[Medical students' attitude towards electroconvulsive therapy: Impact of patient-oriented training]. / Einstellung von Medizinstudenten zur Elektrokonvulsionstherapie : Auswirkungen des Blockpraktikums.

BACKGROUND: As a particular aspect of psychiatric clinical training many students instinctively harbor reservations towards the field of electroconvulsive treatment (ECT). In this context the question arises how controversial issues, such as ECT can be addressed during the placement. The clinical training is predestined to provide basic knowledge concerning ECT for future doctors. As multipliers and potential referrers they then can work to prevent severe mental illness from becoming chronic. MATERIALS AND METHODS: Prior to the clinical psychiatric teaching course 158 medical students of the RWTH Aachen University were randomly assigned to three groups. The first actively took part in an ECT therapy session (ECT group), the second was shown an educational video (video group) and the third served as a control group. A questionnaire was filled in before and after the training concerning the knowledge and the attitudes towards ECT. RESULTS: In the course of the clinical training the attitudes of the students towards ECT became more positive for all items. The willingness to agree to ECT in the case of patients, family members and friends and themselves increased in the ECT group and the video group but not in the control group. Only the ECT group proved to be superior to the control group in the direct comparisons. In both interventions the knowledge about ECT increased more in comparison to the control group despite the very limited interventions. CONCLUSION: Reservations to touch on the controversial issue of ECT during the clinical training do not seem to be justified. Even a single hands-on or video experience can have a relevant impact on knowledge and attitude towards ECT in medical students. This opportunity should be used more intensively.

[The 'dizziness handicap inventory': initial psychometric evaluation of the German version]. / Das "Dizziness Handicap Inventory": Erste psychometrische Kennwerte einer Deutschen Version.

BACKGROUND: Dizziness has a clear impact on quality of life of patients. Standardized instruments such as the "Dizziness Handicap Inventory" (DHI) help clinicians assess this impact systematically. The purpose of this study was to analyse the psychometric quality of a German version of the DHI. METHODS: One hundred and five patients with dizziness as their primary complaint have completed the DHI and undergone vestibular examination. The structure of the DHI was determined with a factor analysis, a principal component analysis with a Varimax rotation. To evaluate the reliability, internal consistency (Cronbach's alpha) was estimated. RESULTS: A three-factor solution was extracted. The factors obtained from the German version of the DHI related to (1) activity and participation limitations (2) emotional problems and (3) motion sensitivity in everyday life of patients. Overall, there was a close correspondence of the factors of the German and the original version. The correlation analysis indicated a close relationship between the DHI-scores and the frequency of dizziness attacks. CONCLUSION: The German version of the DHI exhibited a multidimensional structure and good psychometric quality to assess the impact of dizziness in every day life.

Impact of chronic obstructive pulmonary disease (COPD) on attention functions.

The present study investigates the influence of COPD on attention functions, learning, and logical thinking. Therefore, 60 COPD patients and 60 healthy controls were recruited into a cross-sectional study and underwent extensive neuropsychological testing. The Attention Network Test was used for assessment of tonic and phasic alertness, orienting, and executive attention. Logical thinking and learning were determined with the Standard Progressive Matrices and the Verbal and Nonverbal Learning Test, respectively. Significant group differences were found in phasic alertness (p=0.001) and orienting (p=0.01) but not in executive attention. In addition overall reaction time was significantly slower in the COPD group (p=0.001). Further group differences were found in verbal (p<0.001) and visual learning (p<0.001) and logical thinking (p<0.001). Regression analysis revealed significant correlations for age (p=0.024) and blood carbon dioxide levels (p=0.043) in reaction time, a correlation for age and orienting (p=0.019) and finally for age (p=0.011) as well as for blood carbon dioxide values (p=0.048) and performance in logical thinking. Results are indicating a global impairment in cognitive functions of COPD patients which is negatively influenced by accelerated aging and increasing with disease severity.

The neural basis of risk ratings: evidence from a functional magnetic resonance imaging (fMRI) study.

