A perfectly stoichiometric and flat CeO2(111) surface on a bulk-like ceria film.

In surface science and model catalysis, cerium oxide (ceria) is mostly grown as an ultra-thin film on a metal substrate in the ultra-high vacuum to understand fundamental mechanisms involved in diverse surface chemistry processes. However, such ultra-thin films do not have the contribution of a bulk ceria underneath, which is currently discussed to have a high impact on in particular surface redox processes. Here, we present a fully oxidized ceria thick film (180 nm) with a perfectly stoichiometric CeO2(111) surface exhibiting exceptionally large, atomically flat terraces. The film is well-suited for ceria model studies as well as a perfect substitute for CeO2 bulk material.

Morphology and nanostructure of CeO2(111) surfaces of single crystals and Si(111) supported ceria films.

The surface morphology of CeO(2)(111) single crystals and silicon supported ceria films is investigated by non-contact atomic force microscopy (NC-AFM) and Kelvin probe force microscopy (KPFM) for various annealing conditions. Annealing bulk samples at 1100 K results in small terraces with rounded ledges and steps with predominantly one O-Ce-O triple layer height while annealing at 1200 K produces well-ordered straight step edges in a hexagonal motif and step bunching. The morphology and topographic details of films are similar, however, films are destroyed upon heating them above 1100 K. KPFM images exhibit uniform terraces on a single crystal surface when the crystal is slowly cooled down, whereas rapid cooling results in a significant inhomogeneity of the surface potential. For films exhibiting large terraces, significant inhomogeneity in the KPFM signal is found even for best possible preparation conditions. Applying X-ray photoelectron spectroscopy (XPS), we find a significant contamination of the bulk ceria sample with fluorine while a possible fluorine contamination of the ceria film is below the XPS detection threshold. Time-of-flight secondary ion mass spectroscopy (TOF-SIMS) reveals an accumulation of fluorine within the first 5 nm below the surface of the bulk sample and a small concentration throughout the crystal.

[Smoking reduction during inpatient alcohol detoxification: a controlled clinical pilot trial]. / Rauchreduktion bei Alkoholkranken im Rahmen einer stationären Alkohol-Entzugsbehandlung: Eine kontrollierte klinische Pilotstudie.

Health care professionals tend to advise alcohol dependent patients to quit tobacco consumption only after longer periods of alcohol abstinence. This recommendation reflects concerns that smoking intervention programs may adversely interfere with the outcome of ongoing alcohol detoxification and rehabilitation treatment. However, the issue of appropriate time windows for initiating changes of smoking behaviour in alcoholic patients is still in need of empirical evaluation. Thus the aim of the present study is to investigate whether alcohol dependent smokers may be able to reduce cigarette consumption very early during alcohol detoxification and rehabilitation treatment. We performed a non-randomized controlled clinical pilot trial with 56 female and male alcohol dependent smokers in an inpatient setting providing a 3-weeks alcohol detoxification program. 28 individuals received a smoking reduction program consisting of a 6-sessions approach in a group format following behavioural principles. For the control group of 28 individuals the program was not available. Tobacco consumption was assessed daily by staff members. Alcohol dependent patients participating in the smoking reduction program reduced their daily cigarette consumption rates significantly, whereas the control group showed a tendency to increase tobacco consumption. According to the tentative findings of this pilot study early smoking interventions already during alcohol detoxification appear to be a feasible approach.

Reduction of side effects by combining clozapine with amisulpride: case report and short review of clozapine-induced hypersalivation-a case report.

Side effects from a high-dose clozapine treatment for a schizophrenic patient led to massive compliance problems. The dose of clozapine could be halved without recurrence of an acute psychotic symptomatology by concomitantly administering amisulpride. The side effects, especially hypersalivation, disappeared almost entirely, which in turn led to good compliance. In a short review we would like to present the pathophysiology and therapeutic options of clozapine-induced hypersalivation.

Reducing psychological distress in patients with inflammatory bowel disease by cognitive-behavioural treatment: exploratory study of effectiveness.

