Maladaptive connectivity of Broca's area in schizophrenia during audiovisual speech perception: an fMRI study.

Speech comprehension relies on auditory as well as visual information, and is enhanced in healthy subjects, when audiovisual (AV) information is present. Patients with schizophrenia have been reported to have problems regarding this AV integration process, but little is known about which underlying neural processes are altered. Functional magnetic resonance imaging was performed in 15 schizophrenia patients (SP) and 15 healthy controls (HC) to study functional connectivity of Broca's area by means of a beta series correlation method during perception of audiovisually presented bisyllabic German nouns, in which audio and video either matched or did not match. Broca's area of SP showed stronger connectivity with supplementary motor cortex for incongruent trials whereas HC connectivity was stronger for congruent trials. The right posterior superior temporal sulcus (RpSTS) area showed differences in connectivity for congruent and incongruent trials in HC in contrast to SP where the connectivity was similar for both conditions. These smaller differences in connectivity in SP suggest a less adaptive processing of audiovisually congruent and incongruent speech. The findings imply that AV integration problems in schizophrenia are associated with maladaptive connectivity of Broca's and RpSTS area in particular when confronted with incongruent stimuli. Results are discussed in light of recent AV speech perception models.

Alcohol related conditions represent a major psychiatric problem in emergency departments.

BACKGROUND: Alcoholism represents a huge socioeconomic burden in most developed societies. METHODS: In order to determine the impact of conditions associated with alcohol abuse on emergency care, in 2002 all patients with alcohol related pathology presenting to the emergency department (ED) of a large urban university hospital in Germany were assessed. RESULTS: Of 2194 patients seen by psychiatrists in the ED, the 613 cases associated with alcohol abuse represented the largest diagnostic group (30.7%). Within this group, alcohol intoxication was the most frequent diagnosis (71.4%). Patients with an alcohol related condition needed treatment by different medical specialities and required diagnostic procedures significantly more often and consequently stayed significantly longer in the ED than patients with other psychiatric presentations. CONCLUSIONS: The generally underestimated problem of alcohol abuse in Germany demands an excessive amount of manpower and resources in EDs, where a high yet expensive standard of care is provided. Against this background, how far this burden can be reduced, both in EDs and in society in general, is discussed.

[Identity and dissociation in cyberspace. A case of dissociative identity disorder associated with internet role playing]. / Identität und Dissoziation im Cyberspace. Kasuistik einer dissoziativen Identitätsstörung im Zusammenhang mit einem Internet-Rollenspiel.

OBJECTIVE: By mediating dissociative experiences, the Internet can challenge the boundaries of people's sense of identity. To illustrate this hypothesis, a case of dissociative identity disorder (DID) is presented. CLINICAL PICTURE: A young unemployed woman created and frequently played several characters in an online game. For more than 2 years she spent up to 12 h a day in the Internet, assuming various personalities, which in return intruded upon her neglected real life. TREATMENT AND OUTCOME: During the course of an inpatient psychotherapeutic treatment, the clinical diagnosis of DID was confirmed by psychometric testing. After 12 weeks of psychotherapy, the patient had managed to identify her fragmented identities as character traits and integrated them into her core personality. She rearranged her real everyday life, found a new job, and reduced her online activities. DISCUSSION: Even though the patient's psychopathology stems from a disposition in terms of a personality disorder with histrionic and narcissistic features, excessive internet role play obviously functioned as a trigger to develop DIS. Conclusively, cyberspace's anonymous interactivity may offer the possibility to explore one's identity while also putting at risk its coherence.

[Psychological impact of the new digital media]. / Psychische Wirkungen der neuen digitalen Medien.

This review article starts from the hypothesis that the new digital media's impact on people's mental health, which in professional and private everyday life has become increasingly frequent and intense, is widely underestimated. The disturbances associated with media exposure, which have been already described and examined, are presented and discussed, while classifying them in three groups of disorders, namely dissocial, dissociative and impulse control disorders. In a second step, psychotherapeutic and psychiatric applications of the digital media are presented, especially, psychometric and neuropsychological testing, distribution of information and behavioral therapeutic tools. The positive and negative effects of the internet and cyberspace are applied to the multicausal understanding of the genesis and therapy of mental disturbances. Against this background, the opinion is held, that the paradigmatic medialization of the world has to be taken seriously and actively approached as a psycho-ecological factor with psychosocial, psychopathogenic and also neuroplastic effects. Therefore, also a psychiatric approach is needed to establish both research on media-associated disorders including their therapy and the development of quality standards in the therapeutic use of the Internet and Cyberspace.

Treatment of alcohol withdrawal: chlormethiazole vs. carbamazepine and the effect on memory performance--a pilot study.

Although relatively little attention has been paid to the question how acute alcohol withdrawal might affect cognitive functions, this factor remains of particular interest because it influences psychotherapeutic treatment during detoxification. The clinical outcome and neuropsychological state of 37 inpatients with alcohol withdrawal was investigated in a randomized single-blind approach. Two different medical strategies [chlormethiazole (CMZ) vs. carbamazepine (CBZ)] in the treatment of inpatients with alcohol withdrawal syndrome were compared. Among comparable groups (related to gender, age, initial alcohol level, severity of abuses, severity of initial withdrawal symptoms such as tremor, perspiration, psychomotor agitation, hallucinations, orientation, intelligence, patient demographics), CBZ is just as potent as CMZ in therapy of withdrawal symptoms (circulatory function, vegetative function, psychomotor activity). Patients in both groups showed initial impairments in some neuropsychological tests (d2, Zahlen-Verbundings test, Beck Depression Inventory, Anxiety Sensitivity Index) with significant improvement during detoxification. Additionally, CBZ-treated patients showed significantly better verbal memory performance during the first days of treatment. Without any addictive potential, CBZ therapy could be very supportive in alcohol detoxification. In addition a higher verbal memory performance state could be favourable for a psychotherapeutic approach.