[Expression, identification and experience of emotions in mental diseases. An overview]. / Ausdruck, Erkennen und Erleben von Emotion bei psychischen Störungen. Eine Übersicht.

Several studies in clinical neuroscience have focused on the analysis of expression of emotions, identification of emotions and experience of emotions. These empirical studies produced certain insights into emotional competency in different mental diseases, most of them in schizophrenia. The current article gives a description of the scientific data about alterations in emotional competency in several mental diseases (e.g. schizophrenia, depression, bipolar and borderline diseases) and links the data, if possible, with clinical relevance with a special focus on emotional competency in prodromal schizophrenia.

[Prospective description of the course of psychopathological symptoms in schizophrenia: evaluation of the short form of the Eppendorf Schizophrenia Inventory]. / Prospektive Verlaufsbeschreibung psychopathologischer Symptome bei Schizophrenie: Evaluation der Kurzform des Eppendorfer Schizophrenie-Inventars.

BACKGROUND: The Eppendorf Schizophrenia Inventory (ESI-K) is a self-assessment procedure which can now be considered as the standard procedure in the diagnostics of schizophrenia. It has been evaluated in many studies and is widely used in research and clinical treatment. In contrast little is known about the psychometric characteristics of the short form of the ESI (ESI-K) which was designed in particular for prospective descriptive courses. MATERIALS AND METHODS: The ESI-K was completed for 40 patients with schizophrenia undergoing complete inpatient psychiatric treatment together with the Positive and Negative Syndrome Scale (PANSS), the Clinical Global Impressions (CGI) form and the Nurses' Observation Scale for Inpatient Evaluation (NOSIE). Of the patients 31 participated in a total of 4 measurements at 1-week intervals. RESULTS: The reliability (Cronbachs α) of the ESI-K was high at all measurement time points and was comparable to the reliability of the standard version. The reliability of the PANSS was roughly the same level but that of the NOSIE was poor. The ESI-K correlated in particular with cognitive syndrome and the positive syndrome of the PANSS. All four instruments showed a decrease in scores over the observational time period which indicated a decline in the psychopathological symptoms. CONCLUSIONS: The ESI-K is a valid time-saving procedure for documentation of the course of symptoms in patients with schizophrenia. It reflects clinically relevant aspects from the spectrum of psychotic symptoms.

[Evaluation of subjective experience of cognitive deficit in patients with schizophrenia using the Eppendorf Schizophrenia Inventory].

Presented is a new questionnaire--Eppendorf Schizophrenia Inventory (ESI)--for evaluation of subjective experience of cognitive dysfunction characteristic of schizophrenia and data that confirmed reliability and diagnostic validity of the ESI. The ESI is suggested to be an additional method of psychopathological diagnosis of schizophrenic disorders.

[Identification of possible cognizance parameters of "mimic disintegration" in schizophrenia using facial electromyography]. / Identifizierung möglicher Kennparameter der "mimischen Desintegration" bei schizophrenen Patienten mittels einer Gesichts-EMG-Methode.

UNLABELLED: The aim of this study was to identify signs of "mimic disintegration" in schizophrenics using a facial electromyographic (EMG) method. We compared a group of 20 unmedicated schizophrenics with a group of 20 healthy subjects, measuring the activity of three joy-relevant facial muscles (zygomaticus major, orbicularis oculi, levator labii superioris) and two nonjoy-relevant facial muscles (frontalis, corrugator supercilii) as control muscles during two consecutive presentations of an erotic slide from the International Affective Picture System. RESULT: Schizophrenics show significantly less activity of joy-relevant facial muscles and a lower smile frequency than healthy subjects. Two signs of mimic disintegration" could be identified: 1. undefined mimic reactions and 2. lack of mimic consistency. CONCLUSION: Facial EMG is a state-of-the-art method for analyzing possible signs of mimic disintegration as described by Heimann and Spoerri. We suggest further examination of the two mimic disintegration signs regarding other emotions, necessarily including more facial muscles in the testing.

[Eppendorf Schizophrenia Inventory (ESI) vs. Frankfurt Complaint Questionnaire (FCQ). Direct comparison in a clinical trial]. / Eppendorfer Schizophrenie-Inventar (ESI) vs. Frankfurter Beschwerde-Fragebogen (FBF). Direkter Vergleich in einer klinischen Studie.

