ABSTRACT
The Necker-Zeno model of bistable perception provides a formal relation between the average duration of meta-stable percepts (dwell times T) of ambiguous figures and two other basic time scales (t0, ΔT) underlying cognitive processing. The model predicts that dwell times T covary with t0, ΔT or both. We tested this prediction by exploiting that observers, in particular experienced meditators, can volitionally control dwell times T. Meditators and non-meditators observed bistable Necker cubes either passively or tried to hold their current percept. The latencies of a centro-parietal event-related potential (CPP) were recorded as a physiological correlate of t0. Dwell times T and the CPP latencies, correlated with t0, differed between conditions and observer groups, while ΔT remained constant in the range predicted by the model. The covariation of CPP latencies and dwell times, as well as their quadratic functional dependence extends previous psychophysical confirmation of the Necker-Zeno model to psychophysiological measures.
Subject(s)
Cerebral Cortex/physiology , Evoked Potentials/physiology , Meditation , Models, Theoretical , Pattern Recognition, Visual/physiology , Psychomotor Performance/physiology , Space Perception/physiology , Adult , Electroencephalography , Event-Related Potentials, P300/physiology , Female , Humans , Male , Middle AgedABSTRACT
BACKGROUND: The regular update of the guidelines on fibromyalgia syndrome, AWMF number 145/004, was planned for April 2017. METHODS: The guidelines were developed by 13 scientific societies and 2 patient self-help organizations coordinated by the German Pain Society. Working groups (n =8) with a total of 42 members were formed balanced with respect to gender, medical expertise, position in the medical or scientific hierarchy and potential conflicts of interest. A systematic search of the literature from December 2010 to May 2016 was performed in the Cochrane library, MEDLINE, PsycINFO and Scopus databases. Prospective population-based studies and systematic reviews with meta-analyses of case control studies were taken into consideration for the statements. Levels of evidence were assigned according to the classification system of the Oxford Centre for Evidence-Based Medicine version 2009. The statements were generated by multiple step formalized procedures. The guidelines were reviewed and approved by the board of directors of the societies engaged in the development of the guidelines. RESULTS: Current data do not enable identification of distinct factors in the etiology and pathophysiology of fibromyalgia syndrome. Fibromyalgia syndrome can be associated with inflammatory rheumatic diseases, gene polymorphisms, life style factors (e.g. smoking, obesity and lack of physical activity), depressive disorders as well as physical and sexual abuse in childhood and adulthood. CONCLUSION: Fibromyalgia syndrome is most probably the end result of various pathogenetic factors and pathophysiological mechanisms.
Subject(s)
Fibromyalgia/etiology , Fibromyalgia/physiopathology , Practice Guidelines as Topic , Small Fiber Neuropathy/etiology , Small Fiber Neuropathy/physiopathology , Case-Control Studies , Consensus Development Conferences as Topic , Evidence-Based Medicine , Fibromyalgia/classification , Germany , Humans , Small Fiber Neuropathy/classification , Societies, MedicalABSTRACT
BACKGROUND: The regular update of the guidelines on fibromyalgia syndrome, AWMF number 145/004, was scheduled for April 2017. METHODS: The guidelines were developed by 13 scientific societies and 2 patient self-help organizations coordinated by the German Pain Society. Working groups (n =8) with a total of 42 members were formed balanced with respect to gender, medical expertise, position in the medical or scientific hierarchy and potential conflicts of interest. A literature search for systematic reviews of randomized controlled drug trials from December 2010 to May 2016 was performed in the Cochrane library, MEDLINE, PsycINFO and Scopus databases. Levels of evidence were assigned according to the classification system of the Oxford Centre for Evidence-Based Medicine version 2009. The strength of recommendations was achieved by multiple step formalized procedures to reach a consensus. Efficacy, risks, patient preferences and applicability of available therapies were weighed up against each other. The guidelines were reviewed and approved by the board of directors of the societies engaged in the development of the guidelines. RESULTS AND CONCLUSION: Amitriptyline and duloxetine are recommended in the case of comorbid depressive disorders or generalized anxiety disorder and pregabalin in the case of generalized anxiety disorder. Off-label use of duloxetine and pregabalin can be considered if there are no comorbid mental disorders or no generalized anxiety disorder. Strong opioids are not recommended.
