bluuebunny/crossref_metadata_2025 huggingface dataset:
Die tagesklinische Behandlung in der Kinder- und Jugendpsychiatrie
Authors: Graf Schimmelmann B. , Schulte-Markwort M. , Richter R.
Published: April 2003

Zusammenfassung: Fragestellung: Die Geschichte der Tagesklinik in der Kinder- und Jugendpsychiatrie ist sehr kurz. Entsprechend beschäftigen sich Tageskliniken weiterhin mit Konzepten, Outcome-Studien sowie Indikationen und Kontraindikationen tagesklinischer Behandlungen. Methoden: Die englisch- und deutschsprachige Literatur zwischen 1960 und 2000 wurde auf empirische Studien zur tagesklinischen Behandlung in der Kinder- und Jugendpsychiatrie hin ausgewertet. Outcome-Studien werden referiert und diskutiert. Ergebnisse: Die Ergebnisse empirischer Studien sind heterogen und lassen bislang kaum Rückschlüsse auf Indikationen und Kontraindikationen tagesklinischer Behandlungen zu. Insgesamt sind für sehr unterschiedliche Störungsbilder positive Behandlungsergebnisse dokumentiert worden. Die elterliche Mitarbeit im therapeutischen Prozess wird weitgehend übereinstimmend als prädiktiv für ein positives Behandlungsergebnis angesehen. Schlussfolgerungen: Über randomisierte kontrollierte Outcome-Studien hinaus ist in künftigen Studien zu evaluieren, für welche Patienten in einer gegebenen regionalen Versorgungslandschaft mit welchen Therapiezielen und -ergebnissen sowie mit welchen Kosten von Tageskliniken ein Beitrag zur Versorgung geleistet werden kann.
Transkranielle Magnetstimulation in der Kinder- und Jugendpsychiatrie: Exzitabilität des motorischen Systems bei Tic-Störungen und/oder Aufmerksamkeitsdefizit-/ Hyperaktivitätsstörungen
Authors: Moll G.H. , Heinrich H. , Rothenberger A.
Published: April 2003

Zusammenfassung: Mit der transkraniellen Magnetstimulation (TMS) kann die Exzitabilität des motorischen Systems direkt in vivo untersucht werden. Diese Methode wurde deshalb bei Kindern mit solchen Störungsbildern angewandt, bei denen sich eine unzureichende Steuerung, Kontrolle und/oder Regulation motorischer Abläufe feststellen lässt: Eine “musterbezogene” Überaktivität bei Tic-Störungen, eine “allgemeine” motorische Überaktivität bei Aufmerksamkeitsdefizit-/Hyperaktivitätsstörungen (ADHS). Im Vergleich zu gesunden Kindern waren bei Kindern mit diesen hypermotorischen Störungsbildern unterschiedliche Auffälligkeiten festzustellen: (1) Eine verkürzte Kortikale Silent Period und damit ein Hinweis auf defizitäre inhibitorische Prozesse wahrscheinlich auf Ebene der Basalganglien bei Kindern mit Tic-Störungen (offenbar kein Einfluss klinisch wirksamer Medikamente), (2) eine verminderte intrakortikale Inhibition und damit ein Hinweis auf defizitäre inhibitorische Prozesse eher im Bereich des Motorkortex bei Kindern mit ADHS (Zunahme der intrakortikalen Inhibition unter Methylphenidatgabe). (3) Bei Kindern mit komorbider ADHS und Tic-Störung waren beide neurophysiologischen Veränderungen i.S. eines “additiven” Inhibitionsdefizites im motorischen System aufzeigbar. Mit diesen TMS-Untersuchungen konnten bei Kindern mit den hypermotorischen Störungsbildern Tic-Störungen und ADHS neue Befunde zur Darstellung neurobiologischer Grundlagen (“Inhibitionsdefizite im motorischen System”), zur Frage der Komorbidität (“additiver Effekt im motorischen System”) sowie zum Wirkmechanismus entsprechender Psychopharmaka (“Verbesserung des Inhibitionsvermögens im motorischen System bei ADHS unter Methylphenidat”) erarbeitet werden.
Zur Spezifitätshypothese eines Theory-of-Mind Defizits beim Frühkindlichen Autismus
Authors: Kißgen R. , Schleiffer R.
Published: April 2003

Zusammenfassung: Fragestellung: In einer Replikationsstudie des Sally-und-Anne-Tests nach Baron-Cohen, Leslie & Frith (1985) soll die Spezifitätshypothese eines Theory-of-Mind Defizits beim Frühkindlichen Autismus erstmals im deutschen Sprachraum überprüft werden. Methodik: Der Sally-und-Anne-Test wurde mit 16 autistischen, 24 Probanden mit Down-Syndrom und mit 20 normal entwickelten Probanden im Kindergartenalter durchgeführt. Zusätzlich wurden bei den autistischen und den Probanden mit Down-Syndrom Intelligenztestungen mittels CPM/SPM durchgeführt. In den Familien der Probanden mit Frühkindlichem Autismus und Down-Syndrom wurde zusätzlich das ADI-R durchgeführt. Ergebnisse: Auf der Basis der klinischen Diagnosekriterien für Frühkindlichen Autismus sprechen die Ergebnisse der vorliegenden Replikationsstudie gegen die Annahme, dass ein Theory-of-Mind Defizit autismusspezifisch sei, da 6 von 16 (37,5%) autistischen Probanden die Aufgaben lösten und damit ein besseres Resultat als die Probanden der Kontrollgruppen erzielten. Nach ADI-R Diagnostik konnte lediglich bei 8 der 16 autistischen Probanden die Diagnose des Frühkindlichen Autismus aufrecht erhalten werden. Nur einer dieser 8 Probanden bewältigte die Theorie-of-Mind Aufgaben. Die theory-of-mind positiven autistischen Probandenunterscheidet sich signifikant von den autistischen Probanden ohne dieses Potenzial in den Ergebnissen der Intelligenztestungen. Schlussfolgerungen: Das Ausmaß und die Spezifität eines Theory-of-Mind Defizits bei autistischen Menschen bleibt umstritten. Im Rahmen weiterer Forschungsarbeiten scheint es dringend indiziert, die diagnostische Abklärung des Störungsbildes Frühkindlicher Autismus über das ADI-R vorzunehmen. Die vorliegenden Ergebnisse lassen den Schluss zu, dass die klinische Diagnostik nicht hinreichend genau zwischen Frühkindlichem Autismus und geistiger Behinderung ohne Autismus differenziert.
Verhaltenstherapie bei Kindern mit aggressiv-dissozialen Störungen
Authors: Brezinka V.
Published: April 2003

