[A retrospective study of expert opinions of a psychosomatic-psychotherapeutic university hospital for public and private customers over a period of 12 years]. / Evaluation von Gutachten einer Universitätsklinik für Psychosomatik und Psychotherapie für öffentliche und private Auftraggeber über einen Zeitraum von zwölf Jahren.

A retrospective study of expert opinions of a psychosomatic-psychotherapeutic university hospital for public and private customers over a period of 12 years Objectives: Both the public and the legislative have developed an increasingly critical awareness for the fact that expert witnesses need to be independent. In contrast, to date there have been few studies concerning the quantity and the results of psychosomatic-psychotherapeutic expert opinions for public and private clients. METHODS: In a retrospective study design, 285 expert opinions of a psychosomatic-psychotherapeutic university hospital stemming from consecutive, unselected random sampling over a 12-year time period (1990-2011) were analyzed using a predefined list of criteria. Besides client data, the study also noted the type and the objectives of the expertise, the sociodemographic data of the subjects, the biographic data of the subjects, the size of records, the particular psychopathological findings including conflict and structural diagnostics via the Operationalized Psychodynamic Diagnostics (OPD-2, Research Group 2006), syndromic diagnostics according to ICD-10 (WHO) including the related Impairment Scale Score (ISS, Schepank 1995), and the Global Assessment of Functioning-Scale (GAF, Heuft 2016). RESULTS: 54% of the subjects were men. All subjects were 46 years old at the time of examination; on average symptomatology had existed for 7 years, which made assessment of causality difficult. Most assignments referred to the effects of diseases or accidents in private contexts, followed by pension reports. Among the expert opinions related to possible implications of acts of violence, 95% were women. In 43.2% (n = 123) of the cases, the assessment had occurred in the context of legal action. In 65 cases at least one party had requested a supplemental written report during further procedure. In 17.8% (n = 22) of the cases sought by the courts, the expert witness was requested by at least one party to present the assessment verbally. DISCUSSION: It should be emphasized that OPD conflict and structural diagnostics appear indispensable also for assessing mental health prior to an external event (accident or assault). The use of the two severity ratings (ISS, GAF) is discussed. It is proposed that expert witnesses be requested to name all their clients fromthe last 5 years at the beginning or end of the expert opinion, so that their independence from possible conflicts of interest can be established.

[Prevalence and correlates of anxiety and depression in patients with end-stage renal disease (ESRD)]. / Prävalenz und Korrelate von Angst und Depression bei Hämodialysepatienten.

OBJECTIVES: Depressive symptoms are common among patients with end-stage renal disease (ESRD). They are associated with both high morbidity and high mortality. In this explorative study we investigated the frequency of Major Depression and Generalized Anxiety Disorder in a German dialysis center. We further investigated the correlation between expert-rating and self-report questionnaires as well as the extent to which somatic, dialysis-specific and sociodemographic parameters are associated with depressive and anxious symptoms. METHOD: During dialysis treatment 52 patients (21 women and 31 men) aged 29 to 85 years with end-stage renal disease (ESRD) completed the Beck Depression Inventory (BDI) and the Hospital Anxiety and Depression Scale (HADS-D). A physician administered the Structured Clinical Interview for DSM-IV (SCID) for the expert diagnosis of Major Depression and Generalized Anxiety Disorder. RESULTS: Nine patients met DSM-IV criteria for Major Depression (17 %). The self-report scales showed depressive symptoms in 17 patients (33 %) and 8 patients (15 %), respectively. Generalized Anxiety Disorder according to SCID was diagnosed in 9 patients (17 %), while 12 patients (23 %) scored higher than seven points on the HADS Anxiety subscale. Depressive and anxious symptoms were associated with gender, employment status, and physical activity; anxious symptoms were also associated with the body-mass-index (BMI). CONCLUSIONS: The higher agreement between the HADS depression subscale and the SCID diagnosis of Major Depression suggests that the HADS-D depression subscale is more useful than the BDI when screening for depression in patients with ESRD. Physical activity seems to be a protective factor for patients with ESRD and should be further investigated.

Reduced deactivation in reward circuitry and midline structures during emotion processing in borderline personality disorder.

