The impact of attachment parameters in childhood on the personality of adults with mental disorders.

BACKGROUND: Attachment parameters have an effect on later relationship patterns and the development of parameters of self-concept and personality. In the current study the role of attachment parameters on personality dimensions was investigated, especially with respect to personality disorders. SUBJECTS AND METHODS: 134 psychiatric inpatients were examined on attachment and personality parameters using the schedule FEB as a questionnaire on the parental attachment and the SKI as a self-concept inventory. RESULTS: Regression and correlation analyses suggest positive influences of parental care and negative influences of parental overprotection on the development of ego-strength in adulthood. Patients with personality disorders reported to have experienced less maternal care during their childhood and showed a trend towards a reduced ego-strength in adulthood compared to patients with others mental disorders. CONCLUSIONS: Relationships of attachment parameters in childhood with personality dimension are explorable. This approach seems meaningful for a better understanding of the development of personality disorders. Clinicians should be familiar with attachment patterns when treating people with mental disorders in order to adequately include appropriate personality dimensions in the therapy.

Complementary and Alternative Medicine: Comparison of Current Knowledge, Attitudes and Interest among German Medical Students and Doctors.

Although it has been agreed that complementary and alternative medicine (CAM) should be included in the German medical curriculum, there is no consensus on which methods and how it should be taught. This study aimed to assess needs for CAM education by evaluating current knowledge, attitudes and interests of medical students, general physicians and gynecologists. Two instruments based on established and validated questionnaires were developed. One was given to seventh semester medical students and the other to office-based doctors. Data were analyzed by bivariate correlation and cross-tabulation. Altogether 550 questionnaires were distributed-280 to doctors and 270 to medical students. Completed questionnaires were returned by 80.4% of students and 78.2% of doctors. Although 73.8% (160/219) of doctors and 40% (87/217) of students had already informed themselves about CAM, neither group felt that they knew much about CAM. Doctors believed that CAM was most useful in general medicine, supportive oncology, pediatrics, dermatology and gynecology, while students believed that dermatology, general medicine, psychiatry and rheumatology offered opportunities; both recommended that CAM should be taught in these areas. Both groups believed that CAM should be included in medical education; however, they believed that CAM needed more investigation and should be taught "critically". German doctors and students would like to be better informed about CAM. An approach which teaches fundamental competences to students, chooses specific content based on evidence, demographics and medical conditions and provides students with the skills they need for future learning should be adopted.

Emotion Modulation through Music after Sadness Induction-The Iso Principle in a Controlled Experimental Study.

Music therapy intervention manuals suggest that individuals who suffer from affective disorders benefit from listening to music according to the iso principle. The iso principle comprises listening to music that matches the current mood of patients at first, and then to gradually shift to music that represents a desired mood. Within the current study, we investigate whether the sequence of music with different emotional valence can modulate the emotional state. All participants were healthy adults who underwent a sadness induction via a movie clip. They were subsequently divided into four experimental groups. Each was asked to listen to two pieces of music according to a specific sequence: sad-sad; sad-happy; happy-happy; happy-sad. Participants were prompt to rate their current emotional state at different stages of the experiment: prior to and after the movie clip, as well as after each of the two pieces of music. The frame used for the assessment was the Positive and Negative Affect Schedule and the Self-Assessment Manikin. The results indicate that the movie clip induced sadness. The group of participants who listened to the sad music first and the happy music afterwards ultimately reported a higher positive affect, a higher emotional valence, and a lower negative affect compared with the other groups. However, not all the between-group differences reached significance. We conclude that the sequence of music with different emotional valence affects the current emotional state. The results are generally in line with the iso principle. Directions for future research are presented.

Don't drink and chill: Effects of alcohol on subjective and physiological reactions during music listening and their relationships with personality and listening habits.

