[Expression, identification and experience of emotions in mental diseases. An overview]. / Ausdruck, Erkennen und Erleben von Emotion bei psychischen Störungen. Eine Übersicht.

Several studies in clinical neuroscience have focused on the analysis of expression of emotions, identification of emotions and experience of emotions. These empirical studies produced certain insights into emotional competency in different mental diseases, most of them in schizophrenia. The current article gives a description of the scientific data about alterations in emotional competency in several mental diseases (e.g. schizophrenia, depression, bipolar and borderline diseases) and links the data, if possible, with clinical relevance with a special focus on emotional competency in prodromal schizophrenia.

[Prospective description of the course of psychopathological symptoms in schizophrenia: evaluation of the short form of the Eppendorf Schizophrenia Inventory]. / Prospektive Verlaufsbeschreibung psychopathologischer Symptome bei Schizophrenie: Evaluation der Kurzform des Eppendorfer Schizophrenie-Inventars.

BACKGROUND: The Eppendorf Schizophrenia Inventory (ESI-K) is a self-assessment procedure which can now be considered as the standard procedure in the diagnostics of schizophrenia. It has been evaluated in many studies and is widely used in research and clinical treatment. In contrast little is known about the psychometric characteristics of the short form of the ESI (ESI-K) which was designed in particular for prospective descriptive courses. MATERIALS AND METHODS: The ESI-K was completed for 40 patients with schizophrenia undergoing complete inpatient psychiatric treatment together with the Positive and Negative Syndrome Scale (PANSS), the Clinical Global Impressions (CGI) form and the Nurses' Observation Scale for Inpatient Evaluation (NOSIE). Of the patients 31 participated in a total of 4 measurements at 1-week intervals. RESULTS: The reliability (Cronbachs α) of the ESI-K was high at all measurement time points and was comparable to the reliability of the standard version. The reliability of the PANSS was roughly the same level but that of the NOSIE was poor. The ESI-K correlated in particular with cognitive syndrome and the positive syndrome of the PANSS. All four instruments showed a decrease in scores over the observational time period which indicated a decline in the psychopathological symptoms. CONCLUSIONS: The ESI-K is a valid time-saving procedure for documentation of the course of symptoms in patients with schizophrenia. It reflects clinically relevant aspects from the spectrum of psychotic symptoms.

The association between high-dose cytarabine neurotoxicity and renal insufficiency.

We reviewed the medical records of 110 consecutive patients at our institution who had acute leukemia and received high-dose cytarabine (Ara-C; HDAC) in order to analyze risk factors associated with HDAC neurotoxicity (NT). There were adequate records on 101 patients who received 147 courses of HDAC. Twenty-six treatment courses (18%) were complicated by NT. The median time of NT onset was 5 days (range, 1 to 10 days), and NT was reversible in 16 of 21 survivors (76%). Patients with severe NT (grades 3 to 4) were less likely to have complete reversal of their neurological deficit than those with mild NT (P less than .1). In our patients, there was no significant association between previously described risk factors (age over 49 years, male gender, CNS disorder, and cumulative HDAC dose greater than 48 g/m2) and incidence of NT. However, treatment courses involving HDAC given during renal insufficiency (serum creatinine greater than or equal to 1.5 mg/dL or an increase in serum creatinine greater than 0.5 mg/dL) were much more likely to be complicated by any degree of NT during administration of HDAC (62%) and severe NT (42%) than those given during normal renal function (8% and 3%, respectively; P less than .001). Of the treatment courses involving patients with estimated creatinine clearances less than 60 mL/min, 76% were complicated by NT compared with 8% of treatment courses involving patients with clearances greater than 60 mL/min (P less than .001). HDAC courses with neurotoxic patients had higher serum creatinines (2.1 +/- 1.4 v 1.1 +/- 0.6 mg/dL), greater increases in serum creatinine (+ 0.5 +/- 0.8 v + 0.07 +/- 0.3 mg/dL), and lower estimated creatinine clearances (61 +/- 35 v 91 +/- 29 mL/min) than those courses with nonneurotoxic patients (P less than .001, all parameters). Patients receiving HDAC during renal insufficiency are at high risk for developing NT. Dose reduction of HDAC should be considered for patients with renal insufficiency.

