[Inpatient psychotherapy]. / Stationäre Psychotherapie.

In German-speaking countries inpatient psychotherapy plays a major role in the mental healthcare system. Due to its characteristic features, i. e. multiprofessionalism, multimodality and method integration, the inpatient approach represents a unique and independent type of psychotherapy. In order to be helpful, the manifold verbal and non-verbal methods need to be embedded into an overall treatment plan. Additionally, the therapeutic milieu of the hospital represents an important effective factor and its organization requires a more active construction. The indications for inpatient psychotherapy are not only based on the mental disorder but also on illness, setting and healthcare system-related criteria. In integrative concepts, the multiprofessional team is a key component with many functions. The effectiveness of psychotherapeutic hospital treatment has been proven by meta-analysis studies; however, 20-30% of patients do not benefit from inpatient psychotherapy and almost 13% drop-out prematurely.

Effects of cortisol on memory in women with borderline personality disorder: role of co-morbid post-traumatic stress disorder and major depression.

BACKGROUND: Stress and cortisol administration are known to have impairing effects on memory retrieval in healthy humans. These effects are reported to be altered in patients with major depressive disorder (MDD) and post-traumatic stress disorder (PTSD) but they have not yet been investigated in borderline personality disorder (BPD). METHOD: In a placebo-controlled cross-over study, 71 women with BPD and 40 healthy controls received either placebo or 10 mg of hydrocortisone orally before undertaking a declarative memory retrieval task (word list learning) and an autobiographical memory test (AMT). A working memory test was also applied. RESULTS: Overall, opposing effects of cortisol on memory were observed when comparing patients with controls. In controls, cortisol had impairing effects on memory retrieval whereas in BPD patients cortisol had enhancing effects on memory retrieval of words, autobiographical memory and working memory. These effects were most pronounced for specificity of autobiographical memory retrieval. Patients with BPD alone and those with co-morbid PTSD showed this effect. We also found that co-morbid MDD influenced the cortisol effects: in this subgroup (BPD + MDD) the effects of cortisol on memory were absent. CONCLUSIONS: The present results demonstrate beneficial effects of acute cortisol elevations on hippocampal-mediated memory processes in BPD. The absence of these effects in patients with co-morbid MDD suggests that these patients differ from other BPD patients in terms of their sensitivity to glucocorticoids (GCs).

Association between cortisol awakening response and memory function in major depression.

BACKGROUND: While impaired memory and altered cortisol secretion are characteristic features of major depression, much less is known regarding the impact of antidepressant medication. We examined whether the cortisol awakening response (CAR) is increased in depressed patients with and without medication compared with healthy controls (HC) and whether CAR is associated with memory function in each group. METHOD: We examined 21 patients with major depression without medication, 20 depressed patients on antidepressant treatment, and 41 age-, sex- and education-matched healthy subjects. We tested verbal (Auditory Verbal Learning Task) and visuospatial (Rey figure) memory and measured CAR on two consecutive days. RESULTS: Patient groups did not differ in severity of depression. We found a significant effect of group (p = 0.03) for CAR. Unmedicated patients exhibited a greater CAR compared with medicated patients (p = 0.04) with no differences between patient groups and HC. We found a significant effect of group for verbal (p = 0.03) and non-verbal memory (p = 0.04). Unmedicated patients performed worse compared with medicated patients and HC in both memory domains. Medicated patients and HC did not differ. Regression analyses revealed a negative association between CAR and memory function in depressed patients, but not in HC. CONCLUSIONS: While in unmedicated depressed patients the magnitude of CAR is associated with impaired memory, medicated patients showed a smaller CAR and unimpaired cognitive function compared with HC. Our findings are compatible with the idea that antidepressants reduce CAR and partially restore memory function even if depressive psychopathology is still present.

[Conversion disorders]. / Konversionsstörungen.

Classification, diagnostic and therapeutic problems are central to the disease concept of conversion disorders, which are based on the presentation of psychosocial suffering by means of pseudoneurological symptoms without an organic cause. The nosological status in the current diagnostic and statistical manual of mental disorders (DSM-IV) and international classification of diseases (ICD-10) is disputed. Prevalence rates ranging from 0.3 % in the general population to 50 % in high risk clinical samples underline the relevance. Traumatic experiences play a major role in the pathogenesis. High rates of comorbid mental disorders, the danger to end in a chronic course, a high secondary illness gain and a somatic illness concept complicate psychotherapeutic approaches which are clearly indicated. Clinical experiences and open studies indicate that both psychodynamic as well as cognitive-behaviour therapies are effective.