Recent research indicates that favorite music can induce chills and alters physiological reactions. People frequently listen to music when they drink alcohol, for example in bars or discotheques. Alcohol has numerous effects on emotions, peripheral physiological and neural reactions. We investigated whether alcohol intake influences chill experiences and physiological reactions during music listening. 39 participants took part in the study and were tested twice: Once in a sober condition and once when they had drunken alcohol. Participants listened to two pieces of music in each of the two conditions: A favorite self-selected song and a control-song that was selected by the research group. Participants had to indicate when they experienced a chill and electrodermal activity and heart rate were measured during music listening. In addition, participants filled out questionnaires concerning the big five personality dimensions, music listening habits and general chill experiences. Results indicate that participants experienced most chills when they were sober and listened to their self-selected song. Electrodermal activity was highest when participants were sober. In addition, alcohol intake led to a dedifferentiation in heart rate activity. After alcohol intake, participants had similar heart rates, no matter whether they listened to their self-selected song or to the control-song. Extraversion was negatively related with physiological reactions, while openness to experiences was positively related with physiological reactions. Music listening habits also showed various relationships with chill experiences and physiological reactions, while general chill experiences did not. We conclude that alcohol intake reduces subjective chill experiences during music listening and alters the physiological reactions to music. Music listening habits and personality seem to influence these effects.

Aspects of Piaget's cognitive developmental psychology and neurobiology of psychotic disorders - an integrative model.

Psychological, neurobiological and neurodevelopmental approaches have frequently been used to provide pathogenic concepts on psychotic disorders. However, aspects of cognitive developmental psychology have hardly been considered in current models. Using a hypothesis-generating approach an integration of these concepts was conducted. According to Piaget (1896-1980), assimilation and accommodation as forms of maintenance and modification of cognitive schemata represent fundamental processes of the brain. In general, based on the perceived input stimuli, cognitive schemata are developed resulting in a conception of the world, the realistic validity and the actuality of which is still being controlled and modified by cognitive adjustment processes. In psychotic disorders, however, a disproportion of environmental demands and the ability to activate required neuronal adaptation processes occurs. We therefore hypothesize a failure of the adjustment of real and requested output patterns. As a consequence autonomous cognitive schemata are generated, which fail to adjust with reality resulting in psychotic symptomatology. Neurobiological, especially neuromodulatory and neuroplastic processes play a central role in these perceptive and cognitive processes. In conclusion, integration of cognitive developmental psychology into the existing pathogenic concepts of psychotic disorders leads to interesting insights into basic disease mechanisms and also guides future research in the cognitive neuroscience of such disorders.

The effects of music therapy on the interaction of the self and emotions-An interim analysis.

OBJECTIVES: Music therapy is a well-established non-verbal treatment method in psychiatry and psychosomatic medicine. However, empirical data of its impact on emotion modulation processes and personality dimensions are still sparce. An interesting concept is the use of music for emotion modulation in everyday life. The purpose of this interim study was to assess the interplay of personality dimensions and emotion modulation strategies in patients treated with music therapy versus patients without music therapy. DESIGN: A cross-sectional design was used. SETTING: The study was conducted during the course of inpatient treatment in a general psychiatric hospital. Data from n = 137 patients was included in the analysis. MAIN OUTCOME MEASURES: According to the mediator model a regression analysis was performed using personality variables as potential predictors and emotion modulation variables as outcome criteria. RESULTS: In the music therapy group, insecurity predicted the use of music for both cognitive problem solving and positive stimulation in everyday life. In the non-music therapy group, cooperation and insouciance predicted the use of music for reduction of negative activation. CONCLUSIONS: Specific personality dimensions predict greater targeted emotion modulation strategies if music therapy is applied than without it. That is, music therapy helps patients acquire more conscious (i.e. cognitive-related strategies) emotion modulation techniques by means of including their individual personality, whereas patients without music therapy simply "vent" their negative emotions (i.e. non-cognitive strategies). Conversely, the data suggest that music therapy can contribute to modify personality dimensions through the development of these emotion modulation strategies. This could be a plausible explanation for beneficial long-term effects of music therapy.

Rhythmic Density Affects Listeners' Emotional Response to Microtiming.