Serial renin-angiotensin studies in spontaneously hypertensive and Wistar-Kyoto normotensive rats. Transition from normal- to high-renin status during the established phase of spontaneous hypertension.

To characterize the renin-angiotensin system in the Aoki-Okamoto spontaneously hypertensive rat (SHR) more fully, serial measurements of plasma renin activity (PRA), plasma renin concentration (PRC), renin reactivity (as relative index of circulating modifiers of the renin reaction) and renin substrate concentration were made in 6- to 64-week-old SHR and in age-matched Wistar-Kyoto normotensive rats (WKY). In the evolving phase of SHR hypertension (6 and 13 weeks of age), PRA was comparable to WKY control values, whereas mature SHR with established hypertension developed, between 13 and 35 weeks of age, a high-PRA state persisting through 64 weeks of age. In 64-week-old SHR, increased plasma volume (3.54 +/- 0.91 in SHR vs. 3.18 +/- 0.90 ml/100 g body weight in WKY, p less than 0.025), together with increased PRA (24.9 +/- 3.8 in SHR vs. 13.1 2.2 ng AI/ml plasma/hr in WKY, p less than 0.025), suggest that volume decrease cannot explain increased PRA. In 42-week-old SHR, PRA was incompletely suppressed by deoxycorticosterone acetate plus 1% saline orally for 4 days: 4.9 +/- 1.2 in SHR vs. 0.6 +/- 0.8 ng angiotensin I/ml plasma/hr in WKY, p less than 0.001. Modestly increased renin reactivity of plasma was observed in SHR at all ages studied, supporting the ubiquity of increased circulating accelerators (or decreased inhibitors) of the renin reaction in hypertensive states. However, elevated renin reactivity did not account for the transition from normal to high PRA observed in mature SHR, nor did renin substrate concentration, which was consistently lower in SHR than in age-matched WKY. Temporal patterns of, and strain differences in PRA were closely paralleled by variations in PRC but not by other reaction components. Significant elevation of serum creatinine in old SHR support the presence of renal injury. We conclude that PRA and PRC are normal in evolving SHR hypertension and progress to abnormally elevated levels after hypertension is established. We postulate that "high-renin" hypertension may develop as a consequence of the hypertensive state per se, perhaps due to nephrosclerotic vascular disease.

Adrenocorticotropin-cortisol axis abnormalities in hemodialysis patients.

The ACTH-cortisol axis was studied in 15 hemodialysis patients. Basal plasma cortisol concentrations were found to be elevated and ACTH to be in the high normal range. Cortisol responded normally to exogenous ACTH, but neither cortisol nor ACTH were suppressed in response to oral dexamethasone. 11-Deoxycortisol and ACTH concentrations did not rise normally in response to either oral or iv metyrapone. We conclude that standard testing of the ACTH-cortisol axis in dialysis patients yields results suggesting Cushing's syndrome.

The role of HER-2 expression in predicting response to therapy in breast cancer.

HER-2 expression may have predictive value regarding response to therapeutic interventions in breast cancer. A number of reports describe the interaction of HER-2 overexpression and tamoxifen, but data are inconclusive. Chemotherapy trials have supported an interaction between HER-2 overexpression and chemotherapy sensitivity (cyclophosphamide/methotrexate/5-fluorouracil resistance and doxorubicin sensitivity) which is compelling. More recently, HER-2 has been the target for Food and Drug Administration-approved antibody therapy, trastuzumab (Herceptin; Genentech, Inc, South San Francisco, CA). The Clinical Trials Assay, a scoring system for tumor material, has been used successfully in the trastuzumab clinical development program. As many of the early studies evaluating the role of HER-2 were retrospective, controlled prospective studies are needed to best determine the value of trastuzumab in the adjuvant clinical setting.

Improvement of schizophrenic patients' subjective well-being under atypical antipsychotic drugs.

