Wirksamkeit eines spezifisch für Zwangsstörungen entwickelten stationären Gruppentherapiekonzepts bei gleichzeitiger Verhaltenstherapie und pharmakologischer Behandlung

Purpose: The goal of this treatment trial was to investigate the efficacy of an inpatient group therapy program specifically designed for patients suffering from Obsessive Compulsive Disorder (OCD, ICD 10, F 42). Methods: In the experimental group (EG; n = 14) the specific group therapy was carried out in addition to individual cognitive-behavioral therapy, the control group (KG; n = 16) received non-specific group therapy in mixed patient-groups in addition to individual therapy. 7 patients (EG = 3, KG = 4) received also Selective Serotonin re-uptake inhibitors (SSRIs). Y-BOCS, BDI, and STAI-X1 were performed pre- and post-treatment. Furthermore therapists' ratings and self ratings were taken. Results: At post-treatment both groups showed significant improvement of the symptomatology. For the EG the Y-BOCS mean was reduced from 23.64 to 11.35, for the KG from 23.81 to 12.81. The group comparison showed no significant differences (alpha = 0.05) in clinical measurements, therapists' and self ratings. However, there were significantly more responders (improvement >50%, Y-BOCS) in the EG and treatment duration was shorter by 15 days. Conclusions: Clinical outcome in the EG was not superior. However, the specific group therapy for OCD contributes to an economic and effective treatment

Kinematical analysis of emotionally induced facial expressions in patients with obsessive–compulsive disorder

Background: Motor function is deficient in many patients with obsessive–compulsive disorder (OCD), especially in the face. To investigate subtle motor dysfunction, kinematical analysis of emotional facial expressions can be used. Our aim was to investigate facial movements in response to humorous film stimuli in OCD patients.; Method: Kinematical analysis of facial movements was performed. Ultrasound markers at defined points of the face provided exact measurement of facial movements, while subjects watched a humorous movie (‘Mr Bean’). Thirty-four OCD patients (19 male, 15 female; mean (S.D.) age: 35·8 (11·5) years; mean (S.D.) total Y-BOCS score: 25·5 (5·9)) were studied in unmedicated state and after a 10-week treatment with the SSRI sertraline. Thirty-four healthy controls (19 male, 15 female; mean (S.D.) age: 37·5 (13·1) years) were also investigated.; Results: At baseline, OCD patients showed significantly slower velocity at the beginning of laughing than healthy controls and a reduced laughing frequency. There was a significant negative correlation between laughing frequency and severity of OCD symptoms. Ten weeks later a significant increase of laughing frequency and initial velocity during laughing was found.; Conclusions: Execution of adequate facial reactions to humour is abnormally slow in OCD patients. Susceptibility of OCD patients with regard to emotional stimuli is less pronounced than in healthy subjects. This phenomenon is closely correlated to OCD symptoms and is state-dependent.Peer Reviewe

