Risperidone-induced marked elevation of serum creatine kinase in adolescence. A case report.

We report on a 17-year-old boy who developed a marked increase in serum creatine kinase (CK) (9743 U/l) during treatment with risperidone for catatonic psychosis. Known causes of elevated CK such as delirium, malignant neuroleptic syndrome, infection, cocaine overdose, trauma, and intramuscular injections were ruled out. Vital signs remained always within the normal range. On discontinuation of risperidone, serum CK concentrations returned to 105 U/l within 1 week and remained within normal limits. While a transient moderate increase in CK activity at admission may be related to acute psychosis, risperidone seems to be the causative agent for the later marked elevation. To our knowledge, this is the first reported case of risperidone-associated elevation of serum CK in an adolescent. While discontinuation of risperidone does not seem necessary in patients with a moderate increase of serum CK, withdrawal of neuroleptics is warranted in more severe cases.

[Childhood sexual abuse in the history of patients in high-frequency psychoanalytic long-term therapy--prevalence and diagnosis]. / Sexuelle Missbrauchserfahrungen in der Vorgeschichte von Patienten in hochfrequenten psychoanalytischen Langzeitbehandlungen. Prävalenz und Diagnosestellung.

276 treatment records of patients who were undergoing high-frequent, outpatient, individual, psychoanalytic therapy were analysed with respect to the prevalence and patterns of childhood sexual abuse in the history of these patients. 22.8% of all patients experienced narrowly defined sexual abuse during childhood (the end of the 17th year); additionally, 35.2% of all patients reported minor forms of sexually abusive experiences. The gender distribution, the age at onset of sexual abuse, and the relationship to the perpetrator were analysed. Looking at psychoanalytic diagnoses, a significant correlation between a history of childhood sexual abuse and a diagnosis of hysterical neurosis was found.

Strengths of modified amalgam-to-dentin interphases.

Amalgam remains the primary dental restorative for nearly 200,000,000 Indonesians. Ground occlusal dentin surfaces of 140 formaldehyde-treated human molars were used to study shear strengths of different adhesive bonds (40: Syntac/Variolink, 40: Amalgambond Plus (AP), 40: AP+microfibre, and 20: Amalcoden) to a spherical high-copper amalgam (Valiant, Ivoclar NA). After 24 h at 37 degrees C/100 RH, restorations were stored for 7 d under one of four different conditions (all 37 degrees C) : A, 100% RH; B, deionized water; C, 0.9% NaCl solution; D, saliva electrolyte solution. Amalcoden-treated samples were exposed to conditions A and B only. ANOVA and Tukey post hoc analysis (P<0.05) were applied. For any single storage condition, AP+microfibre bond strengths were significantly greater than those for other agents tested. Storage condition was a significant variable only for the AP+microfibre; weaker bond strengths were observed for saline-stored samples. Improvement of restorative-to-dentin interfaces, eliminating pulp sensitivity, can result from aldehyde pre-treatment of teeth, as well as from the use of microfibre-filled Amalgambond Plus. These results illustrate the importance of "stabilization" of the entire interphase.

Problems of process-efficiency studies in psychotherapy.

Three areas of psychotherapy research can be delimited of which differential efficiency research promises to be the most fruitful, because it will eventually inform us which interventions with what kind of patient and what kind of problem will be the most constructive. One problem it can solve is the so-called equivalence paradox. This epitheton designates the fact, that in spite of the enormous differences in theory and interventions between the different kinds of psychotherapies, their results are not remarkably divergent. One quite popular hypothesis is that this is due to common factors, commun to any and every kind of psychotherapy. Our results indicate that this explanation is too simplistic because it uses a monosubstance-doses-effect-relationship model and disregards interaction. One other avenue is the relevant events approach. Our examples yield equivocal results. Nevertheless this remains a promising field of investigation. Finally there are time series analyses which are probably most germane to the field of psychotherapies. One illustration with a case of negative psychotherapy outcome is presented. Time series analysis is able to show that the patient changed to a negativistic attitude in the middle of session, whereas the psychoanalyst only changed at the beginning of session 10 respectively in its middle.

