Partizipationsverhalten schizophren erkrankter Patienten in Psychoedukationsgruppen

Background

The effectiveness of psychoeducation groups for people with schizophrenia is well documented; however, there are no studies which examined patient participation behavior although this behavior might be critical for accomplishment of the therapeutic goals. This article presents newly developed 4-point Likert scale, the participation quality rating scale (PQRS), together with initial results on practicability, validity, change sensitivity, sociodemographic and clinical correlates and on the question whether participation quality might be a significant predictor of the short and long-term outcome of psychoeducation.

Patient and methods

Within the framework of the Munich Study “Cognitive Determinants of Psychoeducation and Information in Schizophrenic Psychoses” (COGPIP) the individual participation behavior of 97 patients with schizophrenia was examined after each psychoeducational group session (4 weeks). Individual mean PQRS scores were correlated with sociodemographic, anamnestic and clinical variables. In addition to change sensitivity the ability of the scale to predict the acquisition of illness knowledge during psychoeducation was examined as well as readmission during a 9-month follow-up period and the psychopathological endpoint (positive and negative syndrome scale, PANSS).

Results

Practicability and change sensitivity of the PQRS were found to be sufficient. Significant correlations with independently rated illness insight and medication compliance indicated a construct validity of the scale. Higher age, female sex and less pronounced psychopathological symptoms (PANSS) were associated with better participation behavior. Even patients with clearly impaired participation behavior profited from psychoeducation in that they were able to catch up with the delay with regard to illness knowledge. However, the PQRS was not a predictor of readmission during the 9-month follow-up period or of psychopathological endpoints.

Conclusions

The PQRS is qualified as a new tool for the standardized assessment of participation behavior in people with schizophrenia attending psychoeducation groups. The scale can be applied in research as well as clinical contexts in order to further improve understanding of how psychoeducation works and how this kind of supplementary therapy could become even more effective.     

Entwicklung und Evaluation eines interaktiven Films für Jugendliche zur Vermittlung von Gerichtswissen

An interactive movie for juvenile witnesses produced by the author was evaluated in terms of its effectiveness to convey court relevant knowledge to 16-year-old and 17-year-old students. A control group design was used. Controls received a brochure containing information comparable to the movie which was also developed by the author. The aim of the study was to empirically evaluate the movie in order to make it available to juvenile witnesses as an instrument for court preparation in the future. A total of 52 students aged 16 and 17 years at a training college were investigated and court knowledge was measured prior to testing. Participants in the treatment group then viewed the movie, which was produced by the author. The control group received a brochure containing information very similar to the contents of the movie. Approximately 2 weeks later, court relevant knowledge was again assessed and both treatment and control groups showed a strong and significant increase in court relevant knowledge. Comparing the groups showed that the effects tended to be stronger for the treatment group than for the control group. It was also investigated if legal misconceptions could be reduced by the interventions. Analyses indicated that effects were not significant and there was no significant difference between the groups. A significant increase of court relevant knowledge could be found for both treatment conditions. The weak effects concerning the reduction of legal misconceptions could be due to the fact that they were not explicitly presented in the movie but were treated more indirectly by presenting correct knowledge only.     

Turn of Fortune in Psychoanalysis: The 1924 Rank Debates and the Origins of Hermeneutic Psychoanalysis

The history of psychoanalysis can be characterized by conflicts that besides their personal content meant a closure and an opening in the development of the theorecial and practical (self )understanding of the discipline. The 1923-24 conflict that resulted in the separation of Rank from the movement and showed the first signs of uneasiness against the mainstream of psychoanalysis in Ferenczi's approach is relatively less known. However, its theoretical, or more general: discoursive impact on psychoanalysis was enormous.The debate took place among the top leaders of the movement, Rank and Ferenczi on one side, Jones, Abraham, Sachs on the other. In the center of the discussion there were two books, The Trauma of Birth by Rank and the The Development of Psychoanalysis by Ferenczi and Rank. With the help of documents I try to show that Freud first supported his Vienna-Budapest friends, later changed over to the other camp. As a general effect, I suggest that this debate resulted in the withdrawal from the earlier more hermeneutic-dialogical, therapy centered psychoanalysis toward a medical, objective, systematic and metapsychology oriented discipline. Besides the general theoretical change the power centers of psychoanalysis shifted toward West, Vienna and Budapest was substituted first by Berlin, later by London and New York.     

Improving Discrimination and Face Matching with Caricature

Identification of faces from photographs is a common security measure, but matching unfamiliar faces produces high rates of error. Caricatures of familiar people are highly identifiable because they exaggerate distinctive features. We investigated whether exaggerating unfamiliar faces through caricaturing could also improve face‐matching accuracy. In Experiment 1, face‐matching arrays were caricatured relative to an average by 30%, 50% and 70%. Correct rejection of the target‐absent arrays was improved at all levels. Accurate matches increased at 30%, but at 70%, the transformation was too extreme, and all of the arrays were more likely to be rejected. In Experiment 2, photographic identification (ID) images were caricatured by 30% and 50% and matched to life‐size photographs. Rejection of foils improved, but the ID of matching images was impaired. Modest levels of caricature may improve discrimination in unfamiliar face matching, but at stronger levels, a conservative response bias may inhibit accurate ID. Copyright © 2013 John Wiley & Sons, Ltd.     