Zusammenfassung: Aggressiv-dissoziale Störungen bei Kindern und Jugendlichen kommen häufig vor und haben eine schlechte Prognose; sie werden stets mehr als chronische Störung aufgefasst, die sowohl Behandlung als lebenslange Betreuung erfordert. Verhaltenstherapie gilt als effektivste Behandlung, wobei unterschieden wird zwischen Elterntrainings und sozial-kognitiven Problemlösetrainings. Bei jüngeren Kindern ist ein Elterntraining indiziert, bei älteren Kindern zusätzlich ein Problemlösetraining. Die Effekte von Elterntrainings wurden in zahlreichen Studien nachgewiesen; Elterntrainings gelten als «empirically supported treatment», das strengste Kriterium, dem psychologische Behandlungen entsprechen müssen. Auch mit sozial-kognitiven Problemlösetrainings wurden bei klinischen Gruppen signifikante Veränderungen erzielt; sie entsprechen dem etwas weniger strengen Kriterium «probably efficacious». Probleme von Elterntrainings und Problemlösetrainings sind die hohe Abbruchrate bei den Eltern mit den meisten Risikofaktoren und die Tatsache, dass viele Kinder nach einem Problemlösetraining zwar signifikante Verbesserungen erreicht haben, aber immer noch im klinischen Bereich für aggressives Verhalten bleiben. Zur Optimierung des Behandlungserfolgs wurden in den letzten Jahren komplexe Präventionsprogramme entwickelt, die die Entwicklung von delinquentem Verhalten und einer antisozialen Persönlichkeit verhindern sollen. Die bisherigen Ergebnisse sind widersprüchlich; die ersten Resultate zweier noch laufender Studien (FAST- und LIFT-Studie) sind jedoch positiv. Ein höherer Stellenwert von Dissozialität in der kinderpsychiatrisch-psychotherapeutischen Versorgung wäre angesichts der Prävalenz und Folgenschwere der Störung angezeigt.
Frühkindliche Psychose versus Frühkindlicher Autismus?
Authors: Niederhofer H. , Kucan S. , Hackenberg B. , Huber M. , Gasteiger W.
Published: April 2003

Zusammenfassung: Es wird über einen 4-jährigen Patienten berichtet, bei welchem seit sechs Monaten eine schleichende psychotische Entwicklung festzustellen war. Eine mehrmonatige ambulante Verlaufsbeobachtung ließ keine eindeutige differentialdiagnostische Abgrenzung eines frühkindlichen Autismus zu einer infantilen Psychose zu. Während eines einwöchigen stationären Aufenthaltes an unserer Klinik konnten rezidivierende produktiv-psychotische Episoden beobachtet werden, was schließlich zum Ausschluss der Diagnose «frühkindlicher Autismus» (ICD-10 F84.0 (Dilling et al., 1993)) und stattdessen zur Diagnose «sonstige desintegrative Störung des Kindesalters» (ICD-10: F84.3 (Dilling et al., 1993)) führte.
Thrombozytäre Serotoninkonzentration bei depressiven Kindern und Jugendlichen
Authors: Gerhard U.-J. , Blanz B. , Kluge H. , Naumann M.
Published: April 2003

Zusammenfassung: Fragestellung: In dieser Studie wurde der Frage nachgegangen, inwieweit ein Zusammenhang zwischen thrombozytärem Serotoningehalt und depressivem bzw. suizidalem Verhalten bei Kindern und Jugendlichen besteht. Methodik: Innerhalb von 16 Monaten wurde bei allen stationär aufgenommenen Patienten im Alter von 4 bis 19 Jahren (n = 145) das thrombozytäre Serotonin mittels Fluoreszenzspektroskopie bestimmt. Zeitnah wurde bei einem Teil der Patienten der Schweregrad der depressiven Symptome durch das DIKJ erhoben. Die verschiedenen Diagnosegruppen wurden anhand der Kriterien der ICD-10 gebildet. Ergebnisse: Mit zunehmendem Alter zeigte sich ein Abfall des Serotiningehaltes im Thrombozyten. Die männlichen Patienten wiesen höhere Serotoninwerte im Vergleich zu den weiblichen auf, wobei die Mädchen allerdings höhere Depressivitätsscores im DIKJ zeigten. Es bestand eine negative Korrelation zwischen dem thrombozytären Serotonin und dem im DIKJ gemessenen Depressivitätsgrad über alle Diagnosegruppen. Unabhängig von der klinischen Diagnose ergaben sich signifikant niedrigere Serotoninkonzentrationen bei den Kindern und Jugendlichen, die unmittelbar vor der stationären Aufnahme einen Suizidversuch unternommen hatten. Auch bei der Gruppe der depressiven Störungen kristallisierte sich eine Untergruppe mit signifikant niedrigerem Serotoningehalt heraus, die kurz zuvor einen Suizidversuch verübt hatten. Schlussfolgerungen: Die vorliegenden Untersuchungen stützen die Auffassung, dass Depressivität in der Kindheit und Jugend mit einem Mangel an Serotonin im Thrombozyten bzw. analog zum Thrombozytenmodell in zentralen Strukturen verbunden ist und ein relatives Defizit an Serotonin ein Suizidalitätsmarker sein könnte.
Die selektiven Serotonin-Wiederaufnahmehemmer und die neueren Antidepressivasubstanzen in der Kinder- und Jugendpsychiatrie
Authors: Heiser P. , Remschmidt H.
Published: April 2003