Subject(s)
Fibromyalgia/drug therapy , Practice Guidelines as Topic , Amitriptyline/therapeutic use , Anxiety Disorders/drug therapy , Anxiety Disorders/psychology , Comorbidity , Depressive Disorder/drug therapy , Depressive Disorder/psychology , Duloxetine Hydrochloride/therapeutic use , Evidence-Based Medicine , Fibromyalgia/diagnosis , Fibromyalgia/psychology , Germany , Humans , Pregabalin/therapeutic use , Randomized Controlled Trials as Topic , Societies, MedicalABSTRACT
BACKGROUND: Changes in reflexive emotional responses are hallmarks of depression, but how emotional reflexes make an impact on adaptive decision-making in depression has not been examined formally. Using a Pavlovian-instrumental transfer (PIT) task, we compared the influence of affectively valenced stimuli on decision-making in depression and generalized anxiety disorder compared with healthy controls; and related this to the longitudinal course of the illness. METHOD: A total of 40 subjects with a current DSM-IV-TR diagnosis of major depressive disorder, dysthymia, generalized anxiety disorder, or a combination thereof, and 40 matched healthy controls performed a PIT task that assesses how instrumental approach and withdrawal behaviours are influenced by appetitive and aversive Pavlovian conditioned stimuli (CSs). Patients were followed up after 4-6 months. Analyses focused on patients with depression alone (n = 25). RESULTS: In healthy controls, Pavlovian CSs exerted action-specific effects, with appetitive CSs boosting active approach and aversive CSs active withdrawal. This action-specificity was absent in currently depressed subjects. Greater action-specificity in patients was associated with better recovery over the follow-up period. CONCLUSIONS: Depression is associated with an abnormal influence of emotional reactions on decision-making in a way that may predict recovery.
Subject(s)
Anxiety Disorders/psychology , Conditioning, Classical , Depression/diagnosis , Depressive Disorder, Major/psychology , Emotions , Adult , Berlin , Cues , Decision Making , Diagnostic and Statistical Manual of Mental Disorders , Female , Humans , Linear Models , Male , Sensitivity and Specificity , Young AdultABSTRACT
There are two major changes in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) concerning the field of addiction. Firstly, the previous distinction between abuse and dependence has been abolished and both disorders are now subsumed under the category addiction and related disorders. Secondly, pathological gambling has now been included in the section of addiction with slight changes in diagnostic criteria. Both changes have major implications for the definition and conceptualization of what we call a psychiatric "disease" or "disorder", which have also been addressed in the introductory statement of DSM-5. Concerning the category of abuse that is now part of substance use disorders, there is a concern that a well-defined disorder ("dependence") is now mixed with a less well-defined syndrome ("abuse"). The inclusion of non-substance, behavioral addictions poses the danger of pathologizing a wide range of human behavior in future revisions of the classification. Both concerns are further addressed in this article.