Recent research indicates that subjective well-being is a major determinant of medication compliance in schizophrenia. However, it is yet unresolved whether atypical neuroleptics differ regarding subjective side-effects. A self-report instrument has been constructed to evaluate 'subjective well-being under neuroleptics' (SWN). The primary aims of the present study were to develop a short form of the SWN and to investigate the extent to which the atypical antipsychotic improves the patient's subjective well-being. The short form of the SWN was constructed following an item analysis based on data from 212 schizophrenic patients medicated with either typical or atypical antipsychotics. The short form of the SWN showed sufficient internal consistency and good construct validity. The SWN was only moderately correlated with positive and negative syndrome scale (PANSS) scores or changes in psychopathology (r=-0.20 to -0.37). SWN-ratings in patients receiving olanzapine were superior compared to those of patients medicated with either clozapine or risperidone on three of five domains of well-being. Clozapine reduced global psychiatric symptoms significantly more than risperidone. It is concluded that the assessment of subjective well-being under antipsychotic treatment provides an independent outcome measure which is relevant to compliance.

Characteristic subjective experiences of schizophrenia.

The purpose of the study was to identify subjective experiences that are characteristic of schizophrenia. A questionnaire for self-assessment of disturbances in several cognitive-perceptual areas (the Eppendorf Schizophrenia Inventory) was constructed and administered to first episode schizophrenia patients (SCHf; n = 45), negative-syndrome schizophrenia patients (SCHn; n = 45), remitted schizophrenia subjects (SCHr; n = 24), depressive patients (DEP; n = 43), alcoholic patients (ALC; n = 48), obsessive-compulsive patients (OCD; n = 46), and healthy controls (CON; n = 57). Comparisons between the SCHf, SCHn, DEP, ALC, and OCD groups and a subsequent factor analysis revealed four schizophrenia-specific dimensions: Attention and Speech Impairment (AS), Ideas of Reference (IR), Auditory Uncertainty (AU), and Deviant Perception (DP). Further analyses suggested that the AS syndrome represents a mediating vulnerability factor, while IR, AU, and DP probably are reversible episode indicators. The results may contribute to the refinement of the measurement of specific prepsychotic signs, thus facilitating the development of early intervention approaches.

Psychopathological syndromes of schizophrenia: evaluation of the dimensional structure of the positive and negative syndrome scale.

The Positive and Negative Syndrome Scale (PANSS) was originally designed as a rating system that provides balanced representation of positive and negative symptom features. Evidence from recent factor-analytic studies suggests that a five-dimensional solution appears to best fit the psychopathological data as assessed with the PANSS. To investigate the dimensional structure, we administered the PANSS to 253 inpatients with schizophrenia. In accordance with former studies, principal components analyses yielded five orthogonal dimensions: hostile excitement; negative, cognitive, and positive syndrome; and depression. When compared with questionnaires measuring subjective nonpsychotic experiences of schizophrenia, paranoid mood, and depression, the correlation pattern verifies the PANSS components. In addition, we investigated a subsample of 70 male patients with a Continuous Performance Test (CPT), a Span of Apprehension Task, and a Modality Shift Effect (MSE) paradigm; the CPT was significantly associated with the cognitive syndrome, and the MSE correlated with the negative syndrome.

Statistical methods for analyses of incomplete clinical service records: concurrent use of longitudinal and cross-sectional data.

Statistical procedures that have become routine in other social sciences were used to analyze data from clinical service records. Despite the absence of control groups, nonrandom assignment of clients to treatment conditions, and incomplete records, effective analyses of psychotherapeutic processes were possible. Multivariate regression models, with variables that were transformed to significantly improve skewness and regression linearity, were controlled for heteroskedasticity and for end-point censoring of dependent variables. They were also used to measure the effects of a categorical variable (gender) and a scalable variable (intake distress) on a reactive outcome measure (of acute distress) and on an unreactive one (of long-term life satisfaction). Graphical methods for summarizing large data sets helped identify intake variables that could control for attrition-related sampling biases. These longitudinal covariates and corrections to adjust degrees of freedom for cases with repeated measures were then used to construct statistical models that were equivalents of pure cross-sectional designs.

Interoception of respiratory resistance in asthmatic patients.

