Different yet similar? Prisoners versus psychiatric patients - A comparison of their mental health.

BACKGROUND: Previous research indicates that prisoners have severe psychological distress. To assess their distress level and potential need for treatment, the present study compared the subjective psychological distress of long- and short-term prisoners with that of psychiatric and forensic patients. METHODS: Long- (n=98) and short-term prisoners (n=94) and forensic (n=102) and psychiatric (n=199) patients completed the German versions of the Symptom Checklist Revised (SCL-90-R) and Brief Symptom Inventory (BSI). RESULTS: In general, long-term prisoners showed the same level of mental distress as psychiatric patients and more than that reported by forensic patients. Short-term prisoners reported the least level of distress. Long- but not short-term prisoners showed clinically significant results on the scales for depression, paranoid ideation, and psychosis. CONCLUSIONS: The improvements in psychiatric treatment for inmates demanded by many stakeholders need to differentiate between long- and short-term prisoners. Because depression seems to cause the most psychological distress among inmates, suicide prevention seems to be an important issue in prisons.

Expression of Matrix Metalloproteinases and Endogenous Inhibitors in Abdominal Aortic Aneurysm and Aortoiliac Occlusive Disease (Syndrome Leriche).

Matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs) play a complex role in the pathogenesis of atherosclerosis. We compared (1) the histopathological findings in patients with abdominal aortic aneurysms (AAA) and aortoiliac occlusive disease (AOD); (2) the expression of MMP-2/MMP-9 and TIMP-1/TIMP-2 in aortic layers, inflammatory cells and smooth muscle cells (SMCs), aiming to identify the common underlying pathogenic mechanisms of the disease development. Samples were obtained from 30 patients with AAA and 30 with AOD. Aortic histology and immunohistochemistry were performed to evaluate inflammatory changes and MMP and TIMP expression. Thrombosis and ulceration were more frequent in AOD than in AAA. The MMP-9 expression was elevated in all aortic layers of AAA patients and in media/adventitia of AOD patients, mainly followed by lower expression of its inhibitor TIMP-1. Higher MMP-9 expression was also found in SMCs and macrophages of both AAA and AOD specimens, while higher TIMP-1/TIMP-2 were predominantly observed in the lymphocytes and macrophages of the aneurysm. These results showed that both conditions exhibited increased MMP-9 expression; however, the MMP expression pattern differed to some degree between the aneurysms and occlusive disease. The variations in molecular mechanisms underlying dilatative/stenosing disease warrant further investigation.

[Questionnaire for Investigating Therapeutic Alliance in Forensic Setting (FTBF): Results of a Pilot Study]. / Fragebogen zur therapeutischen Beziehung in der Forensik (FTBF): Ergebnisse einer Pilotstudie.

The relation between patient and therapist has a substantial effect on the success of psychotherapy. So far, in German-speaking regions questionnaires translated from English have been used, particularly for studying outpatients. Studies investigating and concerned with specialised features of hospitalised forensic psychiatry patients are sparse. The preliminary results of this study evaluating a recently developed questionnaire aimed to investigate the quality of the therapeutic relationship in forensic psychiatry ("Fragebogen zur therapeutischen Beziehung in der Forensik, FTBF") are reported. The data were collected both in general and forensic psychiatry departments. Factor analyses yielded two essential factors, namely "positive emotional aspects" (12 items, main features trust, respect, helpfulness, harmony, and sympathy; Cronbach's α = .933) and "negative emotional aspects" (4 items, main features power divide and punishment; Cronbach's α = .805). Forensic patients experienced power divide and punishment tendencies more intensively than general psychiatry patients (p < 0.001). Our questionnaire therefore demonstrates not only excellent reliabilities but also differential validity, enabling a differentiation between general and forensic psychiatry patients. Studies with larger samples would enable conclusions about the impact of the therapists' perspective, specific diagnostic subgroups and different psychotherapeutic orientations, on the patient-therapist relationship in forensic psychiatry.

[Convergent validity of SCID-II and TCI: categorical vs. dimensional diagnostics of personality disorders using the example of short-term prisoners]. / Konvergente Validität von SKID-II und TCI: Kategoriale vs. dimensionale Diagnostik von Persönlichkeitsstörungen am Beispiel von Gefangenen mit Kurzzeitstrafe.