UNLABELLED: This study is the first to directly compare two clinical questionnaires which are both aimed at self-experienced cognitive dysfunctions of schizophrenia: Eppendorf Schizophrenia Inventory (ESI) and Frankfurt Complaint Questionnaire (FCQ). Evaluated were (a) diagnostic validity, (b) psychometric properties, (c) scale intercorrelations, and (d) factor analytic stability. Ad (a): schizophrenic subjects (n=36) show highly significant increases in the ESI scales and sum score when compared to other clinical groups (patients with depression, alcohol dependence, or obsessive-compulsive disorder, n>30, respectively); on the other hand, the FCQ yields no systematic group differences. Ad (b): mean of reliability coefficients (Cronbach alpha) of the ESI scales is r(tt)=0.86, mean of reliability coefficients of the FCQ scales is significantly lower. Ad (c): the mean intercorrelation between ESI and FCQ scales amounts to r(xy)=0.56 (minimum 0.29, maximum 0.73), corresponding to an average shared variance of about 31%. Ad (d): factor analysis yielded an ESI factor and a FBF factor; one-way ANOVA with the factor scores confirms the diagnostic validity of the ESI. CONCLUSIONS: ESI and FCQ measure essentially different aspects of schizophrenic psychopathology. Regarding reliability and diagnostic validity, the ESI is superior to the FCQ.

Impact of present and past antipsychotic side effects on attitude toward typical antipsychotic treatment and adherence.

OBJECTIVE: (1) determine which antipsychotic side effects (SE) schizophrenic patients consider the most distressing during treatment with typical antipsychotics, (2) measure the impact of actual and past SE on patients' attitude toward antipsychotics and (3) assess the influence of both on adherence. METHODS: The 213 schizophrenics, treated with conventional antipsychotics, were recruited in two psychiatric hospitals in Hamburg. Subjects were assessed about type and severity of present and past side effects and their attitude and adherence to antipsychotic treatment. RESULTS: The 82 (39%) patients presented present SE while 131 (61%) did not. Sexual dysfunctions (P < 0.001), extrapyramidal (P < 0.05) and psychic side effects (P < 0.05) were rated as significantly subjectively more distressing than sedation or vegetative side effects. Patients presenting with present SE compared with patients without present SE had a significantly more negative general attitude toward antipsychotics (P < 0.05), were more doubtful about their efficacy (P < 0.01) and were less likely to encourage a relative to take such a medication in case of need (P < 0.001). A regression analysis indicated that nonadherence was mainly influenced by negative general and efficacy attitudes toward antipsychotics and the experience of past or present antipsychotic side effects. CONCLUSIONS: All antipsychotic side effects, present or past, can have a durable negative impact on patient's attitude toward antipsychotic treatment and adherence. Non-adherence is mainly determined, among other factors, by these negative attitudes, which are partly influenced by the experience of past or present antipsychotic-induced side effects.

Effect of corn processing on starch digestion and bacterial crude protein flow in finishing cattle.

Six ruminally and duodenally cannulated yearling steers (523 kg) were used in a replicated 3 x 3 Latin square design experiment to study the effects of corn processing on nutrient digestion, bacterial CP production, and ruminal fermentation. Dietary treatments consisted of 90% concentrate diets that were based on dry-rolled (DRC), high-moisture (HMC), or steam-flaked (SFC) corn. Each diet contained 2.0% urea (DM basis) as the sole source of supplemental nitrogen. Each period lasted 17 d, with d 1 through 14 for diet adaptation and d 15 through 17 for fecal, duodenal, and ruminal sampling. Dry matter and OM intakes were similar for DRC and SFC but were approximately 15% higher (P < 0.05) for HMC. True ruminal OM digestibilities were 18 and 10% greater (P < 0.05) for HMC than for DRC or SFC, respectively. Ruminal starch digestibilities were similar between HMC and SFC and were approximately 19% greater (P < 0.05) than DRC. Postruminal OM digestibility was similar among treatments; however, postruminal starch digestibility was 15% greater (P < 0.05) for SFC than for DRC or HMC, which were similar. Total-tract DM and OM digestibilities were similar between HMC and SFC and were 4% greater (P < 0.05) than DRC. Likewise, total-tract starch digestibilities were similar between HMC and SFC and were 3% greater (P < 0.05) than DRC. Bacterial CP flow to the duodenum was 29% greater (P < 0.05) for HMC than for DRC or SFC, which were similar. Bacterial N efficiencies were similar among treatments. Based on bacterial CP flow from the rumen, we estimate that dietary DIP requirements are approximately 12% higher for HMC-based diets than for DRC or SFC-based diets, which were similar.