The interoception of respiratory obstruction was investigated in three different experimental or quasi-experimental studies. In two experiments of the first study, the psychophysics of the perception of externally added flow resistive loads were examined by using a signal detection approach. Asthmatic patients displayed a decreased sensitivity in the discrimination of such loads. The second study assessed the individual consistency of dyspnea ratings at different levels of bronchoconstriction provoked by allergic agents. A great variation in subjects' ability to discriminate consistently between various levels of airway resistance was observed. This ability was found to be relevant for coping with asthma. In the third study the visceral perception hypothesis of J. Brener was examined. This theory states that biofeedback training of voluntary control of respiratory resistance is accompanied by an improvement in perception of airway obstruction. No specific effect on load perception resulted from this training. The results of these three studies are of specific relevance to symptom perception in asthmatic patients. Further experimental studies should be directed towards the interoception of real bronchoconstriction instead of the perception of added loads which only partially models the clinical situation.

Biofeedback-induced voluntary reduction of respiratory resistance in severe bronchial asthma.

Attempts to reduce asthmatic symptoms with respiratory resistance (Ros) biofeedback yielded heterogeneous results. The nature of treatment effects remained unclear (e.g. unspecific relaxation, visceral learning); little is known about clinical long-term effects. The present study investigated the suitability of a statistical single-case approach for an adequate evaluation. A female asthmatic underwent 12 Ros biofeedback sessions. Several breathing parameters were recorded during all sessions and pre/post investigations. The clinical course was observed with symptom diaries for 100 days. The subject achieved considerable voluntary control over her Ros, this control was based upon the expiratory flow. In general, the effects on the clinical course were weak; however, asthmatic attacks decreased in the follow-up period. Careful analyses of physiological, psychophysiological, and course variables allowed the identification of the main processes underlying the biofeedback effects. Further studies should investigate the worth of the expiratory flow as feedback variable.

Overexpression of the HER-2/neu oncogene in pancreatic adenocarcinoma.

Novel systemic treatments are needed in pancreatic cancer. The authors sought to establish the frequency of overexpression of the HER-2/neu oncogene in patients with pancreatic adenocarcinoma to determine the potential role of trastuzumab (Herceptin) as a therapeutic agent in this disease. Tumor specimens from patients with pancreatic adenocarcinoma were analyzed by staining for p185HER2 protein using the DAKO immunohistochemical assay. Patients with and without HER-2/neu overexpression by immunohistochemistry were compared with respect to clinical and pathologic characteristics. HER-2/neu gene amplification was also evaluated by fluorescence in situ hybridization (FISH). Thirty-two of 154 patients (21%) had pancreatic adenocarcinoma that demonstrated HER-2/neu overexpression by immunohistochemistry. At initial diagnosis, 16% of resectable cancers, 17% of locally advanced cancers, and 26% of metastatic cancers were determined to have HER-2/neu overexpression. Three of 11 (27%) patients with HER-2/neu overexpression by immunohistochemistry had gene amplification by FISH. HER-2/neu overexpression occurs in a subset of pancreatic cancer. Evaluation of the efficacy of trastuzumab for patients with pancreatic cancer who overexpress HER-2/neu appears indicated.

Reduced cognitive inhibition in schizotypy.

OBJECTIVES: The relationship between negative priming and the positive symptoms of schizotypy was investigated. It was hypothesized that high schizotypes would display less negative priming than low schizotypes. A further important aim of the study was to disentangle the modalities involved in negative priming performance, since a reduction in negative priming, as revealed by schizophrenics and schizotypes, might reflect a failure to actively inhibit irrelevant information (cognitive inhibition) as well as dyslexia or a general slowness in information processing. DESIGN: A paper test based on the German version of the Stroop test was used to measure negative priming. A baseline condition of the test, colour word reading, that has proven to be a valid indicator of dyslexia was used to measure the influence of reading disturbances on negative priming. Additionally, a priming condition, termed inverted priming, in which the target of a stimulus is identical with the distractor in the subsequent stimulus, was employed. METHODS: Fifty healthy adults were drawn from the general population. After neuropsychological assessment participants completed a battery of schizotypal questionnaires. Correlational analyses and mean comparisons were used to investigate the relationship between neuropsychological data and schizotypy. RESULTS: Results suggest that reduced negative priming is related to positive schizotypy. Reduced negative priming in high schizotypes was unrelated to dyslexia, and found unlikely to be affected by deficits in early processing. The inverted priming condition produced comparatively fewer errors in high schizotypes. CONCLUSIONS: Results support the hypothesis that reduced cognitive inhibition may underlie positive schizotypal symptomatology.

