The impact of acute stress on hormones and cytokines, and how their recovery is affected by music-evoked positive mood.

Stress and recovery from stress significantly affect interactions between the central nervous system, endocrine pathways, and the immune system. However, the influence of acute stress on circulating immune-endocrine mediators in humans is not well known. Using a double-blind, randomized study design, we administered a CO2 stress test to n = 143 participants to identify the effects of acute stress, and recovery from stress, on serum levels of several mediators with immune function (IL-6, TNF-α, leptin, and somatostatin), as well as on noradrenaline, and two hypothalamic-pituitary-adrenal axis hormones (ACTH and cortisol). Moreover, during a 1 h-recovery period, we repeatedly measured these serum parameters, and administered an auditory mood-induction protocol with positive music and a neutral control stimulus. The acute stress elicited increases in noradrenaline, ACTH, cortisol, IL-6, and leptin levels. Noradrenaline and ACTH exhibited the fastest and strongest stress responses, followed by cortisol, IL-6 and leptin. The music intervention was associated with more positive mood, and stronger cortisol responses to the acute stressor in the music group. Our data show that acute (CO2) stress affects endocrine, immune and metabolic functions in humans, and they show that mood plays a causal role in the modulation of responses to acute stress.

Free-field study on auditory localization and discrimination performance in older adults.

Localization accuracy and acuity for low- (0.375-0.75 kHz; LN) and high-frequency (2.25-4.5 kHz; HN) noise bands were examined in young (20-29 years) and older adults (65-83 years) in the acoustic free-field. A pointing task was applied to quantify accuracy, while acuity was inferred from minimum audible angle (MAA) thresholds measured with an adaptive 3-alternative forced-choice procedure. Accuracy decreased with laterality and age. From young to older adults, the accuracy declined by up to 23 % for the low-frequency noise band across all lateralities. The mean age effect was even more pronounced on MAA thresholds. Thus, age was a strong predictor for MAA thresholds for both LN and HN bands. There was no significant correlation between hearing status and localization performance. These results suggest that central auditory processing of space declines with age and is mainly driven by age-related changes in the processing of binaural cues (interaural time difference and interaural intensity difference) and not directly induced by peripheral hearing loss. We conclude that the representation of the location of sound sources becomes blurred with age as a consequence of declined temporal processing, the effect of which becomes particularly evident for MAA thresholds, where two closely adjoining sound sources have to be separated. While localization accuracy and MAA were not correlated in older adults, only a weak correlation was found in young adults. These results point to an employment of different processing strategies for localization accuracy and acuity.

Crossmodal interactions and multisensory integration in the perception of audio-visual motion -- a free-field study.

Motion perception can be altered by information received through multiple senses. So far, the interplay between the visual and the auditory modality in peripheral motion perception is scarcely described. The present free-field study investigated audio-visual motion perception for different azimuthal trajectories in space. To disentangle effects related to crossmodal interactions (the influence of one modality on signal processing in another modality) and multisensory integration (binding of bimodal streams), we manipulated the subjects' attention in two experiments on a single set of moving audio-visual stimuli. Acoustic and visual signals were either congruent or spatially and temporally disparate at motion offset. (i) Crossmodal interactions were studied in a selective attention task. Subjects were instructed to attend to either the acoustic or the visual stream and to indicate the perceived final position of motion. (ii) Multisensory integration was studied in a divided attention task in which subjects were asked to report whether they perceived unified or separated audio-visual motion offsets. The results indicate that crossmodal interactions in motion perception do not depend on the integration of the audio-visual stream. Furthermore, in the crossmodal task, both visual and auditory motion perception were susceptible to modulation by irrelevant streams, provided that temporal disparities did not exceed a critical range. Concurrent visual streams modulated auditory motion perception in the central field, whereas concurrent acoustic streams attracted visual motion information in the periphery. Differential abilities between the visual and auditory system when attempting to accurately track positional information along different trajectories account for the observed biasing effects.

[Direct health-related costs of severely mentally ill patients and their informal carers in community care]. / Gesundheitsbezogene Versorgungskosten schwer psychisch erkrankter Patienten und ihrer Angehörigen während gemeindepsychiatrischer Betreuung.

