Gaze as depicted in Vermeer's Girl with a Pearl Earring.

Ten observers viewed Vermeer's painting Girl With a Pearl Earring and estimated her direction of gaze when her eyes were exposed together and separately. The observers also viewed the painting when her eyes were digitally replaced by those of a real person. The authors found that Vermeer painted the girl's eyes with a precision that was near the limits of visual acuity. Also, Vermeer included 3 gaze illusions, none of which researchers have documented as known in Vermeer's time: (a) when a model whose head is turned to one side gazes at an observer, there is an illusion that she is looking to the side of the observer away from the direction of her head turn; (b) when a model's eyes are viewed separately, they appear to gaze outward relative to each other; and (c) when both of a model's eyes are viewed, the perceived direction of gaze follows that of the nearer eye.

Effectiveness of targeted intervention and maintenance pharmacotherapy in conjunction with family intervention in schizophrenia.

A sample of 85 patients with schizophrenia, of whom 34 later dropped out, received randomised treatment. There were no significant differences between treatment-takers and drop-outs in the variables assessed. Patients received either standard-dose maintenance neuroleptic treatment or targeted maintenance pharmacotherapy and all patients received behavioural family therapy. Measures of psychopathology, social adjustment, side-effects, family burden, and expressed emotion were assessed at baseline and then periodically over an 18-month period. The study was designed to compare the two alternative pharmacological maintenance approaches, each of them supported by psychosocial intervention. Any evaluation of the impact of behavioural family treatment on relapse rates and other outcome criteria is exclusively descriptive. A significantly higher rate of relapse was observed at 18 months in patients randomised to targeted treatment compared to those randomised to standard-dose treatment (35% vs 4%). Although patients assigned to the targeted maintenance group received significantly lower mean doses of neuroleptics, there were no significant differences between the two groups with regard to side-effects, global measures of social function, and overall psychopathology. Family burden was higher in the targeted-treatment group at six months, but did not differ at the one-year and eighteen-month time points. However, both groups improved significantly from baseline to 12 or 18 months in almost all variables assessed. Thus, the behavioural family approach did not compensate for the problems associated with the targeted medication strategy.

[Detection of early warning signs in schizophrenic patients. Possible applications in prevention of recurrence]. / Zur Erfassung von Frühwarnzeichen bei schizophrenen Patienten. Einsatzmöglichkeiten in der Rückfallprophylaxe.

In the treatment of schizophrenia, two new strategies have been developed with the aim of adequate relapse prevention accompanied by lowest possible risk of side-effects. One strategy is to have the patient continue to take medication at a highly reduced dosage (10-20% of the standard dose). The other is to gradually stop neuroleptic medication after remission and to reinstitute medication only in the case of prodromal symptoms (termed targeted or intermittent treatment). According to Herz and Melville [13] many schizophrenic patients show signs of relapse well before recurrence of overt psychotic features. Monitoring to detect prodromal symptoms is especially important in targeted treatment because, otherwise, neuroleptic medication often cannot be initiated in time. In the present study of 51 schizophrenic patients we were able to replicate the results of Herz & Melville in the German-speaking countries. Prior to acute exacerbation of psychosis, most patients experience alterations of feelings and behaviour. These alterations may also be recognized by family members. Such early warning signs of relapse mainly consist of non-specific, non-psychotic symptoms: tenseness and nervousness, eating less, trouble concentrating and sleeping, depressive mood and seeing friends less. Furthermore, the regular monitoring and use of early warning signs specific to each patient in the aftercare of schizophrenic patients seems to be practicable, especially in psychoeducative family therapy.

Deliverability of psychoeducational family management.

As part of an open clinical trial currently underway at the Max Planck Institute of Psychiatry in Munich, the feasibility of behavioral family management (Falloon et al. 1984) for schizophrenia in combination with two different neuroleptic medication strategies was investigated. The treatment approaches were psychoeducational family management with a standard dose or with targeted medication. In this article the following questions were addressed: (1) What proportion of the total schizophrenia population admitted as inpatients might be eligible for psychoeducational family treatment (assessment based on n = 411 over a 33-month period)? (2) How representative of this population are the patients who were randomized to the experimental groups? (3) How many patients dropped out of treatment after entering the trial? The results show that about 60 percent (247) of the patients were eligible for a psychoeducational treatment approach. Of these, 34 percent (85) participated in the trial and were randomized to the treatments. Only 4 percent of the relatives but 20 percent of the patients refused to take part in the study. The 85 trial patients did not differ from the total eligible on the numerous socioeconomic and symptom variables assessed. The treatment dropout rate was 11 percent. Those patients who accepted treatment did not differ from those patients who dropped out on socioeconomic or illness variables. The results indicate that early identification of dropouts is not possible at least with the methods used in this study.

Psychological aspects of NFP practice.

A psychological investigation was implemented to find out if NFP users are characterized by special personality traits and if there are any correlations between NFP practice and changes within the marriage partnership. A total of 258 NFP users, both women and men, were investigated with questionnaires of the type generally used in the field of personality research in the Federal Republic of Germany, and also with questionnaires concerning the partnership and attitudes toward pregnancy, sexuality, and childbirth. It was found that with respect to personality traits, the NFP user does not differ considerably from people designated as "normal population." Only their attitudes toward sexuality are more positive and uninhibited, and the women feel less subjectively helpless than the standard sample. Furthermore, there is a connection between increased NFP experience and changes within the partnership, in that there is a reduction of "dominant" attitude (in both men and women) with growing NFP experience. Couples with long NFP experience and NFP beginners have nearly the same degree of well-being between the partners, whereas couples who have just passed the learning phase show more ill-feeling between husband and wife. Factors concerning the partnership account much more for the differences in marital satisfaction than do sociodemographic variables or personality traits.