BACKGROUND: This prospective study aimed to determine whether cognitive-behavioural group treatment accompanying medical standard care is effective in reducing psychological distress in patients with inflammatory bowel disease. METHODS: Twenty-eight outpatients with Crohn disease or ulcerative colitis completed the treatment programme. Psychological treatment consisting of 12 weekly sessions was conducted in a group setting. Medical and psychometric assessments were taken at the beginning of the 3-month pretreatment waiting period, at pretreatment, at post-treatment and at the 3, 6 and 9-month follow-ups. RESULTS: During baseline, no change was observed in psychological distress. Disease-related worries and concerns decreased significantly from pretreatment to the follow-ups. The disease groups differed in the decline of concerns between pre- and post-treatment, with a significant reduction of concerns in patients with ulcerative colitis but not Crohn disease. This difference did not occur at the follow-ups, indicating long-term improvement for both disease groups. Depressive coping decreased significantly in women and remained stable at the follow-ups, whereas depressive coping did not change in men. The same gender difference was found for depressive symptoms. CONCLUSIONS: The exploratory findings suggest that psychological group treatment for outpatients is a feasible and effective approach for the short- and long-term reduction of psychological distress for patients with inflammatory bowel disease. However, the revealed gender differences on coping and depression might indicate the necessity to consider gender-specific aspects of inflammatory bowel disease when designing and evaluating psychological interventions.

Patterns of recovery of autonomic dysfunctions and neurocognitive deficits in schizophrenics after acute psychotic episodes.

In this study, the authors aimed to identify patterns of autonomic dysfunction and neurocognitive deficit recovery. The authors performed laboratory assessments on 66 patients with schizophrenia immediately after an acute psychotic episode and 6, 12, and 18 months later. Shortly after the psychotic episode, the patients displayed cardiovascular hyperarousal at rest, cardiovascular and electrodermal hyporeactivity during 2 Continuous Performance Tasks (CPTs) and deficits in 2 behavioral CPT measures (i.e., reaction time and omission error rate) compared with 29 normal controls. In the subsequent postpsychotic course, changes indicative of a process of recovery occurred in all measurement areas, although with regard to autonomic hyporeactivity amelioration was limited to a subgroup of schizophrenics with complete and persistent symptomatic remission. Neurocognitive improvement in CPTs did not appear to depend on unimpaired autonomic reactivity mechanisms.

Autonomic reactivity to mental stressors after single administration of lorazepam in male alcoholics and healthy controls.

Clinically unaffected sons of male alcoholics differ from controls without a family history of alcoholism in two respects: increased autonomic reactivity to aversive as well as non-aversive stimuli and increased attenuation of these responses by alcohol. This pattern of autonomic hyper-reactivity and alcohol-induced stress response dampening (SRD) might be a trait marker of genetic vulnerability and is often interpreted in terms of a diathesis stress model of alcohol dependence. Forty-five alcohol-dependent men (mean age: 39.20 years) and 37 healthy controls (mean age: 35.03 years) participated in a double-blind cross-over study in two experimental sessions each. The benzodiazepine lorazepam was selected as an alcohol substitute. Autonomic reactivity and lorazepam-induced SRD were assessed during incentive and non-incentive reaction time tasks as well as mental arithmetics. Alcohol-dependent men showed elevated resting heart rate levels and increased number of non-specific electrodermal responses. Evidence for autonomic hyper-reactivity was found for a subgroup of alcoholics with a family history of alcoholism.

The dimensional complexity of the EEG during cognitive tasks reflects the impaired information processing in schizophrenic patients.

The aim of the present study was to investigate whether schizophrenic patients show a different change of the dimensional complexity of the EEG, as represented by the Grassberger-Procaccia correlation dimension D(2,) under cognitive challenge compared to normal control subjects. With respect to results reported in the literature, it was expected that the complexity of the signal under cognitive challenge is higher in schizophrenic patients than in normal control subjects reflecting the impaired information processing abilities of the patients. Eighty-seven schizophrenic and 30 matched control subjects performed two different types of the continuous performance task. The results revealed differences between schizophrenic patients and control subjects for the performance as well as the complexity measures. Schizophrenic patients produced more omission errors than normal subjects did. For the EEG complexity measure no differences occurred under the baseline condition. In contrast, during the first minute under task conditions the control subjects showed a decrease of the dimension while no changes were found for the schizophrenic group. These results occurred for both types of the cognitive task but they reached clear significance only in one of them. The results are interpreted as reflecting the ability of normal subjects to adapt their information processing system to the cognitive challenge and to focus their attention on the task while schizophrenic subjects do not show this adaptation to the task.