OBJECTIVES. Borderline personality disorder (BPD) is characterized by a pervasive affective dysregulation. While recent imaging studies demonstrated the neural correlates of abnormal emotion processing in BPD and recently one study reported alterations of the reward circuit in this patient group, the exact neural mechanisms underlying the impact of abnormal emotion on reward behavior remain unclear. METHODS. We therefore conducted an fMRI study in healthy controls and BPD patients to investigate the modulation of the anticipation of reward by simultaneously presented emotional pictures. RESULTS. BPD patients revealed a disturbed differentiation between reward and non-reward anticipation in the bilateral pregenual anterior cingulate cortex if a positive or negative emotional picture is presented simultaneously. In the ventral striatum and the bilateral ventral tegmental area, BPD patients and healthy controls are able to differentiate between reward and non-reward even under emotional stimulation, but BPD patients show a reduced deactivation in the above mentioned regions compared to healthy controls. CONCLUSIONS. Altered emotion processing in BPD patients is likely to affect the reward system. More basic deficits in reward circuitry and other midline regions' level of resting state activity may contribute to this effect.

Personality functioning and the cortical midline structures--an exploratory FMRI study.

OBJECTIVE: Recent neuroscience studies explored the neuronal mechanisms underlying our sense of self. Thereby the cortical midline structures and their anterior and posterior regions have been shown to be central. What remains unclear though is how both, self and cortical midline structures, are related to the identity of the self which is of central importance in especially personality disorders. METHODS: Conducting an exploratory study with a dimensional approach, we here compared subjects with high and low level of personality functioning and identity integration as measured in a standardized way in fMRI during both, emotion- and reward-related tasks. RESULTS: Low levels of personality functioning and identity integration were predicted by significantly decreased degrees of deactivation in the anterior and posterior cortical midline structures. CONCLUSIONS: Though exploratory our results show for the first time direct relationship between cortical midline structures and personality functioning in terms of identity integration. This does not only contribute to our understanding of the neuronal mechanism underlying self and identity but carries also major implications for the treatment of patients with personality disorders.

Intermembrane space proteome of yeast mitochondria.

The intermembrane space (IMS) represents the smallest subcompartment of mitochondria. Nevertheless, it plays important roles in the transport and modification of proteins, lipids, and metal ions and in the regulation and assembly of the respiratory chain complexes. Moreover, it is involved in many redox processes and coordinates key steps in programmed cell death. A comprehensive profiling of IMS proteins has not been performed so far. We have established a method that uses the proapoptotic protein Bax to release IMS proteins from isolated mitochondria, and we profiled the protein composition of this compartment. Using stable isotope-labeled mitochondria from Saccharomyces cerevisiae, we were able to measure specific Bax-dependent protein release and distinguish between quantitatively released IMS proteins and the background efflux of matrix proteins. From the known 31 soluble IMS proteins, 29 proteins were reproducibly identified, corresponding to a coverage of >90%. In addition, we found 20 novel intermembrane space proteins, out of which 10 had not been localized to mitochondria before. Many of these novel IMS proteins have unknown functions or have been reported to play a role in redox regulation. We confirmed IMS localization for 15 proteins using in organello import, protease accessibility upon osmotic swelling, and Bax-release assays. Moreover, we identified two novel mitochondrial proteins, Ymr244c-a (Coa6) and Ybl107c (Mic23), as substrates of the MIA import pathway that have unusual cysteine motifs and found the protein phosphatase Ptc5 to be a novel substrate of the inner membrane protease (IMP). For Coa6 we discovered a role as a novel assembly factor of the cytochrome c oxidase complex. We present here the first and comprehensive proteome of IMS proteins of yeast mitochondria with 51 proteins in total. The IMS proteome will serve as a valuable source for further studies on the role of the IMS in cell life and death.

Accident investigation reporting deficiencies related to organizational factors in machinery space fires and explosions.

Careful accident investigation provides opportunities to review safety arrangements in socio-technical systems. There is consensus that human intervention is involved in the majority of accidents. Ever cautious of the consequences attributed to such a claim vis-à-vis the apportionment of blame, several authors have highlighted the importance of investigating organizational factors in this respect. Specific regulations to limit what were perceived as unsuitable organizational influences in shipping operations were adopted by the International Maritime Organization (IMO). Guidance is provided for the investigation of human and organizational factors involved in maritime accidents. This paper presents a review of 41 accident investigation reports related to machinery space fires and explosions. The objective was to find out if organizational factors are identified during maritime accident investigations. An adapted version of the Human Factor Analysis and Classification System (HFACS) with minor modifications related to machinery space features was used for this review. The results of the review show that organizational factors were not identified by maritime accident investigators to the extent expected had the IMO guidelines been observed. Instead, contributing factors at the lower end of organizational echelons are over-represented.