Dynamical aspects of the EEG in different psychopathological states in an interview situation: a pilot study.

Dynamical brain states can be characterized by non-linear measures of EEG. The present study shows that critical transitions, i.e., abrupt changes from one dynamic pattern of neural mass activity to another one, may be detected by abrupt variations in local chaoticity. Using an ambulatory device, EEG was recorded from 10 patients with a schizophrenic and two patients with an affective disorder during a series of 25-min interviews. Dynamical aspects, in particular, phase transitions in the EEG-dynamics of the EEG were characterized by means of a measure that continuously estimates the chaoticity of the EEG signal and is thus related to its predictability. Results indicate simpler dynamics of the EEG time series in paranoid-hallucinatory patients, while at the same time these patients tended to exhibit more abrupt transitions/unit of time between different dynamical EEG states. Such sudden phase transitions in brain activity were significantly enhanced prior to expressions of thought disorders that were detected by the interviewer and an observer in the conversation, compared with time periods during the interview without such symptoms.

[Approaches for the prevention of alcohol abuse]. / Präventive Ansätze zur Verhinderung von Alkoholmissbrauch.

Epidemiological studies of alcohol problems have demonstrated a considerable variation between countries and epoches. Two types of primary prevention strategies of alcohol problems are examined. Firstly, efforts to control and reduce the availability of alcohol including increase of price, restriction of alcohol retail outlets or hours during which alcohol can be sold, minimum legal age for purchase or consumption, drinking-driving laws and enforcement programmes, restriction of alcohol advertising. The second type consists of educational prevention programmes aiming at the reduction of risk factors or the increase of protective factors within the general population. This type includes information to change knowledge and attitudes, education of affects and values, life skill training, resistance training, and mass media campaigns. Programmes aiming at high risk groups and the development of standardised secondary prevention programmes might be more effective and cost-efficient.

Electrodermal and vascular orienting response in schizophrenic patients: relationship to symptoms and medication.

Peripheral indicators of autonomic nervous system activity, including electrodermal activity and finger-pulse volume, were investigated in 100 schizophrenic inpatients. Healthy siblings of the patients and healthy subjects matched for age and gender served as control groups. Acoustic stimuli (70 dB) were presented and orienting response (OR) parameters were determined independently for the two response systems. The relationship of both OR measures to negative symptoms and medication was studied. The two OR measures were found to be not interrelated, i.e. most of the subjects were discordant with regard to presence or absence of their OR in the two different response systems. The electrodermal, but not the vascular OR, differed between patients and control groups. Among patients receiving medication with anticholinergic effects there were significantly more electrodermal nonresponders than among patients without such medication. There was no indication that electrodermal nonresponders show more negative symptoms or generally more severe psychopathology than electrodermal responders.

Smooth-pursuit eye movement dysfunction in schizophrenia: the role of attention and general psychomotor dysfunctions.

Smooth-pursuit eye-tracking performance was examined in 100 schizophrenic patients and various control groups under both attention-enhancing and attention-distracting conditions. The level of attentional demand was varied by introducing a secondary reaction time task that directed attention either toward or away from the visual-tracking target. Distraction from the target led to a significant deterioration of tracking performance in all subjects, which was most pronounced in the group of schizophrenic patients. Attention-enhancement, on the other hand, did not normalize performance in this group. In schizophrenic patients, mainly in the distraction condition, there was a moderate association between performance in tracking and tests presumably measuring prefrontal functions. Tracking accuracy from both conditions was related to general motor performance as measured by the Neurological Evaluation Scale. It was concluded that in schizophrenic patients attentional factors (distraction) may contribute to eye-tracking impairment, and that the impairment may be viewed as an aspect of general motor dysfunctions.

Prediction of relapse of schizophrenic patients: Camberwell Family Interview versus content analysis of verbal behavior.

In a replication of the study by Gottschalk et al. (1988), expressed emotion scores derived from the Camberwell Family Interview were compared with Anxiety and Overt Hostility Outward scores from a content analysis of verbal behavior based on a 10-minute speech sample from parents of 49 German schizophrenic inpatients. The scores from the two methods were significantly correlated, but only expressed emotion scores predicted relapse during a 12-month followup. Scores from the Gottschalk-Gleser content analysis did not exceed chance level in prediction of relapse.

[Lithium in the treatment of chronic alcoholic patients with brain damage--a controlled study]. / Lithium in der Behandlung chronischer Alkoholkranker mit zerebralen Schädigungen--eine kontrollierte Studie.