Der frühe Beginn der Zwangsstörung

Einleitung: Die vorliegende Untersuchung geht der Fragestellung nach, ob sich eine Zwangsstörung, die bereits im Kindes- bzw. Jugendalter beginnt, von einer Zwangsstörung, die erst im Erwachsenenalter beginnt, hinsichtlich Schweregrad und Symptomatik unterscheidet. Patienten und Methoden: Eine Stichprobe von 370 Patienten mit Zwangsstörung (ICD-10 F42), die sich zwischen 1998 und 2002 stationär in der Psychosomatischen Klinik Windach befanden, wurde in eine Early-Onset-Gruppe (Störungsbeginn ≤15 Jahre) und in eine Late-Onset-Gruppe (Störungsbeginn ≥16 Jahre) aufgeteilt. Die Gruppen wurden über ICD-10-Diagnosen und Y-BOCSWerte verglichen. Ergebnisse: Beim Schweregrad zeigte sich, dass 20,5% der Early-Onset-Gruppe, aber lediglich 8,7% der Late-Onset-Gruppe unter einer «massiven Zwangsstörung» leiden. Bei der Symptomatik zeigte sich, dass die Early-Onset-Gruppe häufiger die Diagnose «Zwangsgedanken und -handlungen gemischt» (76,9%)erhält als die Late-Onset-Gruppe (61,8%). Außerdem nennt die Early-Onset-Gruppe sowohl für die Gegenwart als auch für die Vergangenheit mehr Symptome als die Late-Onset-Gruppe (Gegenwart 8,2 vs. 7,0; Vergangenheit 5,5 vs. 3,9 Symptomgruppen). Weiter ergaben sich inhaltliche Unterschiede der Zwangsgedanken und Zwangshandlungen. Schlussfolgerungen: Early-Onset-Patienten scheinen häufiger von einer massiven Form der Zwangsstörung und einer größeren Symptomvielfalt betroffen zu sein als Late-Onset-Patienten. Ob es sich bei der Zwangsstörung mit Beginn im Kindes- und Jugendalter um einen abgrenzbaren Subtypus handelt, konnte jedoch in dieser Untersuchung nicht eindeutig geklärt werden und bedarf weiterer Forschungen.Introduction: This study investigates if obsessive compulsive disorder with early onset differs in severity and symptomatology from that with late onset. Patients and Methods: A sample of 370 patients with obsessive compulsive disorder (OCD; ICD 10 F42) who received in-patient treatment at the psychosomatic clinic of Windach between 1998 and 2002 were divided into an early-onset group (onset ≤15 years) and a late-onset group (onset ≥16 years). Groups were compared regarding ICD-10 diagnosis and Y-BOCS scores. Results: Considering severity of the disorder 20.5% of the early-onset group but merely 8.7% of the late-onset group suffered from an extreme form of OCD. With respect to symptomatology, the early-onset group was diagnosed with ‘obsessions and compulsions, mixed’ (76.9%) more often than the lateonset group (61.8%). Also, the early-onset group reported a wider variety of symptoms both for the present and for the past than the late-onset group (present 8,2 vs 7.0; past 5.5 vs 3.9 types of symptoms). There were also differences in the content of rumination and types of compulsive rituals. Conclusions: Patients with early-onset OCD seem to be more frequently affected by an extreme form of OCD and to experience a higher variety of symptoms than patients with late-onset OCD. If early-onset OCD can be considered a distinct subtype could not be answered unequivocally by the results of this study. This question needs additional research

Predictors of nursing home admission of individuals without a dementia diagnosis before admission - results from the Leipzig Longitudinal Study of the Aged (LEILA 75+)

<p>Abstract</p> <p>Background</p> <p>In previous decades a substantial number of community-based studies mostly including dementia cases examined predictors of nursing home admission (NHA) among elderly people. However, no one study has analysed predictors of NHA for individuals without developing dementia before NHA.</p> <p>Methods</p> <p>Data were derived from the Leipzig Longitudinal Study of the Aged, a population-based study of individuals aged 75 years and older. 1,024 dementia-free older adults were interviewed six times on average every 1.4 years. Socio-demographic, clinical, and psychometric variables were obtained. Kaplan-Meier estimates were used to determine mean time to NHA. Cox proportional hazards regression was used to examine predictors of long-term NHA.</p> <p>Results</p> <p>Of the overall sample, 7.8 percent of the non-demented elderly (n = 59) were admitted to nursing home (NH) during the study period. The mean time to NHA in the dementia-free sample was 7.6 years. Characteristics associated with a shorter time to NHA were increased age, living alone, functional and cognitive impairment, major depression, stroke, myocardial infarction, a low number of specialist visits and paid home helper use.</p> <p>Conclusions</p> <p>Severe physical or psychiatric diseases and living alone have a significant effect on NHA for dementia-free individuals. The findings offer potentialities of secondary prevention to avoid or delay NHA for these elderly individuals. Further investigation of predictors of institutionalization is warranted to advance understanding of the process leading to NHA for this important group.</p

