Spezielle Aspekte bei Angststörungen

Anxiety disorders are among the most common mental health conditions worldwide and frequently cause significant functional impairment. Generalized anxiety disorder is the most commonly occurring impairing anxiety disorder in primary care. The degree of disability attributable to generalized anxiety disorder is comparable to that of major depression and is similar to that of chronic physical illnesses, such as peptic ulceration, arthritis, asthma and diabetes mellitus. Comorbid illnesses, such as mood disorders are commonly seen in clinical practice and have a significant impact on the clinical presentation and the treatment approach. Both psychotherapeutic and pharmacological techniques are recognized as being effective management strategies. The present article focuses on two case-reports of patients with anxiety disorders in an inpatient setting. By describing comorbid conditions subsequent difficulties and challenges in treatment are underlined.     

Angstbewältigung

In the psychiatric outpatient clinic of the University Hospital Tulln, the Canadian Occupational Performance Measure (COPM) – an occupational therapy, evidence-based, and diagnosis-independent assessment – is used to collect and assess performance problems in everyday life. Subjectively perceived everyday problems are assessed with regard to performance and satisfaction on a scale from 1–10 at the start and upon completion of treatment. The particular focus is on the impact and relevance of anxiety symptoms. Using the example of a 35-year-old woman with obsessive-compulsive disorder and anxiety, the possibilities of diagnosis, treatment planning, and quality assurance are shown and the relevance for the treatment process is illustrated.     

The effects of physostigmine and scopolamine on recognition memory in monkeys

The visual recognition of rhesus monkeys was evaluated by means of a delayed nonmatching-to-sample task with trial-unique objects. Each daily session consisted of two lists of 20 objects each, which untreated animals were able to recognize at approximately 75% accuracy. When they were performing at this level reliably, doses of physostigmine (0.32, 1.0, 3.2, 10.0, 32.0, 56.0 micrograms/kg), scopolamine (1.0, 3.2, 5.6, 10.0, 17.8, 32.0 micrograms/kg), or saline were administered 20 min prior to the session. Physostigmine and scopolamine produced dose-related increases and decreases, respectively, in the number of objects correctly remembered. The systematic changes in performance support the view that cholinergic mechanisms contribute to recognition memory and suggest that tasks with trial-unique objects may be particularly useful for studying the mnemonic effects of cholinergic drugs.     

Medikamentenübergebrauchs­kopf­schmerz

Prospective longitudinal studies clearly demonstrate a causal relationship between the overuse of painkillers and migraine relievers and chronic headache. Overuse of any acute headache medication is the main factor in about 30-50% cases for chronic headache, and thus chronic headaches may be attributed to overuse. The prevalence of medication overuse headache (MÜKS, Eng: medication overuse headache, MOH) is likely to be around 3%.The diagnostic criteria of MOH are: Headache more than 15 days per month, Regular overuse of one or more drugs for acute symptomatic headache treatment of over more than 3 months, Headache has developed or is aggravated during medication overuseHeadache disappears or reverts to its initial level within 2 months after discontinuation of the drug overuse. Clinically, it is usually a “mixed” holocranial headache that is no longer consistent with a migraine or tension headache. The so-called “swing model” has proven itself in the context of psychoeducation. If painkiller withdrawal is not possible, in the outpatient setting, then a stationary multimodal withdrawal therapy should also be considered.     

Dissoziative Störung einst und jetzt

psychopraxis. neuropraxis - In der Behandlung der dissoziativen Störungen hat sich in den letzten 150 Jahren sehr viel verändert. Zu Zeiten Jean-Martin Charcots dominierten...     

Benzodiazepine im Fokus

Benzodiazepines (BZDs) are widely disseminated because of their good compatibility and safety profile. But the long-term use appears problematic and is likely to be associated with sleep disorders, increased anxiety, concentration problems, cognitive losses and physical discomfort. A BZD long-term intake syndrome can be hypothesized, with a risk of dementia development.     

Comparison of the effects of scopolamine administered before and after acquisition in a test of visual recognition memory in monkeys

The effect of scopolamine on visual recognition memory in rhesus monkeys was assessed with a delayed nonmatching-to-sample task employing trial-unique stimuli. During the acquisition phase, 40 sample stimuli were presented sequentially. During the test phase, these same stimuli were presented in the reverse order, each paired with a novel stimulus. The animal was rewarded for choosing the novel stimulus in each pair. Two versions of this design were used. In Task 1, scopolamine (10.0 or 17.8 micrograms/kg) was administered 20 min prior to acquisition, which was followed immediately by the test phase. In Task 2, the drug was administered immediately after acquisition, which was followed 20 min later by the test phase. Performance was impaired in a dose-related manner in Task 1, but not at all in Task 2, indicating that the effects of scopolamine on performance cannot be attributed to an impairment either in the retrieval of stored information or in the attentive or perceptual discriminative processes needed for such retrieval, or, by implication, for storage. In addition, the forgetting curves for scopolamine in Task 1 were parallel to those of the control sessions; i.e., the curves did not diverge with increasing delay intervals, indicating that scopolamine did not increase the rate of forgetting. Taken together, the results suggest that scopolamine interferes selectively with the initial storage of the information to be remembered.     

Schlafstörung – Symptom der Depression?

Sleep disorders are an interdisciplinary health issue. Among western industrialized countries, many people suffer from poor quality of sleep. Especially, psychiatric patients have a high prevalence of sleep disorders. The treatment of sleep disorders should follow a detailed sleep history and polysomnographic work-up, which is often not possible in daily work. Thus, patients with sleep disorders are often not treated accurately. Mobile inhospital polysomnography is an attractive alternative that allows tests to be performed already during normal hospitalization on any ward. The following case report shows that the diagnostic work-up of sleep disorders can significantly affect further treatment decisions.     

Motivation and expectancy influences in placebo responding: The mediating role of attention

Drawing upon research in perception and motivation, the current study proposes a motivation‐attention model of placebo in which more motivated persons pay greater attention to placebo‐related stimuli, directly influencing placebo response. We manipulated both motivation to respond to placebo and expectations of placebo response in a 2 × 2 design. Participants (N = 152) evaluated a series of placebo pheromones (slightly scented water) of potential romantic dates and made desirability ratings. Consistent with hypotheses, more highly motivated participants demonstrated greater placebo responses, as evidenced by higher desirability ratings of the “pheromone” and greater variability among ratings, when compared to less motivated participants. Moreover, the relation between motivation and placebo response was mediated by attention. Contrary to expectations, we found no effect for expectancy. These findings highlight the importance of motivation and the mediating factor of attention in placebo and support goal‐oriented models of placebo.