[Patient evaluation of inpatient psychiatric occupational therapy. Determinants of reported patient satisfaction]. / Patientenbewertungen stationärer psychiatrischer Ergotherapie. Bedingungsfaktoren der berichteten Patientenzufriedenheit.

OBJECTIVE: The present study, which falls back on data collected within an extensive evaluation of indoor psychiatric ergotherapy, aims at the investigation of the interaction between patients' satisfaction and patients' characteristics, duration of treatment, and patients' assessments of specific single treatment aspects. METHODS: Fifty-eight inpatients assigned to three ergotherapeutic treatment programs were included into study. Assessments included--among others--a German version of the Client Satisfaction Questionnaire as well as a 74-items questionnaire on specific treatment aspects, such as perceived support, perceived practical orientation, and perceived personal problem orientation. RESULTS: As expected, a high level of satisfaction with treatment was reported. Patients' satisfaction is correlated with some variables under study, such as patients' subjective well-being and patients' assessments of psychosocial and professional treatment aspects. CONCLUSIONS: Findings indicate that--for the purpose of high patient satisfaction--ergotherapeutic treatment programs should distinguish themselves by supportive therapists, practical orientation, and personal problem orientation.

Ritanserin as add-on medication to neuroleptic therapy for patients with chronic or subchronic schizophrenia.

The effect of ritanserin, a potent 5HT 2A/2C receptor antagonist, used as an add-on medication to neuroleptic treatment in patients with schizophrenia, was compared with that of placebo, in an international, double-blind, parallel-group study. Previously established neuroleptic therapy was maintained, and ritanserin 10 mg or placebo was given once daily for 8 weeks. Psychopathology was assessed with the Positive and Negative Syndrome Scale (PANSS) and the Clinical Global Impression (CGI) cale. Safety assessments included the Extrapyramidal Symptom Rating Scale (ESRS), and the requirement for antiparkinsonian medication was monitored. About 70 per cent of patients completed the treatment. There was no difference between the two groups in the numbers of patients with clinical improvement at endpoint on the PANSS negative subscale and total PANSS. The CGIs of overall severity of schizophrenia were better under placebo. The overall prevalence of side effects and the requirements for antiparkinsonism medication were comparable in the two groups. Copyright 2000 John Wiley & Sons, Ltd.

[Feelings without speech or speech without feelings? Further evidence for the decoupling hypothesis of alexithymia]. / Gefühl ohne Sprache oder Sprache ohne Gefühl? Weitere Hinweise auf die Validität der Entkopplungshypothese der Alexithymie.

The theoretical background of the present investigation was the decoupling hypothesis of alexithymia, which presumes for alexithymic individuals a dissociation of psychophysiological indicators of emotion from verbal cognitive awareness of one's emotional state. To study alterations in reactivity to emotionally distressing stimuli in alexithymic individuals, 12 high-alexithymic and 14 low-alexithymic subjects (separated by TAS) out of a general sample of 54 were investigated. All subjects were exposed to cognitive (CPT) and affect inductive (film sequences) distress. During stimulus exposition electrodermal activity (spontaneous fluctuations) was recorded. After stimulus exposition the subjects assessed their emotional reaction towards the film sequences (DAS). Concerning electrodermal activity no differences were found between high and low alexithymics under cognitive distress. In any case a significant autonomous arousal was registered. However, only the low alexithymic subjects but not the high alexithymics showed a significant increase of spontaneous fluctuations as expression of autonomous arousal during presentation of affect inductive stimuli. The altered psychophysiological reactivity found in high alexithymics in contrast to low alexithymic subjects was revealed specifically for the processing of emotional qualified stimuli. However, there was no difference between the groups in cognitive self assessment of emotional response towards the film sequences. The findings are discussed with reference to neurophysiological and psychodynamic models and the decoupling hypothesis of alexithymia.

