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Nübling R, Schiwy F, El Barbari S, Hesse K, Müller H, Straub R, Brandt J, Göttmann-Franke J, Schnell T. [APPS-Study 2020 - On outpatient psychotherapeutic care for people with psychotic disorders]. Psychother Psychosom Med Psychol 2023; 73:489-501. [PMID: 37666269 DOI: 10.1055/a-2136-7473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Abstract
BACKGROUND Although patients with psychotic disorders (PPS) are indicated for outpatient psychotherapy at any stage of their illness, they are rarely treated in this way. For this purpose, structural conditions, the experience of competence of therapists, as well as content-related aspects of training and further education of psychotherapists are analyzed. METHODS Based on a qualitative preliminary study, an online survey was conducted among 487 psychological psychotherapists. RESULTS Half of the respondents indicated a high willingness to treat PPS. In the acute phase of the disease only 20% are willing to do so. In the studies as well as in the theoretical part of the education and further education, there is hardly any preparation for a corresponding treatment. In contrast, practical experience in psychiatric clinics is considered very important. With regard to structural framework conditions, low hourly quotas and inflexible billing modalities are criticized. With regard to patients, in addition to sufficient motivation for treatment, low reliability, low cognitive ability, low insight into the illness, and frequent discontinuation of therapy are stated. Contrary to some prejudices, patients are characterized as "peaceful" in their interactions. The reduction of psychotic relapses, social integration and reduction of comorbid symptoms are mainly mentioned as achievable outcomes. The reduction of psychotic symptoms is rated less optimistically. Psychotherapists from psychiatric outpatient clinics (PIA) differ from other outpatient psychotherapists by better competence experience and correspondingly more frequent work with PPS, also in the acute stage. DISCUSSION Although every second therapist does not feel well trained, the willingness to treat PPS seems to be higher than the pure supply figures suggest. There is potential for optimization in education and training as well as in networking with other professional groups/relatives. This could be responsible for the fact that in the acute psychotic stage there are fears of contact and competence concerns. Psychotherapists in PIAs, where there is closer networking with other professional groups for structural reasons, experience corresponding deficits to a lesser extent. With regard to other structural barriers, the question arises as to whether these represent disorder-specific or rather general problems in psychotherapy.
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Affiliation(s)
- Rüdiger Nübling
- GfQG Gesellschaft für Qualität im Gesundheitswesen, Karlsruhe
- Landespsychotherapeutenkammer Baden-Württemberg, Stuttgart
| | - Frauke Schiwy
- Fakultät Humanwissenschaften, MSH Medical School Hamburg
| | | | - Klaus Hesse
- Universitätsklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Tübingen
| | - Hendrik Müller
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Köln
| | - Roland Straub
- Landespsychotherapeutenkammer Baden-Württemberg, Stuttgart
| | - Joanna Brandt
- Fakultät Humanwissenschaften, MSH Medical School Hamburg
| | | | - Thomas Schnell
- Fakultät Humanwissenschaften, MSH Medical School Hamburg
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2
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Roth MJ, Lindner A, Hesse K, Wildgruber D, Wong HY, Buehner MJ. Impaired perception of temporal contiguity between action and effect is associated with disorders of agency in schizophrenia. Proc Natl Acad Sci U S A 2023; 120:e2214327120. [PMID: 37186822 PMCID: PMC10214164 DOI: 10.1073/pnas.2214327120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 03/28/2023] [Indexed: 05/17/2023] Open
Abstract
Delusions of control in schizophrenia are characterized by the striking feeling that one's actions are controlled by external forces. We here tested qualitative predictions inspired by Bayesian causal inference models, which suggest that such misattributions of agency should lead to decreased intentional binding. Intentional binding refers to the phenomenon that subjects perceive a compression of time between their intentional actions and consequent sensory events. We demonstrate that patients with delusions of control perceived less self-agency in our intentional binding task. This effect was accompanied by significant reductions of intentional binding as compared to healthy controls and patients without delusions. Furthermore, the strength of delusions of control tightly correlated with decreases in intentional binding. Our study validated a critical prediction of Bayesian accounts of intentional binding, namely that a pathological reduction of the prior likelihood of a causal relation between one's actions and consequent sensory events-here captured by delusions of control-should lead to lesser intentional binding. Moreover, our study highlights the import of an intact perception of temporal contiguity between actions and their effects for the sense of agency.
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Affiliation(s)
- Manuel J. Roth
- Department of Cognitive Neurology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Hoppe-Seyler-Str. 3 72076Tübingen, Germany
- International Max Planck Research School for Cognitive and Systems Neuroscience, University of Tübingen, Otfried-Müller-Str. 27 72076Tübingen, Germany
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health, University of Tübingen, Calwerstraße 14 72076Tübingen, Germany
- Dynamic Cognition Group, Max Planck Institute for Biological Cybernetics, Max-Planck-Ring 11 72076Tübingen, Germany
| | - Axel Lindner
- Department of Cognitive Neurology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Hoppe-Seyler-Str. 3 72076Tübingen, Germany
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health, University of Tübingen, Calwerstraße 14 72076Tübingen, Germany
- Division of Neuropsychology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Hoppe-Seyler-Str. 3 72076Tübingen, Germany
| | - Klaus Hesse
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health, University of Tübingen, Calwerstraße 14 72076Tübingen, Germany
| | - Dirk Wildgruber
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health, University of Tübingen, Calwerstraße 14 72076Tübingen, Germany
| | - Hong Yu Wong
- Philosophy of Neuroscience, Werner Reichardt Centre for Integrative Neuroscience, University of Tübingen, Otfried-Müller-Str. 25 72076Tübingen, Germany
- Department of Philosophy, University of Tübingen, Bursagasse 1 72070Tübingen, Germany
| | - Marc J. Buehner
- School of Psychology, Cardiff University, Park Place, CardiffCF10 3AT, Wales, United Kingdom
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Wildgruber D, Hesse K, Eckstein K, Kreifelts B, Martus P, Erb M, Klingberg S. P-35 Neural correlates of psychotherapy-related reduction of negative symptoms in patients with psychosis. Clin Neurophysiol 2023. [DOI: 10.1016/j.clinph.2023.02.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
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4
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Mehl S, Hesse K, Moritz S, Müller DR, Kircher T, Bechdolf A. [Current evidence for various inpatient psychotherapy programs in the treatment of psychoses-A narrative review article]. Nervenarzt 2023; 94:189-197. [PMID: 36695894 DOI: 10.1007/s00115-022-01433-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/14/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND The analysis of the efficacy of evidence-based psychotherapy for patients with psychotic disorders has mostly been carried out in the outpatient field. In the inpatient field the efficacy is sometimes difficult to assess due to different healthcare systems. OBJECTIVE The aim of this narrative review is to summarize international guidelines and meta-analyses on the efficacy of inpatient psychotherapeutic treatment strategies for patients with psychotic disorders. Based on this, recommendations for disorder-specific ward concepts for acute and postacute fields are formulated. METHODS The German S3 guidelines, international guidelines, current meta-analyses and primary studies on psychological interventions in the treatment of psychotic disorders were included. Based on the results, recommendations for the inpatient psychotherapeutic treatment in various phases of treatment were formulated (acute phase and postacute phase). RESULTS In the acute phase a combination of cognitive behavioral therapy (CBTp) in the individual setting and family interventions in the group setting as well as metacognitive training (MCT acute) is effective and recommended. In the postacute phase, in addition to individual and group CBTp and family interventions, psychoeducation, social skills training and cognitive remediation have been shown to be effective and are recommended. DISCUSSION The suggested recommendations for concrete interventions in various treatment phases and the evidence base are critically discussed and recommendations for the structure of wards are presented.
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Affiliation(s)
- Stephanie Mehl
- Universitätsklinik für Psychiatrie und Psychotherapie, Philipps Universität Marburg, Rudolf-Bultmann-Str. 8, 35039, Marburg, Deutschland.
| | - Klaus Hesse
- Universitätsklinik für Psychiatrie und Psychotherapie Tübingen, Tübingen, Deutschland
| | - Steffen Moritz
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Daniel R Müller
- Universitätsklinik für Psychiatrie und Psychotherapie Bern, Universität Bern, Bern, Schweiz
| | - Tilo Kircher
- Universitätsklinik für Psychiatrie und Psychotherapie, Philipps Universität Marburg, Rudolf-Bultmann-Str. 8, 35039, Marburg, Deutschland
| | - Andreas Bechdolf
- Kliniken für Psychiatrie, Psychotherapie und Psychosomatik, Vivantes Klinikum am Urban und Vivantes Klinikum im Friedrichshain, Berlin, Deutschland
- Klinik für Psychiatrie und Psychotherapie, Charité Universitätsmedizin, Charité Campus Mitte (CCM), Berlin, Deutschland
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5
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Rattay TW, Martin P, Vittore D, Hengel H, Cebi I, Tünnerhoff J, Stefanou MI, Hoffmann JF, von der Ehe K, Klaus J, Vonderschmitt J, Herrmann ML, Bombach P, Al Barazi H, Zeltner L, Richter J, Hesse K, Eckstein KN, Klingberg S, Wildgruber D. Cerebrospinal fluid findings in patients with psychotic symptoms-a retrospective analysis. Sci Rep 2021; 11:7169. [PMID: 33785807 PMCID: PMC8010098 DOI: 10.1038/s41598-021-86170-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 03/10/2021] [Indexed: 12/14/2022] Open
Abstract
In current international classification systems (ICD-10, DSM5), the diagnostic criteria for psychotic disorders (e.g. schizophrenia and schizoaffective disorder) are based on symptomatic descriptions since no unambiguous biomarkers are known to date. However, when underlying causes of psychotic symptoms, like inflammation, ischemia, or tumor affecting the neural tissue can be identified, a different classification is used ("psychotic disorder with delusions due to known physiological condition" (ICD-10: F06.2) or psychosis caused by medical factors (DSM5)). While CSF analysis still is considered optional in current diagnostic guidelines for psychotic disorders, CSF biomarkers could help to identify known physiological conditions. In this retrospective, partly descriptive analysis of 144 patients with psychotic symptoms and available CSF data, we analyzed CSF examinations' significance to differentiate patients with specific etiological factors (F06.2) from patients with schizophrenia, schizotypal, delusional, and other non-mood psychotic disorders (F2). In 40.3% of all patients, at least one CSF parameter was out of the reference range. Abnormal CSF-findings were found significantly more often in patients diagnosed with F06.2 (88.2%) as compared to patients diagnosed with F2 (23.8%, p < 0.00001). A total of 17 cases were identified as probably caused by specific etiological factors (F06.2), of which ten cases fulfilled the criteria for a probable autoimmune psychosis linked to the following autoantibodies: amphiphysin, CASPR2, CV2, LGl1, NMDA, zic4, and titin. Two cases presented with anti-thyroid tissue autoantibodies. In four cases, further probable causal factors were identified: COVID-19, a frontal intracranial tumor, multiple sclerosis (n = 2), and neurosyphilis. Twenty-one cases remained with "no reliable diagnostic classification". Age at onset of psychotic symptoms differed between patients diagnosed with F2 and F06.2 (p = 0.014), with the latter group being older (median: 44 vs. 28 years). Various CSF parameters were analyzed in an exploratory analysis, identifying pleocytosis and oligoclonal bands (OCBs) as discriminators (F06.2 vs. F2) with a high specificity of > 96% each. No group differences were found for gender, characteristics of psychotic symptoms, substance dependency, or family history. This study emphasizes the great importance of a detailed diagnostic workup in diagnosing psychotic disorders, including CSF analysis, to detect possible underlying pathologies and improve treatment decisions.