Zusammenfassung: Fragestellung: Seit der ersten Publikation über einen selektiven Serotonin-Wiederaufnahmehemmer (SSRI) 1974 kam es nicht nur zur Weiterentwicklung der Wirkstoffe aus der Gruppe der SSRI, sondern es sind auch neue Substanzgruppen entwickelt worden. Zu diesen neueren Substanzgruppen gehören, gegliedert nach dem pharmakologischen Wirkmechanismus, die Serotonin2-Antagonisten/Serotonin-Wiederaufnahmehemmer (SARI), die noradrenergen und selektiv serotonergen Antidepressiva (NaSSA), die Noradrenalin- und Dopamin-Wiederaufnahmehemmer (NDRI) und die Serotonin- und Noradrenalin-Wiederaufnahmehemmer (SNRI). In dieser Übersichtsarbeit werden die Wirkmechanismen und Nebenwirkungssprofile der neuen Antidepressivasubstanzen dargestellt und mit den älteren Substanzgruppen wie trizyklischen Antidepressiva (TZA), MAO-Hemmern (MAOH) und SSRI verglichen. Es werden Studien mit Antidepressiva bei Kindern und Jugendlichen mit Depression vorgestellt und verglichen, ob es Unterschiede zwischen den älteren und neueren Antidepressiva gibt. Methode: Es wurde eine Medline Recherche bis einschließlich Januar 2002 durchgeführt. Schlussfolgerungen: Die bis jetzt durchgeführten Studien mit den neueren Antidepressiva sind vielversprechend. Allerdings sind weitere doppelblind, Placebo-kontrollierte Studien notwendig.
Schlafstörungen bei kinder- und jugendpsychiatrischen Erkrankungen
Authors: Hagenah U.
Published: April 2003

Zusammenfassung: Schlafstörungen als Symptom zahlreicher kinder- und jugendpsychiatrischer Störungsbilder komplizieren häufig den Verlauf und die Behandlung der Grunderkrankung. Organische Störungen wie die Narkolepsie oder das Kleine-Levin-Syndrom können zu differentialdiagnostischen Schwierigkeiten und Fehleinschätzungen führen. Unklar ist, ob spezifische Veränderungen der Schlafarchitektur bereits im Kindes- und Jugendalter bestehen und damit als biologischer Trait-Marker für psychiatrische Erkrankungen zu verstehen sind. Während für das Erwachsenenalter die Bedeutung von Schlafstörungen vor allem für die Entwicklung späterer depressiver Störungen belegt werden konnte, ist derzeit offen, ob es sich bei persistierenden Schlafstörungen im Kindesalter um Vulnerabilitätsmarker für psychiatrische Erkrankungen handelt. In der vorliegenden Literaturübersicht sollen Wechselwirkungen zwischen Schlafstörung und psychischer Störung aufgezeigt und die Bedeutung der Berücksichtigung von Schlafstörungen für Diagnostik und Therapie kinder- und jugendpsychiatrischer Störungsbilder unterstrichen werden.
Rückblick auf die Eltern: Der Fragebogen zum erinnerten elterlichen Erziehungsverhalten (FEE)
Authors: Schumacher Jörg , Eisemann Martin , Brähler Elmar
Published: April 2003

Zusammenfassung. Im Beitrag werden Ergebnisse der teststatistischen Überprüfung eines neuen Fragebogens zur rückblickenden Erfassung des perzipierten elterlichen Erziehungsverhaltens an einer bevölkerungsrepräsentativen Stichprobe (N = 2968) vorgestellt. Der Fragebogen zum erinnerten elterlichen Erziehungsverhalten (FEE), der konzeptionell auf den international in der klinischen Angst- und Depressionsforschung häufig verwendeten EMBU-Fragebogen zurückgeht, erweist sich dabei als ein reliables und valides Forschungsinstrument. Der FEE gestattet es, Erinnerungen an das Erziehungsverhalten der Eltern (jeweils getrennt für Vater und Mutter) bezüglich der faktorenanalytisch ermittelten Dimensionen “Ablehnung und Strafe”, “Emotionale Wärme” sowie “Kontrolle und Überbehütung” zu erfassen. In unserer Studie ließen sich darüber hinaus signifikante Zusammenhänge zwischen dem erinnerten elterlichen Erziehungsverhalten auf der einen Seite und der Lebenszufriedenheit sowie interpersonalen Problemen auf der anderen Seite aufzeigen. Personen, die rückblickend ein ungünstiges elterliches Erziehungsverhalten schildern, berichten aktuell über eine geringere Lebenszufriedenheit und über mehr Probleme im Umgang mit anderen Menschen.
Common Risk Factors in Adolescent Suicide Attempters Revisited
Authors: Laederach Jérôme , Fischer Werner , Bowen Philippa , Ladame François
Published: April 2003

