Current trends in neuropathic pain treatments with special reference to fibromyalgia

Neuropathic pain and fibromyalgia are prevalent diseases which have major consequences on healthcare resources and the individual. From the clinical point of view neuropathic pains represent a heterogeneous group of aetiologically different diseases ranging from cancer to diabetes. Patients with fibromyalgia also display clinical features common in neuropathic pain suggesting that there might be some overlap. The mechanisms responsible for symptoms and signs in both diseases are still unknown. Recently, there have been numerous reports of various pharmacological treatments of neuropathic pain and fibromyalgia with often disappointing results. Most of the studies were of short duration, had high attrition rates, and displayed other methodological problems. Some compounds had high rates of adverse effects which makes it often difficult for the patients to tolerate the treatment, especially in the long-term. At present, the best options for medication treatment are tricyclic antidepressants in lower dosage than usual in psychiatric disorders and a wide range of anticonvulsants. Opioids are sometimes recommended but have been found to have minor efficacy. Recently, there have been more controlled trials, which are reported here if they had been published between 2002 and 2004. Various compounds have been tested in different studies. Treatment of fibromyalgia, which has many features in common with depressive symptoms, became the focus of interest. New promising studies with dual serotonin-norepinephrine reuptake inhibitors (duloxetine and milnacipram) and a newer antiepileptic drug (pregabalin) are in progress. Future research will have to apply new approaches (e.g., using a mechanism-based classification of neuropathic pain and carrying out studies in populations with the same symptom but not necessarily the same disease) in order to find effective treatments for these common and often debilitating diseases.     

Peripheral cuing by abrupt-onset cues: the influence of color in S-R corresponding conditions

Research on visuospatial attention indicates that a peripheral abrupt-onset cue at target position (valid condition) facilitates processing of the target, whereas a cue at another position interferes. This validity effect seems to be contingent on a similarity of the cue's color to the set of target colors (cf. J. Exp. Psychol.: Human Percep. Perform. 18 (1992) 1030). In Experiments 1-3, we confirm this contingency with cues that have the potential to activate responses. Thus, attentional capture and response capture are apparently governed by the same principle. In Experiment 2, it is demonstrated that color priming is not responsible for the contingency. In Experiment 3, it is shown that a more efficient reallocation of attention after color-dissimilar cues than after color-similar cues might contribute to the contingency.     

The emerging dialogue between psychoanalysis and neuroscience: neuroimaging perspectives

Current progress in the cognitive neurosciences is highly relevant to the development of psychoanalytic theory and practice. Neuroscience is today becoming mature enough to provide empirical biological approaches for the investigation of psychoanalytic models and observations. The current state of functional neuroimaging techniques is reviewed, selected paradigms and findings relevant to psychotherapy research are presented, and ways to pursue the dialogue between psychoanalysts and neuroscientists are discussed, as are some related obstacles and pitfalls. The emerging dialogue between psychoanalysts and neuroscientists may help not only to reestablish a solid position of psychodynamic theory and treatment in contemporary medicine, but also to bridge the division between "psychological" and "somatic" treatments, and gain important insights into the mind-brain relationship.     

Style in Philosophy: Part I

In this article, I attempt to restore the philosophical significance of that nonformalizable, noniterable, "singular' element of natural language that I call "style." I begin by critically addressing the exclusion of such instances of natural language by both semantics-oriented logical analysis and a restricted variation of structuralist linguistics. Despite the obvious advantages – with regard to style – of "pragmatic"approaches to language, such pragmatism merely returns to rule-determination in the guise of "normativity." Although style by definition resists any kind of rule-determination – whether posed in terms of semantics or intersubjective regulations of speech-acts – there can be no consideration of language that ignores the persistence of style in natural language. In terms of cognition, any discursive agent understands more than allowed by either semantics or speech-act theory. I ascribe this element of excessive signification to the role of style. My principal thesis is twofold: (1) a hermeneutic approach (exemplified by Schleiermacher) to literature should reveal the heuristically decisive role played by style in philosophy; and, more radically still, (2) style, in fact, may be crucially determinative of philosophical discourse in general. I suggest that a closer scrutiny of the lesser-known works of Ludwig Wittgenstein, conventionally regarded as having dreamt of a "philosophy without style," may consolidate the restoration of style's philosophical import.     