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Affiliation(s)
- Tim W Rattay
- Department of Neurodegenerative Disease, Hertie-Institute for Clinical Brain Research, and Center for Neurology, University of Tübingen, Hoppe-Seyler-Str. 3, Tübingen, 72076, Germany. .,German Center of Neurodegenerative Diseases (DZNE), Tübingen, Germany. .,Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany. .,Center for Rare Diseases (ZSE), Tübingen, Germany.
| | - Pascal Martin
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany.,Department of Epileptology, Hertie-Institute for Clinical Brain Research, and Center for Neurology, University of Tübingen, Tübingen, Germany
| | - Debora Vittore
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Holger Hengel
- Department of Neurodegenerative Disease, Hertie-Institute for Clinical Brain Research, and Center for Neurology, University of Tübingen, Hoppe-Seyler-Str. 3, Tübingen, 72076, Germany.,German Center of Neurodegenerative Diseases (DZNE), Tübingen, Germany.,Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany.,Center for Rare Diseases (ZSE), Tübingen, Germany
| | - Idil Cebi
- Department of Neurodegenerative Disease, Hertie-Institute for Clinical Brain Research, and Center for Neurology, University of Tübingen, Hoppe-Seyler-Str. 3, Tübingen, 72076, Germany.,Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Johannes Tünnerhoff
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany.,Department for General Neurology and Stroke, Hertie-Institute for Clinical Brain Research, and Center for Neurology, University of Tübingen, Tübingen, Germany
| | - Maria-Ioanna Stefanou
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany.,Department for General Neurology and Stroke, Hertie-Institute for Clinical Brain Research, and Center for Neurology, University of Tübingen, Tübingen, Germany
| | - Jonatan F Hoffmann
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Katrin von der Ehe
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Johannes Klaus
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Julia Vonderschmitt
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Matthias L Herrmann
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany.,Department of Neurology and Neuroscience, Medical Center, University of Freiburg, Breisgau, Germany
| | - Paula Bombach
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Hazar Al Barazi
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Lena Zeltner
- Department of Neurodegenerative Disease, Hertie-Institute for Clinical Brain Research, and Center for Neurology, University of Tübingen, Hoppe-Seyler-Str. 3, Tübingen, 72076, Germany.,Center for Rare Diseases (ZSE), Tübingen, Germany
| | - Janina Richter
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Klaus Hesse
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Kathrin N Eckstein
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Stefan Klingberg
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Dirk Wildgruber
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
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6
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Pytlik N, Soll D, Hesse K, Moritz S, Bechdolf A, Herrlich J, Kircher T, Klingberg S, Landsberg MW, Müller BW, Wiedemann G, Wittorf A, Wölwer W, Wagner M, Mehl S. Problems in measuring the JTC-bias in patients with psychotic disorders with the fish task: a secondary analysis of a baseline assessment of a randomized controlled trial. BMC Psychiatry 2020; 20:554. [PMID: 33228583 PMCID: PMC7685639 DOI: 10.1186/s12888-020-02959-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 11/16/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The jumping to conclusions bias (JTC) is considered to be an important causal factor in theoretical models for the formation and maintenance of delusions. However, recent meta-analytic findings show a rather equivocal pattern of results regarding associations between JTC and delusions. Thus, the present study aims to investigate in a large sample whether the JTC-bias is more pronounced in patients with psychotic disorders in comparison to controls and whether the JTC bias is associated with a more severe delusional conviction, persecutory delusions, and positive symptoms in general. METHODS Patients with psychotic disorders (n = 300) enrolled in a therapy trial and healthy controls (n = 51) conducted a variant of the beads task (fish task) as a measure for the JTC-bias at the start of the trial. Further, clinical interviews were used to assess patients' delusional severity and delusional conviction. RESULTS There were no statistically significant differences between patients with psychotic disorders (with 53% displaying the JTC-bias) and controls (41%). Furthermore, there were no statistically significant correlations between JTC measures and persecutory delusions, delusional conviction, and positive symptoms. CONCLUSIONS We found no differences in JTC between patients with psychotic disorders and healthy controls, which is in part in line with meta-analytic findings using a wide range of JTC task variants. Interestingly, patients with psychotic disorders displayed JTC rates commonly found in the literature, while healthy control subjects showed an unexpectedly high level of JTC. The task variant we used in the present study (fish task) is discussed as a potential reason for our results, as it may induce a more deliberative reasoning style in controls as compared to the traditional beads task. Furthermore, possible implications for the measurement of the JTC-bias, in general, are discussed. TRIAL REGISTRATION ISRCTN29242879 ( isrctn.com ), date of registration: April 12th 2006, retrospectively registered.
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Affiliation(s)
- Nico Pytlik
- Department of Psychiatry and Psychotherapy & Center for Mind, Brain and Behavior (MCMBB), Philipps-University, Rudolf-Bultmann-Str. 8, 35039, Marburg, Germany.
| | - Daniel Soll
- grid.10253.350000 0004 1936 9756Department of Psychiatry and Psychotherapy & Center for Mind, Brain and Behavior (MCMBB), Philipps-University, Rudolf-Bultmann-Str. 8, 35039 Marburg, Germany
| | - Klaus Hesse
- grid.10392.390000 0001 2190 1447Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Steffen Moritz
- grid.9026.d0000 0001 2287 2617Department of Psychiatry and Psychotherapy, University of Hamburg, Hamburg, Germany
| | - Andreas Bechdolf
- grid.6190.e0000 0000 8580 3777Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany ,grid.433867.d0000 0004 0476 8412Department of Psychiatry and Psychotherapy, Vivantes Klinikum am Urban - Teaching Hospital Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Jutta Herrlich
- grid.7839.50000 0004 1936 9721Department of Psychiatry, Psychosomatics and Psychotherapy, University of Frankfurt, Frankfurt, Germany
| | - Tilo Kircher
- grid.10253.350000 0004 1936 9756Department of Psychiatry and Psychotherapy & Center for Mind, Brain and Behavior (MCMBB), Philipps-University, Rudolf-Bultmann-Str. 8, 35039 Marburg, Germany
| | - Stefan Klingberg
- grid.10392.390000 0001 2190 1447Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Martin W. Landsberg
- grid.10388.320000 0001 2240 3300Department of Psychiatry and Psychotherapy, Friedrich-Wilhelms University of Bonn, Bonn, Germany
| | - Bernhard W. Müller
- grid.5718.b0000 0001 2187 5445Department of Psychiatry and Psychotherapy, University of Duisburg-Essen, Essen, Germany
| | - Georg Wiedemann
- Departmenf of Psychiatry and Psychotherapy, Hospital Fulda, Fulda, Germany
| | - Andreas Wittorf
- grid.10392.390000 0001 2190 1447Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Wolfgang Wölwer
- grid.411327.20000 0001 2176 9917Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University of Düsseldorf, Düsseldorf, Germany
| | - Michael Wagner
- grid.7839.50000 0004 1936 9721Department of Psychiatry, Psychosomatics and Psychotherapy, University of Frankfurt, Frankfurt, Germany
| | - Stephanie Mehl
- grid.10253.350000 0004 1936 9756Department of Psychiatry and Psychotherapy & Center for Mind, Brain and Behavior (MCMBB), Philipps-University, Rudolf-Bultmann-Str. 8, 35039 Marburg, Germany ,grid.7839.50000 0004 1936 9721Department of Psychiatry, Psychosomatics and Psychotherapy, University of Frankfurt, Frankfurt, Germany
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7
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Gaebel W, Zäske H, Hesse K, Klingberg S, Ohmann C, Grebe J, Kolbe H, Icks A, Schneider F, Backes V, Wolff-Menzler C, Guse B, Gallinat J, Bock T, Jockers-Scherübl MC, Krüger T, Jessen F, Bechdolf A, Kircher T, Konrad C, Falkai P, Schaub A, Rudolph M, Köllner V, Schmid-Ott G, Linden M, Lieberei B, Stuhlinger M, Sommerfeld S, Schumacher A, Krenge S, Gereke S, Mönter N, Navarro-Urena A, Frosch G, Kuhlbusch FJ, Cleveland H, Riesbeck M. Promoting stigma coping and empowerment in patients with schizophrenia and depression: results of a cluster-RCT. Eur Arch Psychiatry Clin Neurosci 2020; 270:501-511. [PMID: 31520149 DOI: 10.1007/s00406-019-01064-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 08/23/2019] [Indexed: 12/25/2022]
Abstract
There is a need for interventions supporting patients with mental health conditions in coping with stigma and discrimination. A psycho-educational group therapy module to promote stigma coping and empowerment (STEM) was developed and tested for efficacy in patients with schizophrenia or depression. 30 clinical centers participated in a cluster-randomized clinical trial, representing a broad spectrum of mental health care settings: in-patient (acute treatment, rehabilitation), out-patient, and day-hospitals. As randomized, patients in the intervention group clusters/centers received an illness-specific eight sessions standard psychoeducational group therapy plus three specific sessions on stigma coping and empowerment ('STEM'). In the control group clusters the same standard psychoeducational group therapy was extended to 11 sessions followed by one booster session in both conditions. In total, N = 462 patients were included in the analysis (N = 117 with schizophrenia spectrum disorders, ICD-10 F2x; N = 345 with depression, ICD-10 F31.3-F31.5, F32-F34, and F43.2). Clinical and stigma-related measures were assessed before and directly after treatment, as well as after 6 weeks, 6 months, and 12 months (M12). Primary outcome was improvement in quality of life (QoL) assessed with the WHO-QOL-BREF between pre-assessment and M12 analyzed by mixed models and adjusted for pre-treatment differences. Overall, QoL and secondary outcome measures (symptoms, functioning, compliance, internalized stigma, self-esteem, empowerment) improved significantly, but there was no significant difference between intervention and control group. The short STEM module has proven its practicability as an add-on in different settings in routine mental health care. The overall increase in empowerment in both, schizophrenia and depression, indicates patients' treatment benefit. However, factors contributing to improvement need to be explored.The study has been registered in the following trial registers. ClinicalTrials.gov: https://register.clinicaltrials.gov/ Registration number: NCT01655368. DRKS: https://www.drks.de/drks_web/ Registration number: DRKS00004217.
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Affiliation(s)
- Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany.
