Der inferenzbasierte Ansatz bei Zwangsstörungen

Obwohl die kognitive Verhaltenstherapie, häufig in der Form der Exposition und Reaktionsverhinderung, das in der Behandlung der Zwangsstörung am weitesten verbreitete Behandlungsverfahren darstellt, profitieren Betroffene mit bestimmten Subtypen der Zwangserkrankung (z.B. überwertigen Ideen oder ich-syntonen Zwangsgedanken) davon nur unzureichend oder gar nicht. Aufgrund der begrenzten Erfolge von auf verhaltenstherapeutischen oder kognitiv-verhaltenstherapeutischen Modellen basierenden Verfahren hat sich die Forschung vermehrt ausschließlich kognitiven Theorien und Behandlungsmodellen zugewandt. Der inferenzbasierte Ansatz zur Behandlung der Zwangsstörung geht davon aus, dass zwangstypische Kognitionen und Bewertungen von vorausgehenden Zweifeln und Inferenzen herrühren. Dieser Ansatz konzentriert sich auf die fehlerhaften Denkprozesse, die dem zwanghaften Zweifeln zugrunde liegen, welches Zwangsverhalten auslöst. Die vorliegende Arbeit fasst den gegenwärtigen Stand des inferenzbasierten Modells und die es stützenden empirischen Befunde zusammen

Translated article: Current Status of Research Concerning Incompleteness in Obsessive-Compulsive Disorder

<div>In this article, the research on incompleteness experiences</div><div>in obsessive-compulsive disorder (OCD) is reviewed.</div><div>Empircal data concerning the phenomenological</div><div>differentiation between self-related incompleteness (SI)</div><div>and ‘not just right experiences’ (NJREs) are presented.</div><div>Diagnostic</div><div>instruments and empirical results concerning</div><div>frequency, association with different symptom-based subtypes</div><div>and with symptom severity as well as the specificity</div><div>of NJREs for OCD are outlined. Considerations and results</div><div>concerning the theoretical conceptualization of incompleteness</div><div>phenomena are summarized (SI as an OCD-specific</div><div>form of depersonalisation/derealization, with the</div><div>‘Two-Stages-Model’ as an etiological hypothesis; NJREs</div><div>as sensation-based perfectionism related to obsessivecompulsive</div><div>personality features and tic disorders, with a</div><div>presumed neurobiological origin). So far, there is a lack of</div><div>studies evaluating modifications of cognitive-behavioral</div><div>methods tailored to incompleteness-related OCD.</div

Racial Differences in the Relationship of Glucose Concentrations and Hemoglobin A1c Levels

Background: Debate exists as to whether the higher hemoglobin A1c (HbA1c) levels observed in black persons than in white persons are due to worse glycemic control or racial differences in the glycation of hemoglobin. Objective: To determine whether a racial difference exists in the relationship of mean glucose and HbA1c. Design: Prospective, 12-week observational study. Setting: 10 diabetes centers in the United States. Participants: 104 black persons and 104 white persons aged 8 years or older who had had type 1 diabetes for at least 2 years and had an HbA1c level of 6.0% to 12.0%. Measurements: Mean glucose concentration, measured by using continuous glucose monitoring and compared by race with HbA1c, glycated albumin, and fructosamine values. Results: The mean HbA1c level was 9.1% in black persons and 8.3% in white persons. For a given HbA1c level, the mean glucose concentration was significantly lower in black persons than in white persons (P = 0.013), which was reflected in mean HbA1c values in black persons being 0.4 percentage points (95% CI, 0.2 to 0.6 percentage points) higher than those in white persons for a given mean glucose concentration. In contrast, no significant racial differences were found in the relationship of glycated albumin and fructosamine levels with the mean glucose concentration (P \u3e 0.20 for both comparisons). Limitation: There were too few participants with HbA1c levels less than 6.5% to generalize the results to such individuals. Conclusion: On average, HbA1c levels overestimate the mean glucose concentration in black persons compared with white persons, possibly owing to racial differences in the glycation of hemoglobin. However, because race only partially explains the observed HbA1c differences between black persons and white persons, future research should focus on identifying and modifying barriers impeding improved glycemic control in black persons with diabetes. Primary Funding Source: Helmsley Charitable Trust