[Reports and clarification of "critical incidents" as promoting factors in psychotherapy. A process-efficiency study between psychodynamic and client-centered treatment of patients]. / Berichte über und Klärung von "kritischen Ereignissen" als Wirkfaktoren in der Psychotherapie. Eine Prozess-Effizienz-Studie zwischen psychodynamisch und klientzentriert behandelten Patienten.

Our investigation assays if (i) the patient's thematization of and (ii) the attained degree of psychological clarification of "critical incidents" (sensu Rice & Saperia) covariate with favourable outcomes of psychotherapies. The sample consisted of 16 short psychotherapies (maximum 30 sessions), half of which treated with client centered (= CC) and the other half with psychodynamic (= PT) psychotherapy. These had been classified in a previous investigation (on the basis of questionnaire scores in 5 points in time, covering 12 years) into 8 differing time courses. Significant results are: "Critical incidents" were more often found in PT than in CC, reciprocally "psychological clarification" was higher in CC. In sessions rated "good" and in the 10 "ameliorating" time courses "critical incidents" were more frequent than in their respective countergroup. A crass exception was furnished by the "deteriorating" subgroup's quite high frequencies.

[Results and problems of time series analysis of individual observations in client-centered and psychodynamic brief psychotherapy]. / Ergebnisse und Probleme zeitreihenanalytischer Einzelfallbetrachtungen bei klientenzentrierter und psychodynamischer Kurzpsychotherapie.

The longitudinal data of five psychotherapies, collected during the Hamburg Short Psychotherapy Comparison Experiment, were statistically reviewed by the method of time series analysis. The intention of the single case studies was to describe the therapist-patient-interactions in details for acquiring greater knowledge of the therapeutical process. The items to study were obtained by ratings. Although there were thirteen nonverbal characteristics of the therapist and the patient as well as one common feature of the relationship between them both. The results did not correspond with the theoretical expectations. There were only few changes in the behaviors of the therapists and the patients and there was little proof of mutual effects in their behaviors during the therapeutical process. Only one of the therapies showed a significant patient's reaction, but it was unexpectedly negativistic. This supports the idea, that the therapist's influence on the patient may not be very strong und may not necessarily be positive. However, there were some severe methodological data problems mainly concerning the applicability of the time series analysis. Nonequidistant measurements as well as the relative shortness of the time series made the validity of the results a topic to be discussed. In dealing with these problems, the necessity of conceptualizing the time structures of psychological processes became evident.

["The most ill go into psychoanalytic treatment"? Critical comments on an article in Report Psychologie]. / "Die Kränkesten gehen in eine psychoanalytische Behandlung"? Kritische Anmerkungen zu einem Artikel in Report Psychologie.

Thomas and Schmitz claim that they "deliver a proof for the effectiveness of humanistic methods" (p. 25) with their study. However, they did not or were not able to verify their claim due to several reasons: The authors did not say if and if so to what extent the treatments carried out within the framework of the TK-regulation were treatments using humanistic methods. The validity of the only criterium used by the authors, the average duration of the inability to work, must be questioned. The inferential statistical treatment of the data is insufficient; a non-parametrical evaluation is necessary. Especially missing are personal details concerning the treatment groups (age, sex, occupation, method, duration and frequency of therapy), which are indispensable for a differentiated interpretation. In addition there are numerous formal faults (wrong quotations, mistakes in tables, unclear terms etc.). In view of this criticism we come to the conclusion that the results are to a large degree worthless, at least until several of our objections have been refuted by further information and adequate inferential statistical methods. This study is especially unsuitable to prove a however defined "effectiveness of out-patient psychotherapies", therefore also not suitable to prove the effectiveness of those treatments conducted within the framework of the TK-regulation and especially not suitable to prove the superiority of humanistic methods in comparison with psychoanalytic methods and behavioural therapy.

Polylactide inhibition of carcinoma cell growth in vitro.

Normal fibroblasts and epithelial tumor cells were challenged by exposure for 24 hours to extracts of a pure metal, a metal alloy, and a polymer used in facial reconstruction to assess cellular growth effects. While none of these materials significantly altered fibroblast growth rates, poly-L-lactide inhibited carcinoma cell growth at 5.0% extract concentration. No carcinoma cell growth effects were seen from exposure to stainless steel or commercially pure titanium extracts.

