Psychorehabilitation aspects in older age groups.

Throughout medical history, suggestion is the oldest and most common method of relieving human distress and treating physical disease. One of the oldest Egyptian documents, the Ebers Papyrus (1552 BC) states, "Lay your hands upon him to quiet the pain in the arms and say that the pain will disappear." The psychogenic and therapeutic potency of Native American trance dances are also well documented. In a North American tribe practicing ancient traditions, such dances were found to produce an altered feeling for time, loss of conscious control, drastic emotional outbreaks, illusions, hypersuggestibility, and a deep feeling of restored youthfulness (Jilek, 1982). These and other historical documents show the deep historical connection between somatic and mental processes. From the viewpoint of a neurologist or a psychiatrist, a combination of somatic illness, depressive syndromes, organic psychosyndromes, and multimorbidity is frequent in elderly patients (Kortus, 1992). Thus, integrated psychotherapy in geriatric rehabilitation is necessary and useful. Practical psychotherapeutic methods are discussed in this manuscript.

Di-, mono- and nonphytanyl triglycerides in the serum: a sensitive parameter of the phytanic acid accumulation in Refsum's disease.

The relative proportions of the diphytanyl, monophytanyl and nonphytanyl triglycerides ("triglyceride pattern"), the phytanic acid content of the triglycerides and the phytanic acid levels in the serum of 3 patients with Refsum's disease (heredopathia atactica polyneuritiformis, phytanic acid storage disease) were estimated by thin-layer chromatography, densitometry and gas chromatography, respectively. The individual triglyceride patterns were clearly dependent on the phytanic acid content of the triglycerides: the more phytanic acid in the triglycerides, the higher the percentage of the diphytanyl and the lower the percentage of the nonphytanyl triglycerides. The monophytanyl triglycerides were also related to the phytanic acid content of the triglycerides, although in a complex manner. The triglyceride pattern can be taken as a parameter of the phytanic acid accumulation in Refsum's disease to be at least as sensitive as the serum phytanic acid level in the biochemical evaluation of the efficiency of the dietary treatment.

[Guide-lines to the rehabilitation of patients with neurological disorders, especially stroke (author's transl)]. / Einige Rehabilitationsgrundlinien bei neurologischen Erkrankungen, insbesondere nach Schlaganfall.

Rehabilitation requires the interplay of three essential factors, namely medicine, organization and humanity. The concept of entirety and permanency implies that rehabilitation must commence on the very first day of acute therapy and continue, with the aid of relatives, after discharge from hospital. Depression very frequently accompanies a stroke and requires expert handling both with psychopharmaceutical drugs and psychotherapeutical methods (including nursing staff and family) to overcome this hurdle to rehabilitation. Physiotherapy is of paramount importance, with particular emphasis on active movement. Therapeutic management with medicines must continue along the lines commenced in the acute stage. The therapy of stroke requires a considerable involvement of manpower, which must not be denied to this step-child of rehabilitation. Apart from medical considerations, it is salutary to remember that every fifteenth person is likely to be handicapped after a stroke at some time in his life.

[Abnormal cytological findings in cerebrospinal fluid with normal cell count (author's transl)]. / Abnormes Zellbild bei normaler Zellazhl im Liquor cerebrospinalis.

A qualitative cytological study demonstrated that normal cell count in the cerebrospinal fluid does not exclude abnormal cytological findings. Siderophages were found as a late indicator of haemorrhage into the CSF. In some cases of tumours of the CNS sporadic atypical cells were found without other alterations in CSF findings. Granulocytes or macrophages were found in vascular diseases, in response to trauma, in tumours and after inflammation of the meninges as an indicator of persistent minimal inflammatory activity. Two cases of Heredopathia atactica polyneuritiformis (Refsum's syndrome) showed characteristic vacuolar macrophages in the CSF (described for the first time), in spite of a normal cell count. The findings point to the diagnostic values of qualitative cytological analysis even in cerebrospinal fluid specimens with a normal cell count. The importance of adapting the cytological method for routine laboratory procedure is stressed.

Rehabilitation needs psychotherapy.

The rehabilitation patient by his permanent disablement comes into an important crisis which makes psychotherapy as reasonable and necessary as other human crisis situations do. Especially the more senior patient must be regarded within this rank. There is a broad rank of known psychotherapeutic methods which however we propose to classify in six groups with the following main factors: Verbal communication Sociodynamics Representational means The hypnoid Behaviouristic means Physical means as entrance to psychotherapy We recommend 'renaissance of conversation culture' and give further hints on conversion therapy. The hypnoid can by no means only act in functional disturbances, however, its action is directly somatotropic. We could show this in paralysed patients. Conversation with the uncurably ill needs special emphasis schooling, and mainly taking the caregivers into the conversation (systemic approach). We have with good success used a combination model, combining autogenic training with analytically orientated group psychotherapy.

[Rehabilitation especially needs a holistic approach]. / Rehabilitation braucht die Ganzheitlichkeit besonders.

Rehabilitation comprises interdisciplinarity and long-time continuity including permanent accompaniment. In <> [geriatric rehabilitation] this counts specially, according to the demographic steady growth of its importance. Neither social medicine nor rehabilitation science up to now have sufficiently taken up this <>. Regarding human being as biopsycho-social entity demands, besides somatic and pharmacological approach, regarding of mood, distress and environment. The by us so called <> has to be applied as well in its basilar dimension [for everybody dealing with geriatric patients] as well as in specialised proportions. Same counts for pain-rehabilitation. A complex rehabilitation program wants an interdisciplinary team. By further specialisation should scientific progress be stimulated. Interdisciplinarity and overlapping however should ensure that patients do not get lost between the specialisations. All this only can work and progress by stimulating public opinion and political collaboration. These are large tasks for the rehabilitationists in the future.

[Headache and psyche]. / Kopfschmerz und Psyche.

There exists no 'typical' psychogenic headache. But there is no headache without psychogenic component. Preponderance of psychogenesis is given as follows: We find it more in permanent undulating headache than in migraine. There are psychosomatic bridges via vasomotor functions and cervical spine. In the field of triggers, personal biographic psychodynamics, together with the actual situation, play a roll. There is a field of modifiers containing depressivity, expertise-situation and drug abuse. Such psychogenic action on different levels can best be perceived via a multifactorial headache concept. This should lead towards a multidimensional therapy orientated on target symptoms.