Experiences with the indirect Clausen Test using NTA as an antigen in multiple sclerosis and other neurologic diseases

The present study based on the indirect Clausen-test using NTA and PHA as antigens contributed to therapy control and possibly prognosis assessment rather than to immunological differential diagnosis.     

Experiences with psychosocial management of patients with multiple sclerosis in a discussion group

Patients with multiple sclerosis must come to terms with their unpredictable chronic disease. Frequently, they want to establish contacts and exchange information with others sharing the same problems. Discussion groups of outpatients offer many opportunities to further the process of coping with the disease as an interlocking web of defensive and coping patterns. The patients can learn from each other to assess their disabilities and capabilities more realistically and to deal more openly with their fears, hopes and disappointments.     

The nature of benefit finding in multiple sclerosis (MS)

This study examined the nature of benefit finding in MS and the adequacy of the Benefit Finding Scale (BFS; Mohr et al., 1999) as a comprehensive measure of perceived benefits in MS. A total of 502 people with MS completed questionnaires at Time 1 and 3 months later, Time 2 (n=404). Data on demographics and illness were collected at Time 1 and qualitative data on benefit finding was obtained at Time 2. Content analyses revealed seven benefit finding themes (personal growth, strengthening of relationships, appreciation of life, new opportunities, health gains, change in life priorities/goals and spiritual growth). Two of the themes were represented by several items on the BFS (personal, relationship growth), three were not reflected by items on the BFS (health, new opportunities, life priorities) and two were represented by one item each (spiritual, life appreciation).     

Suicide compared to other causes of mortality in physicians

Physicians frequently are early adopters of healthy behaviors based on their knowledge and economic resources. The mortality patterns of physicians in the United States, particularly suicide, have not been rigorously described for over a decade. Previous studies have shown lower all-cause mortality among physicians yet reported conflicting results about cause-specific mortality such as suicide. In this study, we compared all-cause and cause-specific mortality in a sample of physicians to the age-gender matched general U.S. population from 1948 through 1998. We also compared the mortality experience across medical specialties. The risk of all-cause mortality was 56% lower than expected in men, and 26% lower in women, compared to the general population. Standardized mortality ratios (SMRs) were markedly lower for diseases strongly linked to smoking, e.g., cardiovascular diseases, respiratory diseases, and lung cancer. Suicide was the only cause of death where risk was greater than the general population. Overall, we found that physicians are at substantially lower risk of dying compared to the general population for all causes of death except suicide. The findings for suicide are strikingly different than other causes of death and should provide impetus for new research on the mental health of physicians.     

Familial multiple sclerosis with repetitive relapses of manic psychosis in two patients (mother and daughter)

The clinical presentation of multiple sclerosis (MS) with psychiatric symptoms is uncommon but it is believed that MS patients are twice as likely to be afflicted with bipolar disorder as the general population. We report two cases (mother and daughter) of MS presenting with bipolar disorder in the form of recurrent manic psychosis and whose outcome was favourable with neuroleptics and corticosteroids. In both cases we found multiple hypersignal lesions on brain magnetic resonance imaging (MRI), especially in the right frontal lobe where we observed signs of activity. Apart from clinical and radiological concordance, the patients exhibited similar class I HLA alleles and identical class II HLA alleles. We focused discussion on whether there may be a common genetic susceptibility to both illnesses or whether MS caused psychiatric manifestations. The coincidence of psychiatric and neurological symptoms in most relapses supports the second hypothesis.     

Psychiatric treatment of the homeless in a group-based therapeutic community: a preliminary field investigation

This preliminary study investigated the effectiveness of a group-based therapeutic community for the homeless. Thirty-seven individuals residing at a homeless shelter participating in a therapeutic community were assessed across time on several variables: psychiatric symptoms, social functioning, and substance abuse. Significant initial improvements in overall distress, psychiatric symptoms, and substance abuse were found. Improvements in social functioning were exhibited in the therapeutic community participants after six months.     

Spiral drawing performance as an indicator of fine motor function in people with multiple sclerosis

This study investigated spiral drawing performance as an indicator of fine motor function, as well as to gain insight into adaptive movement strategies used by people with multiple sclerosis (MS). Seven people with MS, nine younger controls (mean age of 20) and eight older controls (mean age of 40) drew spirals on a graphics tablet at a comfortable speed and size. Spirography (i.e., a subjective visual assessment of the static trace) revealed indications of reduced control of the pen for people with MS. Analysis of the movements showed that people with MS tended to draw the spirals slower and with less pen pressure than controls. All groups increased their speed and pressure along with spiral size, but this increase was much steeper for the controls. MS participants drew spirals with more variability around an ideal trajectory, highlighting fine motor control degradation. MS patients tended to use a smaller scaling ratio, resulting in smaller spirals for a given number of revolutions. The younger and older control groups drew the spirals in a similar manner, and age was not a significant factor in any of the analyses. It is argued that the relatively lower pressure used, and slower, smaller movements (particularly during the more difficult outer sections of the spiral) are in part an adaptive strategy used to reduce movement variability. These results demonstrate the utility of the analysis of spiral movements as an objective technique for assessing motor control degradation, which can compliment the subjective rating based on the static pen trace. As such, it can provide further insight into the biomechanical strategies used when performing fine movements.     