Atypical Self-Focus Effect on Interoceptive Accuracy in Anorexia Nervosa

Background: Interoceptive abilities are known to be affected in anorexia nervosa (AN). Previous studies could show that private self-focus can enhance interoceptive accuracy (IAcc) in healthy participants. As body dissatisfaction is high in AN, confrontation with bodily features such as the own face might have a directly opposed effect in AN. Whether patients with AN can benefit from self-focus in their IAcc and whether this pattern changes over the time-course of cognitive behavioral therapy was investigated in this study. Methods: 15 patients with AN from the Psychosomatic Clinic in Windach were assessed three times in the time course of a standardized cognitive-behavioral therapy. They were compared to 15 controls, recruited from Ulm University and tested in a comparable setting. Both groups performed the heartbeat perception task assessing interoceptive accuracy (IAcc) under two conditions either enhancing (Self) or decreasing (Other) self-focused attention. Furthermore, body dissatisfaction was assessed by a subscale of the Eating Disorder Inventory 2. Results: Patients with AN scored higher in IAcc when watching others’ faces as compared to one’s own face while performing the heartbeat perception task. The opposite pattern was observed in controls. IAcc remained reduced in AN as compared to controls in the time-course of cognitive-behavioral therapy, while body-dissatisfaction improved in AN. High body dissatisfaction was related to poorer IAcc in the Self condition. Conclusions: Our findings suggest that using self-focused attention reduces IAcc in AN while the opposite pattern was observed in controls. Confronting anorexic patients with bodily features might increase body-related avoidance and therefore decrease interoceptive accuracy. The current study introduces a new perspective concerning the role of interoceptive processes in AN and generates further questions regarding the therapeutic utility of methods targeting self-focus in the treatment of AN

Treino cognitivo em idosos e efeitos nas funções executivas

El envejecimiento se asocia comúnmente con el deterioro cognitivo y la pérdida de otras capacidades, lo cual conlleva la necesidad de investigar elementos que puedan contribuir a las intervenciones preventivas de rehabilitación cognitiva y que tienen como objetivo garantizar la calidad de vida de los ancianos. El objetivo de este estudio fue caracterizar ancianos que se inscribieron en esta intervención, para medir los efectos del entrenamiento cognitivo, con énfasis en las funciones ejecutivas, comparando un grupo experimental con un grupo control. Se trata de una investigación cuantitativa, con un diseño cuasi-experimental; es correlacional y comparativa, con pre y post-test e intervención. La muestra estuvo conformada por 83 ancianos, dividida en un grupo experimental (GE) (45 personas) y un grupo control (GC) (38 personas). Se utilizaron los siguientes instrumentos: entrevista neuropsicológica semiestructurada sobre características sociodemográficas; Examen Mínimo del Estado Mental (Mini Mental State o MMSE, por sus siglas en inglés); Inventario de Ansiedad Beck (BAI, por sus siglas en inglés); Escala de Depresión Geriátrica (GDS, por sus siglas en inglés); subpruebas WAIS-III: prueba de amplitud de dígitos (Digit Span), vocabulario, diseño con bloques, codificación, Secuenciación de Letras y Números (LNS por sus siglas en inglés), y la búsqueda de símbolos; Test de Trazos (TMT por sus siglas en inglés); Figuras Complejas de Rey; Paradigma de Sternberg; tareas de fluidez verbal sobre semántica (animales) y fonemas (F-A-S); Prueba de Aprendizaje Verbal-auditiva de Rey (RVLT por sus siglas en inglés); Prueba de Stroop: colores y palabras; tareas ir/no ir; y Test Wisconsin de Clasificación de Cartas (WCST por sus siglas en inglés). Los resultados de la comparación entre los grupos mostraron que hubo una diferencia significativa en cuanto al número de errores en el Paradigma de Sternberg y las categorías completas del WCST. Las comparaciones intragrupales mostraron que el GE tuvo mejores resultados después de la intervención en las siguientes pruebas: GDS, RAVLT, Figuras Complejas de Rey (memoria), prueba de amplitud de dígitos y vocabulario.O envelhecimento está comumente relacionado ao declínio cognitivo e a outras perdas de diferentes habilidades, o que aponta a necessidade de buscar elementos que possam contribuir para intervenções preventivas de reabilitação cognitiva, que tenham como objetivo assegurar uma melhor qualidade de vida do idoso. O objetivo deste estudo é caracterizar os idosos participantes, mensurar os efeitos do treino cognitivo, com ênfase nas funções executivas, comparados a um grupo controle. Trata-se de uma pesquisa do tipo quantitativa, com delineamento quase experimental, correlacional e comparativa com pré e pós-teste e de intervenção. Houve grupo controle para comparação. A mostra foi composta por 83 idosos da população geral, divididos em 45 idosos que fizeram parte do Grupo Experimental (GE) e 38 idosos participantes do Grupo Controle (GC). Instrumentos utilizados: Entrevista neuropsicológica sociodemográfica; Mini Exame do Estado Mental (MEEM); Inventário de Ansiedade de Beck (BAI); Escala de Depressão Geriátrica (GDS); Subtestes Dígitos, Vocabulário, Cubos, Código, Sequência Números e Letras (SNL); Procurar Símbolos (WAIS-III) ; Trail Makint Test (TMT); Figuras Complexas de Rey; Paradigma de Sternberg; Tarefas de fluência verbal (letras F, A, S); Rey Auditory-Verbal Learning Test (RVLT); Teste Stroop; Tarefas go-no-go e Teste Wisconsin (WCST). Os resultados mostraram na comparação entre os grupos, que houve diferença significativa quanto à variação no número de erros no Paradigma de Sternberg, Categorias Completadas do WCST e Procurar Símbolos. Nas comparações intragrupo, o Grupo Experimental melhorou significativamente os escores após a intervenção dos instrumentos GDS, RAVLT, Figuras Complexas de Rey–memória, Dígitos OD, Dígitos Total e Vocabulário.Aging is commonly associated with cognitive decline and loss of other abilities, which leads to the need for researching elements that may contribute to preventive cognitive rehabilitation interventions aiming to guarantee the elderly a good quality of life. The objective of this study is to characterize elderly who enrolled in this intervention, to measure the effects of cognitive training with emphasis on executive functions, by comparing an Experimental to a Control group. This is a quantitative research that used a quasi-experimental design; it is correlational and comparative, involving pre- and posttesting and intervention. The sample was formed by 83 elders, split into an Experimental Group (EG) (45 people) and a Control Group (GC) (38 people). The instruments used were the following: a neuropsychological semi-structured interview about sociodemographic characteristics; Mini Mental State Examination (MMSE); Beck Anxiety Inventory (BAI); Geriatric Depression Scale (GDS); WAIS-III subtests: Digit Span, Vocabulary, Block Design, Coding, Letter-Number Sequencing (LNS), and Symbol Search; Trail Making Test (TMT); Ray Complex Figures; Sternberg Paradigm; verbal fluency tasks about semantics (animals) and phonemes (F-A-S); Rey Auditory-Verbal Learning Test (RVLT); Stroop Test: colors and words; go/ no go tasks; and the Wisconsin Card Sorting Test (WCST). The results from the comparison between groups showed that there was a significant difference regarding the number of errors in the Sternberg Paradigm and Completed Categories of the WCST. Intragroup comparisons showed that the EG had better results after the intervention on the following tests: GDS, RAVLT, Rey Complex Figures (memory), Digit Span and Vocabulary