[Repeated measurement of memory with valenced test items: verbal memory, working memory and autobiographic memory]. / Messwiederholung von Gedächtnistests unter Berücksichtigung der Valenz des Testmaterials: verbales Gedächtnis, Arbeitsgedächtnis und autobiografisches Gedächtnis.

A large number of questions in clinical and/or experimental neuropsychology require the multiple repetition of memory tests at relatively short intervals. Studies on the impact of the associated exercise and interference effects on the validity of the test results are rare. Moreover, hardly any neuropsychological instruments exist to date to record the memory performance with several parallel versions in which the emotional valence of the test material is also taken into consideration. The aim of the present study was to test whether a working memory test (WST, a digit-span task with neutral or negative distraction stimuli) devised by our workgroup can be used with repeated measurements. This question was also examined in parallel versions of a wordlist learning paradigm and an autobiographical memory test (AMT). Both tests contained stimuli with neutral, positive and negative valence. Twenty-four participants completed the memory testing including the working memory test and three versions of a wordlist and the AMT at intervals of a week apiece (measuring points 1. - 3.). The results reveal consistent performances across the three measuring points in the working and autobiographical memory test. The valence of the stimulus material did not influence the memory performance. In the delayed recall of the wordlist an improvement in memory performance over time was seen. The tests on working memory presented and the parallel versions for the declarative and autobiographical memory constitute informal economic instruments within the scope of the measurement repeatability designs. While the WST and AMT are appropriate for study designs with repeated measurements at relatively short intervals, longer intervals might seem more favourable for the use of wordlist learning paradigms.

Dissociation and emotion regulation in borderline personality disorder.

BACKGROUND: Although some evidence suggests that borderline personality disorder (BPD) is primarily a disorder of the emotion regulation system, findings remain inconsistent. One potential explanation for this is the moderating role of dissociation. METHOD: In this study, 33 female subjects with BPD and 26 healthy controls (HC; matched by education level and nicotine intake) were presented idiographic aversive, standard unpleasant and neutral scripts. Modulation of startle reflex and electrodermal responses (skin conductance level; SCL) were measured during imagery of emotional and neutral scripts. Additionally, self-reports of emotional experience (valence and arousal) and present-state dissociation were assessed. RESULTS: Patients with BPD showed elevated levels of dissociative experiences during testing. Present-state dissociation mediated group differences in SCL and startle response between the HC and BPD groups. CONCLUSIONS: These results suggest that careful attention must be paid to the moderating effect of dissociative symptoms on the psychophysiological responses of BPD patients. Furthermore, the findings have important implications for the assessment and treatment of BPD, including the need to carefully assess BPD patients for dissociative symptoms and to incorporate the treatment of dissociation.

[Depression and neurological diseases]. / Depression und neurologische Erkrankungen.

In many neurological diseases a depressive syndrome is a characteristic sign of the primary disease or is an important comorbidity. Post-stroke depression, for example, is a common and relevant complication following ischemic brain infarction. Approximately 4 out of every 10 stroke patients develop depressive disorders in the course of the disease which have a disadvantageous effect on the course and the prognosis. On the other hand depression is also a risk factor for certain neurological diseases as was recently demonstrated in a meta-analysis of prospective cohort studies which revealed a much higher stroke risk for depressive patients. Furthermore, depression plays an important role in other neurological diseases with respect to the course and quality of life, such as Parkinson's disease, multiple sclerosis and epilepsy. This article gives a review of the most important epidemiological, pathophysiological and therapeutic aspects of depressive disorders as a comorbidity of neurological diseases and as a risk factor for neurological diseases.

Association of airflow limitation with trauma exposure and post-traumatic stress disorder.