Radiofrequency gas plasma (glow discharge) disinfection of dental operative instruments, including handpieces.

The radiofrequency-stimulated argon gas plasma (glow discharge) technique, already well-known for surface cleaning and activation of adhesion, was investigated for determination of its separate potential for rapid disinfection of dental operative instruments. Disinfection effectiveness was judged from diminished post-treatment recovery of viable organisms from the instruments agitated in saline. Streptococcus salivarius, Bacillus stearothermophilus, and Escherichia coli were used as primary contaminant organisms, dried from gelatin-thickened laboratory cultures onto the instruments and not subjected to any preliminary cleaning steps. Significant disinfection was obtained, with no sensible temperature increases, in under 10 minutes in laboratory apparatus consuming fewer than 5 Watts of power per cycle. Also, clinically used and deliberately-saliva-contaminated high-speed handpieces were gas-discharge-treated, with their resultant rapid disinfection noted by complete suppression of the viability of any transferred natural contaminant organisms within two minutes. With regard to preservation of instrument quality, it was also shown that this low-temperature gas-discharge method provides the noted substantial disinfection without deterioration of sharp edges. Work now in progress suggests that the method can provide cool, rapid, and complete sterilization when hydrogen peroxide vapors are present in the gas plasma used for treatment of instruments first given the normally recommended thorough pre-cleaning.

Reduced corrosion of CP Ti and Ti-6A1-4V alloy endosseous dental implants after glow-discharge treatment: a preliminary report.

Inductively coupled argon plasma spectroscopic analysis was used to quantify titanium, aluminum, and vanadium corrosion products released by superficial layers of identically shaped commercially pure titanium and Ti-6A1-4V alloy dental implants. Halves of each of two originally sterile groups were analyzed directly from the manufacturer's packaging and the other halves received glow-discharge treatment prior to their corrosion assay. The implants were incubated in pH 3 modified saline solution and were analyzed after 2- and 12-week corrosion periods. Implants treated with glow discharge showed statistically significant reduction in the amounts of corrosion products released, apparently as a result of glow-discharge-produced surface oxides of greater passivity than originally present.

Multiple cranial nerve deficits after ethylene glycol poisoning.

We report the cases of two patients who developed cranial nerve palsies after drinking ethylene glycol. A 33-year-old man developed multiple cranial nerve deficits nine days after the ingestion of ethylene glycol in a suicide attempt. Clinical findings included profound bilateral cranial nerve VII palsies and severe dysfunction of cranial nerves IX and X. The neuropathy occurred despite treatment with hemodialysis. The dysphagia completely cleared within two weeks, but at six months a severe bilateral cranial nerve VII dysfunction persisted. A 22-year-old man undergoing hemodialysis for ethylene glycol-induced renal failure developed bilateral cranial nerve VII dysfunction 14 days after ingestion. At a three-month follow-up, the patient demonstrated only moderate functional recovery. The etiology of the cranial nerve deficits is unknown but may be related to oxalate crystal deposition of ethylene glycol-induced pyridoxine dysfunction.

[Therapy of patients with severe anorexia (summary of a report on a research project)]. / Therapie schwer erkrankter Anorexie-Patienten (Zusammenfassender Bericht über ein Forschungsprojekt).

From 1981 to 1983 a special project on anorexia nervosa was granted within "Sonderforschungsbereich 115" (Hamburg--West Germany). We want to give a review of those aspects of our studies which led us to a therapeutic concept for severely affected inpatients. Starting in the diagnostic field with problems of motivation and alexithymia we turn to psychodynamic subgroups, mention the studies of endocrinology, the Self-structure and the father-types, continue with epidemiologic studies as a device of interpreting pathologic phenomena. Concerning our therapeutic investigations--basing on a long-term follow-up--we report on therapeutic elements, results, follow-up and a hierarchy in prognostic factors of our in-patient treatment. In a critical survey of the results we finally discuss therapeutic recommendations.

[The future of psychosomatic medicine in West Germany--an illusion?]. / Die Zukunft der Psychosomatik in der BRD--eine Illusion?