Dimensional structure and diagnostic specificity of the Frankfurt Complaint Questionnaire.

The Frankfurt Complaint Questionnaire (FCQ) is a widely used method to investigate non-psychotic subjective experiences of schizophrenics. Less is known about its dimensional structure. Therefore, principal components analyses (PCA) were conducted with the FCQ data of 505 schizophrenics and 187 alcoholics. Furthermore, results of a former analysis using item-to-item comparisons between schizophrenics and alcoholics were examined. PCA yielded two factors called 'dysphoric concomitants of severe illness particularly impairing concentration' and 'subjective experiences of perceptual uncertainties'. Neither of the factors was specific to schizophrenia. The item comparisons suggest that only a group of eight FCQ items (subscale 'FCQ-S') is specific to schizophrenia while ten items ('FCQ-A') are related more to alcoholism. The validity of FCQ-S and FCQ-A was confirmed: schizophrenics reached high scores in FCQ-S and low scores in FCQ-A; alcoholics scored high in FCQ-A and low in FCQ-S; schizophrenics with an additional alcohol disorder scored high in both of the subscales. It is concluded that direct group comparisons seem to be promising for the identification of non-psychotic subjective phenomena which are characteristic for schizophrenia.

Impact of present and past antipsychotic side effects on attitude toward typical antipsychotic treatment and adherence.

OBJECTIVE: (1) determine which antipsychotic side effects (SE) schizophrenic patients consider the most distressing during treatment with typical antipsychotics, (2) measure the impact of actual and past SE on patients' attitude toward antipsychotics and (3) assess the influence of both on adherence. METHODS: The 213 schizophrenics, treated with conventional antipsychotics, were recruited in two psychiatric hospitals in Hamburg. Subjects were assessed about type and severity of present and past side effects and their attitude and adherence to antipsychotic treatment. RESULTS: The 82 (39%) patients presented present SE while 131 (61%) did not. Sexual dysfunctions (P < 0.001), extrapyramidal (P < 0.05) and psychic side effects (P < 0.05) were rated as significantly subjectively more distressing than sedation or vegetative side effects. Patients presenting with present SE compared with patients without present SE had a significantly more negative general attitude toward antipsychotics (P < 0.05), were more doubtful about their efficacy (P < 0.01) and were less likely to encourage a relative to take such a medication in case of need (P < 0.001). A regression analysis indicated that nonadherence was mainly influenced by negative general and efficacy attitudes toward antipsychotics and the experience of past or present antipsychotic side effects. CONCLUSIONS: All antipsychotic side effects, present or past, can have a durable negative impact on patient's attitude toward antipsychotic treatment and adherence. Non-adherence is mainly determined, among other factors, by these negative attitudes, which are partly influenced by the experience of past or present antipsychotic-induced side effects.

In situ neutral detergent insoluble nitrogen as a method for measuring forage protein degradability.

A method of estimating the undegraded intake protein (UIP) concentration of forages was developed and validated with a series of in situ experiments. The hypothesis was that UIP calculated from in situ neutral detergent insoluble N (NDIN) is equal to total in situ N minus the microbial N that is estimated from purines (MN). The in situ disappearance rates of total in situ N (TN), MN, and NDIN were measured for six hay samples and two range masticate samples. Hypothetical rates of passage (2 or 5%/h) were used to calculate UIP (% of DM) for each N pool. Estimates of UIP from TN were higher (P = .0001) than those from either MN or NDIN, and MN estimates of UIP were similar (P = .48) to NDIN estimates. A low-N fiber source (solka floc) was incubated in situ for 8 h. Analysis of the residue detected purines before, but not after, neutral detergent extraction. Several in situ incubation (i.e., Dacron bag size and number of Dacron bags in a mesh bag) and neutral detergent extraction conditions were tested. None of the factors tested affected in situ NDIN disappearance (P > .05). The hypothesis that NDIN is completely digestible in the rumen was tested. Estimates of the extent of NDIN digestion were made using 96-h in situ incubations, and UIP was recalculated for the test samples. Mean in situ UIP concentration decreased upon recalculation (P = .05). In situ NDIN provides estimates of forage UIP that are equal to estimates from MN. Forage UIP estimates are less when extent of N degradation is estimated and included in the calculation.

