[Internet-based approaches in the therapy of eating disorders]. / Internetbasierte Ansätze in der Therapie von Essstörungen.

Recent technological developments of communication media offer new approaches to diagnostic and therapeutic interactions with patients. One major development is Internet-based primary prevention in vulnerable individuals not yet suffering as well as the development of new therapeutic approaches for affected individuals based on the experiences of guided self-help through CD, DVD or bibliotherapy. The eating disorder literature shows several interesting, partly controlled and randomized, studies on bulimia nervosa, a few studies on binge eating disorder and no studies on anorexia nervosa. As part of the German Eating Disorder Network on Psychotherapy (EDNET) a 9-month Internet-based relapse prevention program for patients with anorexia nervosa after inpatient treatment was evaluated. Conception, first experiences and first results of the Internet-based relapse prevention program for anorexia nervosa are reported.

Association between cingulum bundle structure and cognitive performance: an observational study in major depression.

BACKGROUND: Major depression can be regarded as a systemic neurobehavioral disorder resulting from dysfunction of the limbic-cortical networks. The cingulum bundle represents a major association fiber tract of those networks. The aim of our study was to determine the association of brain structural tissue markers of the cingulum bundle and cognitive function in patients with major depression. METHODS: Region-of-interest-based analyses of the middle-anterior and middle-posterior cingulum bundle fractional anisotropy (FA) and mean diffusivity (MD) using color-coded diffusion-tensor imaging and neuropsychological assessment in 14 patients with major depression. RESULTS: FA of the middle-anterior and middle-posterior cingulum bundle was significantly correlated to the performance in a planning and divided attention task. Furthermore, MD of the middle-posterior cingulum bundle was significantly correlated to a planning task. There was no significant correlation between FA and MD of the cingulum bundle and selective attention or memory. CONCLUSIONS: Brain structural tissue markers of the middle-anterior and middle-posterior cingulum bundle were found to be associated with executive functioning and divided attention in patients with major depression. Disconnection within the limbic-cortical networks may underlay cognitive dysfunction in major depression.

[Cognitive training in rehabilitation: a program to treat mild cognitive impairment]. / Gedächtnismanagementtraining in der Rehabilitation (KTR): Programm zur Behandlung leichter kognitiver Beeinträchtigungen.

As part of a research project, a behavior therapy-oriented cognitive training program, designed to improve the cognitive ability of middle-aged employees (50 to 59 years), was implemented and evaluated. The goal of the training program was to analyze the cognitive, affective and behavior-related conditions of memory deficits in the workplace. The training focused on two topics: (1) development of new job tasks, (2) lack of time and deadline constraints. A total of 316 patients in the psychosomatic clinic of Bad Neustadt participated in the study. Those who showed cognitive impairments took part in the cognitive training program during the intervention phase. During the control phase, patients with cognitive impairments received no additional intervention. The neuropsychological screening was repeated with patients with cognitive impairments at discharge. The findings show that the objective and subjective memory performance of the participants improved significantly compared to that of the control group. At the 1-year follow-up, 84% of the participants reported that they could use the training strategies in their job.

[Cognitive impairment, depression, and work capacity of 50-59-year-old psychosomatic inpatients]. / Kognitive Auffälligkeiten, Depressivität und Leistungsfähigkeit bei älteren Arbeitnehmern in stationärer psychosomatischer Behandlung.

Due to aging of the population and a possible rise in retirement age, the cognitive capacity of older people is gaining great importance. As evidenced by the increase in early retirement due to psychosomatic disease, many employees are not capable of working at a higher age. Decreasing cognitive abilities have usually been studied in subjects over 65 years based on the heterogeneous construct of mild cognitive impairment (MCI). This study investigates the prevalence of cognitive impairments in the age group from 50 to 59 years and their reflections in subjective vocational achievement and social medical evaluation. Having been assigned to inpatient rehabilitation due to decreasing work performance, these patients could be considered a risk group for developing MCI. A battery of standardized cognitive tests was conducted with patients at a psychosomatic hospital (Termine Test, CVLT, Block Design, TAP, and Tower of Hanoi). The MCI was defined by performance below the average age norm in at least two of five functional areas. Depression was assessed by the Beck Depression Inventory. Cognitive impairment was observed in 24% of participants. These patients also described vocational difficulties. Cognitive impairments of older employees could possibly be compensated for by specific training programs in order to maintain or rebuild their work capacity.

[Work and vocational integration of psychosomatic patients--utilization and indications for a workload tryout program]. / Arbeit und berufliche Integration psychosomatisch Kranker. Nutzen und Indikation der beruflichen Belastungserprobung.

The effect of a professional workload test was assessed in a longitudinal study with 80 patients psychosomatic rehabilitation during and following their. In a second study indication criteria were tested with 358 consecutive patients. Participants in the workload program show an improvement of their work ability and job performance according to self-appraisal, superior appraisal and medical assessment. Work ability was still maintained 7 months after treatment. Patients with lasting work disability and unemployment not only show negative work-related attitudes, but also elevated psychological symptoms and a reduced quality of life. The program participants show high levels of psychological strain but also a stronger disposition to change the professional situation. Negative work-related and psychological consequences of lasting disability and unemployment deserve more attention in inpatient psychosomatic treatment.