Prediction of Dementia in Primary Care Patients

BACKGROUND: Current approaches for AD prediction are based on biomarkers, which are however of restricted availability in primary care. AD prediction tools for primary care are therefore needed. We present a prediction score based on information that can be obtained in the primary care setting. METHODOLOGY/PRINCIPAL FINDINGS: We performed a longitudinal cohort study in 3.055 non-demented individuals above 75 years recruited via primary care chart registries (Study on Aging, Cognition and Dementia, AgeCoDe). After the baseline investigation we performed three follow-up investigations at 18 months intervals with incident dementia as the primary outcome. The best set of predictors was extracted from the baseline variables in one randomly selected half of the sample. This set included age, subjective memory impairment, performance on delayed verbal recall and verbal fluency, on the Mini-Mental-State-Examination, and on an instrumental activities of daily living scale. These variables were aggregated to a prediction score, which achieved a prediction accuracy of 0.84 for AD. The score was applied to the second half of the sample (test cohort). Here, the prediction accuracy was 0.79. With a cut-off of at least 80% sensitivity in the first cohort, 79.6% sensitivity, 66.4% specificity, 14.7% positive predictive value (PPV) and 97.8% negative predictive value of (NPV) for AD were achieved in the test cohort. At a cut-off for a high risk population (5% of individuals with the highest risk score in the first cohort) the PPV for AD was 39.1% (52% for any dementia) in the test cohort. CONCLUSIONS: The prediction score has useful prediction accuracy. It can define individuals (1) sensitively for low cost-low risk interventions, or (2) more specific and with increased PPV for measures of prevention with greater costs or risks. As it is independent of technical aids, it may be used within large scale prevention programs