Outcomes of a cognitive-behavioral day treatment program for a heterogeneous patient group.

This paper describes a day treatment program that provides predominantly cognitive-behavioral therapy for a heterogeneous group of patients. Preliminary results of the program are also presented. Assessment tools included the Beck Depression Inventory, the Symptom Checklist, and a questionnaire on changes in social life. Instruments were administered at admission, at discharge, and six months after discharge. The patients showed significant improvement in scores on all instruments at discharge. Improvements were stable after six months for all diagnostic categories-depression, eating disorders, and personality disorders. The program shows promise as an effective treatment approach for patients with various psychiatric diagnoses.

One-year outcome of an integrative inpatient treatment for dual diagnosis patients.

The purpose of this study was to evaluate a 4-month dual diagnosis inpatient treatment program that was based on integrative models for patients with substance use and psychiatric disorders. At intake and at 1-year follow-up, dual diagnosis patients (N = 52) were assessed on housing and subsistence level, substance use and psychiatric symptoms. At 1-year follow-up, dual diagnosis patients reported a higher level of housing and subsistence, and less intensive psychiatric symptoms. No change occurred on frequencies of substance use. General improvement may occur even if psychotropic substances are used. Controlled studies are needed on extended inpatient treatment for dual diagnosis patients and outcomes in longer follow-ups.

A comparison of cupola-free perimetry with conventional perimetry: preliminary results.

In the comparison of ten normal and two pathological visual fields, excellent agreement was found between examinations made with Octopus perimeters (types 201 and 500) and a prototype version of a new cupola-free perimeter (CFPP). The examination of a single glaucomatous visual field, however, exhibited an elevated mean defect value with the prototype instrument in comparison with Octopus 201 examinations of the same visual field. Although this difference may be easily explained by long-term fluctuation effects, further investigations based on a broader empirical basis will be required. Based on the results of this preliminary work the following remarks can be made with respect to the cupola-free perimeter: provided that the zero point of the dB scale is chosen appropriately, ie, with a stimulus luminance of about 4,000 asb used as the 0 dB level, the same differential light sensitivity (DLS) values for normal visual fields can be obtained with the CFPP as with all Octopus models (201, 500, 2000). Within the limits of measurement error, the same decrease of DLS was found with the CFPP as obtained using the other perimeters for test locations (of the G1 program), ranging from the center out to an eccentricity of 30 degrees. Thus it appears that the normal values as used in the other Octopus perimeters can also be utilized in this cupola-free instrument within this range.

A comparison of three methods for abbreviating G1 examinations.

The G1 glaucoma program is now widely employed in Octopus automated perimetry in order to detect early visual field damage and as an aid in regular follow up. For some patients, however, the examination duration, about 20 minutes, can be excessive. Three methods which could be used for an abbreviated initial screening phase were studied: 1) examining 30 test locations with full 2 dB minimum step size bracketing; 2) using all 59 test locations, but with 4 dB minimum step size bracketing; and 3) using 30 test locations and 4 dB minimum step size. Two indices derived from these abbreviated examination procedures were compared to those obtained from the first phase of the G1 program. The study was based on data of 1008 visual fields of both normal and pathological eyes. It was found that the 30 test location full bracketing method yielded the best agreement with the results obtained with the first phase of the G1 program. Recommendations concerning the optimal utilization of these methods in possible future versions of the G1 program are included.

A comparison of eight test location configurations for estimating G1 mean defect values.

Examinations performed with the Octopus G1 glaucoma program can last up to 20 minutes or more and this may be too long for some patients who are easily fatigued. It may also be that the examiner wishes to have a first look at examination results and then decide whether to continue examining or be satisfied with preliminary values. Eight different test location configurations consisting of 4, 8, 12, 16, 20, 24, 28 and 32 test locations for obtaining a first look at a visual field were investigated based on 764 examinations of normal and pathological visual fields. The mean errors in estimating the mean defect expected for each configuration were calculated. The results indicate that using configurations with 24 or 28 test locations for an advance estimate of the mean defect produces the least amount of error.

Evaluating human and automated interpretation of visual field data in perimetry.

The complexity of visual field result evaluation has increased with the advent of automated perimetry. This in turn makes software assistance such as provided by the new Octosmart program interesting and desirable. Its accuracy and reliability in visual field evaluation must be tested, though, and the testing methodology itself must be developed. For this purpose, 27 visual fields were evaluated by three human interpreters and the Octosmart program. Based on a newly developed compound index, the performance of the three interpreters and Octosmart is described and a high degree of consistency is demonstrated.

[Measuring psychophysiologic variables during conversations. Quantifying pulse volume changes]. / Messung psychophysiologischer Variablen während Gesprächen. Die Quantifizierung des Pulsvolumengeschehens.

Little is known about connections between events in verbal communication and related physiological variables. Usually used procedures in quantification of pulsevolume data are based on simplifications neglecting essential characteristics of the curve between heart beats. It is shown that the concept of interbeat-intervals (IBI) underlying conventional methods hides these characteristics putting up with a delay in time between heart beats and related verbal factors. An alternative procedure of the extraction of period and amplitude is demonstrated. A software-package is developed to transform and interactively control the analysis of the pulsevolumesignal (filtering and vector-transformation). As results quasi-continuous time series of period and amplitude of the pulsecurve are shown, tracing the shape of the curve in each cardiac cycle. Some first applications of the method in stress research are discussed. The method is appropriate especially for detecting "short time" changes of cardiac activity in naturalistic observational settings (e.g. dyadic interaction).