In order to objectify the diagnostics of personality disorders, questionnaires and structured interviews are used. Nevertheless, due to different methodological approaches even those instruments arrive at different results very often. Therefore, this study aimed to check the convergent validity of two frequently used instruments - the Structured Clinical Interview for DSM IV Axis II Disorders (SCID-II) and the Temperament and Character Inventory (TCI) - the first one representing the categorical and the latter one the dimensional approach for diagnosing personality disorders. The diagnostic concordances were statistically described with Cohen's Kappa, Yule's Y, and correlations. The results indicate that there are striking differences in diagnoses and that the SCID-II rather tends to diagnose a personality disorder earlier than the TCI.

Abnormal resting-state connectivity of motor and cognitive networks in early manifest Huntington's disease.

BACKGROUND: Functional magnetic resonance imaging (fMRI) of multiple neural networks during the brain's 'resting state' could facilitate biomarker development in patients with Huntington's disease (HD) and may provide new insights into the relationship between neural dysfunction and clinical symptoms. To date, however, very few studies have examined the functional integrity of multiple resting state networks (RSNs) in manifest HD, and even less is known about whether concomitant brain atrophy affects neural activity in patients. METHOD: Using MRI, we investigated brain structure and RSN function in patients with early HD (n = 20) and healthy controls (n = 20). For resting-state fMRI data a group-independent component analysis identified spatiotemporally distinct patterns of motor and prefrontal RSNs of interest. We used voxel-based morphometry to assess regional brain atrophy, and 'biological parametric mapping' analyses to investigate the impact of atrophy on neural activity. RESULTS: Compared with controls, patients showed connectivity changes within distinct neural systems including lateral prefrontal, supplementary motor, thalamic, cingulate, temporal and parietal regions. In patients, supplementary motor area and cingulate cortex connectivity indices were associated with measures of motor function, whereas lateral prefrontal connectivity was associated with cognition. CONCLUSIONS: This study provides evidence for aberrant connectivity of RSNs associated with motor function and cognition in early manifest HD when controlling for brain atrophy. This suggests clinically relevant changes of RSN activity in the presence of HD-associated cortical and subcortical structural abnormalities.

Revisiting default mode network function in major depression: evidence for disrupted subsystem connectivity.

BACKGROUND: Major depressive disorder (MDD) is characterized by alterations in brain function that are identifiable also during the brain's 'resting state'. One functional network that is disrupted in this disorder is the default mode network (DMN), a set of large-scale connected brain regions that oscillate with low-frequency fluctuations and are more active during rest relative to a goal-directed task. Recent studies support the idea that the DMN is not a unitary system, but rather is composed of smaller and distinct functional subsystems that interact with each other. The functional relevance of these subsystems in depression, however, is unclear. METHOD: Here, we investigated the functional connectivity of distinct DMN subsystems and their interplay in depression using resting-state functional magnetic resonance imaging. RESULTS: We show that patients with MDD exhibit increased within-network connectivity in posterior, ventral and core DMN subsystems along with reduced interplay from the anterior to the ventral DMN subsystems. CONCLUSIONS: These data suggest that MDD is characterized by alterations of subsystems within the DMN as well as of their interactions. Our findings highlight a critical role of DMN circuitry in the pathophysiology of MDD, thus suggesting these subsystems as potential therapeutic targets.

[Pharmacotherapeutic treatment strategies for smoking cessation]. / Pharmakologische Strategien zur Unterstützung einer Raucherentwöhnung.

Regular tobacco smoking occurs in about 35% of the male and 25% of the female German population. Individual attempts to independently quit smoking and to remain abstinent for 1 year have been shown to be successful in less than 5% of cases. This rate can be doubled by means of individual consulting and cognitive-behavioral interventions and additional pharmacological treatment might increase abstinence rates up to 25%. Apart from nicotine substitution (e.g. transdermal, oral and inhalative applications) and bupropion, recent studies have shown beneficial effects of varenicline for smoking cessation and abstinence. Varenicline, a selective partial nicotinergic agonist, has been specifically developed for the purpose of smoking cessation. Currently available data suggest that varenicline is more effective compared to nicotine substitution therapy and bupropion, increasing the abstinence likelihood by a factor of 2.3 compared to a placebo. Recent data regarding anti-nicotine vaccines suggest that this approach might yield a comparable treatment outcome and probably even better relapse-preventing effects than conventional psychopharmacological strategies. The first anti-nicotine vaccines are expected to be approved by national authorities within the forthcoming 1-2 years.