[Integrated occupational work capacity evaluation in medical rehabilitation--experiences and prospects exemplified by psychosomatic rehabilitation]. / Die integrierte berufliche Belastungserprobung in der medizinischen Rehabilitation--Erfahrungen und Perspektiven am Beispiel der psychosomatischen Rehabilitation.

Psychosomatic rehabilitation is often initiated when lasting work disability, loss of job, and pension application have occurred. After a review of the relevance of vocational strains and of predictors for reintegration, we present a model of an integrated work hardening programme in Psychosomatic Rehabilitation. Results for 64 patients are illustrated by case vignettes. Especially when lasting work disability and unemployment have undermined the patients' sense of competence and endurance, work hardening promotes return to work, realistic self-appraisal and vocational reorientation. The social and medical assessment and the coordination of vocational rehabilitation measures are improved. The implementation of a work hardening programme requires the provision of a variety of (unpaid) work opportunities, independent assessment of work performance by supervisors and social worker, psychological support and close cooperation with rehabilitation services.

Alterations of autonomic cardiac control in anorexia nervosa.

BACKGROUND: The authors investigated autonomic cardiac function in anorexia nervosa. METHODS: Forty-eight patients, who in the present or past met the DSM-III-R criteria for anorexia nervosa, and 16 normal control subjects participated in a standardized analysis of heart rate variability during supine and standing postures. RESULTS: Several heart rate variability parameters showed an inverse correlation to the present weight of the anorexic subjects. The values of the spectral power analyses were significantly (p < .01) lower in patients (n = 18) weighing less than 75% of ideal weight when compared to the results found in the control group; however, the heart rate variability parameters of anorexic subjects with restored weight (n = 12) did not differ from those of the control subjects. CONCLUSIONS: The obtained results provide evidence for autonomic cardiac dysfunction in acutely ill anorexic patients. Further research is required to elucidate possible clinical consequences of these findings.

[Successful treatment of brain metastases in breast cancer with blood-brain barrier-impervious cytostatics and hormones]. / Erfolgreiche Behandlung von Hirnmetastasen bei Mamma-Karzinom mit nicht liquorgängigen Zytostatika und Hormonen.

11 patients (age 36-60 years) with breast cancer and CT-scan documented brain metastases (BM) were treated with hormonochemotherapy: 5-fluorouracil 500 mg/m2 i.v. day 1 + 8, adriamycin 50 mg/m2 i.v. day 1, cyclophosphamide 500 mg/m2 i.v. day 1-q4 weeks (FAC) and tamoxifen (TXF) 20 mg/day per os. Ovarectomy was carried out in 3 praemenopausal patients. In 3 cases single BM were surgically resected (2 subtotal, 1 total). One patient was shunted due to a hydrocephalus occlusus. Complete response (CR), i.e. normalization of CT-scan and disappearance of CNS related symptoms, was achieved in 9 out of 11 patients. One patient with partial remission (PR) and another with progressive disease died 6 and 5 months after diagnosis of BM. The median duration of remissions of all patients was 12 (5-43) months. The median survival time from diagnosis of BM was 15 (5-44) months and from mastectomy 46 (26-142) months. The cumulative probability of surviving was 63% one year after diagnosis of BM. One relapsing patient achieved a second CR, another a PR by whole brain irradiation. 4 patients survived more than 18 months from the diagnosis of BM. It appears that chemo-hormonotherapy provides a rational approach to palliation in breast cancer patients with BM in prolonging the survival.

[Allergic reaction to melphalan]. / Allergische Reaktion auf Melphalan?

The most common side effects of melphalan administration include nausea, vomiting, and bone marrow suppression. Less well known is the fact that allergic reactions can become evident after both intravenous and oral melphalan administration. In the present study we report a patient with a plasmocytoma, who developed an allergic reaction with melphalan intravenously, but tolerated melphalan orally.

[Treatment results in unselected small cell bronchial carcinoma patients]. / Therapieergebnisse beim kleinzelligen Bronchialkarzinom an einem nicht selektionierten Patientenkollektiv.

18 of 36 consecutive patients with small cell carcinoma of the lung received a combination of chemotherapy (Adriblastin, Oncovin, Cyclophosphamide) and radiotherapy (primary tumor and CNS). This treatment resulted in a response rte of 78%, and in a median survival of 10.6 months ("limited disease" 13 months, "extensive disease" 9 months). Complete remissions were obtained only in 4 of 18 patients, 4 patients of these were long-term survivors (greater than 18 months). Due to heart diseases, age, or poor general condition 18 patients received a milder combination of chemotherapy ("COM", "VP-O-C") and tumor irradiation. The response rate was 66%. Complete remission was achieved in only 2 of 18 patients. The median survival rate was 8.6 ("limited disease" 10.5 months, "extensive disease" 6.0 months). Survival exceeded 18 months in 4 of these patients. The toxicity was mild, the mean cumulative duration of hospitalization was 78 (30-120) days per patient.