Zur Beziehung zwischen Schizophrenie und gewaltt?tigem Verhalten

The relationship between schizophrenia and violence with its substantial implications for the care of the severely mentally ill is one major reason for the special position of psychiatry. Due to the unique complexity of the human brain psychiatry was able to catch up with all other medical disciplines as late as the second half of the twentieth century only by means of the progress in biological brain research and psychopharmacology. At the same time the position of psychopathology has substantially changed. Being one of the core research issues until the introduction of antipsychotic drugs, it is nowadays primarily understood as a mere auxiliary tool for communication, for the collection of administrative data and for the recruitment of patients for various research projects. After a short overview of the current knowledge concerning the association between schizophrenia and violence the authors demonstrate by means of two psychopathological models, the differentiated classification according to Leonhard and the concept of structural dynamics by Janzarik, that many of the findings of current brain research are compatible with these models, exclusively based on detailed psychopathological observations. Differentiated psychopathology plays an indispensable mediator role between biological brain research methods and the complex reality of human behaviour, which is of major importance especially in forensic psychiatric issues. By neglecting this fact psychiatry is in danger of abandoning the possibility to generate relevant questions and hypotheses for future research.     

Disentangling the adult attention-deficit hyperactivity disorder endophenotype: parametric measurement of attention

Attention deficit hyperactivity disorder (ADHD) persists frequently into adulthood. The decomposition of endophenotypes by means of experimental neuro-cognitive assessment has the potential to improve diagnostic assessment, evaluation of treatment response, and disentanglement of genetic and environmental influences. We assessed four parameters of attentional capacity and selectivity derived from simple psychophysical tasks (verbal report of briefly presented letter displays) and based on a "theory of visual attention." These parameters are mathematically independent, quantitative measures, and previous studies have shown that they are highly sensitive for subtle attention deficits. Potential reductions of attentional capacity, that is, of perceptual processing speed and working memory storage capacity, were assessed with a whole report paradigm. Furthermore, possible pathologies of attentional selectivity, that is, selection of task-relevant information and bias in the spatial distribution of attention, were measured with a partial report paradigm. A group of 30 unmedicated adult ADHD patients and a group of 30 demographically matched healthy controls were tested. ADHD patients showed significant reductions of working memory storage capacity of a moderate to large effect size. Perceptual processing speed, task-based, and spatial selection were unaffected. The results imply a working memory deficit as an important source of behavioral impairments. The theory of visual attention parameter working memory storage capacity might constitute a quantifiable and testable endophenotype of ADHD.     

Has someone moved my plate? The immediate and persistent effects of object location changes on gaze allocation during natural scene viewing

In this study, we investigated the immediate and persisting effects of object location changes on gaze control during scene viewing. Participants repeatedly inspected a randomized set of naturalistic scenes for later questioning. On the seventh presentation, an object was shown at a new location, whereas the change was reversed for all subsequent presentations of the scene. We tested whether deviations from stored scene representations would modify eye movements to the changed regions and whether these effects would persist. We found that changed objects were looked at longer and more often, regardless of change reportability. These effects were most pronounced immediately after the change occurred and quickly leveled off once a scene remained unchanged. However, participants continued to perform short validation checks to changed scene regions, which implies a persistent modulation of eye movement control beyond the occurrence of object location changes.     

Residual attentional capacity amongst young and elderly during dual and triple task walking

Walking is considered an automatic function which demands little attentional resources. Thus a residual attentional capacity is available for a concurrent task (dual task). Minor age-related deficits in postural control may minimize the residual attentional capacity, however this may not be detected by a simple examination of the individuals gait performance. This study investigated the use of challenging dual task combinations to detect age related changes in gait performance. Eleven community-dwelling elderly (mean age 76 years) and 13 young subjects (mean age 26 years) participated in the study. The participants walked along a figure-of-eight track at a self-selected speed. The effect of introducing a concurrent cognitive task and a concurrent functional motor task was evaluated. Stride-to-stride variability was measured by heel contacts and by trunk accelerometry. In response to the cognitive task the elderly increased their temporal stride-to-stride variability by 39% in the walking task and by 57% in the combined motor task. These increases were significantly larger than observed for the young. Equivalent decreases in trunk acceleration autocorrelation coefficients and gait speed were found. A combination of sufficiently challenging motor tasks and concurrent cognitive tasks can reveal signs of limited residual attentional capacity during walking amongst the elderly.     

Emotional competence in children with autism: Diagnostic criteria and empirical evidence

The diagnostic criteria of autism spectrum disorders (ASD) include emotional impairments. However, scientific evidence for these impairments is varied and subtle. In this contribution, recent empirical studies that examined the emotional competence in children and adolescents with ASD are reviewed. Four aspects of emotional competence that are important to children’s daily social functioning (expression, perception, responding, and understanding) are discussed, differentiating between mentally retarded and normally intelligent children and adolescents with and without ASD in natural and structured contexts. On various accounts, the emotional impairments of children with ASD that are found in scientific studies provide a more differentiated view on the impairments suggested by the diagnostic literature. Consistent empirical findings and gaps in the field are discussed. Theoretical and clinical recommendations for assessment procedures are suggested.     