Due to historical developments the structure and function of German Psychosomatics is unique in the world. Hence, to predict its future is difficult. There is the intimate conjunction of psycho-somatics with psychotherapy and the mandatory teaching of this combination to medical students, so that every medical school has to have a corresponding department and that most of these are psychoanalytically orientated. Medical care insurances finance psycho-therapy to a degree unknown in any other country. Then, in excess of the 700 beds for psychosomatics/psychotherapy in university and communal hospitals, the FRG provides another 4000 beds which are legally, financially and geographically separated from the former. Epidemiological data show that in spite of the above average out-patient financing many patients in need are not treated psychotherapeutically until their working capacity is reduced by which they become subject to another (and separate) legal system: The law of rehabilitation the measures of which are financed by the federal or state pension funds. At this late stage only in-patient psychosomatic treatment has some chance of rehabilitation. Hence, in cooperation with private entrepreneurs or non-profit organizations the above-mentioned over 4000 additional beds were provided. Two examples show that the effects of psychotherapy with somatic illness (myocardial infarction and metastatic cancer) are remarkable but discrete and their full impact can only been seen after several years. These features probably explain the habitual underestimation of psychotherapy in medicine.

[Common factors in psychotherapy as an explanation for results that are approximately indistinguishable--one more myth in psychotherapy research?]. / Kommunale Faktoren in der Psychotherapie als Erklärung für nicht grob unterschiedliche Ergebnisse--Ein Mythos mehr in der Psychotherapieforschung?

The fact that the gross outcomes of quite different forms of psychotherapy do not differ accordingly has been attributed to the existence of factors communal to any and every form of psychotherapy. For empirical study this thesis has to be dichotomized: (1) Are there really communal factors? (2) Do these engender communal effects in different therapies? Our empirical investigation of client-centered versus psycho-dynamic short psychotherapy shows that (1) is correct, however, the frequencies of these communal element often differ significantly between the two therapy samples. The results and (2) show that in spite of communality the correlation between a certain process category and an outcome variable regularly only attains significance in one but not the other therapy sample--sometimes they even show contrary signs. Hence the initially described explanation seems to be yet another myth in psychotherapy research. This myth assumes (i) interventions to be "monosubstances" (ii) the "doses" of which can be adequately measured in frequency per time unit and (iii) which shows a monotone relation to outcome.

[Systems theory solution of the Bieri trilemma. Comments on the comments by E. G. Schmidt on my comments on the body-mind problem in psychosomatic medicine]. / Probleme einer systemtheoretischen Lösung des Bieri-Trilemma. Bemerkungen zu den Bemerkungen von E. G. Schmidt zu meinen Bemerkungen über die Leib-Seele-Problematik in der Psychosomatik.

E. G. Schmidt criticizes my critique of the wholist-emergentist solution for the mind-body problem. Against my repudiation he proposes an emergentist system theory solution apparently solving the so-called Bieri trilemma. I contend that his solution falsely introduces "psychogenic" causality into the wholist-emergentistic theory.

[Verbalization of the therapeutic relationship in focal-psychoanalytic and client-centered psychotherapy. A content analytic study from the Hamburg comparative brief psychotherapy experiment]. / Die Verbalisierung der therapeutischen Beziehung in der fokal-psychoanalytischen und in der klientzentrierten Psychotherapie. Eine inhaltsanalytische Untersuchung aus dem Hamburger Kurzpsychotherapie-Vergleichs-Experiment.

The present investigation emerged from the Hamburg Short Psychotherapy Comparison Experiment. Its aim was to compare psychodynamic, conflict-centred, time-limited psychotherapy (PT) to client-centred psychotherapy (CC) with regard to the direct and indirect verbalization of the therapeutic relationship--particularly of transference and resistance--for the purpose of investigating the congruity of theory and practice of the therapists involved. Transcriptions of 28 PT and 21 CC audio-recorded therapies were examined by means of a content analysis catalogue. The following (ascending) rank order in the frequency of verbalization of transference was found: CC-therapists, CC-patients, PT-patients, PT-therapists. The main differences are statistically significant. The contrary approach of the therapists probably conditions the differences found in the patients. Therapists in PT verbalised the occurrence of resistance in a much more frequent manner than their patients did. In CC resistance was verbalised only sporadically. These results confirm that the therapists involved acted in conformity with their respective theory.