehabilitation needs in subgroups of schizophrenia patients different in learner status, and the neurocognitive characteristics of the subgroups.

[Development of a city planning hygiene analysis and its application in the framework of an environmental-epidemiological study]. / Entwicklung einer "Städtebauhygienischen Analyse" und ihre Anwendung im Rahmen einer umweltepidemiologischen Untersuchung.

A "town-planning hygienic analysis" is presented which has been developed within an environmental epidemiological study. This analysis contains 7 marks (maximum sound pressure level Lmax, equivalent pressure level Leq, housing conditions/sanitary, size of flat, brightness/day-light ratio, environment, building order) whose quality is scored into 3 categories (very good/good, sufficient, insufficient). The evaluation is performed by relating the frequency of the proportional quality as well as the score for the general quality, which is constructed by the mean of the proportional qualities. First results are discussed with a comparative study on 297 flats.

[Differential diagnosis of destructive processes of the skull base. Aggressive polypoid eosinophilic pansinusitis with expression of carcinoembryonic antigen (CEA)]. / Ein Beitrag zur Differentialdiagnose von destruierenden Prozessen der Schädelbasis. Die aggressive polypöse eosinophile Pansinusitis mit Expression von karzinoembryonalem Antigen (CEA).

We report a woman with extensive polypoid sinusitis and bony destruction of the middle and posterior skull base. Histological examination of the specimen from the paranasal sinuses and adjacent skull base revealed polypoid eosinophilic sinusitis: malignancy could be excluded histologically and clinically. Plasma-CEA-levels were elevated to 85 micrograms/l with no typical source of CEA expression, and they fell after therapy. Immunocytochemistry revealed a remarkable expression of CEA in the surface epithelia of the specimen obtained from the paranasal sinuses. CEA-immunoscintigraphy showed an enhancement in the regions of the paranasal sinuses without expression elsewhere in the body. The authors discuss the possibility of using CEA as a marker for aggressive forms of chronic sinusitis and suggest radiotherapy is a successful treatment option in addition to surgery. The observation period of almost two years confirms the value of the chosen therapy.

[Coping with illness as conforming to technological rules: an analysis of coping behavior of schizophrenic patients]. / Krankheitsbewältigung als Befolgung technologischer Regeln: Eine Analyse des Bewältigungsverhaltens schizophrener Patienten.

Coping can be conceptualized in terms of conformity with certain rules describing the relation between appraisals (here: control-ability and variability of stressors) and coping behaviour (here: problem-oriented, non-problem-oriented). The goal of the study is to examine the relevance of this approach for the analysis of schizophrenic patients' coping with their disease. This was done with the help of a reanalysis of data from a previous study. Subjects were 40 patients, which could be grouped in three clusters: high symptom strain, low symptom strain, specific strain (prodromal). Results showed that patients with low strain had a higher level of rule-conformity. Also, subjects with high rule conformity had a higher level of well-being, better prognosis and a higher level of professional education.

[Personal experiences with tympanoscopy in sudden deafness]. / Unsere Erfahrungen mit der Tympanoskopie beim Hörsturz.

The rupture of the round window membrane with consecutive perilymph fistula has gained in importance in the discussion of the pathogenesis of sudden hearing loss. In a retrospective study, the results of 23 tympanoscopies performed at the ENT Department of the University of Hamburg are reported. Two confirmed perilymph fistulas were seen, whereas in three cases they could not be excluded. After obliteration of the window niches with connective tissue an improvement of the hearing loss was seen in 9 cases. In comparison with our intraoperative findings, the number of perilymphatic fistulas mentioned in literature often seems very high. Nevertheless, tympanoscopy and obliteration of the window niches have their definite place in the therapeutic concept of sudden hearing loss, although the indication must be severely restricted.

Ultrastructural morphometry of prolactin secreting adenomas treated with dopamine agonists.

19 macroprolactinomas and 1 microprolactinoma were analysed by light microscopical, immunohistological and ultrastructural as well as morphometrical methods. 8 adenomas were removed from patients who were treated preoperatively with bromocriptine and/or Lisurid for different periods. 18 of 20 adenomas were positive for PRL on the immunohistological level. One case was negative. This patient showed a good response to the pharmacological treatment. The ultrastructure of this case revealed many secretory granules. A morphometric analysis of the ultrastructure could be performed in 19 cases; 1 case had to be excluded because of large necrotic areas. The following qualitative significant alterations after the treatment could be established: Reduction of the volume density of the rough endoplasmatic reticulum; Reduction of the size of the granula diameter; Increase of the volume density of the more irregular and indented nuclei. Other alterations were as follows: Reduction of the nuclear size; Increase of the number of secretory granules and of the volume density of lysosomes. These changes were to be observed in most of those tumors which responded to the dopamine agonist treatment. The non-responding adenomas and one which was removed 6 days after having discontinued a successful preoperative medical therapy were similar to the untreated adenomas. The results display the influence of dopamine agonist on the hormone synthesis, release and degradation in PRL secreting adenoma cells.

Effect of low-molecular-weight proteins on protein (lysozyme) binding to isolated brush-border membranes of rat kidney.

Filtered proteins including the low-molecular-weight protein lysozyme are reabsorbed by the proximal tubule via adsorptive endocytosis. This process starts with binding of the protein to the brush-border membrane. The binding of 125I-labelled egg-white lysozyme (EC 3.2.1.17) to isolated brush-border membranes of rat kidney and the effect of several low-molecular weight proteins on that binding was determined. The Scatchard plot revealed a one-component binding type with a dissociation constant of 5.3 microM and 53.0 nmol/mg membrane protein for the number of binding sites. The binding of the cationic lysozyme was inhibited competitively by the addition of cationic cytochrome c to the incubation medium, while the neutral myoglobin had no effect. The anionic beta-lactoglobulin A inhibited the lysozyme binding in a noncompetitive manner. These data suggest that the binding takes place between positively charged groups of the protein molecule and negative sites on the brush-border membrane, and, the competition between the cationic cytochrome c and the cationic lysozyme for the binding sites may be responsible for the inhibitory effect of cytochrome c on renal lysozyme reabsorption. The binding step at the brush-border membrane appears to be cation-selective.