The principle risk factors for suicide attempts in adolescents discussed in the literature are examined on the basis of data from a study carried out at the Geneva University Hospitals. 148 adolescents aged between 15 and 19 years form the sample. The results concerning mental disorders at the time of the suicide attempt confirm the clear predominance of affective disorder as well as the elevated frequency of comorbidity. Other main risk factors include suicidal behavior in family members and among acquaintances, poor state of health, poor integration into school or professional life, as well as sexual abuse.
Suicide Attempts During Adolescence: Systematic Hospitalization and Crisis Treatment
Authors: Ottino Jérôme
Published: April 2003

This paper deals with an inpatient unit that recently opened in Geneva, specializing in the treatment of patients aged 16-21 years who had attempted suicide or felt the desire to commit suicide. This particular center was established because of the significant weaknesses found in the provision of care to adolescents who had attempted suicide. Despite the growing interest of health workers in this area of study over recent years, the frequency of suicide among the young has not decreased and there are numerous recurrences of the suicide attempts. Further, all efforts to improve the adolescents' compliance with psychiatric treatment have failed to date. The number of drop-outs from treatment is still very high. Thus, the objectives of our inpatient unit are as follows: (1) to overcome initial resistance to treatment and to improve long-term compliance; (2) to decrease the number of recurrent attempts as a consequence of the above, thus increasing life expectancy; (3) to offer the adolescents who have tried (or have contemplated) committing suicide an improved quality of life, after first helping them overcome the suicidal crisis. To achieve these goals, the therapeutic team of the unit proposes short stays during which the work with the adolescents consists of a very intensive psychoanalytic-oriented crisis intervention. Numerous practical aspects of our therapeutic approach in the inpatient unit are related here in detail, always with reference to our theoretical hypothesis.
Efficacy of Crisis Intervention
Authors: Reisch Thomas , Schlatter Petra , Tschacher Wolfgang
Published: April 2003

This study assesses the efficacy of the treatment approach implemented in the Bern Crisis Intervention Program, where particular emphasis is placed on the remediation of suicide ideation and suicidal behavior, and depression, fear, and phobia are generally considered to be contributing factors. Four questionnaires addressing psychopathology, emotional well-being, social anxiety, and personality were administered prior to and after the treatment of 51 patients over a period of 2 to 3 weeks. The reduction of symptoms contributing to suicidal ideation and behavior was interpreted as indirect evidence of an antisuicidal effect of the program. Significant improvements were found in the psychopathology ratings, with depression and anxiety showing the largest reductions. The impact on personality and social phobia, however, was only moderate, and on average patients still exhibited symptoms after attending the program. This residual symptomatology points to the necessity of introducing a two-step therapy approach of intensive intervention targeted at the precipitating causes of the crisis, augmented by long-term therapy to treat underlying problems.
Treatment of Mental Disorders in Seven Physicians Committing Suicide
Authors: Lindeman S , Henriksson M , Isometsä E , Lönnqvist J
Published: April 2003

Through psychological autopsy seven cases of physician suicide were studied. All seven victims received a diagnosis of current mood disorder, two of them bipolar disorder. Five had suffered a disabling physical condition. None of the victims had had adequate treatment with antidepressant or mood-stabilizing drugs, nor had they been in psychotherapy. Current adequate treatment for depression seems to be as rare among physician victims as among suicides with major depressive disorders in the population.
Psychopathology 8½ Years Post Parasuicide
Authors: Curran Stephen , Fitzgerald Michael , Greene Vincent T
Published: April 2003

There are few long-term follow-up studies of parasuicides incorporating face-to-face interviews. To date no study has evaluated the prevalence of psychiatric morbidity at long-term follow-up of parasuicides using diagnostic rating scales, nor has any study examined parental bonding issues in this population. We attempted a prospective follow-up of 85 parasuicide cases an average of 8½ years later. Psychiatric morbidity, social functioning, and recollections of the parenting style of their parents were assessed using the Clinical Interview Schedule, the Social Maladjustment Scale, and the Parental Bonding Instrument, respectively. Thirty-nine persons in total were interviewed, 19 of whom were well and 20 of whom had psychiatric morbidity. Five had died during the follow-up period, 3 by suicide. Migration, refusals, and untraceability were common. Parasuicide was associated with parental overprotection during childhood. Long-term outcome is poor, especially among those who engaged in repeated parasuicides.
Guns, Alcohol, and Intimate Partner Violence: The Epidemiology of Female Suicide in New Mexico
Authors: Olson Lenora , Huyler Frank , Lynch Arthur W , Fullerton Lynne , Werenko Deborah , Sklar David , Zumwalt Ross
Published: April 2003

Suicide is among the leading causes of death in the United States, and in women the second leading cause of injury death overall. Previous studies have suggested links between intimate partner violence and suicide in women. We examined female suicide deaths to identify and describe associated risk factors. We reviewed all reports from the New Mexico Office of the Medical Investigator for female suicide deaths occurring in New Mexico from 1990 to 1994. Information abstracted included demographics, mechanism of death, presence of alcohol/drugs, clinical depression, intimate partner violence, health problems, and other variables. Annual rates were calculated based on the 1990 census. The New Mexico female suicide death rate was 8.2/100,000 persons per year (n = 313), nearly twice the U. S. rate of 4.5/100,000. Non-Hispanic whites were overrepresented compared to Hispanics and American Indians. Decedents ranged in age from 14 to 93 years (median = 43 years). Firearms accounted for 45.7% of the suicide deaths, followed by ingested poisons (29.1%), hanging (10.5%), other (7.7%), and inhaled poisons (7.0%). Intimate partner violence was documented in 5.1% of female suicide deaths; in an additional 22.1% of cases, a male intimate partner fought with or separated from the decedent immediately preceding the suicide. Nearly two-thirds (65.5%) of the decedents had alcohol or drugs present in their blood at autopsy. Among decedents who had alcohol present (34.5%), blood alcohol levels were far higher among American Indians compared to Hispanics and non-Hispanic Whites (p = .01). Interpersonal conflict was documented in over 25% of cases, indicating that studies of the mortality of intimate partner violence should include victims of both suicide and homicide deaths to fully characterize the mortality patterns of intimate partner violence.
Counseling the Suicidal Client by Letter
Authors: Schustov Dmitri , Lester David
Published: April 2003