Research investigating risk perception suggests that not only the quantitative parameters used in technical risk assessment (i.e., frequency and severity of harm) but also 'qualitative' aspects such as the dread a hazard provokes or its controllability influence risk judgments. It remains to be elucidated, however, which neural mechanism underlie risk ratings in healthy subjects. Using fMRI to detect changes in neural activity we compared the neural activations elicited by risk ratings with those elicited by a letter detection task performed on the same stimuli. The latter task served to control for basic stimulus processing, response selection and button-pressing during task performance. Risk ratings differentially activated the medial prefrontal cortex, the inferior frontal gyrus, the cerebellum (P<0.05, FWE corrected, whole brain approach), and in an additional ROI analysis the amygdala (P<0.05, FWE corrected). Of these structures, particularly the amygdala and the prefrontal cortex have been previously associated with decisions about affective interference. Furthermore our data suggest both, similarities and differences between the neural correlates of risk ratings and risk taking as involved, for e.g., in gambling tasks.

[Item response theory and its application in neurology. Measurement of activity limitations in neurologic patients]. / Item-response-Theorie und deren Anwendung in der Neurologie Messung von Aktivitätseinschränkungen neurologischer Patienten.

This article is concerned with the measurement of activity limitations in neurologic patients and with the application of the item response theory (IRT), especially the Rasch analysis, in analyzing activity ratings. Activity limitations of 166 patients with different neurologic disorders (e.g., stroke, traumatic brain injury) were assessed with the Functional Independence Measure (FIM) during their stay in a rehabilitation hospital. Data analysis was performed with the Rasch model, which allows testing the psychometric qualities of the FIM. Results indicate that the FIM has good psychometric qualities. However, results also show that the 18 FIM items define two statistically and clinically different indicators. Thirteen items define disability in motor functions. Five items define disability in cognitive functions. Separate analyses of the two scales help to improve the psychometric quality of the FIM.

Inhibition of ongoing responses in patients with Parkinson's disease.

OBJECTIVES: We investigated the involvement of the basal ganglia in inhibiting ongoing responses in patients with Parkinson's disease (PD). METHODS: Thirty two patients with PD and 31 orthopaedic controls performed the stop signal task, which allows an estimation of the time it takes to inhibit an ongoing reaction (stop signal reaction time, SSRT). RESULTS: Patients with PD showed significantly longer SSRTs than the controls. This effect seemed to be independent of global cognitive impairment and severity of PD. Furthermore, in the PD patients, there was no significant relation between general slowing and inhibitory efficiency. CONCLUSIONS: Our results provide evidence for involvement of the basal ganglia in the inhibition of ongoing responses.

[Agreement on the Barthel Index. A rapid analysis of other and self-assessment in elderly stroke patients]. / Beurteilungsübereinstimmung beim Barthel-Index. Eine Rasch-Analyse der Fremd- und Selbstbeurteilungen älterer Schlaganfall-Patienten.

The relationship between staff and patient ratings of activity restrictions (Barthel Index, BI) was investigated in 120 elderly stroke patients (on average 78 years old) using the Rasch model and the rating scale analysis. In addition, the relationship between the rated activity restrictions and measures from the Geriatric Assessment was analyzed. We found good patient-staff agreement (r = 0.90) with the poorest agreement in the item "bathing" of the BI. There was also a highly significant correlation between staff and patient ratings and the Tinetti Gait and Balance Scales (r = 0.72 and r = 0.76, respectively). Correlations between other measures of the Geriatric Assessment and the rated activity restrictions were low explaining less than 8% of variance. Our findings merit the use of patient ratings of activity restrictions in stroke outcome research. However, self-ratings of activity restrictions were measured by an unstructured interview and it cannot be ruled out that this method had an influence on the correlation between self-rating and staff rating.

Goal setting and reaction time performance in brain-damaged patients.

A goal-setting approach was used to examine the way in which 62 patients with closed head injuries or cerebral vascular accidents and 47 orthopedic control patients alter their performance on a four-choice reaction time (RT) task. Both patient groups were randomly assigned to two conditions: one in which a specific and high goal was assigned and one in which a "do your best" goal was given. Statistical analysis indicated that patients with a specific and high goal responded faster than patients with a "do your best" goal. No clinical or neuropsychological variables (e.g., attention, memory) had a moderating influence on the goal setting effect. These results demonstrate that goal setting as a motivational technique is a reliable and robust technique and can enhance performance (intensity of behavior) not only in healthy participants but also in brain-damaged patients.