Microtiming has been assumed to be vital for the experience of groove, but past research presented conflicting results: some studies found that microtiming is irrelevant for groove, others reported that microtiming has a detrimental effect on the groove experience, yet others described circumstances under which microtiming has no negative impact on groove. The three studies in this paper aim at explaining some of these discrepancies by clarifying to what extent listeners' emotional responses to microtiming depend on the distribution of microtiming deviations across instrumental parts (voicing) or other moderating factors like tempo or rhythmic density. The studies use data from two listening experiments involving expert bass and drums duo recordings in swing and funk style. - Study A investigates the effect of fixed time displacements within and between the parts played by different musicians. Listeners (n = 160) reacted negatively to irregularities within the drum track, but the mutual displacement of bass vs. drums did not have an effect.- Study B develops three metrics to calculate the average microtiming magnitude in a musical excerpt. The experiment showed that listeners' (n = 160) emotional responses to expert performance microtiming aligned with each other across styles, when microtiming magnitude was adjusted for rhythmic density. This indicates that rhythmic density is a unifying moderator for listeners' emotional response to microtiming in swing and funk.- Study C used the data from both experiments in order to compare the effect of fixed microtiming displacements (from Study A) with scaled versions of the originally performed microtiming patterns (from Study B). It showed that fixed snare drum displacements irritated expert listeners more than the more flexible deviations occurring in the original performances. This provides some evidence that listeners' emotional response to microtiming deviations not only depends on the magnitude of the deviations, but also on the kind and origin of the microtiming patterns (fixed lab displacements vs. flexible performance microtiming).

Glucocorticosteroid receptors in ovarian carcinomas.

The use of glucocorticoids (GCs) in oncology, including in the treatment of ovarian carcinomas, is controversial. In vitro experiments suggest that GCs negatively influence the response to chemotherapy, but the few available clinical data show only benefits. Glucocorticoid action is mediated via glucocorticoid receptors (GRs). This study aims to define any clinical implications of GR expression in ovarian cancer to further the debate. Archived tissue samples from patients with histologically confirmed ovarian cancer were analyzed for GR expression and evaluated by immunohistochemistry and immunoreactive score. The results were related to the patients' overall survival. Kaplan-Meier survival and residual survival analyses gave no evidence that GR expression had any prognostic value in the 85 cases studied. No evidence of poorer survival was found in a small subset of GR-positive patients who received GC treatment. Glucocorticoid receptor expression had no prognostic impact in our study. However, GC (cortisol) is being produced continuously by the body, which may have stimulated GR-positive ovarian cancer cells. Our finding does not exclude the possibility that long-term GC treatment has adverse effects, and it should also be emphasized that treatment duration, dosage and dosing regimens, as well as the choice of an appropriate GC and the mode of application, determine the risks and benefits. Our study showed no evidence against using GC for antiemetic prophylaxis in ovarian carcinomas.

The Effect of Expert Performance Microtiming on Listeners' Experience of Groove in Swing or Funk Music.

This study tested the influence of expert performance microtiming on listeners' experience of groove. Two professional rhythm section performances (bass/drums) in swing and funk style were recorded, and the performances' original microtemporal deviations from a regular metronomic grid were scaled to several levels of magnitude. Music expert (n = 79) and non-expert (n = 81) listeners rated the groove qualities of stimuli using a newly developed questionnaire that measures three dimensions of the groove experience (Entrainment, Enjoyment, and the absence of Irritation). Findings show that music expert listeners were more sensitive to microtiming manipulations than non-experts. Across both expertise groups and for both styles, groove ratings were high for microtiming magnitudes equal or smaller than those originally performed and decreased for exaggerated microtiming magnitudes. In particular, both the fully quantized music and the music with the originally performed microtiming pattern were rated equally high on groove. This means that neither the claims of PD theory (that microtiming deviations are necessary for groove) nor the opposing exactitude hypothesis (that microtiming deviations are detrimental to groove) were supported by the data.

Physicians and complementary and alternative medicine cancer therapies in Greece: a survey.

OBJECTIVES: To assess the prevalence of complementary and alternative medicine (CAM) cancer therapies and attitudes toward them in a nonrandom sample of physicians in Greece. SUBJECTS: Four hundred and ninety-four (494) physicians from private practices and hospitals in the Athens area were approached to complete a questionnaire on perceived cancer etiology, self-reported knowledge, and attitudes about CAM therapies used by cancer patients. Two hundred and thirty-six (236) (47.8%) questionnaires were returned. RESULTS: Greek physicians are most familiar with homoeopathy (58.5%), diets (58.1%), antioxidants (vitamin C) (55.9%), and acupuncture (47.9%). Perceived rates of patients using CAM are low. Predominantly, physicians shared concepts of carcinogenesis accepted by conventional biomedicine. Only physicians who considered disorders of cellular metabolism or in the flow of body energy to be relevant believed that homoeopathy could be an adequate CAM therapy. CONCLUSIONS: Greek physicians in our sample displayed little interest in CAM. However, media and Internet coverage may generate a greater demand for these methods in the future in Greece and physicians will thus need to be better informed.