Evaluating a perimetric expert system: experience with Octosmart.

When evaluating expert systems to be used in clinical perimetry, various aspects of their performance as compared with that of human interpreters must be considered. In this investigation, the results produced by the new Octosmart diagnostic program have been compared with the performance of three interpreters with various amounts of experience in visual field analysis. The evaluations were based on 27 visual fields with glaucomatous damage, which had been examined with the Octopus program G1. It is shown that in borderline cases (i.e., neither clearly normal nor clearly pathological) where strict statistical criteria must be employed in order to distinguish between possible pathology and artifacts, the "personal styles" of human interpreters, more than standardized decision criteria, implicitly guide the decision process, resulting in unpredictable, non-standardized interindividual differences. A standardized expert system, based on constant, explicit, and logical criteria is therefore considered to be superior to unaided human interpretation. It is pointed out that the influence of the implicit decision criteria of human interpreters must be controlled carefully if expert systems are to be evaluated with reference to human interpreters.

Extrapolating global visual field indices from local parameters in the nasal region.

The local mean and the average difference of four pairs of test locations within the 26 degrees visual field, situated above and below the horizontal nasal meridian, were used to predict the global field indices MD and CLV of the Gl glaucoma program. Out of 539 examinations (194 eyes suspected of having glaucoma), the local indices NDIFF (describing asymmetrical behavior around the nasal horizontal meridian), ND0 (the mean defect in the nasal region), and the global indices MD and CLV were calculated. Seven hundred fifty-five examinations (446 normal eyes) served as a control group. First and second examinations of 146 glaucoma suspect eyes were used to calculate the retest reliability scores for the indices in question. When analyzing the glaucoma suspects, the local index NDIFF, together with the local mean defect, ND0, yielded highly reliable estimates of the global indices MD and CLV, with a retest correlation r = 0.86 for NDIFF, and r = 0.96 for ND0. The covariance of NDIFF with CLV was r = 0.67, while the co-variance of MD with ND0 was r = 0.95. The ranges of the local indices ND0 and NDIFF were each classified into 'normal range' and 'range of suspected pathology', in analogy to the normal and pathological ranges of the global field indices. Equivalence of the local indices with the corresponding ranges of MD and CLV was investigated and the results are shown. The establishment of local indices may prove to be a powerful tool in early detection of glaucomatous damage.

A comparison of five methods for estimating general glaucomatous visual field depression.

The separation of local and diffuse visual field loss is important for evaluating the nature and extent of glaucomatous visual field damage. Here, five automated methods for estimating diffuse loss in glaucomatous visual fields (as measured with the Octopus G1 program) are compared. Four are taken from the published literature, and one is introduced in this investigation. It is shown that the new index (here called diffuse loss) provides the best agreement with a value determined using a more empirical approach.

A preliminary study of dream-telling among mentally healthy elderly: no adverse effects on life or sleep quality.

While there have been several studies about dreams and dreaming among the elderly, there does not seem to have been any study of the effects of regular dream-telling (without interpretation). Listening to dreams could become a regular part of caring for the elderly and infirm. The effects of regular dream-telling in mentally healthy elderly clinical research volunteers were measured on several variables using standardized testing and self-report: life satisfaction, intrapsychic boundaries, sleep quality, sleep duration, dream recall, dream tone, and dream epoch, and were compared with two control groups. The six variables showed no significant differences among the three groups, indicating that dream-telling produced no adverse effects. The present findings seem to imply that dream-telling is not dangerous for mentally healthy individuals and may thus serve as a baseline for future studies involving geriatric patients with mental disorders or elderly undergoing significant life-events, e.g., bereavement or retirement, using the method of regular dream-telling.

Reliability in dream research: a methodological note.

The coefficients of internal consistency and retest reliability had been rarely investigated within the methodology of dream content analysis. Analyzing a dream series of elderly, healthy persons obtained from weekly telephone interviews, the internal consistency of a series of 20 dreams and retests after 4 or 22 weeks, respectively, had been computed. The findings indicate that dream recall and dream length are quite stable, but dream characteristics such as bizarreness and emotional tone underlie large intraindividual fluctuations. In order to obtain reliable measures for these variables which will be important for correlational studies, including waking-life trait measures, one has to obtain as many dreams as possible (about 20) in a very short time period. Further research is needed to extend the present findings to diary dreams and laboratory dreams.

The study of emotional processes in communication: II. Peripheral blood flow as an indicator of emotionalization.

Traditional methods of analyzing human peripheral blood flow (PBF) do not account for its continuous nature or small-scale variation. Sequel transformation is presented as a new methodology for measuring these variations. This analysis generates a richer record of aspects of activation of the autonomous nervous system than traditional interbeat-interval (IBI) measurement. Presumably, in addition to heartbeat (i.e., IBI), other information can be extracted that is consistent with the influence of several physiological and psychological factors. This kind of variation is reflected in the PBF signal. After determining and extracting relevant events from vascular volume data generated by sequel transformation, we demonstrate the use of template analysis to analyze patterns of events as time courses of activation. All procedures are included in the computer program VASC Analyzer.