Aberrant functional connectivity of dorsolateral prefrontal and cingulate networks in patients with major depression during working memory processing.

BACKGROUND: In patients with major depressive disorder (MDD), functional neuroimaging studies have reported an increased activation of the dorsolateral prefrontal cortex (DLPFC) during executive performance and working memory (WM) processing, and also an increased activation of the anterior cingulate cortex (ACC) during baseline conditions. However, the functional coupling of these cortical networks during WM processing is less clear. METHOD: In this study, we used a verbal WM paradigm, event-related functional magnetic resonance imaging (fMRI) and multivariate statistical techniques to explore patterns of functional coupling of temporally dissociable dorsolateral prefrontal and cingulate networks. By means of independent component analyses (ICAs), two components of interest were identified that showed either a positive or a negative temporal correlation with the delay period of the cognitive activation task in both healthy controls and MDD patients. RESULTS: In a prefronto-parietal network, a decreased functional connectivity pattern was identified in depressed patients comprising inferior parietal, superior prefrontal and frontopolar regions. Within this cortical network, MDD patients additionally revealed a pattern of increased functional connectivity in the left DLPFC and the cerebellum compared to healthy controls. In a second, temporally anti-correlated network, healthy controls exhibited higher connectivity in the ACC, the ventrolateral and the superior prefrontal cortex compared to MDD patients. CONCLUSIONS: These results complement and expand previous functional neuroimaging findings by demonstrating a dysconnectivity of dissociable prefrontal and cingulate regions in MDD patients. A disturbance of these dynamic networks is characterized by a simultaneously increased connectivity of the DLPFC during task-induced activation and increased connectivity of the ACC during task-induced deactivation.

[Clinico-radiological characteristics of bronchial carcinoid].

OBJECTIVES: To review clinical and radiological characteristics of a patients with bronchial carcinoid. METHODS: In this retrospective study, we reviewed the clinical, pathological and imaging findings in 42 patients diagnosed with bronchial carcinoid during the seven years period. RESULTS: There were 23 women and 19 men, with a mean age of 47 years (range from 15 to 75). Thirty patients had typical and 12 atypical bronchial carcinoid. Dominant symtoms were cough (46.7%) and 38%. Tumor was localized in 28 patients in the left, and 14 in the right lung. On radiographs carcinoid manifested as tumor shadow in 40.5%, nodule and atelectasis in 21.4% cases each respectively, pleural effusion and pneumonia in 7.1% each respectively and hyperinflation in 2.4% of the cases. Computerized tomography revealed endoluminal tumor in 30.9% patients. CONCLUSION: Major imaging findings are central, tumor mass or nodule and obstruction signs like atelectasis. Diagnosis is confirmed by pathological examination of samples taken by bronchoscopy or surgery.

[Radiologic manifestation of primary pleural tumors].

OBJECTIVES: To show the radiological manifestations of primary pleural tumors. PATIENTS AND METHODS: we carried out a retrospective analysis of radiological findings in 62 patients with primary malignant tumor of pleura. RESULTS: Study included 39 male and 23 female patients. Malignant tumors were present in 92.7% of the patients and benign ones in 7.2%. The most common malignant tumor was mesothelioma (85.4%), and solitary fibrous tumor prevailed among benign tumors (9.7%). Diffuse malignant mesothelioma manifested on computed tomography (CT) as a pleural thickening and effusion in 67.4% of the patients, tumors and effusion in 11.7%, and only as an effusion in 9.8% cases. Thickening of the pleura appeared diffuse in 54% of patients and most often it had nodular pattern. Both localized malignant and all benign tumors presented as tumor-like changes with the signs of necrosis in 50%. CONCLUSION: The imaging methods have a key role in the diagnosis of pleural tumors. CT shows different morphologic features of pleural lesions that have been established as a useful tool for differentiating malignant from benign disease. However, magnetic resonance is preferred imaging method for assessing the extent and resectability of pleural tumors.