- WHO Collaborating Center for Quality Assurance and Empowerment of Mental Health, LVR-Klinikum Düsseldorf, Bergische Landstr. 2, 40629, Düsseldorf, Germany.
| | - Harald Zäske
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Klaus Hesse
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Stefan Klingberg
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Christian Ohmann
- Coordination Center for Clinical Trials, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Jürgen Grebe
- Coordination Center for Clinical Trials, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Henrike Kolbe
- Coordination Center for Clinical Trials, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Andrea Icks
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
- German Diabetes Center, Düsseldorf, Germany
| | - Frank Schneider
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen, Aachen, Germany
- University Hospital, Heinrich Heine University, Düsseldorf, Germany
| | - Volker Backes
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen, Aachen, Germany
| | - Claus Wolff-Menzler
- Department of Psychiatry, University Medical Center Göttingen, Göttingen, Germany
| | - Birgit Guse
- Department of Psychiatry, University Medical Center Göttingen, Göttingen, Germany
| | - Jürgen Gallinat
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Bock
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Timo Krüger
- Charité Universitätsmedizin Berlin, Berlin, Germany
- Oberhavel Kliniken GmbH, Klinik Hennigsdorf, Hennigsdorf, Germany
| | - Frank Jessen
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Andreas Bechdolf
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Tilo Kircher
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
| | - Carsten Konrad
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Annette Schaub
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Matthias Rudolph
- Mittelrhein-Klinik for Psychosmatics and Rehabilitation, Bad Salzig, Germany
| | - Volker Köllner
- Department of Psychosomatic Medicine, Mediclin Bliestal Clinic, Blieskastel, Germany
- Department of Behavioral Medicine, Rehabilitation Center Seehof, Teltow, Germany
| | | | - Michael Linden
- Department of Behavioral Medicine, Rehabilitation Center Seehof, Teltow, Germany
| | - Barbara Lieberei
- Department of Behavioral Medicine, Rehabilitation Center Seehof, Teltow, Germany
| | - Monika Stuhlinger
- Psychiatric-Psychotherapeutic Rehabilitation Center grund.stein, Tübingen, Germany
| | | | | | | | | | | | | | - Günter Frosch
- Psychiatric Practices Düsseldorf, Düsseldorf, Germany
| | | | - Helen Cleveland
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Mathias Riesbeck
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
- WHO Collaborating Center for Quality Assurance and Empowerment of Mental Health, LVR-Klinikum Düsseldorf, Bergische Landstr. 2, 40629, Düsseldorf, Germany
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Mehl S, Hesse K, Schmidt AC, Landsberg MW, Soll D, Bechdolf A, Herrlich J, Kircher T, Klingberg S, Müller BW, Wiedemann G, Wittorf A, Wölwer W, Wagner M. Theory of mind, emotion recognition, delusions and the quality of the therapeutic relationship in patients with psychosis - a secondary analysis of a randomized-controlled therapy trial. BMC Psychiatry 2020; 20:59. [PMID: 32041577 PMCID: PMC7011563 DOI: 10.1186/s12888-020-2482-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 02/04/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Cognitive models of psychosis postulate an important role of Theory of mind (ToM) in the formation and maintenance of delusions, but research on this plausible conjecture has gathered conflicting findings. In addition, it is still an open question whether problems in emotion recognition (ER) are associated with delusions. We examined the association of problems in ToM and ER with different aspects of delusions in a large sample of patients with psychosis enrolled in a therapy trial. This also enabled us to explore the possible impact of ToM and ER on one part of patients' social life: the quality of their therapeutic relationship. METHODS Patients with psychotic disorders and delusions and/or hallucinations (n = 185) and healthy controls (n = 48) completed a ToM picture sequencing task and an ER task. Subsequently, patients were enrolled in a randomized-controlled Cognitive Behavior Therapy (CBT) trial (ISRCTN29242879). Patients and therapists rated the quality of the therapeutic relationship during the first five sessions of therapy. RESULTS In comparison to controls, patients were impaired in both ToM and ER. Patients with deficits in ER experienced more severe delusional distress, whereas ToM problems were not related to delusions. In addition, deficits in ER predicted a less favorable therapeutic relationship and interactional problems viewed by the therapist. Impaired ER also moderated (increased) the negative influence of delusions on the therapeutic relationship and interactional difficulties viewed by the therapist. CONCLUSIONS Cognitive models on the formation and maintenance of delusions should consider ER as a potential candidate that might be related to the formation and maintenance of delusional distress, whereas problems in ToM might not be directly related to delusions and secondary dimensions of delusions. In addition, problems in ER in patients with psychosis might have an impact on the quality of the therapeutic relationship and patients with problems in ER are more likely to be viewed as problematic by their therapists. Nevertheless, training ER might be a way to improve the quality of the therapeutic relationship and potentially the effectiveness of CBT or other interventions for patients with psychosis.
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Affiliation(s)
- Stephanie Mehl
- Department of Psychiatry and Psychotherapy, University of Bonn, Sigmund-Freud-Straße 25, 53105, Bonn, Germany. .,Department of Psychiatry and Psychotherapy, Philipps-University of Marburg, Rudolf-Bultmann-Straße 8, 35039, Marburg, Germany.
| | - Klaus Hesse
- grid.10392.390000 0001 2190 1447Department of Psychiatry and Psychotherapy, University of Tübingen, Calwerstraße 14, 72076 Tübingen, Germany
| | - Anna-Christine Schmidt
- grid.10388.320000 0001 2240 3300Department of Psychiatry and Psychotherapy, University of Bonn, Sigmund-Freud-Straße 25, 53105 Bonn, Germany
| | - Martin W. Landsberg
- grid.10388.320000 0001 2240 3300Department of Psychiatry and Psychotherapy, University of Bonn, Sigmund-Freud-Straße 25, 53105 Bonn, Germany
| | - Daniel Soll
- grid.10253.350000 0004 1936 9756Department of Psychiatry and Psychotherapy, Philipps-University of Marburg, Rudolf-Bultmann-Straße 8, 35039 Marburg, Germany
| | - Andreas Bechdolf
- grid.6190.e0000 0000 8580 3777Department of Psychiatry and Psychotherapy, University of Cologne, Gleuler Straße, 50931 Köln, Germany ,Department of Psychiatry and Psychotherapy, Vivantes Hospital Berlin, Dieffenbachstraße 1, 10967 Berlin, Germany
| | - Jutta Herrlich
- grid.7839.50000 0004 1936 9721Department of Psychiatry, Psychosomatic and Psychotherapy, University of Frankfurt, Heinrich-Hoffmann-Straße 10, 60528 Frankfurt am Main, Germany
| | - Tilo Kircher
- grid.10253.350000 0004 1936 9756Department of Psychiatry and Psychotherapy, Philipps-University of Marburg, Rudolf-Bultmann-Straße 8, 35039 Marburg, Germany
| | - Stefan Klingberg
- grid.10392.390000 0001 2190 1447Department of Psychiatry and Psychotherapy, University of Tübingen, Calwerstraße 14, 72076 Tübingen, Germany
| | - Bernhard W. Müller
- grid.5718.b0000 0001 2187 5445Department of Psychiatry and Psychotherapy, University of Duisburg- Essen, Virchowstraße 147, 45147 Essen, Germany
| | - Georg Wiedemann
- Department of Psychiatry and Psychotherapy, Hospital Fulda, Pacelliallee 4, 36043 Fulda, Germany
| | - Andreas Wittorf
- grid.10392.390000 0001 2190 1447Department of Psychiatry and Psychotherapy, University of Tübingen, Calwerstraße 14, 72076 Tübingen, Germany
| | - Wolfgang Wölwer
- grid.411327.20000 0001 2176 9917Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University of Düsseldorf, Bergische Landstraße 2, 40629 Düsseldorf, Germany
| | - Michael Wagner
- grid.10388.320000 0001 2240 3300Department of Psychiatry and Psychotherapy, University of Bonn, Sigmund-Freud-Straße 25, 53105 Bonn, Germany
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Richter J, Hesse K, Schreiber L, Burmeister CP, Eberle MC, Eckstein KN, Zimmermann L, Wildgruber D, Klingberg S. Evidence for two distinct domains of negative symptoms: Confirming the factorial structure of the CAINS. Psychiatry Res 2019; 271:693-701. [PMID: 30791343 DOI: 10.1016/j.psychres.2018.12.043] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 12/06/2018] [Accepted: 12/06/2018] [Indexed: 01/04/2023]
Abstract
Negative symptoms are an important predictor of course of illness as well as social and occupational functioning. Clinically effective interventions are scarce. For negative symptoms to become a reliable primary endpoint in treatment studies, clear operationalization and construct validation is needed. Recent factor analyses mostly find two main factors for negative symptoms: diminished expression und amotivation/anhedonia. The Clinical Assessment Interview for Negative Symptoms (CAINS) consists of the subscales "motivation and pleasure" and "expression". We assessed three samples of subjects with schizophrenia (n = 105) for different aspects of the scale's reliability and validity. A confirmatory factor analysis (CFA) of the CAINS confirmed its two-factorial structure. The subscales had distinct correlational profiles: "Motivation and pleasure" was strongly associated with functional outcome and depression and further with neurocognition, positive symptoms and social cognition. "Expression" seems independent of sources of secondary negative symptoms and neurocognition. We found good internal consistency and interrater agreement. Test-retest reliability (two-week interval) was moderate for the CAINS and its "expression" subscale and low for the "motivation and pleasure" subscale. Our findings indicate that the CAINS differentiates reliably between the two main domains of negative symptoms with some questions remaining concerning the validity of the "motivation and pleasure" subscale.
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Affiliation(s)
- Janina Richter
- Department of Psychiatry and Psychotherapy, University of Tuebingen, Calwerstrasse 14, 72076 Tuebingen, Germany.
| | - Klaus Hesse
- Department of Psychiatry and Psychotherapy, University of Tuebingen, Calwerstrasse 14, 72076 Tuebingen, Germany.
| | - Lisa Schreiber
- Department of Psychiatry and Psychotherapy, University of Tuebingen, Calwerstrasse 14, 72076 Tuebingen, Germany.
| | - Carolin P Burmeister
- Department of Psychiatry and Psychotherapy, University of Tuebingen, Calwerstrasse 14, 72076 Tuebingen, Germany.
| | - Mark-Christian Eberle
- Department of Psychiatry and Psychotherapy, University of Tuebingen, Calwerstrasse 14, 72076 Tuebingen, Germany.
| | - Kathrin N Eckstein
- Department of Psychiatry and Psychotherapy, University of Tuebingen, Calwerstrasse 14, 72076 Tuebingen, Germany.
| | - Lina Zimmermann
- Department of Psychiatry and Psychotherapy, University of Tuebingen, Calwerstrasse 14, 72076 Tuebingen, Germany.
| | - Dirk Wildgruber
- Department of Psychiatry and Psychotherapy, University of Tuebingen, Calwerstrasse 14, 72076 Tuebingen, Germany.
| | - Stefan Klingberg
- Department of Psychiatry and Psychotherapy, University of Tuebingen, Calwerstrasse 14, 72076 Tuebingen, Germany.