OBJECTIVE: Within the last few years, a small number of German cost analyses of patients treated in community mental health care settings was presented. None of these studies, however, examined direct health care costs of the patients' close reference persons focusing on costs associated with providing informal care. Therefore, our study aimed to analyse health-related direct costs of severely ill patients suffering from affective or schizophrenic disorders, and of their informal carers during community mental health care; further, we examined if these costs differed between the diagnostic groups. METHODS: 69 patients currently treated by community mental health services of the Dresden region and their closest reference person providing informal care were assessed twice within an interval of 3 months by use of the CSSRI- D. Thus, direct health care costs of patients and their informal carers covering a 6-months-period could be calculated. RESULTS: 25.35% and 38.24%, respectively, of the closest reference persons' direct health care costs were caused by the situation of acting as informal carer. This was 9.12% and 22.74%, respectively, of the patients' direct health care costs assessed at the same time-points. Patients' costs did not differ between the diagnostic categories, but were influenced by the current severity of psychopathological symptoms. Reference persons' costs were influenced by the severity of the patient's psychopathological symptoms, but also by the social control behaviour of the reference persons themselves as well as by their sense of coherence. CONCLUSIONS: While a replication of our findings is urgently needed, they point at the economic significance of direct health-related costs caused by acting as informal carers. Further, therapeutic approaches adequate for minimizing these costs could be suggested, like emphasizing protective factors of mental well-being in psycho-educational programmes for relatives.

Assessing the opinions of relatives on the causes and social consequences of different mental disorders: are instruments cross-culturally valid?

Obtaining valid information about the opinions of relatives on the causes and social consequences of mental disorders should be an important component in specifically tailoring therapeutic interventions for relatives according to their needs. The available range of instruments is small, however, the most prominent being the Italian Questionnaire on the Opinions of the Family (QOF), developed specifically for schizophrenic disorders. The German validation study of this instrument sought to determine whether the subscale structure of the QOF can be replicated in a group of relatives (N=161) of patients with schizophrenic disorders as well as recurrent depressive and bipolar disorders. Results demonstrate that the original QOF subscales cannot be transferred to groups of relatives of patients with affective disorders, nor to a German group of relatives of patients with only schizophrenic disorders. Therefore, a German version of the QOF was created. Using this modified version of the instrument, researchers established a three-factor solution differentiating the opinions of relatives on chronic mental disorders into three components, reflecting orientation towards pathology, towards normality and towards optimising resources for treatment. None of these factors showed significant relationships with the relatives' causal attributions about mental disorders. Further research is needed to establish cross-nationally valid versions of such instruments.

Standardized assessment of psychopathology by relatives of mentally disordered patients. Preliminary results of using the positive and negative syndrome scale to compare schizophrenic and affective disorders.

BACKGROUND: For optimizing the validity of diagnoses of mental disorders, several sources of information should be used to assess psychopathological symptoms. Among these are relatives of patients with mental illness. The very low number of empirical studies examining the assessment of psychopathology by relatives of adult, nondemented mentally ill patients stands in significant contrast to the clinical importance of this source of information, however. SAMPLING AND METHODS: Using the Positive and Negative Syndrome Scale (PANSS), researchers asked 163 relatives of patients with the main clinical ICD-10 diagnosis of schizophrenic, recurrent depressive or bipolar disorders to rate the current symptoms of the patients at the time of outpatient community-oriented treatment. RESULTS: On average, severity of symptoms was rated as absent or minimal, although anxiety, depression and passive/apathetic social as well as emotional withdrawal, motor retardation, poor attention, and disturbance of volition were clearly rated above the PANSS mean total score for all patients. A six-factor structure identified by factor analysis better illustrates the significant differences in the assessments of the three main diagnostic groups than the three established PANSS scales. With the exception of 'problematic social behavior', differences among the diagnostic groups appeared in all factors and were particularly pronounced for 'delusional beliefs' and 'motor impairments'. CONCLUSIONS: The results of this study showed that the use of standardized instruments such as PANSS for the assessment of psychopathology by relatives is not only practical, but produces adequately reliable results. The use of PANSS for this purpose, however, requires interviewing of relatives by trained experts able to explain technical terms. Because this study did not sufficiently explore the validity of this approach, further research on this specific issue is urgently needed and should, for example, assess the concordance of ratings between professionals and relatives as well as correlation with suitable external criteria.