[The vigilance paradigm in schizophrenia research - studies on the Continuous Performance Test (CPT)]. / Das Vigilanzparadigma in der Schizophrenieforschung - Untersuchungen zum Continuous Performance Test (CPT) -

Deficits in vigilance/sustained attention of schizophrenic subjects have been a main topic of neuropsychological schizophrenia research for many years. The degraded stimulus Continuous Performance Test (ds-CPT) is the standard paradigm for measuring vigilance. Measurement of vigilance requires the observation of the course of perceptual sensitivity over time. The present review shows that from a theoretical point of view it is possible to show vigilance deficits (as a decrease of sensitivity) with the ds-CPT if certain conditions are given. However, only in a few schizophrenia studies the course of sensitivity over time was evaluated, while in most studies merely the level of sensitivity was analysed. Results presented in this review suggest that level and course of sensitivity are largely independent variables. Vigilance can be operationalised adequately only when considering the course of sensitivity over time. Therefore there still is a considerable need for research on the meaning of vigilance deficits for manifestation, course and treatment of schizophrenia.

Overexpression of the HER-2/neu oncogene in pancreatic adenocarcinoma.

Novel systemic treatments are needed in pancreatic cancer. The authors sought to establish the frequency of overexpression of the HER-2/neu oncogene in patients with pancreatic adenocarcinoma to determine the potential role of trastuzumab (Herceptin) as a therapeutic agent in this disease. Tumor specimens from patients with pancreatic adenocarcinoma were analyzed by staining for p185HER2 protein using the DAKO immunohistochemical assay. Patients with and without HER-2/neu overexpression by immunohistochemistry were compared with respect to clinical and pathologic characteristics. HER-2/neu gene amplification was also evaluated by fluorescence in situ hybridization (FISH). Thirty-two of 154 patients (21%) had pancreatic adenocarcinoma that demonstrated HER-2/neu overexpression by immunohistochemistry. At initial diagnosis, 16% of resectable cancers, 17% of locally advanced cancers, and 26% of metastatic cancers were determined to have HER-2/neu overexpression. Three of 11 (27%) patients with HER-2/neu overexpression by immunohistochemistry had gene amplification by FISH. HER-2/neu overexpression occurs in a subset of pancreatic cancer. Evaluation of the efficacy of trastuzumab for patients with pancreatic cancer who overexpress HER-2/neu appears indicated.

Schizophrenic disorders among Turkish migrants in Germany. A controlled clinical study.

Several studies have implied cultural differences in the psychopathology of schizophrenia between migrants and natives. In a diagnostically strictly controlled study, including comparison of diagnosis with a Turkish-speaking psychiatrist, 74 patients of Turkish and 48 of German origin, all with a diagnosis of schizophrenic disorder, were compared using PANSS and HAM-D. The Turkish sample showed higher depression and hostile excitement, even in the subsample of those with paranoid schizophrenia, and no differences in positive, negative or cognitive symptoms. The similarities especially concerning core symptoms reflect evidence from cross-cultural studies on schizophrenia. In conclusion this study shows main differences in psychopathology between psychotic migrants and natives, as discussed in the literature, may be mainly due to diagnostic differences.

Relationship between cannabis use, schizotypal traits, and cognitive function in healthy subjects.

This research examined the relationship between cannabis use and schizotypal features. A sample of cannabis users (n = 20) was compared with a matched control group (n = 20). All participants were male students of the University of Hamburg. Subjects completed the Perceptual Aberration Scale and the Schizotypal Personality Questionnaire. A Negative Priming procedure and the Trail Making Test were carried out. A urine sample was obtained from each subject. Cannabis users exceeded controls in schizotypy scores and showed impaired neuropsychological parameters. Only within the cannabis group schizotypy scores correlated with neuropsychological parameters. Furthermore, cannabis users reported more often high-risk factors than controls. These findings indicate that among cannabis users there is an increased number of subjects with schizotypal features; schizotypal subjects seem to be more likely to use cannabis than the general population. Therefore, cannabis use may be a vulnerability indicator for schizophrenia.

Improvement of schizophrenic patients' subjective well-being under atypical antipsychotic drugs.