The efficacy of lithium aspartate in reducing alcohol consumption was examined in a double-blind, placebo controlled cross-over study. Subjects were male alcohol-dependent in-patients with organic brain disorder of moderate or severe degree. Starting with 22 men who fulfilled our selection criteria, only 8 finished the seven months trial (one month base-line, three months placebo, three months lithium). Measures of treatment response were the number of drinking episodes and the severity of intoxication on each episode (both registered by the nursing staff). Both measures showed no evidence of different responses to lithium and placebo treatment.

Placebo injections and surveillance of alcohol intake during inpatient treatment of female alcoholics.

Institutions for treating alcoholics differ widely with respect to how restrictively they apply psychopharmacological agents and how rigorously they control patients for intake of alcohol. This study investigates the impact of such policies on relapse rates. During a three month inpatient treatment, 70 female alcoholics were assigned to one of four conditions: (a) strict surveillance of alcohol intake by means of breath tests and frequent checks of patient's rooms as well as injections of a placebo purportedly reducing craving, (b) no surveillance but placebo injections, (c) surveillance but no placebo injections, and (d) neither surveillance nor placebo injections. The amount of surveillance did not influence relapse rates. However, during inpatient treatment more relapses occurred among patients who received the placebo injections than among those who did not. Although this effect was no longer significant following treatment, the increase of relapse rates suggests caution in the application of nonspecific medication in the treatment of alcoholics.

The patient rejection scale: cross-cultural consistency.

The Patient Rejection Scale, which was developed to assess rejecting feelings of family members toward mental patients, was administered to a sample of 80 relatives living with schizophrenic patients in the Federal Republic of Germany. In spite of the cross-cultural differences involved, the response distributions of the German sample and a New York City sample of families were almost identical. The findings are discussed in the context of "expressed emotions" research.

[A program for the care of relatives of schizophrenic patients]. / Ein Programm zur Betreuung von Angehörigen schizophrener Patienten.

The present paper gives a description of a research project which tries to evaluate the significance of family support in reducing relapse rates in schizophrenic patients. Two different forms of support for relatives are compared, a discussion group and an approach furnishing a behavior training in addition. The report is supplemented by depicting some key conditions which should be taken into consideration when establishing a support system for relatives in a Mental State Hospital. This account is based on the data of 35 patients and 62 meetings with relatives collected during the pilot phase of the project.

Self assessment of social competence in situations with and without alcohol by female alcoholics in treatment.

Female alcoholic in-patients (N = 156) were asked during a three months treatment to rate the degree of discomfort they expected (a) in situations demanding assertiveness, but not involving rejection of alcoholic beverages and (b) in situations characterized by social temptation to drink. Correlations of ratings with age, duration of problem drinking, mean ethanol consumption per day or length of education were insignificant. Actual experience with social temptation situations in the past did not influence the rating. A principal Component Analysis showed that ratings of discomfort in general social situations and in alcohol related social situations are largely unrelated. The result of partially independent appraisals of general and alcohol related assertiveness suggests that both should be assessed independently, and generalizations from one to the other might be misleading.

Self assessment of relapse risk and assertiveness in relation to treatment outcome of female alcoholics.

Prior to and following social-skills training during a three months inpatient treatment, 145 female alcoholics indicated for various situations involving social pressure to drink alcohol (a) how difficult it would be for them not to drink (Relapse Risk) and (b) the degree of discomfort they expected (Specific Assertiveness). In addition, General Assertiveness situations, not related to alcohol, were evaluated. Patients who relapsed three months after treatment evaluated the situations more difficult to deal with and creating more discomfort than abstaining patients, although the groups did not differ in their self-rated assertiveness in non-alcohol-related situations. All ratings improved throughout the training, but the differences between outcome groups were similar before and after. When patients were excluded who had relapsed already during treatment, Relapse Risk but not Specific Assertiveness still discriminated between outcome groups. The prognostic power of the Risk rating seems to reflect a general efficacy expectation evident in a strong relation to patients' conviction of being able to stay abstinent, stated already at admission.

Alcoholic women treated by behaviorally orientated therapy: an 18-month follow-up study.

Follow-up results of a behaviorally orientated treatment program for alcoholic women are presented. Sixty patients, carefully screened, were admitted on a special ward in groups of not larger than 12 for a period of 3 months. Abstinence was the declared goal of all individual and group treatments. More than 13 months after discharge interviews were carried out with 58 of the 60 former patients in their homes. Further information was collected from relatives and social workers. Forty per cent of those interviewed qualified as abstinent, 9% had improved, 3% were controlled drinkers, 5% had become worse and 43% had not improved. Specific aspects of the program are discussed.