[Unconventional cancer therapies--comparisons of attitudes and knowledge between physicians in Germany and Greece]. / Unkonventionelle Krebstherapien -- Vergleich von Einstellungen und Kenntnissen bei ärzten in Deutschland und Griechenland.

BACKGROUND AND OBJECTIVES: Unconventional cancer therapies are becoming increasingly popular, especially in Germany. This study was conducted to determine if there are differences regarding perceived cancer etiology, knowledge and expected therapeutic success of unconventional cancer therapies between German physicians and their Greek colleagues. PERSONS AND METHODS: In 2002, a questionnaire on the topic, developed on the basis of earlier studies and the literature, was sent to 300 German physicians and distributed among 494 Greek colleagues. RESULTS: Significant differences between German and Greek physicians were found regarding all aspects mentioned. German physicians generally considered themselves better informed than did their Greek colleagues. However, the percentage of physicians with good and very good knowledge amounts to more than 30% only for mistletoe therapy and antioxidants. Fewer than 10% of Greek physicians are familiar with any type of unconventional cancer therapies. CONCLUSION: The study supports the hypothesis that cultural background affects aspects of unconventional cancer therapies. However,the differences found may also be partially explained by demographic factors, for example most of the Greek physicians who answered the questionnaire were younger than the German physicians. Improved education in the field of unconventional cancer therapies seems necessary in order to meet future demands.

[Does dark field microscopy according to Enderlein allow for cancer diagnosis? A prospective study]. / Erlaubt die Dunkelfeldmikroskopie nach Enderlein die Diagnose von Krebs? Eine prospektive Studie.

BACKGROUND: Dark field microscopy according to Enderlin claims to be able to detect forthcoming or beginning cancer at an early stage through minute abnormalities in the blood. In Germany and the USA, this method is used by an increasing number of physicians and health practitioners (non-medically qualified complementary practitioners), because this easy test seems to give important information about patients' health status. OBJECTIVE: Can dark field microscopy reliably detect cancer? MATERIALS AND METHODS: In the course of a prospective study on iridology, blood samples were drawn for dark field microscopy in 110 patients. A health practitioner with several years of training in the field carried out the examination without prior information about the patients. RESULTS: Out of 12 patients with present tumor metastasis as confirmed by radiological methods (CT, MRI or ultra-sound) 3 were correctly identified. Analysis of sensitivity (0.25), specificity (0.64), positive (0.09) and negative (0.85) predictive values revealed unsatisfactory results. CONCLUSION: Dark field micoroscopy does not seem to reliably detect the presence of cancer. Clinical use of the method can therefore not be recommended until future studies are conducted.

The Change of Music Preferences Following the Onset of a Mental Disorder.

A psychiatric population (n=123) was examined on how music preferences had changed after the onset of a mental disorder. Most patients did not change their previous music preference; this group of patients considered music helpful for their mental state, showed more attractivity and enforcement as personality traits and used music more for emotion modulation. Patients who experienced a preference shift reported that music had impaired them during the time of illness; these patients showed less ego-strength, less confidence and less enforcement and used music less for arousal modulation. A third subgroup stopped listening to music completely after the onset of the mental disorder; these patients attribute less importance to music and also reported that music had impaired their mental state. They showed more ego-strength and used music less for emotion modulation. The results suggest that the use of music in everyday life can be helpful as an emotion modulation strategy. However, some patients might need instructions on how to use music in a functional way and not a dysfunctional one. Psychiatrists and psychotherapists as well as music therapists should be aware of emotion modulation strategies, subjective valence of music and personality traits of their patients. Due to the ubiquity of music, psychoeducative instructions on how to use music in everyday life plays an increasing role in the treatment of mental illness.

The Relationship Between Personality Traits, Flow-Experience, and Different Aspects of Practice Behavior of Amateur Vocal Students.