Subject(s)
Diagnostic and Statistical Manual of Mental Disorders , Guidelines as Topic , Manuals as Topic/standards , Psychiatric Status Rating Scales/standards , Psychiatry/standards , Substance-Related Disorders/classification , Substance-Related Disorders/diagnosis , Humans , Substance-Related Disorders/psychology , United StatesABSTRACT
BACKGROUND: The scheduled update to the German S3 guidelines on fibromyalgia syndrome (FMS) by the Association of the Scientific Medical Societies ("Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften", AWMF; registration number 041/004) was planned starting in March 2011. MATERIALS AND METHODS: The development of the guidelines was coordinated by the German Interdisciplinary Association for Pain Therapy ("Deutsche Interdisziplinären Vereinigung für Schmerztherapie", DIVS), 9 scientific medical societies and 2 patient self-help organizations. Eight working groups with a total of 50 members were evenly balanced in terms of gender, medical field, potential conflicts of interest and hierarchical position in the medical and scientific fields. Literature searches were performed using the Medline, PsycInfo, Scopus and Cochrane Library databases (until December 2010). The grading of the strength of the evidence followed the scheme of the Oxford Centre for Evidence-Based Medicine. The formulation and grading of recommendations was accomplished using a multi-step, formal consensus process. The guidelines were reviewed by the boards of the participating scientific medical societies. RESULTS AND CONCLUSION: Low-to-moderate intensity aerobic exercise and strength training are strongly recommended. Chiropractic, laser therapy, magnetic field therapy, massage and transcranial current stimulation are not recommended. The English full-text version of this article is available at SpringerLink (under "Supplemental").
Subject(s)
Fibromyalgia/rehabilitation , Physical Therapy Modalities , Adult , Cooperative Behavior , Evidence-Based Medicine , Fibromyalgia/diagnosis , Follow-Up Studies , Humans , Interdisciplinary Communication , Randomized Controlled Trials as TopicABSTRACT
BACKGROUND: The scheduled update to the German S3 guidelines on fibromyalgia syndrome (FMS) by the Association of the Scientific Medical Societies ("Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften", AWMF; registration number 041/004) was planned starting in March 2011. MATERIALS AND METHODS: The development of the guidelines was coordinated by the German Interdisciplinary Association for Pain Therapy ("Deutsche Interdisziplinären Vereinigung für Schmerztherapie", DIVS), 9 scientific medical societies and 2 patient self-help organizations. Eight working groups with a total of 50 members were evenly balanced in terms of gender, medical field, potential conflicts of interest and hierarchical position in the medical and scientific fields. Literature searches were performed using the Medline, PsycInfo, Scopus and Cochrane Library databases (until December 2010). The grading of the strength of the evidence followed the scheme of the Oxford Centre for Evidence-Based Medicine. The formulation and grading of recommendations was accomplished using a multi-step, formal consensus process. The guidelines were reviewed by the boards of the participating scientific medical societies. RESULTS AND CONCLUSION: The use of a multicomponent therapy (the combination of aerobic exercise with at least one psychological therapy) for a minimum of 24 h is strongly recommended for patients with severe FMS. The English full-text version of this article is available at SpringerLink (under "Supplemental").
Subject(s)
Cooperative Behavior , Fibromyalgia/rehabilitation , Interdisciplinary Communication , Patient Care Team , Adult , Combined Modality Therapy/methods , Evidence-Based Medicine , Exercise , Fibromyalgia/diagnosis , Fibromyalgia/psychology , Follow-Up Studies , Humans , Patient Admission , Psychotherapy , Somatoform Disorders/psychology , Somatoform Disorders/rehabilitationABSTRACT
BACKGROUND: Interdisciplinary guidelines for the definition, classification and diagnosis of chronic widespread pain (CWP) and fibromyalgia syndrome (FMS) were developed by collaboration of 10 German medical and psychological associations and 2 patient self-help organizations. METHODS: A systematic literature search was performed in the Cochrane Library (1993-12/2006). Medline (1980-2006), and Scopus (1980-12/2006). Levels of evidence were assigned according to the classification system of the Oxford Center for Evidence-Based Medicine. Grading of the strength of recommendation was done according to the German program for disease management guidelines. Standardized procedures to reach a consensus on recommendations were used. RESULTS: CWP is defined by the criteria of the American College of Rheumatology (ACR-strong consensus). FMS can be diagnosed for clinical purposes by symptom-based criteria (without tender point examination) as well as by the ACR criteria (strong consensus).