Recent research indicates that subjective well-being is a major determinant of medication compliance in schizophrenia. However, it is yet unresolved whether atypical neuroleptics differ regarding subjective side-effects. A self-report instrument has been constructed to evaluate 'subjective well-being under neuroleptics' (SWN). The primary aims of the present study were to develop a short form of the SWN and to investigate the extent to which the atypical antipsychotic improves the patient's subjective well-being. The short form of the SWN was constructed following an item analysis based on data from 212 schizophrenic patients medicated with either typical or atypical antipsychotics. The short form of the SWN showed sufficient internal consistency and good construct validity. The SWN was only moderately correlated with positive and negative syndrome scale (PANSS) scores or changes in psychopathology (r=-0.20 to -0.37). SWN-ratings in patients receiving olanzapine were superior compared to those of patients medicated with either clozapine or risperidone on three of five domains of well-being. Clozapine reduced global psychiatric symptoms significantly more than risperidone. It is concluded that the assessment of subjective well-being under antipsychotic treatment provides an independent outcome measure which is relevant to compliance.

Effects of cerebral hemispheric laterality on the span of apprehension of schizophrenic and healthy subjects.

The effects of hemispheric laterality on a forced-choice Span of Apprehension (SoA) task were investigated. Forty-eight adult schizophrenic inpatients were recruited. A control group of healthy subjects was put together using the matched-pairs method with age, gender, and education as control variables. SoA performance was determined separately for the left and right visual field (VF), respectively. No SoA group differences were found; in both groups, the hit percentage was higher in the right VF. However, in the schizophrenic group, the left VF performance showed significant negative correlations with psychopathologic symptoms (especially auditory verbal hallucinations). In a subsample of patients receiving atypical neuroleptic drugs, the daily dosage correlated negatively with left VF performance. In general, young subjects performed better than old subjects (both VFs), males performed better than females, and subjects with high education performed better than subjects with low education (right VF).

[The Eppendorf Schizophrenia Inventory (ESI). Development and evaluation of a questionnaire for assessment of characteristic self perception of cognitive dysfunctions by schizophrenic patients]. / Das Eppendorfer Schizophrenie-Inventar (ESI). Entwicklung und Evaluation eines Fragebogens zur Erfassung charakteristischer Selbstwahrnehmungen kognitiver Dysfunktionen schizophren Erkrankter.

This study explored characteristic subjective experiences of schizophrenia. A questionnaire for self-assessment of disturbances in several cognitive and perceptual areas (the Eppendorf Schizophrenia Inventory, or ESI) was constructed and administered to first-episode schizophrenics (SCHe, n = 45), negative syndrome schizophrenics (SCHn, n = 45), remitted schizophrenics (SCHr, n = 24), depressives (DEP, n = 43), alcoholics (ALK, n = 48), obsessive-compulsive patients (ZWA, n = 46), and healthy controls (KON, n = 57). Comparisons between the SCHe, SCHn, DEP, ALK, and ZWA groups and a subsequent factor analysis revealed four schizophrenia-specific dimensions: attention and speech impairment (AS), ideas of reference (IR), auditory uncertainty (AU), and deviant perception (DP). Further analyses suggested that the AS syndrome may represent a mediating vulnerability factor while IR, AU, and DP probably are reversible episode indicators. The results may contribute to refinements in the measurement of specific prepsychotic signs, thus facilitating the development of early intervention approaches.

[Differences between psychopathological evaluation in German and Turkish language of Turkish immigrants]. / Differenzen zwischen der psychopathologischen Evaluation in deutscher und türkischer Sprache bei türkischen Migranten.

The elevated rate of schizophrenia among migrants has been explained, among others, with misdiagnosis due to symptoms' being misinterpreted as psychotic. Previous studies have shown both higher and lower rates of psychotic symptoms of these patients when interviewed in their mother tongues, compared to being interviewed in the second language. In this study, 91 patients of Turkish origin and 50 of German origin with a paranoid-hallucinatory syndrome at admission were examined by an one interviewer each of Turkish and German origins using a standardized psychopathological instrument. In spite of comparative samples, correlation of psychopathological evaluation as well as diagnostic agreement between the two interviewers was significantly higher in the German patient group. Within the Turkish patient group, correlation was higher for those with good German language knowledge than for those with poor knowledge, yet only on a few items and without an effect on diagnostic agreement. The greatest difficulties lie in the evaluation of delusions. In spite of higher disagreement on psychopathology, the potential misdiagnoses cannot sufficiently explain the higher rate of schizophrenia among migrants.

Characteristic subjective experiences of schizophrenia.