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10
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Richter J, Hesse K, Eberle MC, Eckstein KN, Zimmermann L, Schreiber L, Burmeister CP, Wildgruber D, Klingberg S. Self-assessment of negative symptoms - Critical appraisal of the motivation and pleasure - Self-report's (MAP-SR) validity and reliability. Compr Psychiatry 2019; 88:22-28. [PMID: 30466014 DOI: 10.1016/j.comppsych.2018.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 09/29/2018] [Accepted: 10/21/2018] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE The negative symptom domain remains a major challenge concerning treatment. A valid self-report measure could assist clinicians and researchers in identifying patients with a relevant subjective burden. The Motivation and Pleasure - Self Report (MAP-SR) derives from the CAINS and is supposed to reflect the "amotivation" factor of negative symptoms. We evaluated different aspects of the scale's reliability and validity. This is the first factorial analysis as well as the first analysis of test-retest reliability. METHODS We assessed three samples of subjects with schizophrenia or schizoaffective disorder (n = 93) and a broad spectrum of related domains. RESULTS We explored a 3-, 2- and 1-factor solution (explaining 50.93, 44.85 and 36.18% of variance, respectively). The factor "pleasure and hedonic activity" consists of eight items and was most robust; the factors "social motivation" and "motivation for work" were problematic. Test-retest reliability of the scale was adequate (rS = 0.63, p = .005). Neither the MAP-SR nor the "pleasure and hedonic activities" factor are associated with the PANSS negative symptom scale. There are significant associations with the observer-rated CAINS-MAP scale, experiences of pleasure, and social cognition but none with functional outcome. Discriminant validity could not be established with regards to depression and extrapyramidal symptoms. CONCLUSIONS We found that the MAP-SR is adequate to assess anhedonia but is less suitable when assessing motivation. Therefore, we propose using the "pleasure and hedonic activity scale" to cover the "anhedonia" subdomain. We think the "motivation" part of the instrument requires reconstruction.
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Affiliation(s)
- Janina Richter
- Department of Psychiatry and Psychotherapy, University of Tübingen, Calwerstraße 14, 72076 Tübingen, Germany.
| | - Klaus Hesse
- Department of Psychiatry and Psychotherapy, University of Tübingen, Calwerstraße 14, 72076 Tübingen, Germany.
| | - Mark-Christian Eberle
- Department of Psychiatry and Psychotherapy, University of Tübingen, Calwerstraße 14, 72076 Tübingen, Germany.
| | - Kathrin N Eckstein
- Department of Psychiatry and Psychotherapy, University of Tübingen, Calwerstraße 14, 72076 Tübingen, Germany.
| | - Lina Zimmermann
- Department of Psychiatry and Psychotherapy, University of Tübingen, Calwerstraße 14, 72076 Tübingen, Germany.
| | - Lisa Schreiber
- Department of Psychiatry and Psychotherapy, University of Tübingen, Calwerstraße 14, 72076 Tübingen, Germany.
| | - Carolin P Burmeister
- Department of Psychiatry and Psychotherapy, University of Tübingen, Calwerstraße 14, 72076 Tübingen, Germany.
| | - Dirk Wildgruber
- Department of Psychiatry and Psychotherapy, University of Tübingen, Calwerstraße 14, 72076 Tübingen, Germany.
| | - Stefan Klingberg
- Department of Psychiatry and Psychotherapy, University of Tübingen, Calwerstraße 14, 72076 Tübingen, Germany.
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Abstract
Cognitive behavioral therapy (CBT) is an established treatment for the patients with psychosis including schizophrenia. The evidence for the efficacy of CBT is proved by randomized clinical trials and meta-analyses. Evidence-based treatment guidelines recommend CBT for routine treatment. The aim of this paper is to give a short practical guideline for different cognitive behavioral treatment strategies. Cognitive Behavior Therapy for psychosis (CBTp) is an adaptation of general principles of CBT modified for patients with psychotic disorders. Basis of CBT are cognitive models of symptoms to identify treatment targets. The major goal is to foster every-day functioning by realizing a self-management approach. A caring, genuine and real-life oriented therapeutic attitude can help to establish a therapeutic alliance. An individualized functional analysis should be the core for every intervention. Basic strategies like psychoeducation and crisis plans are briefly described. Relatives and close friends of patients should be involved in order to improve crisis management and problem solving. Behavioral and cognitive treatment strategies for delusions, hallucinations and negative symptoms are outlined. Metacognitive treatment as well as social competence training is presented.
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12
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Chapman AR, Hesse K, Andrews JPM, Lee KK, Anand A, Ferry A, Stewart S, Marshall L, Strachan FE, Shah AS, Newby DE, Mills NL. 1085High-sensitivity cardiac troponin I and clinical risk scores in patients with suspected acute coronary syndrome. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.1085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A R Chapman
- University of Edinburgh, BHF Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - K Hesse
- University of Edinburgh, BHF Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - J P M Andrews
- University of Edinburgh, BHF Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - K K Lee
- University of Edinburgh, BHF Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - A Anand
- University of Edinburgh, BHF Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - A Ferry
- University of Edinburgh, BHF Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - S Stewart
- University of Edinburgh, BHF Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - L Marshall
- University of Edinburgh, BHF Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - F E Strachan
- University of Edinburgh, BHF Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - A S Shah
- University of Edinburgh, BHF Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - D E Newby
- University of Edinburgh, BHF Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - N L Mills
- University of Edinburgh, BHF Centre for Cardiovascular Science, Edinburgh, United Kingdom
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13
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Herbert C, Hesse K, Wildgruber D. Emotion and self in psychotic disorders: Behavioral evidence from an emotional evaluation task using verbal stimuli varying in emotional valence and self-reference. J Behav Ther Exp Psychiatry 2018; 58:86-96. [PMID: 28918343 DOI: 10.1016/j.jbtep.2017.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 07/20/2017] [Accepted: 09/04/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES Psychotic disorders are accompanied by changes in emotional and self-referential processing. This behavioral study investigates the link between emotional and self-referential processing in 21 psychotic patients with and without symptoms of disordered self-processing and 21 healthy age-matched controls during emotional evaluation of words varying in emotional valence and self-reference. METHODS Emotional and neutral words related to the self of the reader (e.g., "my fear", "my happiness", "my books"), to the self of another person, unknown to the reader (e.g., "his fear", "his happiness", "his books") or without person reference (e.g., "the fear", "the happiness", "the books") had to be judged in reference to one's own feelings as positive, negative or neutral. RESULTS Compared to healthy controls (HC) psychotic patients with symptoms of self-disorders (PwSD) showed significantly reduced valence congruent judgments in response to self-related (particularly positive and negative) words and no difference between self-, other-, and personally unreferenced positive words. These differences between PwSD and HC were also reflected in post-experimental ratings of subjective experience. Additionally, no reaction time or memory advantage for self-related or emotional words could be found in psychotic patients irrespective of the presence of self-disorders. LIMITATIONS The results may be preliminary due to the small sample sizes. CONCLUSIONS Taken together, the results argue in favor of a differentiated view regarding changes in emotional experience in psychotic disorders. They provide preliminary evidence that in psychotic disorders changes in emotion and self-processing may be related to the severity of self-disorders thought to underlie disordered thinking and feeling in psychotic patients.
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Affiliation(s)
- Cornelia Herbert
- Applied Emotion and Motivation Research, Institute of Psychology and Education, University of Ulm, Germany.
| | - Klaus Hesse
- Department of Psychiatry and Psychotherapy, University of Tübingen, Germany
| | - Dirk Wildgruber
- Department of Psychiatry and Psychotherapy, University of Tübingen, Germany
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14
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Judd A, Zangerle R, Touloumi G, Warszawski J, Meyer L, Dabis F, Mary Krause M, Ghosn J, Leport C, Wittkop L, Reiss P, Wit F, Prins M, Bucher H, Gibb D, Fätkenheuer G, Julia DA, Obel N, Thorne C, Mocroft A, Kirk O, Stephan C, Pérez-Hoyos S, Hamouda O, Bartmeyer B, Chkhartishvili N, Noguera-Julian A, Antinori A, d’Arminio Monforte A, Brockmeyer N, Prieto L, Rojo Conejo P, Soriano-Arandes A, Battegay M, Kouyos R, Mussini C, Tookey P, Casabona J, Miró JM, Castagna A, Konopnick D, Goetghebuer T, Sönnerborg A, Quiros-Roldan E, Sabin C, Teira R, Garrido M, Haerry D, de Wit S, Miró JM, Costagliola D, d’Arminio-Monforte A, Castagna A, del Amo J, Mocroft A, Raben D, Chêne G, Judd A, Pablo Rojo C, Barger D, Schwimmer C, Termote M, Wittkop L, Campbell M, Frederiksen CM, Friis-Møller N, Kjaer J, Raben D, Salbøl Brandt R, Berenguer J, Bohlius J, Bouteloup V, Bucher H, Cozzi-Lepri A, Dabis F, d’Arminio Monforte A, Davies MA, del Amo J, Dorrucci M, Dunn D, Egger M, Furrer H, Grabar S, Guiguet M, Judd A, Kirk O, Lambotte O, Leroy V, Lodi S, Matheron S, Meyer L, Miro JM, Mocroft A, Monge S, Nakagawa F, Paredes R, Phillips A, Puoti M, Rohner E, Schomaker M, Smit C, Sterne J, Thiebaut R, Thorne C, Torti C, van der Valk M, Wittkop L, Tanser F, Vinikoor M, Macete E, Wood R, Stinson K, Garone D, Fatti G, Giddy J, Malisita K, Eley B, Fritz C, Hobbins M, Kamenova K, Fox M, Prozesky H, Technau K, Sawry S, Benson CA, Bosch RJ, Kirk GD, Boswell S, Mayer KH, Grasso C, Hogg RS, Richard Harrigan P, Montaner JSG, Yip B, Zhu J, Salters K, Gabler K, Buchacz K, Brooks JT, Gebo KA, Moore RD, Moore RD, Rodriguez B, Horberg MA, Silverberg MJ, Thorne JE, Rabkin C, Margolick JB, Jacobson LP, D’Souza G, Klein MB, Rourke SB, Rachlis AR, Cupido P, Hunter-Mellado RF, Mayor AM, John Gill M, Deeks SG, Martin JN, Patel P, Brooks JT, Saag MS, Mugavero MJ, Willig J, Eron JJ, Napravnik S, Kitahata MM, Crane HM, Drozd DR, Sterling TR, Haas D, Rebeiro P, Turner M, Bebawy S, Rogers B, Justice AC, Dubrow R, Fiellin D, Gange SJ, Anastos K, Moore RD, Saag MS, Gange SJ, Kitahata MM, Althoff KN, Horberg MA, Klein MB, McKaig RG, Freeman AM, Moore RD, Freeman AM, Lent C, Kitahata MM, Van Rompaey SE, Crane HM, Drozd DR, Morton L, McReynolds J, Lober WB, Gange SJ, Althoff KN, Abraham AG, Lau B, Zhang J, Jing J, Modur S, Wong C, Hogan B, Desir F, Liu B, You B, Cahn P, Cesar C, Fink V, Sued O, Dell’Isola E, Perez H, Valiente J, Yamamoto C, Grinsztejn B, Veloso V, Luz P, de Boni R, Cardoso Wagner S, Friedman R, Moreira R, Pinto J, Ferreira F, Maia M, Célia de Menezes Succi R, Maria Machado D, de