Trauma exposure and post-traumatic stress disorder (PTSD) are associated with self-reported asthma and chronic obstructive pulmonary disease. However, these conditions have not yet been related to objective measures of lung function. 1,772 adults from the general population were assessed regarding their medical histories and spirometric lung function. Additionally, they were administered a PTSD interview, and assigned to three groups: no trauma; trauma, but no PTSD; and trauma with PTSD. Adjusting for sociodemographic, clinical and lifestyle factors, subjects with PTSD had significantly higher odds ratios for most asthma-related symptoms than PTSD-negative participants (OR 3.2-8.8). The mean ratio of forced expiratory volume in 1 s (FEV1) to forced vital capacity (FVC) was lowest in the PTSD group and highest in those without trauma exposure. Traumatic stress was independently associated with FEV1 and FEV1/FVC. Participants with PTSD, compared with those without, had a significantly increased risk for airflow limitation independent of its definition (OR 4.2-7.8). This is the first study relating traumatic stress and PTSD, respectively, to objective parameters of lung function. Our findings suggest an association of trauma exposure and PTSD with airflow limitation, which may be mediated by inflammatory processes.

[Psychiatric symptoms in German short-term and long-term prisoners]. / Psychische Symptombelastung bei Kurz- und Langzeitgefangenen in Deutschland.

Previous studies have indicated high prevalence rates of mental disorders among prisoners. Based on a sample of 98 male German long-term prisoners and 94 male German short-term prisoners, psychiatric symptoms were comparatively assessed by means of the brief symptom inventory (BSI). The study showed a considerable increased in psychological stress, especially with regard to long-term prisoners. In this context a significant difference (p<0.01) was found between short-term and long-term prisoners where 65% of long-term prisoners and 40% of short-term prisoners showed a noticeable increase in the amount of psychological stress. Furthermore, high prevalence rates of a history of attempted suicide (29.7%) and self-injurious behavior (43.2%) were found. The following clinical implications are deduced from this study: there is a general need for treatment during imprisonment, especially with respect to long-term prisoners. In addition, the high rates of attempted suicide and self-injurious behavior require a focus on a more elaborated crisis management as well as psychotherapeutic treatment for this population.

[Familial transmission of depression: the importance of harm avoidance]. / Familiäre Transmission depressiver Störungen : Die Bedeutung von Schadensvermeidung.

BACKGROUND: Previous research about the aetiology of depression has analysed how depression-associated personality traits influence familial transmission. Using the community-based sample of the Greifswald Family Study, we investigated longitudinally to which extent the temperament factor harm avoidance influences the correlation between parent's depression and the depression of their offspring (with regard to possible sex differences). METHODS: To test this familial transmission a structural equation model was conducted with the data of 193 children (mean age 19.5, SD=2.41) and their biological parents. Depression was assessed with structured clinical interviews, and harm avoidance with Cloninger's Temperament and Character Inventory (TCI, JTCI). RESULTS: The harm avoidance scores of the mothers were significantly correlated with the harm avoidance scores of their children, but the correlation of the father's and children's scores did not reach significance. The extent of harm avoidance at the first assessment of the 14-year-old children predicted depression 5 years later. CONCLUSION: These results indicate the importance of personality as a vulnerability marker for developing affective disorders. The results are discussed with respect to prevention programmes for children and parents with depression, especially if they exhibit strongly avoidant or anxious behaviour.

[The short version of the Brief Symptom Inventory (BSI -18): preliminary psychometric properties of the German translation]. / Die Kurzform des Brief Symptom Inventory (BSI -18): erste Befunde zu den psychometrischen Kennwerten der deutschen Version.

The short version of the Brief Symptom Inventory (BSI-18) is an easily applicable, reliable and valid self-report measure in wide international use. It assesses the syndroms of somatisation, depression and anxiety by means of 6 items each. For the psychometric evaluation of the German translation, undergraduate students, non-clinical subjects and psychosomatic outpatients were administered the BSI-18. Across these populations, all scales showed satisfactory to good internal consistencies (Cronbachs alpha ranged between 0.63 and 0.93). The item-total correlation as item discrimination index was sufficiently high, patricularly in the patient sample (rit ≥ 0.40). The correlations of the BSI-18 with measures of similar dimensions were moderate to high indicating a good convergent validity. Criterion-related validity was established in so far that patients scored significantly higher in all BSI-18 scales than did the non-clinical samples. With some exceptions, the German translation of the BSI-18 has similarly good psychometric qualities as the American original.

Viking magnetic properties investigation: preliminary results.