Crisis counseling by means of letters written from the client to the counselor and back is discussed, and an example is presented of counseling a suicidal adolescent using this technique.
Suicide Prevention in Schools: The Art, the Issues, and the Pitfalls
Authors: Leenaars Antoon A , Wenckstern Susanne
Published: April 2003

Suicide is a major mental health problem and public health problem worldwide. Schools and their communities must respond in a comprehensive fashion. Caplan's model of primary, secondary, and tertiary prevention—or prevention, intervention, and postvention—is proposed as a comprehensive response to suicide in youths. Current myths and facts about these fabrications are discussed for each mode of response. Research, clinical suggestions, and a call for further discussion are presented.
Season and Suicide
Authors: Preti Antonio , Miotto Paola , De Coppi Monica
Published: April 2003

Seasonal asymmetry in yearly suicide occurrence is a long-observed phenomenon in psychiatric, suicidological, and sociological research, and the effects of seasonal factors on suicidal behavior have been the focus of a number of earlier studies. Taking into account limitations of data and methods, these studies have generally favored interpretations based on psychosocial factors. Recent studies have challenged the widely held notion that seasonal effects on suicide are a unitary phenomenon, not influenced by age, gender, or circumstances of the act. In particular, the seasonal occurrence of suicides has been found to differ significantly between the young and the elderly, and differences have also been found between male and female cycles of occurrence. Suicides using violent methods have been shown to follow clearer seasonal patterns than suicides by less violent methods (such as drug or gas poisoning), possibly reflecting the greater impulsive component involved in the choice of a violent lethal means. In this paper, findings from Italy are used to illustrate the clinical implications of studies into the topic of season and suicide, with the aim of developing more effective preventative strategies.
An Exercise in Improving Suicide Reporting in Print Media
Authors: Michel Konrad , Frey Conrad , Wyss Kathrin , Valach Ladislav
Published: April 2003

This study was conducted to support the publication of guidelines for media reporting on suicide. First, quantitative and qualitative aspects of suicide reporting in Swiss print media were surveyed over a time span of 8 months. The results were presented at a national press conference, and written guidelines for suicide reporting were sent out to all newspaper editors. The results of the survey and the guidelines were discussed in a personal meeting with the Editor-in-Chief of the main tabloid. After the publication of the guidelines a second, identical survey was conducted. The main variables regarding frequency, form, and content of the newspaper reports before and after the press conference were compared. The number of articles, on the one hand, increased over the 3 years between the first and second survey, but the quality of reporting clearly improved on the other. The personal contact with the editor of the tabloid was probably the most effective means of intervention.
Telephone Crisis Intervention Skills
Authors: Bryant Richard A , Harvey Allison G
Published: April 2003

Counseling skills were evaluated in a telephone counseling service for Vietnam veterans. Thirty simulated crisis calls were made to telephone counselors by experienced clinical psychologists. The counselors' responses were rated on dimensions that indexed general counseling skills, knowledge of veteran needs, and provision of appropriate advice. Whereas the majority of callers demonstrated adequate counseling skills, many lacked knowledge of veterans' posttraumatic stress, common veteran terminology, and the nature of veterans' experiences. The findings suggest that telephone counseling services that target specific populations should employ comprehensive training to ensure that counselors possess adequate and relevant knowledge about callers and their presenting problems. The simulated caller paradigm appears to be an effective paradigm for training and evaluation of telephone counselors.
Sleep Disorder, Depression, and Suicidality in Female Sexual Assault Survivors
Authors: Krakow Barry , Artar Ali , Warner Teddy D , Melendrez Dominic , Johnston Lisa , Hollifield Michael , Germain Anne , Koss Mary
Published: April 2003

The role of sleep in psychiatric illness in general, and depression and suicidality in particular, is poorly understood and has not been well researched despite the pervasiveness of sleep complaints in these conditions. As an exploratory, hypothesis-generating study, female sexual assault survivors with posttraumatic stress disorder (n = 153) who had enrolled in a nightmare-treatment program were assessed for subjectively determined sleep breathing and sleep movement disorders. Diagnoses of potential disorders were based on clinical practice parameters and research algorithms from the field of sleep disorders medicine. Potential sleep breathing and sleep movement disorders were present in 80% of the participants (n = 123) and included three subgroups: sleep-disordered breathing only (n = 23); sleep movement disorder only (n = 45); and both sleep disorders (n = 55). Based on the HamiltonDepression Rating Scale and Suicide subscale, participants with potential sleep disorders suffered greater depression (Cohen's d = .73-.96; p < .01) and greater suicidality (Cohen's d = .57-.78; p < .05) in comparison to participants without potential sleep disorders. The group with both sleep disorders suffered from the most severe depression and suicidality. A provisional hypothesis is formulated that describes how sleep disorders may exacerbate depression and suicidality through the effects of chronic sleep fragmentation.
Epidemiology and Psychiatric Morbidity of Suicidal Ideation Among the Elderly
Authors: Barnow S , Linden M
Published: April 2003