Fátima Barbosa Gouvêa A, Wolff M, Cortes C, Fernanda Rodriguez M, Allendes G, William Pape J, Rouzier V, Marcelin A, Perodin C, Tulio Luque M, Padgett D, Sierra Madero J, Crabtree Ramirez B, Belaunzaran P, Caro Vega Y, Gotuzzo E, Mejia F, Carriquiry G, McGowan CC, Shepherd BE, Sterling T, Jayathilake K, Person AK, Rebeiro PF, Giganti M, Castilho J, Duda SN, Maruri F, Vansell H, Ly PS, Khol V, Zhang FJ, Zhao HX, Han N, Lee MP, Li PCK, Lam W, Chan YT, Kumarasamy N, Saghayam S, Ezhilarasi C, Pujari S, Joshi K, Gaikwad S, Chitalikar A, Merati TP, Wirawan DN, Yuliana F, Yunihastuti E, Imran D, Widhani A, Tanuma J, Oka S, Nishijima T, Na S, Choi JY, Kim JM, Sim BLH, Gani YM, David R, Kamarulzaman A, Syed Omar SF, Ponnampalavanar S, Azwa I, Ditangco R, Uy E, Bantique R, Wong WW, Ku WW, Wu PC, Ng OT, Lim PL, Lee LS, Ohnmar PS, Avihingsanon A, Gatechompol S, Phanuphak P, Phadungphon C, Kiertiburanakul S, Sungkanuparph S, Chumla L, Sanmeema N, Chaiwarith R, Sirisanthana T, Kotarathititum W, Praparattanapan J, Kantipong P, Kambua P, Ratanasuwan W, Sriondee R, Nguyen KV, Bui HV, Nguyen DTH, Nguyen DT, Cuong DD, An NV, Luan NT, Sohn AH, Ross JL, Petersen B, Cooper DA, Law MG, Jiamsakul A, Boettiger DC, Ellis D, Bloch M, Agrawal S, Vincent T, Allen D, Smith D, Rankin A, Baker D, Templeton DJ, O’Connor CC, Thackeray O, Jackson E, McCallum K, Ryder N, Sweeney G, Cooper D, Carr A, Macrae K, Hesse K, Finlayson R, Gupta S, Langton-Lockton J, Shakeshaft J, Brown K, Idle S, Arvela N, Varma R, Lu H, Couldwell D, Eswarappa S, Smith DE, Furner V, Smith D, Cabrera G, Fernando S, Cogle A, Lawrence C, Mulhall B, Boyd M, Law M, Petoumenos K, Puhr R, Huang R, Han A, Gunathilake M, Payne R, O’Sullivan M, Croydon A, Russell D, Cashman C, Roberts C, Sowden D, Taing K, Marshall P, Orth D, Youds D, Rowling D, Latch N, Warzywoda E, Dickson B, Donohue W, Moore R, Edwards S, Boyd S, Roth NJ, Lau H, Read T, Silvers J, Zeng W, Hoy J, Watson K, Bryant M, Price S, Woolley I, Giles M, Korman T, Williams J, Nolan D, Allen A, Guelfi G, Mills G, Wharry C, Raymond N, Bargh K, Templeton D, Giles M, Brown K, Hoy J. Comparison of Kaposi Sarcoma Risk in Human Immunodeficiency Virus-Positive Adults Across 5 Continents: A Multiregional Multicohort Study. Clin Infect Dis 2017; 65:1316-1326. [PMID: 28531260 PMCID: PMC5850623 DOI: 10.1093/cid/cix480] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 05/19/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND We compared Kaposi sarcoma (KS) risk in adults who started antiretroviral therapy (ART) across the Asia-Pacific, South Africa, Europe, Latin, and North America. METHODS We included cohort data of human immunodeficiency virus (HIV)-positive adults who started ART after 1995 within the framework of 2 large collaborations of observational HIV cohorts. We present incidence rates and adjusted hazard ratios (aHRs). RESULTS We included 208140 patients from 57 countries. Over a period of 1066572 person-years, 2046 KS cases were diagnosed. KS incidence rates per 100000 person-years were 52 in the Asia-Pacific and ranged between 180 and 280 in the other regions. KS risk was 5 times higher in South African women (aHR, 4.56; 95% confidence intervals [CI], 2.73-7.62) than in their European counterparts, and 2 times higher in South African men (2.21; 1.34-3.63). In Europe, Latin, and North America KS risk was 6 times higher in men who have sex with men (aHR, 5.95; 95% CI, 5.09-6.96) than in women. Comparing patients with current CD4 cell counts ≥700 cells/µL with those whose counts were <50 cells/µL, the KS risk was halved in South Africa (aHR, 0.53; 95% CI, .17-1.63) but reduced by ≥95% in other regions. CONCLUSIONS Despite important ART-related declines in KS incidence, men and women in South Africa and men who have sex with men remain at increased KS risk, likely due to high human herpesvirus 8 coinfection rates. Early ART initiation and maintenance of high CD4 cell counts are essential to further reducing KS incidence worldwide, but additional measures might be needed, especially in Southern Africa.
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Hesse K, Schroeder PA, Scheeff J, Klingberg S, Plewnia C. Experimental variation of social stress in virtual reality - Feasibility and first results in patients with psychotic disorders. J Behav Ther Exp Psychiatry 2017; 56:129-136. [PMID: 27939053 DOI: 10.1016/j.jbtep.2016.11.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 11/09/2016] [Accepted: 11/16/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVES Social interaction might lead to increased stress levels in patients with psychotic disorders. Impaired social stress tolerance is critical for social functioning and closely linked with symptom relapse and hospitalization. We present an interactive office built-up in virtual reality (VR). METHODS Patients with psychotic disorders (PP, N = 26 including N = 5 dropouts) and matched healthy controls (HC, N = 20) were examined with a VR simulating an open-plan office. In a randomized, controlled cross-over design, participants were introduced to virtual co-workers (avatars) and requested to ask them for task assistance. Social feedback in each of the two sessions was either cooperative or rejective in randomized order. RESULTS The office environment was tolerable for most PP and all HC, five PP and none of the HC dropped out for any reason. Drop-outs reported simulator sickness, influence on thoughts and symptom exacerbations. Statistical trends indicated heightened paranoid ideations for PP after social rejection. State measures of paranoid ideations showed high convergent validity with conventional measures of delusions. Of note, measures of presence were higher for PP than for HC. LIMITATIONS The exploratory design limits the robustness of the findings. Only statistical trends on paranoid ideation were found. CONCLUSION The use of VR to assess the effects of social rejection is feasible and tolerable for most PP (87%). However, its implementation for PP is challenged by increased simulator sickness and an additional stress load for some patients. Further studies continuing on these first results that point towards an increased paranoid ideation evoked by negative social feedback and generally higher subjective presence are needed.
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Affiliation(s)
- Klaus Hesse
- Department of Psychiatry and Psychotherapy, University of Tuebingen, Germany.
| | - Philipp A Schroeder
- Department of Psychiatry and Psychotherapy, University of Tuebingen, Germany
| | | | - Stefan Klingberg
- Department of Psychiatry and Psychotherapy, University of Tuebingen, Germany
| | - Christian Plewnia
- Department of Psychiatry and Psychotherapy, University of Tuebingen, Germany
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Schicht M, Hesse K, Schröder H, Naschberger E, Lamprecht W, Garreis F, Paulsen F, Bräuer L. Efficacy of aflibercept (EYLEA ® ) on inhibition of human VEGF in vitro. Ann Anat 2017; 211:135-139. [DOI: 10.1016/j.aanat.2017.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 02/09/2017] [Accepted: 02/14/2017] [Indexed: 12/27/2022]
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Schaper K, Köther B, Hesse K, Satzger I, Gutzmer R. The pattern and clinicopathological correlates of programmed death-ligand 1 expression in cutaneous squamous cell carcinoma. Br J Dermatol 2017; 176:1354-1356. [PMID: 27516151 DOI: 10.1111/bjd.14955] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- K Schaper
- Skin Cancer Center Hannover, Department of Dermatology and Allergy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - B Köther
- Skin Cancer Center Hannover, Department of Dermatology and Allergy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - K Hesse
- Skin Cancer Center Hannover, Department of Dermatology and Allergy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - I Satzger
- Skin Cancer Center Hannover, Department of Dermatology and Allergy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - R Gutzmer
- Skin Cancer Center Hannover, Department of Dermatology and Allergy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
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Früh-Green G, Orcutt B, Green S, Cotterill C, Morgan S, Akizawa N, Bayrakci G, Behrmann JH, Boschi C, Brazleton W, Cannat M, Dunkel K, Escartin J, Harris M, Herrero-Bervera E, Hesse K, John B, Lang S, Lilley M, Liu HQ, Mayhew L, McCaig A, Menez B, Morono Y, Quéméneur M, Rouméjon S, Sandaruwan Ratnayake A, Schrenk M, Schwarzenbach E, Twing K, Weis D, Whattham S, Williams M, Zhao R. Expedition 357 methods. Proceedings of the International Ocean Discovery Program 2017. [DOI: 10.14379/iodp.proc.357.102.2017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Früh-Green G, Orcutt B, Green S, Cotterill C, Morgan S, Akizawa N, Bayrakci G, Behrmann JH, Boschi C, Brazleton W, Cannat M, Dunkel K, Escartin J, Harris M, Herrero-Bervera E, Hesse K, John B, Lang S, Lilley M, Liu HQ, Mayhew L, McCaig A, Menez B, Morono Y, Quéméneur M, Rouméjon S, Sandaruwan Ratnayake A, Schrenk M, Schwarzenbach E, Twing K, Weis D, Whattham S, Williams M, Zhao R. Western sites. Proceedings of the International Ocean Discovery Program 2017. [DOI: 10.14379/iodp.proc.357.105.2017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Früh-Green G, Orcutt B, Green S, Cotterill C, Morgan S, Akizawa N, Bayrakci G, Behrmann JH, Boschi C, Brazleton W, Cannat M, Dunkel K, Escartin J, Harris M, Herrero-Bervera E, Hesse K, John B, Lang S, Lilley M, Liu HQ, Mayhew L, McCaig A, Menez B, Morono Y, Quéméneur M, Rouméjon S, Sandaruwan Ratnayake A, Schrenk M, Schwarzenbach E, Twing K, Weis D, Whattham S, Williams M, Zhao R. Eastern sites. ACTA ACUST UNITED AC 2017. [DOI: 10.14379/iodp.proc.357.103.2017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2023]
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Früh-Green G, Orcutt B, Green S, Cotterill C, Morgan S, Akizawa N, Bayrakci G, Behrmann JH, Boschi C, Brazleton W, Cannat M, Dunkel K, Escartin J, Harris M, Herrero-Bervera E, Hesse K, John B, Lang S, Lilley M, Liu HQ, Mayhew L, McCaig A, Menez B, Morono Y, Quéméneur M, Rouméjon S, Sandaruwan Ratnayake A, Schrenk M, Schwarzenbach E, Twing K, Weis D, Whattham S, Williams M, Zhao R. Central sites. Proceedings of the International Ocean Discovery Program 2017. [DOI: 10.14379/iodp.proc.357.104.2017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Früh-Green G, Orcutt B, Green S, Cotterill C, Morgan S, Akizawa N, Bayrakci G, Behrmann JH, Boschi C, Brazleton W, Cannat M, Dunkel K, Escartin J, Harris M, Herrero-Bervera E, Hesse K, John B, Lang S, Lilley M, Liu HQ, Mayhew L, McCaig A, Menez B, Morono Y, Quéméneur M, Rouméjon S, Sandaruwan Ratnayake A, Schrenk M, Schwarzenbach E, Twing K, Weis D, Whattham S, Williams M, Zhao R. Northern sites. ACTA ACUST UNITED AC 2017. [DOI: 10.14379/iodp.proc.357.106.2017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
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Hesse K, Hermanutz U, Hölzel LP, Klingberg S. [What Determines Treatment Recommendations of Relatives: The Role of Expectations, Negative Consequences and Control Attributions for the Treatment of Patients with Psychosis]. Psychiatr Prax 2016; 44:213-220. [PMID: 27399590 DOI: 10.1055/s-0042-102622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective Therapy recommendations of relatives of individuals with psychotic disorders. Method A total of n = 52 inpatient relatives were interviewed about their attitude towards psychotherapy and antipsychotics. Results Over 80 % of the relatives recommended psycho- and pharmacotherapy. Concerns reduced recommendations for pharmacotherapy, poor/lack of hope for improvement reduced recommendations for psychotherapy. Conclusion The relatives' therapy recommendations could be influenced by discussing their concerns and expectations of success.