Three permanent magnet arrays are aboard the Viking lander. By sol 35, one array, fixed on a photometric reference test chart on top of the lander, has clearly attracted magnetic particles from airborne dust; two other magnet arrays, one strong and one weak, incorporated in the backhoe of the surface sampler, have both extracted considerable magnetic mineral from the surface as a result of nine insertions associated with sample acquisition. The loose martian surface material around the landing site is judged to contain 3 to 7 percent highly magnetic mineral which, pending spectrophotometric study, is thought to be mainly magnetite.

Viking magnetic properties investigation: further results.

The amounts of magnetic particles held on the reference test chart and backhoe magnets on lander 2 and lander 1 are comparable, indicating the presence of an estimated 3 to 7 percent by weight of relatively pure, strongly magnetic particles in the soil at the lander 2 sampling site. Preliminary spectrophotometric analysis of the material held on the backhoe magnets on lander 1 indicates that its reflectance characteristics are indistinguishable from material within a sampling trench with which it has been compared. The material on the RTC magnet shows a different spectrum, but it is suspected that the difference is the result of a reflectance contribution from the magnesium metal covering on the magnet. It is argued that the results indicate the presence, now or originally, of magnetite, which may be titaniferous.

Physical properties of the martian surface from the viking 1 lander: preliminary results.

The purpose of the physical properties experiment is to determine the characteristics of the martian "soil" based on the use of the Viking lander imaging system, the surface sampler, and engineering sensors. Viking 1 lander made physical contact with the surface of Mars at 11:53:07.1 hours on 20 July 1976 G.M.T. Twenty-five seconds later a high-resolution image sequence of the area around a footpad was started which contained the first information about surface conditions on Mars. The next image is a survey of the martian landscape in front of the lander, including a view of the top support of two of the landing legs. Each leg has a stroke gauge which extends from the top of the leg support an amount equal to the crushing experienced by the shock absorbers during touchdown. Subsequent images provided views of all three stroke gauges which, together with the knowledge of the impact velocity, allow determination of "soil" properties. In the images there is evidence of surface erosion from the engines. Several laboratory tests were carried out prior to the mission with a descent engine to determine what surface alterations might occur during a Mars landing. On sol 2 the shroud, which protected the surface sampler collector head from biological contamination, was ejected onto the surface. Later a cylindrical pin which dropped from the boom housing of the surface sampler during the modified unlatching sequence produced a crater (the second Mars penetrometer experiment). These two experiments provided further insight into the physical properties of the martian surface.

The "soil" of Mars (viking 1).

The location of the Viking 1 lander is most ideal for the study of soil properties because it has one footpad in soft material and one on hard material. As each soil sample was acquired, information on soil properties was obtained. Although analysis is still under way, early results on bulk density, particle size, angle of internal friction, cohesion, adhesion, and penetration resistance of the soil of Mars are presented.

The environs of viking 2 lander.

Forty-six days after Viking 1 landed, Viking 2 landed in Utopia Planitia, about 6500 kilometers away from the landing site of Viking 1. Images show that in the immediate vicinity of the Viking 2 landing site the surface is covered with rocks, some of which are partially buried, and fine-grained materials. The surface sampler, the lander cameras, engineering sensors, and some data from the other lander experiments were used to investigate the properties of the surface. Lander 2 has a more homogeneous surface, more coarse-grained material, an extensive crust, small rocks or clods which seem to be difficult to collect, and more extensive erosion by the retro-engine exhaust gases than lander 1. A report on the physical properties of the martian surface based on data obtained through sol 58 on Viking 2 and a brief description of activities on Viking 1 after sol 36 are given.

[Modified procedure for patient registration for navigation control instruments in ENT surgery]. / Ein modifiziertes Verfahren zur bissschienenbasierten Patientenregistrierung für die HNO-Navigation.

PROBLEM: Surgical navigation and navigation-controlled instruments demand a robust and precise patient registration process. For navigation in the skull, a bite-splint-based registration method has been widely applied, which had to be manufactured by dental technicians. The additional cost and time could be avoided by directly using the manufactured imprint, which is prepared by the ENT surgeon in one step. MATERIAL AND METHODS: This study examined the re-positioning accuracy for three silicon materials in a laboratory study with a 3D measuring device (Faro-arm) after several re-positioning cycles (simulating erosion) in comparison to the gold standard. RESULTS: The mean deviation after two cycles was lower for all three materials compared to the gold standard. Only C-Silikon Optosil was better then the gold standard after all cycles and with a deviation of 0.17 mm it well below that of the conventional bite-splint (0.28 mm). The additional cost benefits of 10 euro per imprint compared to the bite-splint with >100 euro favor this material for clinical application. CONCLUSIONS: As a consequence of this investigation Optosil was successfully used in 6 patients during the period from 01.09.2007 to 30.11.2007. The bite-splint was manufactured completely in the ENT department and could be used during the planning CT and surgery. The resulting accuracy corresponded to the experiences gained in previous surgery with a maximum deviation of 0.87 mm. The favorable ergonomic characteristics for patient and surgeon could be confirmed. As a result of this study this clinic now exclusively uses the procedure described in this article for bite-splint-based registration.