This study investigates the epidemiology and psychiatric morbidity of the wish to be dead, suicidal ideation, and suicidal intent in a group of elderly persons (> 70 years). A representative community sample of 516 persons aged 70 to 105 was extensively investigated by psychiatrists using the structured interview GMS-A and various other self-rating and observer-rating scales. Diagnoses were made according to DSM-III-R and clinical judgment. In a cross-section of this population, we found the following prevalence rates: At the time of the study, 14.7% of the elderly community had symptoms of tiredness of life, 5.4% wished to die, and 1% showed suicidal ideation or gestures. Depending on the intensity of suicidality, 80% to 100% were clinically diagnosed as suffering from psychiatric disorders and 50-75% showed symptoms fulfilling the criteria of at least one specific psychiatric diagnosis. Further, logistic regression analysis showed a significant influence of major depression and specific DSM-III-R diagnosis on suicidality in old age. Our conclusion is that suicidal ideation in the elderly is usually a sign of a mental illness warranting diagnosis and treatment rather than assisted suicide.
Self-Report vs. Computerized Measures of Impulsivity as a Correlate of Suicidal Behavior
Authors: Horesh Netta
Published: April 2003

Objectives: To compare the use of a self-report form of impulsivity versus a computerized test of impulsivity in the assessment of suicidal adolescent psychiatric inpatients. Methods: Sixty consecutive admissions to an adolescent in patient unit were examined. The severity of suicidal behavior was measured with the Childhood Suicide Potential Scale (CSPS), and impulse control was measured with the self report Plutchik Impulse Control Scale (ICS) and with the Test of Variables of Attention (TOVA), a continuous performance test (CPT). The TOVA is used to diagnose adolescents with attention deficit disorder. Results: There was a significant but low correlation between the two measures of impulsivity. Only the TOVA commission and omission errors differentiated between adolescent suicide attempters and nonattempters. Conclusions: Computerized measures of impulsivity may be a useful way to measure impulsivity in adolescent suicide attempters. Impulsivity appears to play a small role only in nondepressed suicidal adolescents, especially boys.
Suicide, Serotonin, and the Brain
Authors: van Heeringen C.
Published: April 2003

Summary: The involvement of impaired serotonergic functioning in the development of suicidal behavior is one of the best documented findings in biological psychiatry. It is, however, less clear in which way this dysfunction contributes to the occurrence of suicidal behavior. Correlational studies have demonstrated associations between peripheral measures of serotonergic function and characteristics such as impulsivity, disinhibition, anxiety, and/or behavioral inhibition. Postmortem and neuroimaging studies have provided insight in the localization of serotonergic dysfunction in the central nervous system. Nevertheless, results in this area of research have also been contradictory. Following a short overview of recent research findings on serotonin and suicidal behavior, this paper focuses on the involvement of the prefrontal cortex of the brain in the development of suicidal behavior and on the role of serotonin in its executive functions. Based on these considerations, suggestions for future research are discussed.
Can Professionals and Nonprofessionals Work Together Following a Suicide?
Authors: Hall Barry L. , Epp Hedie L.
Published: April 2003

Summary: Suicide is the taking of one's own life by one's own hand. It is often sudden and creates many emotional reactions for the survivors left behind. Survivor responses can be impacted by a range of circumstances, from how the person died to the reactions of people to the survivor. This contribution examines the uniqueness of survivor grief and how best to help survivors. It is suggested that their grief may be too quickly viewed as pathological, resulting in the premature medicalization of basically normal reactions. It is time for professionals and nonprofessionals to recognize boundaries and work toward mutual goals of health for those persons left behind after a suicide.
Suicide and the Media
Authors: Pirkis Jane , Blood R. Warwick
Published: April 2003

Summary: The association between the portrayal of suicide in fictional media and actual suicide has been debated since 1774, when it was asserted that Goethe's The Sorrows of Young Werther had led people to take their own lives. Since that time, a plethora of studies considering the association has been conducted. This review considered 34 studies examining the impact of fictional portrayal of suicide (in film and television, music, and plays) on actual suicidal behavior. It asked the question: “Is there any association, and if so, can it be considered causal?” Using strict criteria to establish causality, we found that the evidence was more equivocal than was the case for nonfictional reporting.
Struggling Against Suicide
Authors: De Leo Diego
Published: April 2003

Summary: Transcultural comparisons would be beneficial for both our understanding of suicide phenomena and the setting up of preventative strategies. Changes in attitude throughout history, gender and age differences, socio-economic factors, influence of race and ethnicity, and the impact of religion are among the aspects mentioned in this article. All of them can actually have a considerable effect on suicide rates, and all of them should be taken into account when interpreting suicide trends and designing antisuicide strategies. In fact, both risk and protective factors may vary remarkably in different cultures. The need for an integrative approach is evident today more than ever, and this fact calls for more concerted and coordinated, multidisciplinary approaches to suicide prevention.
Suicide in the Ukraine
Authors: Kondrichin Sergei V. , Lester David
Published: April 2003

Summary: The suicide rates of the 24 provinces (oblasts) of the Ukraine were found to be strongly associated with indices of social disintegration (such as divorce and illegitimacy rates), with the Western provinces incorporated in the USSR later than other Ukrainian territories having lower suicide rates and lower levels of social disintegration.
Clinical Evaluation of Prior Suicide Attempts and Suicide Risk in Psychiatric Inpatients
Authors: Modai I. , Hirschmann S. , Hadjez J. , Bernat C. , Gelber D. , Ratner Y. , Rivkin O. , Kurs R. , Ponizovsky A. , Ritsner M.
Published: April 2003