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Affiliation(s)
- Klaus Hesse
- Universitätsklinik für Psychiatrie und Psychotherapie Tübingen
| | | | - Lars P Hölzel
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Freiburg
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Hesse K, Kriston L, Mehl S, Wittorf A, Wiedemann W, Wölwer W, Klingberg S. The Vicious Cycle of Family Atmosphere, Interpersonal Self-concepts, and Paranoia in Schizophrenia-A Longitudinal Study. Schizophr Bull 2015; 41:1403-12. [PMID: 25925392 PMCID: PMC4601709 DOI: 10.1093/schbul/sbv055] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Recent cognitive models of paranoid delusions highlight the role of self-concepts in the development and maintenance of paranoia. Evidence is growing that especially interpersonal self-concepts are relevant in the genesis of paranoia. In addition, negative interpersonal life-experiences are supposed to influence the course of paranoia. As dysfunctional family atmosphere corresponds with multiple distressing dyadic experiences, it could be a risk factor for the development and maintenance of paranoia. A total of 160 patients with a diagnosis of schizophrenia were assessed twice within 12 months. Standardized questionnaires and symptom rating scales were used to measure interpersonal self-concepts, perceived family atmosphere, and paranoia. Data were analyzed using longitudinal cross-lagged structural equation models. Perceived negative family atmosphere was associated with the development of more pronounced negative interpersonal self-concepts 12 months later. Moreover, paranoia was related to negative family atmosphere after 12 months as well. As tests revealed that reversed associations were not able to explain the data, we found evidence for a vicious cycle between paranoia, family atmosphere, and interpersonal self-concepts as suggested by theoretical/cognitive model of paranoid delusions. Results suggest that broader interventions for patients and their caretakers that aim at improving family atmosphere might also be able to improve negative self-concepts and paranoia.
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Affiliation(s)
- Klaus Hesse
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany;
| | - Levente Kriston
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stephanie Mehl
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
| | - Andreas Wittorf
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Wolfgang Wiedemann
- Department of Psychiatry and Psychotherapy, Klinikum-Fulda, Fulda, Germany
| | - Wolfgang Wölwer
- Department of Psychiatry and Psychotherapy, Medical Faculty University of Düsseldorf, Germany
| | - Stefan Klingberg
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
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Frank F, Wilk J, Kriston L, Meister R, Shimodera S, Hesse K, Bitzer EM, Berger M, Hölzel LP. Effectiveness of a brief psychoeducational group intervention for relatives on the course of disease in patients after inpatient depression treatment compared with treatment as usual--study protocol of a multisite randomised controlled trial. BMC Psychiatry 2015; 15:259. [PMID: 26497218 PMCID: PMC4619254 DOI: 10.1186/s12888-015-0633-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 10/02/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Relapses and rehospitalisations are common after acute inpatient treatment in depressive disorders. Interventions for stabilising treatment outcomes are urgently needed. Psychoeducational group interventions for relatives were shown to be suitable for improving the course of disease in schizophrenia and bipolar disorders. A small Japanese monocentre randomised controlled trial also showed promising results for depressive disorders. However, the evidence regarding psychoeducation for relatives of patients with depressive disorders is unclear. METHODS/DESIGN The study is conducted as a two-arm multisite randomised controlled trial to evaluate the incremental effect of a brief psychoeducational group intervention for relatives as a maintenance treatment on the course of disease compared to treatment as usual. Primary outcome is the estimated number of depression-free-days in patients within one year after discharge from inpatient treatment. 180 patients diagnosed with unipolar depressive disorders as well as one key relative per patient will be included during inpatient treatment and randomly allocated to the conditions at discharge. In the intervention group, relatives will participate in a brief psychoeducational group intervention following the patient's discharge. The intervention consists of four group sessions lasting 90 to 120 min each. Every group session contains informational parts as well as structured training in problem-solving. In both study conditions, patients will receive treatment as usual. Patients as well as relatives will be surveyed by means of questionnaires at discharge and three, six, nine and twelve months after discharge. In addition to the primary outcome, several patient-related and relative-related secondary outcomes will be considered and health economics will be investigated. DISCUSSION Our study will provide evidence on the incremental effect of a brief psychoeducational intervention for relatives as a maintenance treatment after inpatient depression treatment. Positive results may have a major impact on health care for depression. TRIAL REGISTRATION German Clinical Trials Register (DRKS): DRKS00006819; Trial registration date: 2014 Oktober 31; Universal Trial Number (UTN): U1111-1163-5391.
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Affiliation(s)
- Fabian Frank
- Department of Psychiatry and Psychotherapy, Research Group Psychotherapy and Health Services Research, Medical Center - University of Freiburg, Hauptstraße 5, D-79104, Freiburg, Germany. .,Department of Public Health and Health Education, University of Education Freiburg, Kunzenweg 21, D-79117, Freiburg, Germany.
| | - Juliette Wilk
- Department of Psychiatry and Psychotherapy, Research Group Psychotherapy and Health Services Research, Medical Center - University of Freiburg, Hauptstraße 5, D-79104, Freiburg, Germany.
| | - Levente Kriston
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, D-20246, Hamburg, Germany.
| | - Ramona Meister
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, D-20246, Hamburg, Germany.
| | - Shinji Shimodera
- Department of Neuropsychiatry, Kochi Medical School, Kohasu, Okoh-cho, Nankokushi, Kochi, 783-8505, Japan.
| | - Klaus Hesse
- Department of Psychiatry and Psychotherapy, University Medical Center Tübingen, Calwerstraße 14, D-72072, Tübingen, Germany.
| | - Eva-Maria Bitzer
- Department of Public Health and Health Education, University of Education Freiburg, Kunzenweg 21, D-79117, Freiburg, Germany.
| | - Mathias Berger
- Department of Psychiatry and Psychotherapy, Research Group Psychotherapy and Health Services Research, Medical Center - University of Freiburg, Hauptstraße 5, D-79104, Freiburg, Germany.
| | - Lars P. Hölzel
- Department of Psychiatry and Psychotherapy, Research Group Psychotherapy and Health Services Research, Medical Center – University of Freiburg, Hauptstraße 5, D-79104 Freiburg, Germany
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Stanek M, Mokszycki R, Hesse K, Nejak D, Sweis R, Lyons N, Hormese M, Lomotan N, Kulstad E. 403 Reduced Length of Stay With Inhaled Loxapine: A Retrospective Comparison Study. Ann Emerg Med 2015. [DOI: 10.1016/j.annemergmed.2015.07.440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Langton-Lockton J, Hesse K, Carr A, Field AS, Hillman RJ. P10.04 A new paradigm for follow-up of men with anal squamous cell cancer (ascc). Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052270.432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Hesse K, Kriston L, Wittorf A, Herrlich J, Wölwer W, Klingberg S. Longitudinal relations between symptoms, neurocognition, and self-concept in schizophrenia. Front Psychol 2015; 6:917. [PMID: 26191025 PMCID: PMC4490211 DOI: 10.3389/fpsyg.2015.00917] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 06/19/2015] [Indexed: 12/18/2022] Open
Abstract
Objective: Cognitive models suggest that the self-concept of persons with psychosis can be fundamentally affected. Self-concepts were found to be related to different symptom domains when measured concurrently. Longitudinal investigations to disentangle the possible causal associations are rare. Method: We examined a sample of 160 people with a diagnosis of schizophrenia who took part in a psychotherapy study. All participants had the DSM-IV diagnosis of a schizophrenia and pronounced negative symptoms. Neurocognition, symptoms, and self-concepts were assessed at two time points 12 months apart. Structural equation modeling was used to test whether symptoms influence self-concepts (scar-model) or self-concepts affect symptoms (vulnerability model). Results: Negative symptoms correlated concurrently with self-concepts. Neurocognitive deficits are associated with more negative self-concepts 12 months later. Interpersonal self-concepts were found to be relevant for paranoia. Conclusion: The findings implicate that if deficits in neurocognition are present, fostering a positive self-concept should be an issue in therapy. Negative interpersonal self-concept indicates an increased risk for paranoid delusions in the course of 1 year. New aspects for cognitive models in schizophrenia and clinical implications are discussed.
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Affiliation(s)
- Klaus Hesse
- Department of Psychiatry and Psychotherapy, University of Tübingen Tübingen, Germany
| | - Levente Kriston
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf Hamburg, Germany
| | - Andreas Wittorf
- Department of Psychiatry and Psychotherapy, University of Tübingen Tübingen, Germany
| | - Jutta Herrlich
- Department of Psychiatry and Psychotherapy, University of Frankfurt Frankfurt, Germany
| | - Wolfgang Wölwer
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Duesseldorf Duesseldorf, Germany
| | - Stefan Klingberg
- Department of Psychiatry and Psychotherapy, University of Tübingen Tübingen, Germany
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Hesse K, Klingberg S. Examining the cognitive model of caregiving--a structural equation modelling approach. Psychiatry Res 2014; 217:171-6. [PMID: 24740133 DOI: 10.1016/j.psychres.2014.02.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 02/05/2014] [Accepted: 02/08/2014] [Indexed: 10/25/2022]
Abstract
The study tests assumptions from the "cognitive model of caregiving" (Kuipers et al., 2010), which aims to inform interventions for carers of people with psychoses. The sample comprised 61 relatives of patients with schizophrenia. Standardized psychological assessments were conducted twice within 6 months including Involvement Evaluation Questionnaire (IEQ-EU), a short form of the Symptom Checklist 90-R (SCL K9), the Family Questionnaire (FQ), scales measuring control attributions of the Illness Perception Questionnaire for Schizophrenia (IPQS-R) and emotions toward the ill relative. Structural equation modelling was used to analyse data. We identified two pathways: (a) from "attributing control to relatives" to distress, intermediated by anxiety for the patient and emotional overinvolvement (EOI), and (b) from "attribution control to patient" to distress, intermediated by anger about the patient and criticism. The model provided a good fit to the data and was successfully replicated at a second point in time. We were able to find supporting evidence for a cognitive model of caregiving. Control attributions and emotions of informal caregivers are important when interventions are planned reducing expressed emotion and burden of caregivers.