The purpose of the study was to identify subjective experiences that are characteristic of schizophrenia. A questionnaire for self-assessment of disturbances in several cognitive-perceptual areas (the Eppendorf Schizophrenia Inventory) was constructed and administered to first episode schizophrenia patients (SCHf; n = 45), negative-syndrome schizophrenia patients (SCHn; n = 45), remitted schizophrenia subjects (SCHr; n = 24), depressive patients (DEP; n = 43), alcoholic patients (ALC; n = 48), obsessive-compulsive patients (OCD; n = 46), and healthy controls (CON; n = 57). Comparisons between the SCHf, SCHn, DEP, ALC, and OCD groups and a subsequent factor analysis revealed four schizophrenia-specific dimensions: Attention and Speech Impairment (AS), Ideas of Reference (IR), Auditory Uncertainty (AU), and Deviant Perception (DP). Further analyses suggested that the AS syndrome represents a mediating vulnerability factor, while IR, AU, and DP probably are reversible episode indicators. The results may contribute to the refinement of the measurement of specific prepsychotic signs, thus facilitating the development of early intervention approaches.

Differential sustained attention/vigilance changes over time in schizophrenics and controls during a degraded stimulus Continuous Performance Test.

The Continuous Performance Test (CPT) is a widely used procedure for sustained attention/vigilance measurement. However, though the key index of vigilance impairment is the decrement of sensitivity over time during the test period, only few studies have examined whether schizophrenics show a larger drop in CPT performance than do healthy controls. 48 schizophrenic inpatients and 48 controls were investigated with the Munich CPT (480 visual stimuli, 25% target stimuli, one stimulus per second). Stimuli were degraded by randomly inverting 40%, 41%, 42%, or 43% of the pixels. Results were calculated separately for three consecutive trial sections. Additionally, PANSS ratings, medication, and other clinical data were documented. Schizophrenics show a vigilance decrement over time, controls show a vigilance increase. Differential vigilance changes were not related to the level of stimulus degradation. Schizophrenics performed worse than controls only at the lowest degradation level. While overall sensitivity correlated negatively with the dose of atypical neuroleptics and benzodiazepines, vigilance shifts over time correlated negatively with the dose of typical neuroleptics. Furthermore, sensitivity was related to the cognitive PANSS syndrome, number of admissions/duration of illness. Differential sensitivity decrements of schizophrenics and controls can be shown if suited CPT procedures are used. The need for basic research on experimental conditions of the CPT as well as examination of the relationship between sustained attention/vigilance decrements and clinical features of schizophrenia is suggested.

Potential for misdiagnosis among Turkish migrants with psychotic disorders: a clinical controlled study in Germany.

OBJECTIVE: The elevated rate of schizophrenia among migrants has been explained in part by possible misdiagnosis. In this study an attempt is made to quantify the extent of potential misdiagnosis among migrants in comparison to non-migrants. METHOD: One hundred patients of Turkish origin (Tr-Pat) and a control group of 50 patients of German origin (G-Pat), all with a paranoid-hallucinatory syndrome upon admission, were examined by an interviewer of Turkish origin (Tr-Int), an interviewer of German origin (G-Int) and the clinician. The diagnostic evaluation was then compared. RESULTS: Nineteen per cent of Tr-Pat and 4% of G-Pat showed diagnostic disagreement between the three raters, while in 8% of Tr-Pat and 0% of G-Pat the two research diagnoses disagreed. In Tr-Pat with 'bad' German knowledge showed tendentially more (29%) diagnostic disagreement than Tr-Pat with 'good' German knowledge (17%). CONCLUSION: The rate of potential misdiagnosis is higher among migrants, yet not strongly correlated to poor second language proficiency.

The role of HER-2 expression in predicting response to therapy in breast cancer.

HER-2 expression may have predictive value regarding response to therapeutic interventions in breast cancer. A number of reports describe the interaction of HER-2 overexpression and tamoxifen, but data are inconclusive. Chemotherapy trials have supported an interaction between HER-2 overexpression and chemotherapy sensitivity (cyclophosphamide/methotrexate/5-fluorouracil resistance and doxorubicin sensitivity) which is compelling. More recently, HER-2 has been the target for Food and Drug Administration-approved antibody therapy, trastuzumab (Herceptin; Genentech, Inc, South San Francisco, CA). The Clinical Trials Assay, a scoring system for tumor material, has been used successfully in the trastuzumab clinical development program. As many of the early studies evaluating the role of HER-2 were retrospective, controlled prospective studies are needed to best determine the value of trastuzumab in the adjuvant clinical setting.