Sudden onset of excessive repetitions in the speech of a patient with multiple sclerosis: A case report

This report provides a detailed analysis of excessive part- and whole-word repetitions in the speech of a 36-year-old male patient hospitalized for treatment of multiple sclerosis (MS) who also exhibited concurrent language and prosodic disturbances. Shortly following his hospitalization, a magnetic resonance imaging examination revealed plaques in the white matter of the medulla, cerebellum, basal ganglion, and periventricular white matter. His speech strongly resembled apractic speech patterns, chiefly syllable segregation. The source of data collected for this study was seven tape-recorded speech samples containing 2536 words spoken in 32.75 min, diagnostic reports, and clinical notes of 27 biweekly speech therapy sessions across a 5-month period. This report focused on an analysis of variables associated with the patient's part- and whole-word repetitions, and it was concluded that they were used as a compensatory device to procure additional time to articulate complex syllables. A brief critique of the therapeutic procedures used for treating his speech problem is also presented.

Educational objectives: The reader will learn about and be able to describe (1) the effects of MS on speech and language; (2) the kinds of data that were gathered to account for this patient's sudden onset of speech and language disorders; and (3) the findings that led them to conclude that his excessive repetitions were compensatory behaviors.     

The lived experiences of people diagnosed with multiple sclerosis in relation to exercise

The purpose of this study was to examine the lived experiences of people diagnosed with Multiple Sclerosis (MS). Seven active exercisers with MS participated in semi-structured interviews regarding their exercise experiences since diagnosis. Data were analysed using Interpretative Phenomenological Analysis (IPA; Smith?&?Osborn, 2003 Smith, JA and Osborn, M. 2003. “Interpretive phenomenological analysis”. In Qualitative psychology: A practical guide to research methods, Edited by: Smith, JA. 51–80. London: Sage.  [Google Scholar]). Interpretive Phenomenological Analysis. The results and interpretations of narratives revealed a number of functional limitations due to the severity of MS symptoms, which were found to have a major effect on the ability of the participants to exercise. Furthermore, psychological problems and the heightened behavioural adjustments to the progressive disability led to re-appraisal of ability to exercise. Previous, relevant exercise experience made participants more determined to continue to be able to exercise after diagnosis. The wider exercise experience narratives were related to concerns about safety, dependability on others to overcome the challenges, and potential environmental hazards. The loss of spontaneous opportunities to exercise because of these actual and perceived barriers was key to this population. This research highlighted the need to rethink the health and social service arrangements in relation to exercise provision for individuals with MS.     

Probabilistic choice (models) as a result of balancing multiple goals

We conceptualize probabilistic choice as the result of the simultaneous pursuit of multiple goals in a vector optimization representation, which is reduced to a scalar optimization that implies goal balancing. The majority of prior theoretical and empirical work on such probabilistic choice is based on random utility models, the most basic of which assume that each choice option has a valuation that has a deterministic (systematic) component plus a random component determined by some specified distribution. An alternate approach to probabilistic choice has considered maximization of one quantity (e.g., utility), subject to constraints on one or more other quantities (e.g., cost). The multiple goal perspective integrates the results regarding the well-studied multinomial logit model of probabilistic choice that has been derived from each of the above approaches; extends the results to other models in the generalized extreme value (GEV) class; and relates them to recent axiomatic work on the utility of gambling.     

Experiences and empirical results of ambulatory psychotherapy in care and treatment of special psychosomatic disorders (neuroses)

Object of the outlying paper are some few practical experience and theoretical based reflections in application of some elements of special-psychotherapeutical, personality- and conflict-centred techniques by treatment of psychosomatical disorders or likewise structured disorders in a district near Berlin (GDR). The methodical and methodological basis is directly related to some elements of the psychotherapeutical system of Oderich, developed while the last ten years have passed. In the centre of this methodical procedure we see especially self-relaxation, active therapeutical attitudes by patient and real-demand-related and patient-centred, conflict-orientated treatment as basis for systematic behavior modification. In the last part of this paper we refered some aspected results of empirical-statistical analysis.     

Quality of life in transplant patients, compared to other stressful health situations in pulmonary patients

Transplantation may imply severe biopsychosocial impairments. In order to know the quality of life of patients one year after transplantation, 58 subjects were compared to three different groups of patients (stabilized and acute COPD patients, and lung cancer patients in a surgery unit). Patients filled in two questionnaires: EORTC QLQ-C30 (quality of life) and HAD (anxiety and depression). The quality of life dimensions with inter-group differences were physical, role, emotional and cognitive functioning, global health status, and a number of symptoms (fatigue, dyspnea, insomnia and appetite loss). There were differences in depression, and but not in anxiety. Transplant and surgical patients showed better quality of life and affective status than chronic pulmonary patients. Discriminant analysis showed that the transplant group was the best described group. We conclude that patients, one year after transplantation, show similar quality of life as asymptomatic hospitalised patients, somewhat better than chronic patients in a stabilized stage of the disease, and much better than severe chronic patients.