[Computer-assisted cognitive training of schizophrenic patients. Use of evaluation outcome for developing an individualized training method]. / Computergestütztes kognitives Training bei schizophrenen Patienten. Die Nutzung von Evaluationsergebnissen für die Entwicklung eines individualisierten Trainingsverfahrens.

The paper deals with the evaluation of a computer-based cognitive group training programme for schizophrenic patients. The evaluation of the training results of 100 patients who participated in an earlier training scheme showed ceiling effects in up to 46% of the cases. In the remaining cases the improvements varied in a wide range between 1.6 and 20%. These results implied that the training had to be adapted more closely to the specific needs of the individual patient. To this end we developed criteria for each task to decide whether training in this task is necessary or the performance is sufficient. This approach limits training to those tasks in which patients display deficits. Satisfactory improvement terminating training for the specific task, is defined as an increase in correct responses of at least 10%. For those tasks in which reaction times are used as performance measure, the criterion is a 10% increase in percentile rank. An analysis of the new training programme with the data of 20 patients revealed that 27% of the tasks showed ceiling performance with no further training need. In the remaining tasks the patients' performance attained the training criterion in 68%, at instances mostly even after one additional session. These preliminary results indicate that the new training scheme is able to provide more flexibility, individualization and an enhanced focus on the patients' deficits.

[Computer-assisted training in genetically-induced neuropsychological deficits. A case report of a patient with de Grouchy syndrome I (chromosome 18 p syndrome)]. / Computergestütztes Training bei genetisch bedingten neuropsychologischen Defiziten. Eine kasuistische Darstellung bei einem Patienten mit de-Grouchy-Syndrom I (Chromosom 18 p-Syndrom).

The present case study is a report on computer-based training approach in a male patient suffering from the de-Grouchy syndrome I (with a characteristic chromosomal deletion pattern), who along with psychotic symptoms displayed neuropsychological deficits. Participating in a well-established intervention programme aimed at a broad spectrum of psychological functions, the patient went through 36 training sessions. With regard to outcome assessments one focus was on improved performance in the training tasks, while the other one referred to transfer effects, as indexed by a neuropsychological test battery which was given before and after the entire programme. In both areas substantial gains from training emerged according to the collected data. In view of these results neuropsychological training approaches appear to have a perspective even in behavioural deficits with a genetic basis.

[Family therapy as a component of routine management of schizophrenic patients. A report of experiences]. / Angehörigenarbeit als Bestandteil der Routineversorgung schizophrener Patienten. Ein Erfahrungsbericht.

Since 1993 we have been working with nine groups of relatives of schizophrenic patients who were admitted as inpatients to two different psychiatric wards at the Landesklinik Nordschwarzwald. We summarise our experience with the family groups as a part of the psychiatric care for schizophrenic patients. The concept of family groups combines psychoeducational aspects with the concept of "Expressed Emotion". The relatives valued the combination of information, discussion and exchange of experiences positively. The groups offer relief and support. The involvement of the relatives has proved useful in the treatment of schizophrenic patients at our institution and will be continued. Further studies designed to improve the efficiency and quality of family groups will be important for their general establishment in psychiatric care.

Personality related effects of nicotine, mode of application, and expectancies on performance, emotional states, and desire for smoking.