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Affiliation(s)
- Klaus Hesse
- Department of Psychiatry and Psychotherapy, University Hospital Tuebingen, Calwerstr. 14, 72076 Tuebingen, Germany.
| | - Stefan Klingberg
- Department of Psychiatry and Psychotherapy, University Hospital Tuebingen, Calwerstr. 14, 72076 Tuebingen, Germany
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Koppitz H, Kühl H, Hesse K, Kohl JG. Some Aspects of the Importance of Genetic Diversity inPhragmites australis(Cav.) Trin. ex Steudel for the Development of Reed Stands. ACTA ACUST UNITED AC 2014. [DOI: 10.1111/j.1438-8677.1997.tb00632.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hesse K, Klingberg S. Kein Grund für therapeutischen Pessimismus: Kognitive Verhaltenstherapie der Negativsymptomatik schizophrener Psychosen. Verhaltenstherapie 2011. [DOI: 10.1159/000324222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Bittrich HJ, Hesse K, Braun L, Sauerbrey A. Effektiver Einsatz des Kühlsystems Tecotherm TSmed 200 mit Kühlmatte bei kritisch kranken Kindern und Jugendlichen. Z Geburtshilfe Neonatol 2009. [DOI: 10.1055/s-0029-1223163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Calmy A, Petoumenos K, Lewden C, Law M, Bocquentin F, Hesse K, Cooper D, Carr A, Bonnet F. Combination antiretroviral therapy without a nucleoside reverse transcriptase inhibitor: experience from 334 patients in three cohorts. HIV Med 2007; 8:171-80. [PMID: 17461861 PMCID: PMC10548334 DOI: 10.1111/j.1468-1293.2007.00448.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Toxicity and resistance may limit the use of HIV nucleoside reverse transcriptase inhibitors (NRTIs). We assessed the safety and activity of regimens that did not include an NRTI. METHOD AND PATIENTS We analysed NRTI-sparing regimens using pooled data from three cohorts in Australia and France where HIV RNA viral load, CD4 lymphocyte count and metabolic parameters are assessed prospectively. The inclusion criterion was the commencement of any antiretroviral combination excluding NRTIs. RESULTS A total of 334 (3.9%) of 8477 patients were included in the present study for a median follow-up time of 105 weeks. Therapeutic combinations were one nonnucleoside reverse transcriptase inhibitor (NNRTI) plus one protease inhibitor (PI) (58%), two PIs (26%), one PI (16%), and one NNRTI plus two PIs (8%). At baseline, the median CD4 lymphocyte count was 264 cells/muL (interquartile range 164-446 cells/muL) and 25% of patients had plasma HIV RNA below 500 HIV-1 RNA copies/mL. In intent-to-treat analysis, 64% of patients had HIV RNA <500 copies/mL at 6 months and 68% at 24 months. The mean CD4 lymphocyte count increase was 60 cells/microL (95% confidence interval 41-76 cells/microL) at 6 months and 111 cells/microL (95% confidence interval 82-140 cells/microL) at 24 months. Prognostic factors for having HIV RNA <500 copies/mL at 6 months included independently having undetectable HIV RNA at baseline and being naïve for NNRTIs. The proportion of patients with triglycerides >2.3 mmol/L increased from 32% to 63% at 6 months and to 62% at 24 months (P-trend=0.002), and those with total cholesterol >6.2 mmol/L increased from 18% to 38% at 6 months and to 44% at 24 months (P-trend <0.001), with an increased risk for patients treated with NNRTI+PIs. Forty-one per cent of patients discontinued their NRTI-sparing regimen. CONCLUSION In these antiretroviral-experienced patients, NRTI-sparing therapy appeared to have satisfactory virological and immunological efficacy. However, hyperlipidaemia was frequent and requires monitoring of cardiovascular risk factors.
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Affiliation(s)
- A Calmy
- HIV Immunology and Infectious Diseases Clinical Services Unit, St Vincent's Hospital, Sydney, Australia.
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Hesse K, Gliemann G. Magnetic field effect on the luminescence of octahedral hexachloroselenate(IV). Evidence for the vibronic nature of the low-temperature emission. ACTA ACUST UNITED AC 2002. [DOI: 10.1021/j100154a022] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Halladay AK, Kirschner E, Hesse K, Fisher H, Wagner GC. Role of monoamine oxidase inhibition and monoamine depletion in fenfluramine-induced neurotoxicity and serotonin release. Pharmacol Toxicol 2001; 89:237-48. [PMID: 11881977 DOI: 10.1034/j.1600-0773.2001.d01-154.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The role of both monoamine synthesis and monoamine oxidase inhibition in mediating the fenfluramine-induced damage to serotonin neurones was examined; as pretreatment agents, both alpha-methyl-para-tyrosine (AMPT) and parachlorophenylalanine (PCPA) were used to deplete dopamine and serotonin, respectively, while clorgyline and deprenyl were used to inhibit monoamine oxidase types A and B. While both AMPT and deprenyl did not alter fenfluramine induced serotonin or 5-hydroxyindoleacetic acid (5-HIAA) depletion in any area, PCPA did partially reduce the serotonin depletion in the hippocampus and hypothalamus. Although pretreatment with clorgyline did not significantly alter fenfluramine-induced serotonin depletion, it did produce a 65% mortality rate in animals treated with both drugs. Both PCPA and clorgyline significantly increased the depletion of striatal 5-HIAA concentration consequent to fenfluramine; however, these drugs also produced a long-term depletion of striatal 5-HIAA when administered alone, therefore, the changes seen after the coadministration with fenfluramine may be viewed as additive. Finally, acute PCPA pretreatment attenuated the rapid rise in 3,4-dihydroxyphenylacetic acid (DOPAC) and homovanillic acid (homovanillic acid) induced by fenfluramine, and acute clorgyline reversed the drop in serotonin and rise in 5-HIAA induced by fenfluramine. These results indicate that the rapid increase in dopamine activity induced by fenfluramine is partially dependent on serotonin concentration and release and that the mechanism of fenfluramine-induced toxicity is unlike that of the other substituted amphetamines.
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Affiliation(s)
- A K Halladay
- Department of Pharmacology and Toxicology, Rutgers University, New Brunswick, NJ 08903, USA
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Schlettwein D, Hesse K, Gruhn NE, Lee PA, Nebesny KW, Armstrong NR. Electronic Energy Levels in Individual Molecules, Thin Films, and Organic Heterojunctions of Substituted Phthalocyanines. J Phys Chem B 2001. [DOI: 10.1021/jp001912q] [Citation(s) in RCA: 108] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- D. Schlettwein
- Institut für Angewandte und Physikalische Chemie, FB 2, Universität Bremen, Postfach 33 04 40, D-28334 Bremen, Germany, and Department of Chemistry, The University of Arizona, Tucson, Arizona 85721
| | - K. Hesse
- Institut für Angewandte und Physikalische Chemie, FB 2, Universität Bremen, Postfach 33 04 40, D-28334 Bremen, Germany, and Department of Chemistry, The University of Arizona, Tucson, Arizona 85721
| | - N. E. Gruhn
- Institut für Angewandte und Physikalische Chemie, FB 2, Universität Bremen, Postfach 33 04 40, D-28334 Bremen, Germany, and Department of Chemistry, The University of Arizona, Tucson, Arizona 85721
| | - P. A. Lee
- Institut für Angewandte und Physikalische Chemie, FB 2, Universität Bremen, Postfach 33 04 40, D-28334 Bremen, Germany, and Department of Chemistry, The University of Arizona, Tucson, Arizona 85721
| | - K. W. Nebesny
- Institut für Angewandte und Physikalische Chemie, FB 2, Universität Bremen, Postfach 33 04 40, D-28334 Bremen, Germany, and Department of Chemistry, The University of Arizona, Tucson, Arizona 85721
| | - N. R. Armstrong
- Institut für Angewandte und Physikalische Chemie, FB 2, Universität Bremen, Postfach 33 04 40, D-28334 Bremen, Germany, and Department of Chemistry, The University of Arizona, Tucson, Arizona 85721
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Hesse K, Heinrich B, Zimmermann F, Kau R, Sommer G, Achterrath W, Molls M, Feldmann HJ. Combined radiochemotherapy with docetaxel in patients with unresectable locally advanced head and neck tumors. Strahlenther Onkol 2000; 176:67-72. [PMID: 10697653 DOI: 10.1007/pl00002330] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND As the treatment with docetaxel in metastatic head and neck cancer resulted in an encouraging response rate, the following phase-I study examined the effects of a combined radiochemotherapy with weekly docetaxel in patients with inoperable advanced head and neck tumors. PATIENTS AND METHODS Six patients with Stage IV head and neck cancer were included into the study. Within the treatment regimen the primary tumor and the involved lymph nodes were irradiated up to a total dose of 70 Gy, the non involved cervical and supraclavicular lymph nodes received 50 Gy in conventional fractionation. Simultaneously docetaxel was given 1 hour before radiotherapy. The initial dose was 15 mg/m2. RESULTS A dose escalation was impossible because of several dose limiting toxicities (NCI-CTC) already in the first dose level. Two patients showed skin reactions Grade 4, 2 patients pulmonary complications Grade 4, 2 patient neurologic side effects Grade 3 and 1 a thrombocytopenia Grade 3. The response rate resulted in 3 complete and 1 partial remission, 1 death, 1 patient was not evaluable. CONCLUSION Unexpectedly already in the first dose level several dose limiting toxicities were evaluated. For that reason the treatment scheme is not feasible.
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Affiliation(s)
- K Hesse
- Klinik für Strahlentherapie und Radiologische Onkologie, Klinikum rechts der Isar, TU, München
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Hesse K, Schlettwein D. Spectroelectrochemical investigations on the reduction of thin films of hexadecafluorophthalocyaninatozinc (F16PcZn). J Electroanal Chem (Lausanne) 1999. [DOI: 10.1016/s0022-0728(99)00381-2] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Brockmann U, Raabe T, Hesse K, Viehweger K, Rick S, Starke A, Fabiszisky B, TopÇu D, Heller R. Seasonal budgets of the nutrient elements N and P at the surface of the German Bight during winter 1996, spring 1995, and summer 1994. ACTA ACUST UNITED AC 1999. [DOI: 10.1007/bf02764177] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Dreher I, Schütze N, Baur A, Hesse K, Schneider D, Köhrle J, Jakob F. Selenoproteins are expressed in fetal human osteoblast-like cells. Biochem Biophys Res Commun 1998; 245:101-7. [PMID: 9535791 DOI: 10.1006/bbrc.1998.8393] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Selenoproteins are involved in mechanisms of cell differentiation and defense. We investigated the expression of glutathione peroxidases, as well as other selenoproteins, in fetal human osteoblasts (hFOB-cells). Using 75-selenium metabolic labelling of viable hFOB-cells, we identified several selenoproteins in cell lysates of about 45-80 kDa and in the migration range of 14 kDa to 24 kDa. Cells expressed low mRNA levels of both cellular glutathione peroxidase and plasma glutathione peroxidase mRNA as analysed by Southern analysis of RT-PCR products. Basal cellular glutathione peroxidase enzyme activity in hFOB-cells (19.7 nmol NADPH oxidised per min and microg protein) was further increased 2.5-fold by the addition of 100 nM sodium selenite to the culture medium for 3 days. Furthermore, expression of selenoprotein P mRNA was demonstrated by RT-PCR. hFOB-cells did not show activities of the selenoproteins type I or type II 5'-deiodinase. In summary, we identified cellular glutathione peroxidase, plasma glutathione peroxidase and selenoprotein P among of a panel of several 75-selenium labelled proteins in human fetal osteoblasts. The expression of selenoproteins like glutathione peroxidases in hFOB-cells represents a new system of osteoblast antioxidative defense that may be relevant for the protection against hydrogen peroxide produced by osteoclasts during bone remodelling.