Summary: Background: In practice psychiatrists rely on their own experience and intuition to evaluate the suicide potential of individual patients, but the algorithms for the decision-making process remain unclear. Objectives: (1) to establish models for the decision making process for evaluating suicide risk; (2) to simulate the impact of information concerning the number of previous suicide attempts on the clinician's ability to detect patients who performed medically serious suicide attempts (MSSAs). Methods: Four decision models (linear, dichotomized, hyperbolic, and undifferentiated) depicting the influence of the number of previous suicide attempts on the clinician's recognition of MSSAs in 250 psychiatric inpatients were elicited and tested by a series of discriminant analyses. Results: The dichotomized model (“all or none”) was found to be the most efficient in detecting medically serious suicide attempts. Conclusion: The “all or none” paradigm seems to be the most appropriate way to evaluate the weight of previous suicide attempts in the decision-making process identifying medically serious suicide attempt patients.
Analysis of Crisis Intervention Processes
Authors: Tschacher Wolfgang , Jacobshagen Nina
Published: April 2003

Summary: The remediation processes in psychosocial crisis intervention were modeled focusing on cognitive orientation. Frequent observations and subsequent process modeling constitute a novel approach to process research and reveal process-outcome associations. A sample of 40 inpatients who were assigned to treatment in a crisis intervention unit was monitored in order to study the process of crisis intervention. The process data consisted of patients' self-ratings of the variables mood, tension, and cognitive orientation, which were assessed three times a day throughout hospitalization (M = 22.6 days). Linear time series models (vector autoregression) of the process data were computed to describe the prototypical dynamic patterns of the sample. Additionally, the outcome of crisis intervention was evaluated by pre-post questionnaires. Linear trends were found pointing to an improvement of mood, a reduction of tension, and an increase of outward cognitive orientation. Time series modeling showed that, on average, outward cognitive orientation preceded improved mood. The time series models partially predicted the treatment effect, notably the outcome domain “reduction of social anxiety,” yet did not predict the domain of symptom reduction. In conclusion, crisis intervention should focus on having patients increasingly engage in outward cognitive orientation in order to stabilize mood, reduce anxiety, and activate their resources.
Acute Carbon Monoxide Poisoning and Alcohol Intoxication
Authors: Kouimtsidis Christos
Published: April 2003

Summary: Since the changeover in the gas used in domestic appliances, the prevalence of acute carbon monoxide (CO) poisoning has been dramatically reduced. In suicide attempts with car exhaust fumes lies the most common cause of the disorder. As a consequence, patients are more complex to manage as they often have other associated diagnoses such as substance use disorder, depressive disorder, or long-standing personality disorder. This report details such a case. The medical treatment was based on the carboxyhemoglobin (COHgb) levels at the time of admission. The patient developed permanent cognitive and functional deficits consistent with the observed brain scan changes. The author discusses the importance of an appropriate early diagnosis of the condition, the difficulties associated with it, and the validity of using the carboxyhemoglobin levels as a guide to treatment.
Effects of Fear Induction on Heart Period Variability
Authors: Stark Rudolf , Hamm Alfons , Schienle Anne , Walter Bertram , Vaitl Dieter
Published: April 2003

Abstract The present study investigated the influence of contextual fear in comparison to relaxation on heart period variability (HPV), and analyzed differences in HPV between low and high anxious, nonclinical subjects. Fifty-three women participated in the study. Each subject underwent four experimental conditions (control, fear, relaxation, and a combined fear-relaxation condition), lasting 10 min each. Fear was provoked by an unpredictable aversive human scream. Relaxation should be induced with the aid of verbal instructions. To control for respiratory effects on HPV, breathing was paced at 0.2 Hz using an indirect light source. Besides physiological measures (HPV measures, ECG, respiration, forearm EMG, blood pressure), emotional states (pleasure, arousal, dominance, state anxiety) were assessed by subjects' self-reports. Since relaxation instructions did not have any effect neither on the subjective nor on the physiological variables, the present paper focuses on the comparison of the control and the fear condition. The scream reliably induced changes in both physiological and self-report measures. During the fear condition, subjects reported more arousal and state anxiety as well as less pleasure and dominance. Heart period decreased, while EMG and diastolic blood pressure showed a tendency to increase. HPV remained largely unaltered with the exception of the LF component, which slightly decreased under fear induction. Replicating previous findings, trait anxiety was negatively associated with HPV, but there were no treatment-specific differences between subjects with low and high trait anxiety.
Is There a Mismatch Negativity Analogue in the Olfactory Event-Related Potential?
Authors: Krauel Kerstin , Schott Philipp , Sojka Bernfried , Pause Bettina M. , Ferstl Roman
Published: April 2003

Abstract The mismatch negativity (MMN) is thought to indicate automatic stimulus discrimination in response to acoustic stimuli. In the present study six male subjects were presented with the odors linalool and eugenol within a passive oddball-paradigm. The subjects were instructed to ignore the odors and concentrate on an auditory distractor task. In two sessions each odor served once as the standard stimulus and once as the deviant stimulus. Both odors when presented as deviants led to a negative deflection of the olfactory event-related potential (OERP) between 500-600 ms. After 600 ms the waveforms in response to the deviants were differentially influenced by odor quality. Although the present study should be understood as exploratory, the results suggest the existence of an early mismatch detector in the olfactory modality independent of attention and odor quality.
Relation Between Level of Prefrontal Activity and Subject's Performance
Authors: Casini Laurence , Macar Françoise , Giard Marie-Hélène
Published: April 2003