[Psychotherapy with the elderly in outpatient settings: are elderly patients the easier ones?]. / Ambulante Psychotherapie Alterer: Sind ältere Psychotherapiepatienten "einfachere" Patienten?

Elderly patient's preconditions for outpatient psychotherapy are compared with regard to symptom levels, psychological and bodily functioning, and interpersonal problems with groups of younger patients. Based on the Age and Disorder-Specific Model of Psychotherapy (ADS-MP) we predicted that the group of older patients exhibits more favorable preconditions for psychotherapy as well as a shorter duration of treatments than younger groups. A total of 169 outpatients from an university clinic were divided into four groups and compared. Rates of mental disorders did not differ between the groups for all frequent disorders. The group of elderly patients did not show a difference in symptom levels although their psychological functioning was better than in the comparison groups. Two of eight interpersonal problems showed more favorable initial values for the elderly. The number of necessary therapy hours up to the treatment conclusion was significantly smaller in the older group (on average 21 hours) than with young to middle-aged patients groups. The results point to the fact that the psychological preconditions for psychotherapy in old age are good and indicate promising directions for the development of age-appropriate interventions.

[Teaching of psychosomatic medicine and psychotherapy as an element of the Dresden DIPOL-Curriculum -- the PBL-course "Nervous system" and psyche]. / Unterricht in Psychosomatik und Psychotherapie im Dresdner DIPOL-Curriculum -- Der POL-Kurs "Nervensystem und Psyche".

A federal law, the "Approbationsordnung für Arzte", regulates Medical education in Germany. In 2002 a revised version of this law demanded of the medical faculties to implement interdisciplinary and problem-based (PBL) courses in their curriculum. Already in 1998 the faculty of medicine of the TU Dresden decided to reform the traditional curriculum. The reform-curriculum is being created in close co-operation with the Harvard Medical School. It is a hybrid curriculum retaining traditional elements as lectures and bedside teaching with PBL-tutorials and a special doctor-patient-communication-training, which is based on role-play exercises. Psychosomatic Medicine is taught together with neurology and psychiatry as a major topic of the 7,5-week PBL-course "Nervous System and Psyche" but there are also lectures and special skills training exercises in other PBL-courses like "Oncology" or "Emergency medicine". Data of the external evaluation showed, that the students accepted psychosomatic topics of the curriculum very well. This paper describes concept, implementation and evaluation data of the PBL-course "Nervous System and Psyche".

What is a good tutorial from the student's point of view? Evaluation of tutorials in a newly established PBL block course "Basics of Drug Therapy".

Problem-based learning (PBL) within a tutorial is the core element in a 6-week block course "Basics in Drug Therapy" recently introduced into the medical curriculum of an eastern German university. Under the supervision of one tutor a group of 6-9 students solved a total of six clinical cases related to drugs used in general anaesthetics; to analgetic/antiphlogistic, antihypertensive, cardiovascular and lipid-lowering drugs; to drugs acting on the central nervous system; and to intoxicating agents. By answering questionnaires students and tutors extensively evaluated each individual case as well as the whole block course. Factors evaluated also included students' and tutors' behaviour during sessions. The purpose of the analysis was to identify factors associated with the students' perception of tutorials with the aim of improving future courses. The ratings which tutorials, cases and tutor performance received by the students differed significantly between 14 groups that could be analysed. A ranking order of groups was established according to the scores they gave for the cases and the three groups with top ratings were further compared with the three groups with lowest ratings. We found significant differences between the two groups in their assessment of tutor performance and perception of team-work during tutorials. The tutors of the groups giving top ratings were considered to have more effectively supported the students' work during tutorials. Furthermore, self-assessment of the tutors judging their own ability to facilitate PBL correlated with their familiarity with case content. The marks achieved in the first national exam (i.e. "Physikum", equivalent to medical school entrance exams), performance in triple jump examination and multiple choice test at the end of the course, or marks obtained in the first state board exam after the course, did not differ between the two groups. From students' point of view, the main characteristics for a good tutorial as far as tutors are concerned consist of allowing enough time for discussion, accepting students as partners, refraining from interference and having expertise. As a consequence we will increase our efforts to optimise case quality as well as support and training of tutors in order to improve our new PBL course.