Electronic data processing-compatible documentation in neurology--developmental stage of neurologic findings for a specialty-specific scientific evaluation system and print-out of a computer assisted epicrisis

A computer compatible neurological examination record has been drawn up for a neurological documentation called "ADOK Neurologie" as part of a scheme for the basic registration of patient-related information from all patients receiving ward treatment at the Medical Academy Dresden and the County Neurological and Psychiatric Hospital Arnsdorf. The examination questionnaire consists of dichotomous questions and permits up to 1,525 separate items of neurological information per patient to be stored and processed. The information permits purposeful scientific analysis and computer print-out of the epicrisis. The article reports on the structure of the questionnaire, the prospects and limits of the method and experience gained during many years of practical use.     

The death instinct

The death instinct has always been a controversial concept, insufficient to account for actual dying, and usually taken to be fused with aggression. After dislodging it from the shadow of aggression in order to evaluate its function, the instinct turns out to be one of the components that form the death motivation. Human beings develop a complex motivation for death, one that is more than biology (instincts) or physics (entropy). It includes (a) the death instinct, the primary analogue; (b) sequellae of the universal experience of object-loss, with identification and fantasies of a restorative reunion; (c) guilt over hostile attitudes toward the lost object, with depression, longings for atonement , and self-punishment; (d) compliance with reality, like that of old age or grave sickness. Examined in light of the complementary series of Freud's aetiological equation, the death instinct turns into a precondition of the composition motivation. Death motivation is a comprehensive concept, since patients express various of its aspects during their psychoanalyses , and it facilitates a metapsychological understanding and refines the accuracy of interpretation.     

Social interaction and the development of cognitive operations

This paper presents two experiments to support the general hypothesis that the coordination of actions between individuals promotes the acquisition of cognitive coordinations. The first experiment shows that two children, working together, can successfully perform a task involving spatial coordinations; children of the same age, working alone, are not capable of performing the task. The second experiment shows that subjects who did not possess certain cognitive operations involved in Piaget's conservation of liquids task acquire these operations after having actualized them in a social coordination task.     

The use of nitrous oxide as a contrast medium during fractionated gas encephalography in halane-nitrous-oxide anesthesia]

40 children were employed as test cases in fractionated gas encephalography using Halan-nitrous oxide anesthesia, and the level of cerebrospinal pressure, the r?ntgenoparent quality of the extracerebral spaces and the duration of postencephalographical symptoms were examined using air and nitrous oxide as contrast media. In the course of the examination the cerebrospinal pressure showed a tendency to rise when air was introduced, to fall when nitrous oxide was introduced. After instillation of N2O however the filling of the subarachnoid space was over so quickly that it could not be included in the assessment. Sufficient r?ntgenograms were obtained for all diagnostic demands through 'hybrid filling', (introduction of nitrous oxide into the ventricles, introduction of air into the subarachnoid spaces). With the aid of the results obtained from this examination attempts will be made to derive differentiated indications for filling with nitrous oxide.     

Temporal contiguity in electric aversion therapy for cigarette smoking

Seventy dependent heavy smokers (32 cigarettes per day) were randomly assigned to one of five treatment and control procedures: (1) electric aversion therapy, involving ten 20-trial sessions of shocks contiguous with the smoking act. (2) simulated electric aversion. with non-contiguous shocks, (3) non-shock smoking sessions, to control for stimulus satiation and negative practice effects. (4) simple support and attention from therapist, (5) no-treatment. Before treatment, simple ‘self-monitoring’ and ‘self-control’ reduced cigarette consumption by an average of 12% (p < 0.001) and 26% (p < 0.001) respectively. Thirty-four of the 56 treated subjects (61%) were able to stop smoking compared with two out of fourteen (14%) of the no-treatment controls (p < 0.005). Treatment was highly effective at reducing and stopping smoking during the 4-week course and for 2 weeks afterwards (p < 0.005). Its effect was rapid, but not immediate. Outcome was virtually decided after 1 week (five sessions); subjects who had not stopped or almost stopped at this stage were most unlikely to respond later on (p < 0.001). All four treatments were equally effective, regular attendance for 15 min of simple support being as effective as the treatments involving additional 45-min sessions with a second therapist. The effects of contiguous vs non-contiguous shocks did not differ. A motor response was conditioned in 19 of the 28 subjects who received shocks but this was therapeutically irrelevant. The clinical outcome depended on the kind of subject rather than the kind of treatment. Those who were depressed, with poor psychiatric adjustment and a high Eysenck-Scale P score tended to do badly, while those who initially expressed high confidence in the outcome were more likely to succeed (p < 0.001). It is concluded that traditional conditioning processes do not contribute significantly to the clinical response of human subjects to electric aversion therapy for cigarette smoking.     

Evaluation of ego strength based on certain Rorschach variables.

Despite the importance of the assessment of ego strength for appropriate assignment of clients for psychotherapy and/or rehabilitation, existing techniques have not fulfilled expectations. A method for assessing ego strength through the Rorschach Test independent of clinical criterion is proposed. In addition to certain variables of Klopfer's RPRS (M+, FM+, FC+ plus CF+), sharply preceived space responses are included. They constitute a highly intercorrelated global measure of ego strength and are also highly correlated to a relatively independent Rorschach variable of global ego efficiency, i.e. integrated whole responses. In accordance with prediction, non-controlled color responses as well as accuracy of form perception did not correlate in a non-clinical sample with either measure of ego strength.