The role of strategies in deciding advantageously in ambiguous and risky situations

In decision situations of everyday life, the potential positive or negative consequences of a decision are often specified and the associated probabilities are known or they are principally calculable ("decisions under risk"). On the basis of correlations reported in patient studies, it has been recently proposed that decisions under risk involve strategic components, i.e. calculation of the risk, as well as emotional processes, i.e. processing feedback from previous decisions. However, the potential impact of calculative strategies on decision-making under risk has not been investigated systematically, so far. In the current study, we examined 42 healthy subjects (21 females) with the Game of Dice Task measuring decisions under risk, and a questionnaire assessing strategy application in items comparable to the choices in the Game of Dice Task. In addition, the subjects performed the Iowa Gambling Task, examining decision-making under ambiguity, and a neuropsychological test battery focusing on executive functions. Results indicate that deciding advantageously in a decision-making task with explicit and stable rules is linked to applying calculative strategies. In contrast, individuals who decide intuitively prefer risky or disadvantageous choices in the Game of Dice Task. Applying calculative strategies was correlated with executive functions but not with performance on the Iowa Gambling Task. The results support the view that calculative processes and strategies may improve decision-making under explicit risk conditions.     

Anxiety and post-traumatic stress symptoms following wisdom tooth removal

The purpose of the present study was to determine the psychological impact of wisdom teeth removal and to identify the psychological risk factors for the development of dental anxiety and post-traumatic stress symptoms. Participants were 34 consecutive elective patients referred for surgical removal of a wisdom tooth under local anesthesia. Frequency of previous distressing dental events and general traumatic life events were assessed at baseline (t1), and emotional distress (pain, state anxiety and disturbance) immediately after treatment (t2). Post-traumatic stress responses were determined three days after treatment (t3), and at four weeks follow-up (t4), while severity of dental trait anxiety was assessed at t1 and at t4. Two patients (8%) met screening criteria for Post-Traumatic Stress Disorder (PTSD) at t4. Multivariate analysis revealed that previous exposure to distressing dental events and pre-operative anxiety level predicted anxiety level at t4, accounting for 71% of the variance. Severity of pain during treatment was a significant predictor variable of PTSD symptom severity at t4 (25% explained variance). The findings underline the importance of pain-free treatments and awareness of patients' individual predisposition to anxiety or trauma-related symptoms to reduce the risk of iatrogenic psychological harm.     

Group processes and process evaluations in a new treatment setting: inpatient group psychotherapy followed by internet-chat aftercare groups

Little is known about processes characterizing therapeutic Internet-chat groups, which offer a novel way of providing group therapy over distances. In this study group processes and group evaluations were examined in a treatment setting where face-to-face inpatient groups are followed by chat aftercare groups. For a sample of 121 patients who participated in both treatment modalities, group processes and group evaluations were modeled using hierarchical linear modeling. The group evaluations followed a consistent upward course from the beginning of therapy until the end of chat aftercare. For the process measures Activity and Emotional Reactivity, the initial scores at the beginning of the chat groups were lower than at the end of the inpatient treatment, but higher than at admission. During chat aftercare, Activity and Emotional Reactivity scores increased less than during the inpatient phase, but on average Activity and Emotional Reactivity were higher during Internet-chat aftercare. The predictive value of the acquaintance of the therapist from inpatient treatment and the course of group evaluations during inpatient treatment on the course of group evaluations during chat aftercare were examined.     

Coordination of a discrete response with periodic finger tapping: additional experimental aspects for a subtle mechanism

The authors investigated the coordination of periodic right-hand tapping with single stimulus-evoked discrete lefthand taps to check for task interactions and a possible relationship between phase resetting (see tapping literature; e.g., J. Yamanishi, M. Kawato, & R. Suzuki, 1979) and phase entrainment (see tremor literature; e.g., R. J. Elble, C. Higgins, & L. Hughes, 1994). The experimental paradigm employs a dual-task condition as used by K. Yoshino, K. Takagi, T. Nomura, S. Sato, and M. Tonoike (2002), and it includes normal tapping and isometric tapping with the authors recording finger positions and ground contact forces. Four different types of coordination schemes were observed in tapping behavior: marginal tapping interaction (MTI), periodic tap retardation (PTR), periodic tap hastening (PTH), and discrete tap entrainment (DTE); MTI and PTR correspond to the phase-resetting effect for the coordination of periodic tapping with single discrete taps. The novel aspect of the study described in this article includes the impact of the periodic tapping on the discrete tap timing and the hastening of the periodic tapping due to the discrete tap behaviors resulting in a synchronized execution of the two concurrent tapping tasks. All participants showed a dominant tapping behavior, but they all used the other nondominant forms of the four reported coordination schemes in some trials too, which reflects possible constraints of the sensorimotor system in handling two competing tasks.