Subject(s)
Fibromyalgia/diagnosis , Algorithms , Comorbidity , Disability Evaluation , Evidence-Based Medicine , Fibromyalgia/classification , Fibromyalgia/therapy , Germany , Humans , Myofascial Pain Syndromes/diagnosis , Myofascial Pain Syndromes/therapy , Patient Care Team , Prognosis , Psychophysiologic Disorders/diagnosis , Psychophysiologic Disorders/therapy , Somatoform Disorders/diagnosis , Somatoform Disorders/therapyABSTRACT
BACKGROUND: Interdisciplinary guidelines for the definition, classification and diagnosis of chronic widespread pain (CWP) and fibromyalgia syndrome (FMS) were developed by collaboration of 10 German medical and psychological associations and 2 patient self-help organizations. METHODS: A systematic literature search was performed in the Cochrane Library (1993-12/2006), Medline (1980-2006), PsychInfo (1966-12/2006), and Scopus (1980-12/2006). Levels of evidence were assigned according to the classification system of the Oxford Centre for Evidence-Based Medicine. Grading of the strength of recommendation was done according to the German program for disease management guidelines. Standardized procedures to reach a consensus on recommendations were used. RESULTS: CWP is defined by the criteria of the American College of Rheumatology (ACR--strong consensus). FMS can be diagnosed for clinical purposes by symptom-based criteria (without tender point examination) as well as by the ACR criteria (strong consensus).
Subject(s)
Fibromyalgia/diagnosis , Algorithms , Evidence-Based Medicine/standards , Fibromyalgia/classification , Germany , Humans , Interdisciplinary Communication , Patient Care Team , Quality Assurance, Health Care/standardsABSTRACT
BACKGROUND: A guideline for the treatment of fibromyalgia syndrome (FMS) was developed in cooperation with 10 German medical and psychological associations and 2 patient self-help groups. METHODS: A systematic literature search including all controlled studies evaluating multicomponent therapy (MT) was performed in the Cochrane Library (1993-12/2006), Medline (1980-12/2006), PsychInfo (1966-12/2006) and Scopus (1980-12/2006). Levels of evidence were assigned according to the classification system of the Oxford Centre for Evidence-Based Medicine. Grading of the strengths of recommendations was done according to the German program for disease management guidelines. Standardized procedures to reach a consensus on recommendations were used. RESULTS: MT is superior to control groups or routine treatment (evidence level 1A) and should be offered to FMS patients (recommendation strength A). CONCLUSIONS: Future studies should consider medication, other co-therapies and comorbidities. MT programs tailored to FMS subgroups should be tested.
Subject(s)
Fibromyalgia/rehabilitation , Patient Care Team , Combined Modality Therapy , Evidence-Based Medicine , Fibromyalgia/diagnosis , Germany , Humans , Self-Help Groups , Societies, MedicalABSTRACT
Although symptom validity tests have become available to German test users during the last few years, there is very little research into measures of negative response bias in personality assessment. The present study investigates the effects of negative response bias as measured by the Word Memory Test (WMT) and the Structured Inventory of Malingered Symptomatology (SIMS) on self-report personality scales. A retrospective analysis was performed on data from 93 patients who had undergone neuropsychiatric assessment in the context of independent medical examination. Complete data sets were available for the WMT, the SIMS, and the Freiburg Personality Inventory-Revised (FPI-R). Significant differences were found for a number of personality scales, depending on WMT and SIMS classification. The FPI-R validity scale (Openness) was linked to neither WMT nor SIMS, whereas the results in the latter two instruments showed a significant overlap of classification results (phi=0.44). A principal axis analysis yielded corresponding results. It is concluded that self-report personality measures may be considerably distorted by negative response bias. FPI-R Openness scale scores do not allow any interpretation in terms of negative response bias. More effort should be directed in German-speaking countries towards the development and validation of appropriate validity scales.