Most of the existing studies on musical practice are concerned with instrumentalists only. Since singers are seldom considered in research, the present study is based on an online-sample of amateur vocal students (N = 120; 92 female, 28 male). The study investigated the correlations between personality traits, flow-experience and several aspects of practice characteristics. Personality was represented by the three personality dimensions extraversion, neuroticism and psychoticism, assessed by Eysenck's Personality Profiler as well as the trait form of the Positive and Negative Affect Schedule. 'Flow-experience,' 'self-congruence' and 'fear of losing control over concentration,' assessed by the Practice Flow Inventory, served as variables for flow-experience. The practice motivation was measured by the Practice Motivation Questionnaire in four categories ('self,' 'group,' 'audience,' 'teacher'). In addition, the Practice Behavior Questionnaire was used to provide an insight into the practice situation and behavior of singing students. The results show significant correlations: participants with high extraversion-scores experience significantly more flow than less extraverted persons, whereas lesser flow-experience seems to be related to high neuroticism-scores. Nevertheless, there is no influence in flow-experience concerning singing style ('classical' or 'popular'). The longer the practicing time, the more likely students are to achieve flow-experience. However, older singers tend to have less flow-experience. Consequently, singers seem to differ in their personality and practice behavior compared to other musicians. Most of the findings show that having control over one's instrument is decisive for achieving a performance of high quality, especially for singers. On the other hand, certainty in handling an instrument is essential to arouse a flow-feeling. However, flow-experience seems to be common mainly with amateur singers. In conclusion, this offers a starting point for new research on the psychology of vocalists in greater depth.

Impact of hemoglobin levels before and during chemotherapy on survival of patients with ovarian cancer.

Anemia is a common complication of cancer that has been associated with poor response to treatment and decreased survival in many malignancies. A retrospective chart review was undertaken to determine the effects of hemoglobin (Hb) levels, measured prior to initiation of chemotherapy and before each chemotherapy cycle, and clinical prognostic factors (e.g., age, tumor stage, residual tumor size, hematologic parameters, and type of health insurance) in 250 ovarian cancer patients treated between 1985 and 1998. All patients were scheduled to receive at least 6 courses of systemic chemotherapy. None of the patients received recombinant human erythropoietin. The difference between observed overall survival and its predicted value was computed by multiple regression analysis for each patient with respect to prognostic factors. Hemoglobin levels prior to and during chemotherapy were identified as a prognostic factor for overall survival. Hemoglobin levels > or =12 g/dl were significantly associated with prolonged overall survival (P<0.001). In addition, Hb level correlated with scheduled completion of chemotherapy, overall therapeutic success, tumor stage, age at diagnosis, and residual tumor size (all, P<0.005). Hemoglobin level represents an important prognostic factor for patients with ovarian cancer. This finding supports the use of measures to maintain adequate Hb levels, such as treatment with recombinant human erythropoietin, to improve patient survival.

Hemoglobin levels during radiation therapy and their influence on local control and survival of patients with endometrial carcinoma.

Anemia is a common complication of cancer that has been associated with poor response to treatment and decreased survival in a number of malignancies. By chart review the effects of prognostic factors (e.g. age, body mass index, tumor stage) and hemoglobin levels, measured prior to and during adjuvant (724/996; 72.7%) and primary radiotherapy (185/996; 18.6%) in 996 endometrial cancer patients treated between 1986 and 1998 were investigated using Kaplan-Meier survival on disease-free and overall survival. Preoperative hemoglobin levels were of no prognostic value. Patients with normal hemoglobin had an improved survival during primary radiotherapy (p<0.05). Anemia and course of hemoglobin during adjuvant radiotherapy were significantly associated with poor survival in patients undergoing adjuvant radiotherapy (p=0.001). Cox regression analysis confirmed these findings for adjuvant treatment. Local recurrences were also less frequently observed in patients with normal hemoglobin levels (p=0.044). Hemoglobin levels prior to and during radiotherapy seem to be important with respect to treatment outcome for endometrial cancer. This finding supports the use of measures to maintain adequate hemoglobin levels (transfusions, erythropoietin) to improve local control and patient survival.

Association between fibronectin expression and prognosis in ovarian carcinoma.