Abstract The experiment reported here was aimed at determining whether the level of brain activity can be related to performance in trained subjects. Two tasks were compared: a temporal and a linguistic task. An array of four letters appeared on a screen. In the temporal task, subjects had to decide whether the letters remained on the screen for a short or a long duration as learned in a practice phase. In the linguistic task, they had to determine whether the four letters could form a word or not (anagram task). These tasks allowed us to compare the level of brain activity obtained in correct and incorrect responses. The current density measures recorded over prefrontal areas showed a relationship between the performance and the level of activity in the temporal task only. The level of activity obtained with correct responses was lower than that obtained with incorrect responses. This suggests that a good temporal performance could be the result of an efficacious, but economic, information-processing mechanism in the brain. In addition, the absence of this relation in the anagram task results in the question of whether this relation is specific to the processing of sensory information only.
The Computation of Evoked Heart Rate and Blood Pressure
Authors: Koers Greetje , Mulder Lambertus J. M. , van der Veen Frederik M.
Published: April 2003

Abstract For many years psychophysiologists have been interested in stimulus related changes in heart rate and blood pressure. To represent these evoked heart rate and blood pressure patterns, heart rate and blood pressure data have to be transformed into equidistant time series. This paper presents an extensive comparison between two methods. The most often used method is based on linear interpolation, also known as weighted averaging. The low pass filtering method presented here is based on a well-known model for the generation of heart beats, the integral pulse frequency modulation model (IPFM). The comparison shows that the results of the filtering and interpolation procedures are virtually identical. Practically, small differences between the methods disappear in the averaging process. Therefore, the interpolation method is a suitable practical alternative to the computationally complex filtering method.
Variations Across the Menstrual Cycle in EEG Activity During Thinking and Mental Relaxation
Authors: Krug R. , Mölle M. , Fehm H.L. , Born J.
Published: April 2003

Abstract Previous studies have indicated: (1) peak performance on tests of divergent creative thinking during the ovulatory phase of the menstrual cycle; (2) compared to convergent analytical thinking, divergent thinking was found to be associated with a distinctly increased dimensional complexity of ongoing EEG activity. Based on these findings, we hypothesized that cortical information processing during the ovulatory phase is characterized by an increased EEG dimensionality. Each of 16 women was tested on 3 occasions: during the ovulatory phase, the luteal phase, and menses. Presence of the phases was confirmed by determination of plasma concentrations of estradiol, progesterone, and luteinizing hormone. The EEG was recorded while the women performed: (1) tasks of divergent thinking; (2) tasks of convergent thinking; and (3) during mental relaxation. In addition to EEG dimensional complexity, conventional spectral power analysis was performed. Behavioral data confirmed enhanced creative performance during the ovulatory phase while convergent thinking did not vary across cycle phases. EEG complexity was higher during divergent than convergent thought, but this difference remained unaffected by the menstrual phase. Influences of the menstrual phase on EEG activity were most obvious during mental relaxation. In this condition, women during the ovulatory phase displayed highest EEG dimensionality as compared with the other cycle phases, with this effect being most prominent over the central and parietal cortex. Concurrently, power within the alpha frequency band as well as theta power at frontal and parietal leads were lower during the luteal than ovulatory phase. EEG results indicate that task demands of thinking overrode effects of menstrual cycle. However, with a less demanding situation, an ovulatory increase in EEG dimensionality became prominent suggesting a loosening of associative habits during this phase.
Human Cerebral Potentials During Motor Training Under Different Forms of Sensory Feedback
Authors: Niederberger Uwe , Gerber Wolf-Dieter
Published: April 2003

Abstract In two experiments with four and two groups of healthy subjects, a novel motor task, the voluntary abduction of the right big toe, was trained. This task cannot usually be performed without training and is therefore ideal for the study of elementary motor learning. A systematic variation of proprioceptive, tactile, visual, and EMG feedback was used. In addition to peripheral measurements such as the voluntary range of motion and EMG output during training, a three-channel EEG was recorded over Cz, C3, and C4. The movement-related brain potential during distinct periods of the training was analyzed as a central nervous parameter of the ongoing learning process. In experiment I, we randomized four groups of 12 subjects each (group P: proprioceptive feedback; group PT: proprioceptive and tactile feedback; group PTV: proprioceptive, tactile, and visual feedback; group PTEMG: proprioceptive, tactile, and EMG feedback). Best training results were reported from the PTEMG and PTV groups. The movement-preceding cortical activity, in the form of the amplitude of the readiness potential at the time of EMG onset, was greatest in these two groups. Results of experiment II revealed a similar effect, with a greater training success and a higher electrocortical activation under additional EMG feedback compared to proprioceptive feedback alone. Sensory EMG feedback as evaluated by peripheral and central nervous measurements appears to be useful in motor training and neuromuscular re-education.
Response Specificity in Psychophysiology
Authors: Hinz Andreas , Seibt Reingard , Hueber Bernhard , Schreinicke Gert
Published: April 2003

Abstract In the field of response specificity, we are faced with a great diversity of specificity measures and definitions which make it difficult to compare the results presented in the literature. The objective of this paper is to assess different specificity calculations (individual, situational, and motivational response specificity) and to elucidate the underlying meaning of those measures which are based on correlations and on specific sources of variance. It will be shown that an approach on the basis of variance components is suitable to elucidate different specificity measures. The main advantage of this approach is that it explicitly describes the frame of reference of the specificity measures and that it clarifies the relationships between specificity, consistency, and covariation. An empirical investigation is presented which demonstrates the application of the approach and which gives an idea of the magnitude of the differences between the specificity measures. Special features (averaging procedures, fixed/random factors) are discussed and recommendations for further research are derived.