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Affiliation(s)
- I Dreher
- Klinische Forschergruppe, Medizinische Poliklinik, Universität Würzburg, Würzburg, 97070, Germany
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Kirsten R, Breidert M, Sparwasser K, Ochs JG, Hesse K, Nelson K. Carmoxirole inhibits platelet aggregation in vitro and ex vivo. Int J Clin Pharmacol Ther 1995; 33:76-80. [PMID: 7757314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
The influence of carmoxirole, a new antihypertensive DA2-agonist on human platelet aggregation was studied in vitro and ex vivo. In an open study 15 patients with essential hypertension received 3 doses of carmoxirole, 0.5, 1 and 2 mg daily, each for a 2-week period, following a 2-week placebo phase. At the end of each 2-week period blood pressure, platelet aggregation, plasma carmoxirole and plasma catecholamines were measured. Preliminary experiments in vitro showed that 10 microM carmoxirole inhibited the adrenaline induced aggregation velocity by 10%: Increasing the carmoxirole concentration caused dose dependent inhibition which was complete at 1 mM. Carmoxirole itself caused a weak aggregating effect on human platelets in vitro. Blood pressure was reduced from 163 +/- 11/103 +/- 3 before treatment to 155 +/- 11/97 +/- 4, 148 +/- 11/93 +/- 4 and 143 +/- 11/90 +/- 6 mmHg following 2 weeks of 0.5, 1 and 2 mg oral carmoxirole, respectively. Carmoxirole plasma levels 2 1/2 h after the last capsule administration were 0.37 +/- 0.612, 0.95 +/- 1.045 and 3.69 +/- 2.570 ng/ml following treatment with 0.5, 1 and 2 mg carmoxirole, respectively. No influence of carmoxirole on plasma catecholamines could be established. Compared to 100% before treatment, the 5-hydroxytryptamine induced platelet aggregation velocity ex vivo decreased to 70%, 38% and 69% after the administration of 0.5, 1 and 2 mg carmoxirole, respectively. The adrenaline induced aggregation velocity was reduced in the same manner. These results show that carmoxirole is an antihypertensive agent with antithrombotic potential.
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Affiliation(s)
- R Kirsten
- Abteilung Klinische Pharmakologie, Universitätsklinikum Frankfurt/M, Germany
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Kirsten R, Erdeg B, Moxter D, Hesse K, Breidert M, Nelson K. Platelet aggregation after naftidrofuryl application in vitro and ex vivo. Int J Clin Pharmacol Ther 1995; 33:81-4. [PMID: 7757315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Naftidrofuryl has been shown to inhibit the interaction between platelets and damaged endothelium, which may lead to thrombosis and is mediated by the 5-hydroxytryptamine. (5-HT2) receptor. This study was designed to investigate the effects of naftidrofuryl on 5-HT induced platelet aggregation. In vitro experiments were carried out on platelets from healthy laboratory personnel. Naftidrofuryl (0.0625-100 microM) caused a continual increase in in vitro inhibition, whereby the inhibition at 0.0625 microM was already significant when compared to control (p < 0.05). The IC50 was approximately 10 microM induced aggregation. Subsequently, ex vivo effects of naftidrofuryl on 5-HT induced platelet aggregation of healthy volunteers together with naftidrofuryl plasma levels were measured. Twelve healthy volunteers received either 400 mg naftidrofuryl or placebo in this double-blind, crossover study. Blood samples for determination of aggregation and naftidrofuryl plasma levels were taken before, 0.5, 1, 2, 3, 4, 5, 6.5 and 9 h after medication application. One hour after application of 400 mg naftidrofuryl a maximal plasma level of approximately 380 ng/ml was measured. Under control conditions the aggregation (Vmax) increased from an arbitrary 100% at 8:00 am to about 150% by 10:00 am, remaining at this level until 5:00 pm. Application of 400 mg naftidrofuryl p.o. resulted in a 50% decrease in Vmax 2 h after drug application. Thereafter, the aggregation rose to the initial 100% value 4 h after drug application and remained at this level during the observation period.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- R Kirsten
- Abteilung Klinische Pharmacologie, Universitätsklinikum Frankfurt/M, Germany
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Hesse K. [Civil law and jurisprudence for the health personnel in the new federal provinces. Experiences and problems in nursing education and continuing education]. Pflege Z 1994; 47:suppl 18-9. [PMID: 7952726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Kirsten R, Heintz B, Nelson K, Hesse K, Schneider E, Oremek G, Nemeth N. Polyenylphosphatidylcholine improves the lipoprotein profile in diabetic patients. Int J Clin Pharmacol Ther 1994; 32:53-6. [PMID: 8004358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Patients with diabetes mellitus commonly exhibit pathological lipoprotein profiles and concomitant cardiovascular or peripheral atherosclerotic complications. Thirty non-insulin-dependent diabetics with secondary hyperlipidemia received 2.7 g 3-sn-polyenylphosphatidylcholine (PPC) or placebo daily, orally over a 2-month period under randomized, double-blind trial conditions, to investigate the efficacy and tolerance of the treatment. This period was followed by a one-month observation phase without investigational medication. Serum LDL cholesterol, total cholesterol, HDL cholesterol and triglycerides were determined on days 1, 14, 28, 56 and 84. After 56 days of treatment with PPC, the primary variable of effectiveness, LDL cholesterol, decreased significantly (p = 0.0174) by 17% from 191 +/- 31 to 159 +/- 36 mg/dl, whereas values did not change in the placebo group. Total cholesterol (TC) in serum decreased by 16% from 303 +/- 22 to 255 +/- 23 mg/dl with PPC. In the placebo group, only a slight decrease from 292 +/- 27 to 289 +/- 41 mg/dl occurred. Mean serum triglyceride (TG) levels fell by 9% from 194 +/- 32 to 177 +/- 27 mg/dl in the PPC group. In the control group, values increased from 193 +/- 34 to 202 +/- 41 mg/dl. The differences in LDL, TC and TG between the treatment groups were statistically significant; p = 0.0014, p = 0.0001 and p = 0.007, respectively. HDL cholesterol in serum increased 12% from 50 +/- 10 to 55 +/- 13 mg/dl after PPC application. The control group did not show any alteration of mean HDL cholesterol level at any time.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- R Kirsten
- Department of Clinical Pharmacology, University of Frankfurt, Germany
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Gillick MR, Hesse K, Mazzapica N. Medical technology at the end of life. What would physicians and nurses want for themselves? Arch Intern Med 1993; 153:2542-7. [PMID: 8239847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Advance directives assume that patients are able to decide what interventions they would wish in the event of catastrophic illness. This study examines the preferences of nurses and physicians, who have extensive exposure to sick patients, for care at the end of life. METHODS Nursing and medical staff of a community teaching hospital were asked to complete the medical directive, detailing which of 12 interventions they would wish for themselves in each of four scenarios. Two additional scenarios were added to ascertain preferences for care in the event of severe illness in a previously healthy 85-year-old subject and in a chronically ill 75-year-old subject. RESULTS Refusal rate among the 127 nurses and 115 physicians who completed the questionnaire, averaged over the four scenarios, was 78%. Nurses and physicians refused 31% of proposed therapies in the case of acute illness in a previously healthy 85-year-old subject and 57% of interventions in the case of major illness in a 75-year-old subject with multiple debilitating chronic illnesses. Nurses reported significantly higher refusal rates than physicians for the scenarios involving possible reversible coma, the healthy 85-year-old subject, and the chronically ill 75-year-old subject. Factors predicting refusal patterns were age and being a nurse. CONCLUSION We conclude that physicians and nurses, who have extensive exposure to hospitals and sick patients, are unlikely to wish aggressive treatment if they become terminally ill, demented, or are in a persistent vegetative state. Many would also decline aggressive care on the basis of age alone, especially in the presence of functional impairment. These findings call into question the utility of detailed advance directives and suggest a need to focus on the goals of treatment for all elderly patients.
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Affiliation(s)
- M R Gillick
- Department of Medicine, Mount Auburn Hospital, Cambridge, Mass
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Hansmann ML, Kikuchi M, Wacker HH, Radzun HJ, Nathwani BN, Hesse K, Parwaresch MR. Immunohistochemical monitoring of plasmacytoid cells in lymph node sections of Kikuchi-Fujimoto disease by a new pan-macrophage antibody Ki-M1P. Hum Pathol 1992; 23:676-80. [PMID: 1592391 DOI: 10.1016/0046-8177(92)90324-v] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The new monoclonal antibody Ki-M1P, which detects a formalin-resistant epitope on conventional paraffin sections, was applied in 20 cases of different stages of Kikuchi-Fujimoto disease. This new pan-macrophage immunoreagent detects plasmacytoid T cells, referred to as plasmacytoid cells, and renders a reliable delineation of these cells against other similar cell types, such as blasts of high-grade B- and T-cell lymphoma. Histiocytes as well as macrophages were strongly positive, and plasmacytoid cells showed a somewhat weaker and primarily granular, intracytoplasmic immunoreactivity. Plasmacytoid cells, being a diagnostic feature of the Kikuchi-Fujimoto disease, facilitate a clear distinction of this disease entity from large cell or high-grade lymphomas. These results may represent an additional argument favoring the histiocytic origin of plasmacytoid cells. Additionally, they may point to an immunohistochemical tool that facilitates the differential diagnosis between Kikuchi-Fujimoto disease, especially in early stages of the disease, and malignant lymphoma.
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Affiliation(s)
- M L Hansmann
- Department of Pathology, University of Kiel, Germany
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Hesse K, Gliemann G, Kiss A, Kleinschmit P, Völker W. Photophysics of Ceramic Luminophores. Zeolite-Based Luminophores of the Types Zn 2SiO 4: Mn and (CdO) 2B 2O 3: Mn. Zeitschrift für Naturforschung B 1989. [DOI: 10.1515/znb-1989-0510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The emission spectra (at T = 10 K and 296 K) and the excitation spectra (at T = 295 K) of zeolite-based luminophores of the types Zn2SiO4:Mn and (CdO)2B2O3:Mn show the characteristics of Mn2+ in tetrahedral and octahedral surroundings, respectively, as well as additional features due to impurities and/or structural defects of the host crystal. The ZnSiO4⁻type phosphor exhibits photostimulated emission, which can be assigned to trap states of the silicate host.
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Affiliation(s)
- K. Hesse
- Institut für Physikalische und Theoretische Chemie, Universität Regensburg*, D-8400 Regensburg
| | - G. Gliemann
- Institut für Physikalische und Theoretische Chemie, Universität Regensburg*, D-8400 Regensburg
| | - A. Kiss
- Degussa AG, D-6000 Frankfurt
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Krause G, Budeus G, Gerdes D, Schaumann K, Hesse K. Frontal Systems in the German Bight and their Physical and Biological Effects. Marine Interfaces Ecohydrodynamics 1986. [DOI: 10.1016/s0422-9894(08)71042-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Hagenbruch B, Hesse K, Hünig S, Klug G. Berichtigung. European J Org Chem 1982. [DOI: 10.1002/jlac.198219820224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Nagel T, Hesse K, Just H, Scholz M. [MO calculations of the electronic structure and properties of adrenochrome derivatives. 17. MO calculations of heterocyclics]. Pharmazie 1978; 33:117-9. [PMID: 674295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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