Subject(s)
Disability Evaluation , Expert Testimony/legislation & jurisprudence , Malingering/diagnosis , Mental Disorders/diagnosis , Neuropsychological Tests/statistics & numerical data , Personality Inventory/statistics & numerical data , Post-Concussion Syndrome/diagnosis , Whiplash Injuries/psychology , Adult , Bias , Depression/diagnosis , Depression/psychology , Female , Humans , Male , Malingering/psychology , Mental Disorders/psychology , Mental Recall , Middle Aged , Motivation , Paired-Associate Learning , Post-Concussion Syndrome/psychology , Psychometrics/statistics & numerical data , Reference Values , Reproducibility of ResultsABSTRACT
In the context of independent medical examinations, negative response bias in patients is a problem of primary importance, especially in cases where self-reported symptoms cannot be directly verified by the examiner. Estimates of the prevalence of uncooperativeness in neuropsychological evaluations demonstrated that invalid test profiles are to be expected in a sizable minority of examinees. However, no estimates have ever been published in German-speaking countries. Symptom validity was checked in 235 patients who reported cognitive symptoms after suffering an accident and who underwent forensic neuropsychiatric assessment. Patient classification was based on the results obtained with the Word Memory Test (WMT) or the Medical Symptom Validity Test (MSVT). When applying the recommended cutoffs for these tests, 44.3 percent of the sample was found to be classified as suspect for insufficient effort. In a subsample of 47 patients with claims of posttraumatic stress disorder 51.1 percent were found to score below the cutoffs. These findings underline the importance of modern methods for assessment of symptom validity in forensic contexts. Cooperativeness of compensation claimants cannot be assumed solely on the basis of clinical impression.
Subject(s)
Disability Evaluation , Expert Testimony/legislation & jurisprudence , Forensic Psychiatry/legislation & jurisprudence , Interprofessional Relations , Neurology/legislation & jurisprudence , Treatment Refusal/statistics & numerical data , Brain Injury, Chronic/diagnosis , Cross-Sectional Studies , Diagnosis, Differential , Germany , Humans , Malingering/diagnosis , Somatoform Disorders/diagnosis , Stress Disorders, Post-Traumatic/diagnosis , Treatment Refusal/legislation & jurisprudence , Whiplash Injuries/diagnosisABSTRACT
In 20 persons in old age and in 20 young persons the immunization with 0,5 ml of a vaccine (tetanus toxoid) was performed. The cell--immediated immunity of lymphocytes of these probands were investigated on the 0,7 21. and 28. day by lymphocyte-transformation test and E-rosette test. The boostering followed after 21 days with the same dose of the vaccine. It was found that the spontaneous transformation rate in T-lymphocytes in old age compared to the young age was duplicated. The stimulation with PHA (Phytämagglutinin) showed no significant differences while the specific cellular reactivity of the T-cells in old age is delayed and reduced compared to the T-cells in young age.
Subject(s)
Immunity, Cellular , Tetanus Toxoid/immunology , Adolescent , Adult , Aged , Humans , Immunization , Lymphocyte Activation , Male , Rosette FormationABSTRACT
It was found that 61 per cent of ageing persons (average age 73 years) had no protective concentrations of tetanus antitoxin in their serums. After active immunization with a vaccine (tetanus toxoid) the increase of the tetanus antitoxin concentration was slower and lower in old age compared to the young age.
Subject(s)
Antibodies, Bacterial/analysis , Clostridium tetani/immunology , Immunization , Tetanus Toxoid/immunology , Adolescent , Adult , Aged , Animals , Humans , Mice , Neutralization TestsABSTRACT
It was established, that there gives no significant correlations between LTT, MMHT and the intracutanous skin-test. The results show, how multifarious and self-contained immunological reactions can be. The results show too, that the tuberculosis infection (tuberculin skin test) from people after the 60th living year is very lower (64%) compared to the people in the 40th living year.
Subject(s)
Immunity, Cellular , Aged , Cell Migration Inhibition , Geriatrics , Humans , Lymphocyte Activation , Macrophages/immunology , Middle Aged , Tuberculin TestABSTRACT
In serums from persons in old age were more antinuclear factors, the DNA-antibodies were increased compared to the serums in young age.