Assessing the Level of Structural Integration Using Operationalized Psychodynamic Diagnosis (OPD): Implications for DSM-5

A key ingredient in the current proposal of the DSM-5 Work Group on Personality and Personality Disorders is the assessment of overall severity of impairment in personality functioning: the Levels of Personality Functioning Scale (LPFS). The aim of this article is to contribute a conceptual and empirical discussion of the LPFS from the perspective of the Operationalized Psychodynamic Diagnosis (OPD) system (OPD Task Force, 2008 ). First, we introduce the OPD Levels of Structural Integration Axis (OPD-LSIA), a measure of individual differences in severity of personality dysfunction that is rooted in psychodynamic theory. We show that the OPD-LSIA is reliable, valid, and highly associated with observer ratings of personality disorders. In the second part, we present results from an OPD expert consensus study exploring potential limitations of the current LPFS item set from the perspective of the OPD-LSIA. We conclude with highlighting implications for future revisions of the DSM-5 proposal.     

Direktausbildung Psychotherapie an der medizinischen Fakultät

Background

There is ongoing political discussion at the Federal Ministry of Health that a university entrance diploma should allow psychotherapy to be studied directly: Graduation leads to a licensure that qualifies for further specialization, e.g. in cognitive behavioral therapy (CBT) or psychodynamic psychotherapy analog to medical specialization. As psychotherapy has its roots in both psychology and in medicine, the question is raised which faculty should be the future home of direct psychotherapy schools.

Material and methods

A theoretical model curriculum of psychosomatic psychotherapy is proposed. Its structure which is oriented to the established structure of medical training and its contents are described. It is argued that the proposed model in the tradition of psychosomatic medicine is suitable to meet ongoing changes in the structure of psychotherapeutic care due to new challenges in the field of public health.

Conclusion

The study of psychotherapy should be associated with chairs in clinical psychology and psychosomatic medicine in order to maintain and further develop the variety and quality which psychotherapy has gained in Germany.     

Psychodynamic focal group treatment for psychosomatic inpatients--with an emphasis on work-related conflicts

Conflicts arising from the work setting have remained a neglected issue in psychotherapy. To address this, the present study investigated the effectiveness of a manualized focal group treatment for psychotherapeutic inpatients suffering from vocational strains and conflicts and identified predictors of outcome. Cohorts of patients were assigned either to a treatment (N=144) or control condition (N=135). The group therapy intervention was found to be highly accepted by participants who were also more optimistic about returning to work and more favorable in their evaluations of treatment than patients in the treatment-as-usual condition. Group climate was found to be a predictor of favorable outcome. The findings suggest that a group therapy intervention with a strong emphasis on motivations and attitudes about work may be particularly suitable to deal with vocational conflicts and strains.     

Reciprocal relationships between value orientation and motivational interference during studying and leisure

Background. Motivational interference is defined as the amount of impairment in a target activity due to the incentives of a non‐chosen attractive alternative. The amount to which pupils experience motivational interference while studying or while performing a leisure activity in a school–leisure conflict situation is seen as depending on the values they attach to achievement and well‐being. At the same time, values may also be effects of frequent experience of motivational interference in the respective areas. Aims. The study is aimed at investigating the reciprocal relationship between personal value orientations and the experience of motivational interference during studying and leisure. Sample. A total of 363 pupils (sixth to eighth graders at the time of first measurement) completed the same questionnaire twice in a 2‐year interval. Method. The questionnaire included measures of achievement and well‐being value orientation and the experience of motivational interference during studying and during leisure in school–leisure conflicts. For this, two scenarios were created. In regression analyses, achievement and well‐being value orientations as well as their interaction terms were used as predictors for experience of motivational interference at t₂ while controlling for experience of motivational interference at t₁, and vice versa. Additionally in path models, these relations were tested in an integrative way. Results. Pupils' achievement value orientations were connected to differential changes in experiencing motivational interference during leisure and during studying in one scenario but only for pupils low or medium in well‐being value orientation. Conversely, experience of motivational interference at t₁ was related to changes in value orientations 2 years later. High motivational interference during studying led to an increase in well‐being value orientation, while high motivational interference during leisure was followed by a decrease in well‐being value orientation and an increase in achievement value orientation. Overall, path models supported these results. Conclusions. The results are discussed in terms of value change and are linked to self‐control and motivation research.     

Does Duration of Deregulated Religious Markets Affect Church Attendance? Evidence from 26 Religious Markets in Europe and North America Between 1981 and 2006

This study tests the deregulation hypothesis of religious market theory in 26 European and Northern American countries by examining differences in religious involvement between and within countries. The deregulation hypothesis, which is assumed to be universally valid, predicts that religious involvement is higher in deregulated religious markets. Moreover, countries having deregulated religious markets for a longer period of time are supposed to have higher levels of involvement. Therefore, we test the duration hypothesis. This test is important, as it also has been argued that it may take time for deregulation to have an effect on religious involvement. Multilevel analysis on the stacked European and World Value Surveys of 1981, 1990, 2000, and 2006 show that deregulation fosters church attendance, but duration of deregulation does not increase church attendance. Although the deregulation hypothesis cannot be rejected, we find that modernization corrodes church attendance to a larger extent than deregulation can stimulate church attendance.