Inhibitory control in children with traumatic brain injury (TBI) and children with attention deficit/hyperactivity disorder (ADHD).

The behavioural and cognitive sequelae of traumatic brain injury (TBI) have features in common with attention deficit/hyperactivity disorder (ADHD), best characterized by deficits in response inhibition.The performance was, therefore, examined of 27 children with TBI, 31 children with developmental ADHD, and 26 matched controls aged 8-12, on two inhibition tasks: the Stop-Signal Task and a Delayed-Response-Task. Children with TBI and children with ADHD showed a pervasive deficit in their inhibitory control processes with respect to inhibition of both pre-potent and on-going responses. In addition, children with TBI were found to suffer from a general slowing of their information processing, which was not correlated with the inhibition deficit. TBI children with and without a secondary ADHD differed only tendentially in their Mean Go-Reaction time in the stop-task. However, subdividing TBI children according to actigraph data into hypo-, hyper- and normokinetic subgroups revealed that the hyperactive TBI children had inhibitory deficit patterns that were similar to children with developmental ADHD. It is concluded that slowing of information processing speed seems to be a general consequence of TBI in childhood, whereas slowing of the stop-processes or inhibitory deficits, specifically, are associated with post-injury hypo- or hyperactivity.

Relationship between cognitive impairments and rated activity restrictions in stroke patients.

OBJECTIVE: To investigate the relationship between cognitive impairments and rated activity restrictions. DESIGN: Comparison of neuropsychological tests and activity questionnaires. Activity ratings were made by staff and stroke patients. SETTING: Two neurological rehabilitation hospitals. PARTICIPANTS: Eighty-seven stroke patients. RESULTS: Moderately high correlations were found between cognitive test scores and activity ratings made by staff members. In contrast, correlations between ratings made by patients and cognitive tests were much lower. There was also little agreement between the staffs' ratings and the patients' own ratings. Multiple regression analyses indicate that cognitive impairments account for 28.9% of the variance in the activity rating made by the staff members. The coefficient of determination was slightly higher when age, time since onset of illness, and depression scores were included as predictors. CONCLUSIONS: These findings provide partial support for a hierarchical structure of the "International Classification of Impairment, Activities and Participation" model of the World Health Organization.

The impact of positive and negative feedback on reaction time in brain-damaged patients.

Little is known about the impact of feedback on the reaction times (RTs) of brain-damaged (BD) patients. The authors therefore investigated the effect of positive and negative feedback on these patients, using a 4-choice RT task. Participants were 107 BD patients with different etiologies and 50 orthopedic (OG) control patients. Patients were assigned to 3 groups in which performance-independent negative, positive, and no feedback were given. Statistical analysis showed that negative feedback led to significantly shorter RTs in BD patients. Even BD patients with high depression scores were affected by negative feedback. In contrast, negative feedback had no impact on the RTs of the OG controls, and positive feedback had no influence on the RTs of any group. These results raise some interesting questions about motivational processes in BD patients.

Lack of inhibition: a motivational deficit in children with attention deficit/hyperactivity disorder and children with traumatic brain injury.

Recent research has demonstrated that both brain-injured children and children with attention deficit/hyperactivity disorder (ADHD) suffer from response inhibition deficits. To investigate whether these deficits can be influenced by motivational factors, the stop-signal task was performed with and without reward contingencies for successful inhibition. Three groups of children between 8 and 12 years of age, participated in the study: 31 children with ADHD, 37 with traumatic brain injuries (TBI), and 26 normal controls. Results indicated that, although all groups showed comparable learning effects, reward contingencies had different effects on the groups. Whereas the performance of children with ADHD under reward contingencies were brought up to the performance level of normal controls, rewards were found less effective at improving response inhibition in children with TBI. The results further support a motivational/energetic explanation of the inhibitory deficit in children with ADHD, and of a primary response inhibition deficit due to structural brain damage in children with TBI.