Top-down selective visual attention: A neurodynamical approach

We propose a system of interconnected modules consisting of populations of neurons for modelling the underlying mechanisms involved in selective visual attention. We demonstrate that it is plausible to build a neural system for visual search, which works across the visual field in parallel, but, due to the intrinsic dynamics of the system, resembles apparent modes of visual attention, namely the serial focal and the parallel spread over the space mode. Thus, neither explicit serial focal search nor saliency maps need to be assumed. A focal attentional spotlight is not included in the system but rather focal attention emerges due to the convergence of the dynamic behaviour of the neural networks. The dynamics of the system can be interpreted as a mechanism for routing information from the sensory input.     

Mirror reading of words and numbers: Practice and transfer effects

It remains unknown whether mirror reading represents a genuine text processing skill or is based on recognition of visual patterns. The present study attempts to determine whether (1) systematic practice with a particular mirrored typography also improves reading performance for other mirrored typographies, and whether (2) this transfer extends from lexical to numerical material and vice versa. The results show that short-term intensive practice with mirror-reversed words significantly improves reading performance not only for the trained typography but also for other mirrored typographies and mirror-reversed Arabic digits. Practice with mirror-reversed Arabic digits showed a mixed pattern of transfer effects with regard to other digit transformations and there were no transfer effects to lexical material. Hence, for lexical material, at least, improvement after training seems to be based on generalized skill with transfer effects beyond lexical material, rather than on mere improvement of visual recognition of the material used in training.     

‘Mr K’ – A successful case of analytic oriented therapy documented empirically: the role of the therapeutic relationship and reflexive self-awareness

A successful case of analytic treatment over the course of 250 sessions is described from different perspectives, including considerations from the two-year follow-up. The therapeutic alliance and the patient’s experiencing were evaluated. Pre-treatment diagnosis was validated via diagnostic interview. Symptoms and interpersonal problems were assessed at intervals. Data were analysed using two different time-series analyses. Aspects of agency with regard to mentalizing capacity were assessed with the Metacognitive Assessment Scale. We obtained the following main results: (1) Symptoms and interpersonal problems improved continuously until the end of treatment. Symptom severity fell to below the clinical cut-off. This successful outcome remained stable at the two-year follow-up. (2) The therapeutic relationship improved during the therapeutic process. (3) The patient’s capability for reflexive self-awareness, operationalized as experiencing, decreased. (4) The metacognitive mastery of the patient increased. The following conclusions were made after combining the empirical data with the clinical observations: (1) Mr K improved clinically in terms of symptoms, self-regulation and interpersonal problems as a result of his gaining affect control. (2) The patient’s experiencing does not capture a positive outcome in all cases. (3) Aspects of agency (i.e. metacognitive mastery) deserve further attention in psychoanalytic treatments.     

Retro- and prospection for mental time travel: Emergence of episodic remembering and mental rotation in 5- to 8-year old children

We investigate the common development of children’s ability to “look back in time” (retrospection, episodic remembering) and to “look into the future” (prospection). Experiment 1 with 59 children 5 to 8.5 years old showed mental rotation, as a measure of prospection, explaining specific variance of free recall, as a measure of episodic remembering (retrospection) when controlled for cued recall. Experiment 2 with 31 children from 5 to 6.5 years measured episodic remembering with recall of visually experienced events (seeing which picture was placed inside a box) when controlling for recall of indirectly conveyed events (being informed about the pictures placed inside the box by showing the pictures on a monitor). Quite unexpectedly rotators were markedly worse on indirect items than non-rotators. We speculate that with the ability to rotate children switch from knowledge retrieval to episodic remembering, which maintains success for experienced events but has detrimental effects for indirect information.     

Individual differences in attentional capability are linked to creative decision making

There is a link between visual attention and creativity concerning the generation of rare and flexible decisions/solutions. However, the relationship between individual differences in attentional capability and creative decision making has not yet been investigated in detail. The current study scrutinized this link in a sport‐specific divergent thinking task including videos of real game situations and compared performances between football players being divided into two different expertise levels (expert and amateur football players). We conducted a multiple linear regression analysis to assess whether attentional capability along the attentional focus’ meridians (horizontal, vertical, diagonal) and participants’ expertise level predict creative decision making. The attentional capability along the horizontal meridian of participants’ attentional focus and participants’ expertise level emerged as positive predictors. The findings provide evidence of a relationship between football players’ spatial distribution of attention that match the demands of their sport and an expertise advantage in sport‐specific creative decision making. Implications are not only important for sports, but also for all areas in which spatial attention is required in order to generate unusual solutions.     

Transcranial direct current stimulation and visual perception

Membrane potentials and spike sequences represent the basic modes of cerebral information processing. Both can be externally modulated in humans by quite specific techniques: transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS). These methods induce reversible circumscribed cortical excitability changes, either excitatory or inhibitory, outlasting stimulation in time. Experimental pharmacological interventions may selectively enhance the duration of the aftereffects. Whereas rTMS induces externally triggered changes in the neuronal spiking pattern and interrupts or excites neuronal firing in a spatially and temporally restricted fashion, tDCS modulates the spontaneous firing rates of neurons by changing resting-membrane potential. The easiest and most common way of evaluating the cortical excitability changes is by applying TMS to the motor cortex, since it allows reproducible quantification through the motor-evoked potential. Threshold determinations at the visual cortex or psychophysical methods usually require repeated and longer measurements and thus more time for each data set. Here, results derived from the use of tDCS in visual perception, including contrast as well as motion detection and visuo-motor coordination and learning, are summarised. It is demonstrated that visual functions can be transiently altered by tDCS, as has been shown for the motor cortex previously. Up- and down-regulation of different cortical areas by tDCS is likely to open a new branch in the field of visual psychophysics.