Altered frontostriatal coupling in pre-manifest Huntington's disease: effects of increasing cognitive load.

BACKGROUND AND PURPOSE: Functional neuroimaging studies have suggested a dysfunction of prefrontal regions in clinically pre-symptomatic individuals with the Huntington's disease (HD) gene mutation (pre-HD) during cognitive processing. The objective of this study was to test the impact of cognitive demand on prefrontal connectivity in pre-HD individuals. METHODS: Sixteen healthy controls and sixteen pre-HD subjects were studied using functional MRI and a verbal working memory task with increasing cognitive load. Load-dependent functional connectivity of the left dorsolateral prefrontal cortex (DLPFC) was investigated by means of psychophysiological interactions. RESULTS: In pre-HD subjects, aberrant functional connectivity of the left DLPFC was found at high working memory load levels only. Compared with healthy controls, pre-HD individuals exhibited lower connectivity strength in the left putamen, the right anterior cingulate and the left medial prefrontal cortex. Pre-HD individuals close to the onset of motor symptoms additionally exhibited lower connectivity strength in the right putamen and the left superior frontal cortex. The connectivity strength in the left putamen was associated with several clinical measures including CAG repeat length, Unified Huntington's Disease Rating Scale motor score and predicted years to manifest symptom onset. CONCLUSION: These findings suggest that early prefrontal connectivity abnormalities in pre-HD individuals are modulated by cognitive demand.

[Functional imaging of cognitive processes in Huntington's disease and its presymptomatic mutation carriers]. / Funktionelle Bildgebung kognitiver Prozesse bei M.-Huntington-Patienten und präsymptomatischen Mutationsträgern.

Cognitive deficits are among the core symptoms of patients with Huntington's disease (HD). While impaired attention, visuospatial processing, and memory can be observed during early stages of the illness, HD patients exhibit deficits in executive function on tests requiring planning, problem solving, and cognitive flexibility with progression of the disease. Cognitive dysfunction is already present in individuals who carry the HD gene mutation but remain presymptomatic for motor and cognitive disturbances. This review provides an overview and a discussion of functional neuroimaging findings on cognitive dysfunction in patients with HD and presymptomatic HD gene mutation carriers. In HD patients, currently available evidence suggests a functional deficit of multiple cortical and subcortical regions extending beyond volumetric abnormalities. Early dysfunction of lateral prefrontal and cingulate regions has been shown in individuals with presymptomatic HD, while compensatory responses of posterior brain regions may occur closer to the onset of manifest clinical symptoms. While functional neuroimaging techniques may substantially contribute to defining neurodegenerative disease phenotypes and to identifying neural biomarkers in presymptomatic individuals, the extant data on cognitive function in HD patients and HD gene carriers however is sparse and has to be expanded through further studies.

Cerebrospinal fluid protein reactions during non-neurological surgery.

OBJECTIVE: To study changes in cerebrospinal fluid (CSF) protein markers of blood-CSF barrier integrity and immunological reactions during surgical stress. SUBJECTS AND METHODS: Thirty-five patients without neurological or psychiatric disorders undergoing knee replacements had CSF and serum samples drawn from spinal and arterial catheters before, 3 h after and the morning after surgery. RESULTS: Serum albumin decreased during surgery and CSF albumin decreased during and after surgery, and, as a consequence, the CSF/serum albumin ratio decreased significantly during the study period, especially after the intervention. In contrast, CSF concentrations of beta-2-microglobuline (beta2M) increased significantly during surgery and remained high. The CSF general marker beta-trace protein (betaTP) remained unchanged. CONCLUSIONS: Central nervous system protein reactions to a non-neurological surgical intervention include sharply decreased permeability of albumin into the CSF and signs of intrathecal inflammatory activity.

[Executive functions in patients with depression. The role of prefrontal activation]. / Exekutive Funktionen bei depressiven Patienten. Zur Rolle der präfrontalen Aktivierung.