Effect of corn processing on starch digestion and bacterial crude protein flow in finishing cattle.

Six ruminally and duodenally cannulated yearling steers (523 kg) were used in a replicated 3 x 3 Latin square design experiment to study the effects of corn processing on nutrient digestion, bacterial CP production, and ruminal fermentation. Dietary treatments consisted of 90% concentrate diets that were based on dry-rolled (DRC), high-moisture (HMC), or steam-flaked (SFC) corn. Each diet contained 2.0% urea (DM basis) as the sole source of supplemental nitrogen. Each period lasted 17 d, with d 1 through 14 for diet adaptation and d 15 through 17 for fecal, duodenal, and ruminal sampling. Dry matter and OM intakes were similar for DRC and SFC but were approximately 15% higher (P < 0.05) for HMC. True ruminal OM digestibilities were 18 and 10% greater (P < 0.05) for HMC than for DRC or SFC, respectively. Ruminal starch digestibilities were similar between HMC and SFC and were approximately 19% greater (P < 0.05) than DRC. Postruminal OM digestibility was similar among treatments; however, postruminal starch digestibility was 15% greater (P < 0.05) for SFC than for DRC or HMC, which were similar. Total-tract DM and OM digestibilities were similar between HMC and SFC and were 4% greater (P < 0.05) than DRC. Likewise, total-tract starch digestibilities were similar between HMC and SFC and were 3% greater (P < 0.05) than DRC. Bacterial CP flow to the duodenum was 29% greater (P < 0.05) for HMC than for DRC or SFC, which were similar. Bacterial N efficiencies were similar among treatments. Based on bacterial CP flow from the rumen, we estimate that dietary DIP requirements are approximately 12% higher for HMC-based diets than for DRC or SFC-based diets, which were similar.

Pathology and clinical features of gastro-intestinal lymphoma in Saudi Arabia.

The histopathology and clinical presentation of 19 cases of primary gastrointestinal lymphoma is described. Our patients are similar to others in the Middle East but have a lower incidence of diarrhoea and malabsorption. All revealed a widespread chronic inflammatory background. Four patients with primary gastric lymphoma had endoscopic biopsies from the duodenum; these biopsies were completely free from tumour but showed a moderate to severe diffuse lymphoplasmacytic infiltrate. Electron microscopy shows that tumour cells penetrate basement membranes and invade the epithelium which becomes thin and attenuated. Substances which inhibit lymphocyte tropism might be useful in preventing intestinal ulceration. The MALT concept has been found useful in classification of the tumours. Two patients with unusual mesenteric node histology are described and it is thought that the appearances may indicate a substantial capacity for differentiation in the group of tumours.

A device for functional residual capacity controlled biofeedback of respiratory resistance.

A computer-aided procedure is presented providing subjects with analogous visual feedback of respiratory resistance, which is continuously measured using the forced oscillation method. Simultaneous pneumotachographical control of the breathing volume curve makes it possible to prevent reinforcement for decreases of respiratory resistance which are due to increases of functional residual capacity (FRC). Lung hyperinflation is an unsuitable way to reduce respiratory resistance; if it occurs, feedback is interrupted until the subject decreases his FRC to its initial level. Analysis of the data of 15 adult asthmatic subjects which underwent a 12-sessions feedback training showed that no substantial changes of FRC appeared within feedback trials. Advantages of this new biofeedback technique compared to other procedures are discussed with regard to volume control and feedback signal.