BACKGROUND: Fibronectin is involved in tumour neovascularisation and metastasis, prevents apoptosis and is considered to be immunosuppressive. This study aimed to determine the prognostic value of fibronectin expression in ovarian carcinoma. MATERIALS AND METHODS: Records and archival tumour tissue from 211 German women with ovarian carcinoma were reviewed. Total fibronectin was determined immunohistochemically (clone N-294). Univariate and residual Kaplan-Meier survival analysis were used to correlate fibronectin expression with established prognostic indicators and overall survival. RESULTS: Fibronectin expression correlated significantly with tumour stage (p = 0.002) and tumour growth fraction (p = 0.005). The degree of expression had a significant adverse influence on overall survival even after other prognostic factors had been excluded (p = 0.009). CONCLUSION: Fibronectin is an important prognostic factor in ovarian cancer and may be central to tumour progression. These findings offer new treatment possibilities since several agents may antagonise the mechanism of fibronectin expression.

Influence of surgery and postoperative therapy and tumor characteristics on patient prognosis in advanced ovarian carcinomas.

OBJECTIVES: The prognosis in advanced ovarian cancer depends on clinical, morphological, biological and therapeutic variables. However, little is known about their real influences and interrelationships. STUDY DESIGN: One hundred and nineteen long-term, follow-up patients with advanced ovarian carcinoma were analyzed. Overall survival was related to the extent of debulking surgery, response to chemotherapy and several clinicomorphological, histopathological, and immunohistochemical variables. RESULTS: Among all variables, both radical surgery and response to chemotherapy exerted the greatest influence on patient prognosis as shown in both univariate and multifactorial analyses. Most established prognostic factors were of minor importance. Success of chemotherapy correlated with lower residual tumor volume, CA125 expression, FIGO-stage, and serous tumor type. CONCLUSION: Prognosis and chemotherapeutic success in advanced ovarian cancer seem to be interrelated and may be influenced by the intensity of surgical interventions. This demands for greatest cytoreduction during initial surgery and correction for residual tumor volume and success of therapy in studies of prognostic factors.

Post-therapy surveillance and after-care in ovarian cancer.

OBJECTIVES: Methods for surveillance of patients having completed primary cancer treatment are still not based on clinical studies, due to lack thereof. Therefore this study investigated how far surveillance as such, location of follow-up, method of detection, time of detection as well as early versus delayed start therapy for recurrence influences patients' overall survival. STUDY DESIGN: Seven hundred and four patient cases were retrospectively analyzed by chart review, each of whom had no evidence of tumor remaining after completion of primary cancer treatment. RESULTS: The aforementioned parameters had no significant influence on survival. Patients with late relapses showed significantly better chances of being cured by treatment for cancer recurrence (P<0.001). Patients profited significantly from successful treatment for recurrence (P<0.001). CONCLUSION: The study provided no evidence of intensive follow-up offering higher chances of survival. However, more intensive surveillance after a period of 2 years may prove beneficial.

Use of complementary and alternative medicine in departments of obstetrics in Germany.

BACKGROUND: This nationwide study aimed to assess the use of complementary and alternative medicine (CAM) methods in German departments of obstetrics. METHODS: All German departments of obstetrics were identified and were sent a questionnaire designed to assess which CAM methods, if any, they used during childbirth, how frequently, and why. SPSS software was used for statistical analyses (Spearman's bivariate correlation, cross-tabulation, and Pearson's chi-square test). RESULTS: The questionnaires were returned by 40.3% (381/946) of the identified departments. The most commonly used CAM therapy was acupuncture (available in 97.3% (366/376) of departments) followed by homeopathy (offered in 93.4%) and aromatherapy (available in 76.6%). Most decisions regarding CAM use were made by midwives; only decisions on acupuncture were taken by obstetricians and midwives. Reasons given for using CAM were patient demand and perceived efficacy of CAM, particularly by midwives. Obstetricians were only partly convinced of the efficacy of CAM methods and their conviction varied with the type of unit they worked in. CONCLUSIONS: CAM methods are widely used in German departments of obstetrics despite lacking evidence of effectiveness. Efficacy, side effects and consequences of CAM use should be assessed using the mandatory German quality assurance measures and birth surveys. CAM use elsewhere also merits further study.