Depression is a multifarious disease, having an impact on most aspects of everyday life. Cognitive deficits cause considerable impairments and restraints in performance and have become one of the major clinical and research foci in recent years. According to previous work, deficits in executive functioning seem to be particularly prominent. At present only a few functional neuroimaging studies investigated the neurofunctional correlates aimed at these deficits by using specific activation tasks. These findings are somewhat controversial, revealing prefrontal hypo- as well as hyperactivation as a substrate of executive performance. This paper reviews current functional neuroimaging findings within a framework of depression as a dysfunction in limbic-cortical circuits. As a conclusion, the concept of "simple" hypofrontality does not offer a satisfactory explanation. Rather, a more dynamic model will be necessary in order to achieve a more realistic concept of executive deficits in depression.

[The concept of working memory in schizophrenia: current evidence and future perspectives]. / Das Arbeitsgedächtniskonzept in der Schizophrenie: Uberblick und Ausblick.

Working memory (WM) deficits are core symptoms of cognitive impairment in schizophrenia. The psychological concept of WM offers a theoretical and empirical framework for the investigation of perceptual and attentional dysfunction as well as of deficits of higher cognitive functions in schizophrenia. From a theoretical perspective, schizophrenic psychopathology and cognitive dysfunction can be both integrated and experimentally validated within the concept of WM-impairment. In the last years investigation of WM has been a major issue in neuropsychiatric research, not least because of the association of prefrontal cortex and WM-function. The advent of functional imaging techniques, e. g. functional magnetic resonance imaging (fmri) has additionally contributed in generating neurobiological WM-models. Regarding the neuronal basis of WM-deficits in schizophrenia, prefrontal cortex dysfunction has been of major interest. This review provides a short overview on the concept of WM and its relevance for cognitive psychology, discussing both recent behavioral and functional neuroimaging evidence on WM-dysfunction in schizophrenia.

[Chronic renal diseases in shoe industry workers]. / Hronicna oboljenja bubrega kod radnika u industriji obuce.

Surveillance of 1000 workers employed in shoeware industry (720 females and 280 male), revealed 56 workers with chronic renal disorders. The most frequent were: renal calculosis, inflammatory diseases and nephropathy with diabetes. There were no cases of malignant diseases or tuberculosis. With regard to labour conditions and the potential harmful effects of the production process no direct effects were observed in this field. However, their presence was evident in the already existing diseases.

The role of ECG monitoring during bronchoscopy in lung cancer patients.

Bronchoscopy, as an endoscopic technique, is associated with respiratory and circulatory disorders. Cardiac rhythm disorders are the most common cardiovascular complications of bronchoscopy. In order to study ECG changes during bronchological procedures, ECG monitoring was undertaken (30 min before, during and 30 min after bronchoscopy) in 100 patients, 76 with bronchial carcinoma and 24 suffering from some other pulmonary disease. Within the same intervals PaO2, PaCO2 and pH were recorded. All recorded arrhythmias were classified as minor and major. According to arrythmia noted during bronchoscopy, patients were divided into two groups: group 1 comprised 70 patients without arrythmia or with minor arrythmia (70%) and group 2, 30 patients with major arrythmia (30%). No significant difference was noted in associated cardiac disease, cardiological medication, blood pressure, pulse rat, PaO2, PaCO2 and pH (P < 0.05). The only statistically significant difference between the two groups of patients was related to localization of tumour in the lungs. We could not correlate the occurrence of major arrythmia during bronchoscopy in patients with lung carcinoma with any underlying cardiopulmonary condition. Significant differences were noted in effects of tumour localization, i.e. major arrhythmias are more common and more dangerous in cases of tumours of the left bronchial trunk (possible bronchoscopic stimulation of the left stellate ganglion), and we therefore believe that ECG monitoring is desirable in these cases for the early detection and appropriate management of haemodynamically dangerous arrhythmias.

[Dressler's syndrome during radiotherapy in bronchial carcinoma]. / Dresslerov sindrom u toku zracne terapije karcinoma bronha.

A case of Dressler's syndrome which has developed in a patient with bronchogenic carcinoma during radiotherapy is presented. Diagnosis is established according to symptomatology, clinical findings, chest X-ray, laboratory analysis and immunological findings. Existence of metastatic deposits in heart is excluded by the method of echocardiography. Short-term cardiologic therapy with antiflogistics is completely sufficient for maintaining the stability of "cardiologic status".