Three separate factors relevant to nicotine effects have been investigated in this experiment in combination: the experimentally induced expectation about receiving a sham or a nicotine cigarette, the mode of application of nicotine by a tablet, by a cigarette or not at all, while the belief of receiving the nicotine via smoking was held constant in each condition (by nicotine or sham smoking), and the personality factors of extraversion or neuroticism, respectively. Ninety-six healthy female student smokers were tested in a 2 x 3 x 2 factorial group comparison design with respect to critical flicker fusion and reaction time performance as well as to self-ratings on emotional and cortical arousal and ratings on desire for further cigarettes (satisfaction from smoking a single cigarette containing either 0.8 mg nicotine or a sham cigarette). In each case, a tablet containing either nicotine or placebo was administered together with the cigarette. The results showed that performance is sensitive to interaction effects of instruction and mode of application. The instruction of sham or nicotine assignment when applied with a congruent treatment (sham with a sham cigarette, or nicotine with a nicotine cigarette) both increased performance, while groups with discordant information showed worse performance. The administration of nicotine by tablets or by smoking differs considerably, nicotine cigarettes causing a stronger increase in emotional arousal, tablets rather a decrease or no effect, while the true placebo condition increases arousal due to deprivation effects. This leads to an enhancement of the nicotine effect with real smoking and to reactive increase of effort when sham smoking. The instruction affects alertness, the nicotine illusion leading to a lower reduction in subjective reports of alertness and concentration than that observed with the sham instruction. Neurotic subjects become more anxious and tense with nicotine cigarettes than stable subjects. This effect is less pronounced or even reversed with tablets. No interactions with instructions are observed with neuroticism. Extraverts tend to show a decrease in performance but an increase in alertness with the instruction of receiving nicotine as opposed to the sham expectation, whereas introverts behave the opposite way. Subjective ratings on arousal seem to follow the law of transmarginal inhibition, with extraverts being pushed from low arousal to high and introverts vice versa by the mere expectation.

Cholinergic REM induction test: muscarinic supersensitivity underlies polysomnographic findings in both depression and schizophrenia.

Disinhibition of rapid eye movement (REM) sleep (e.g. shortening of REM latency, heightened REM density) is frequently encountered in patients with a major depressive disorder (MDD). Administration of cholinomimetics prior to or during sleep leads to a more pronounced advance of REM sleep in depressed patients compared to healthy controls and patients with other psychiatric disorders. The present study tested whether the cholinergic REM induction test (CRIT) with 1.5 mg RS 86 (an orally acting muscarinic agonist) differentiates patients with MDD (n = 40) from those with schizophrenia (n = 43) and healthy controls (n = 36). The most pronounced shortening of REM latency after cholinergic stimulation occurred in patients with MDD. However, a significant number of patients with schizophrenia also displayed short REM latencies (REM latency < 25 minutes) under placebo conditions and after cholinergic stimulation. REM density measures more clearly differentiated patients with MDD from those with schizophrenia. It is concluded that a subgroup of patients suffering from schizophrenia displays signs of a muscarinic receptor supersensitivity.

[Psychoses in encephalitis of uncertain etiology. Atypical course of multiple sclerosis?]. / Psychosen bei Enzephalitiden unklarer Atiologie. Atypische Verlaufsformen einer Multiplen Sklerose?

We report on 6 patients (4 female, 2 male, age 17-40 yrs.), admitted to hospital because of psychotic illness. In 2 patients paranoid-hallucinatory symptomatology was prominent, while a manic, a schizo-affective, a catatonic and a mixed organic brain syndrome were found in one case each. Neurological signs could be detected in 4 and EEG-abnormalities in 5 patients. On the basis of CSF findings typical of chronic encephalitis, together with evidence of demyelinating lesions on MRT we confirmed the presence of inflammatory brain disease in all six patients. As a specific etiology could not be established in any of the cases, we suggest the encephalitic variant of multiple sclerosis as the probable diagnosis. In view of our clinical observations, we assume that by using modern investigational techniques--especially sophisticated CSF analysis and MRT--an encephalitic etiology of schizophrenic and affective syndromes may be proven in higher frequency than in the past.

A weighted time budget approach for the assessment of cognitive and social activities.

An instrument designed to assess potentially challenging cognitive and social activities in a wide range of both psychiatric and normal study populations is described in this paper. The technique used combines traditional time budget approaches with an additional, significant component, i.e. a rating indicating the amount of challenge for each activity that is sampled. Separate ratings reflecting the subject's and the interviewer's perspective are generated. Along with a detailed description of this weighted time budget instrument, preliminary data regarding practicality, reliability and validity are reported. An analysis based on time budget interviews with 30 schizophrenic patients showed overall interrater agreement to average 84% (kappa = 0.72). In a study with a possible bearing on the concurrent validity of the instrument, relapsing schizophrenics significantly differed from stable subjects in weighted time budget indices.