[Psychiatric disorders and childhood trauma in prisoners with antisocial personality disorder]. / Psychische Störungen und Kindheitstraumata bei Strafgefangenen mit antisozialer Persönlichkeitsstörung.

Previous studies indicate high prevalence rates of mental disorders and trauma among prisoners. Based on a sample of 102 male German prisoners, the comorbidity and childhood trauma experiences in 72 criminals with antisocial personality disorder were investigated. Furthermore, associations of antisocial personality disorder and early traumatic experiences with the age at first conviction and the lifetime months of imprisonment were examined. Subjects had high rates of comorbid lifetime and current disorders as well as childhood trauma experiences. Physical abuse in childhood and adolescence was identified as a predictor for lifetime months of imprisonment, antisocial personality disorder was found to be a predictor for the age at first conviction. Our findings confirm the hypothesis of prisoners with antisocial personality disorder being a severely traumatized population with serious mental disorders. Traumatic childhood experiences and antisocial personality disorder are associated with criminality variables. This has important implications on preventive treatments as well as on how prison services are addressing these problems.

Major depression and atrial natriuretic peptide: The role of adverse childhood experiences.

Atrial natriuretic peptide (ANP) exerts anxiolytic effects in animals and humans. Patients with anxiety, trauma-associated and depressive disorders exhibit lower ANP plasma levels compared to healthy individuals. However, the role of ANP in patients with major depressive disorder (MDD) with and without concomitant adverse childhood experiences (ACE) and in healthy individuals with and without ACE is not clear. We recruited a total of 93 women: 23 women with MDD and ACE, 24 women with MDD without ACE, 22 women with ACE but no current or lifetime MDD, and 24 healthy women without ACE. ANP plasma levels were measured with a radioimmunoassay. The four groups did not differ in demographic and clinical variables. We found a positive correlation between age and plasma levels of ANP (r = .39; p < .001). After controlling for age, there was no significant main effect of MDD or ACE on ANP plasma levels, but a significant interaction between MDD and ACE such that ACE was associated with reduced basal ANP levels in the absence of MDD. We assume that low plasma ANP might be a consequence of ACE in the absence of current psychopathology. Therefore, future studies are needed to replicate our findings and to characterize the influencing factors of ACE on ANP more comprehensively, for example by including a comprehensive trauma and comorbidity anamnesis as well as cardiovascular state and risk factors.

Association between depression and subclinical carotid atherosclerosis in patients with Type 1 diabetes.

AIMS: Recent studies have suggested an association between depression and subclinical atherosclerosis as measured by presence of carotid atherosclerotic plaque and increased intima-media thickening in non-clinical populations. Given the high prevalence of depression in patients with Type 1 diabetes and the diabetes-related risk factors for atherosclerosis, we hypothesized that this relation might also be of special relevance in Type 1 diabetic patients. METHODS: Intima-media thickness (IMT) and the presence of plaques in the carotid arteries were quantitatively assessed by high-resolution ultrasound in 175 adults (89 men, 86 women) with an established diagnosis of Type 1 diabetes. Having been treated for depression or current Beck Depression Inventory scores > 10 were considered to indicate depression. RESULTS: In men, the risk of plaque was higher in depressed subjects relative to non-depressed participants after adjustment for age, smoking status, systolic blood pressure, dyslipidaemia and body mass index [odds ratio (OR) 5.19; 95% confidence interval (CI) 1.29, 20.81]. Depressed women did not have an increased risk of plaque compared with non-depressed women (OR 0.97; 95% 95% CI 0.22, 4.34). We did not observe an association between depression and IMT, in men or in women. CONCLUSIONS: In line with previous research, our findings suggest a link between depression and subclinical atherosclerosis in Type 1 diabetic men, but not in women.