Vertical gaze direction and the resting posture of the eyes

With horizontal gaze, the resting posture of binocular vergence typically corresponds to a distance of about 1 m. The effect of vertical direction of gaze on this basic resting posture was investigated. The dark vergence of twenty-four subjects was measured while they fixated a dim monocular light-point at vertical directions ranging from -45 degree (lowered) to +30 degrees (elevated). In one condition, gaze was varied by changes in eye position with the head held upright; in a second condition, gaze was varied by changes in head inclination with the eyes held in constant (horizontal) position with respect to the head. In both conditions, dark vergence shifted in the convergent (nearer) direction with lowered gaze and in the divergent (farther) direction with elevated gaze. The effect of varied eye inclination was larger, more variable across subjects, and more stable over time than that of varied head inclination. These findings indicate that multiple mechanisms contribute to gaze-related variations of the resting posture of the eyes. They may help to explain the variations of space perception and visual fatigue that are observed with different gaze inclinations.     

Psychotherapeuten und Internet

Background

Communication is part and parcel of every interaction. This raises the question of the role of modern media in mental health care. The aim of this explorative study was to investigate the use of modern media in the clinical practice.

Material and methodology

In an Internet survey 234 psychotherapists from Nordrhein-Westfalen (NRW) were surveyed about the extent to which they integrate new media in the practice and their opinion about this integration. For this purpose a questionnaire was developed based on the questionnaire of Wangberg et al. (2007).

Results

Most of the psychotherapists already use e-mails as well as mobile communication to contact their patients. The main reason for choosing this modern way of communication is the possibility to simplify the management of formal issues. Psychotherapists were indifferent about the idea of web-based counseling.

Conclusion

Forms of digital media are used as an addition to conventional ways of therapeutic communication but face-to-face interaction cannot be replaced completely which is also indicated by the fact that professionals still highly value personal contact.     

Psychological and social characteristics of attenders for breast screening

Abstract

Demographic characteristics, health behaviour and knowledge of breast cancer were assessed in 183 women from a regional breast screening unit and compared with those of 182 women from a breast clinic and 41 control subjects. A questionnaire yielded information on (i) demographic characteristics and cancer-related behaviours including breast self-examination (BSE), use of screening and promptness of presentation of breast symptoms in the clinic group, (ii) the extent and effects of knowledge about breast cancer and (iii) the role of Health Belief Model dimensions. Results showed the screening unit attenders to be significantly older and to be significantly more likely to be from higher social classes. Differences between the groups in health beliefs and knowledge did not remain once the effects of age and social class were partialled out. While attitudes towards BSE and its practice related to health beliefs. only a minority of the women indicated that they practised BSE with any regularity. The results suggest that screening is failing to attract a truly representative sample of the community and raise the possibility that this failure is a consequence of sociological as much as psychological factors.     

Sexualit?t in Zeiten des Internet

The Internet shows several more or less specific characteristics, in particular accessibility, anonymity, affordability, worldwide connectivity and interactivity. These characteristics hold chances as well as risks for the development of sexuality and sexual relationships. Rarely stressed and investigated are the possible positive effects, such as easier sexual contacts especially for individuals with social deficits, for sexual minorities (e.g. gay, lesbian, transgender, sadomasochists or fetishists), reducing sexual prejudices and stereotypes, better partner matching and easy access to reliable information and counseling platforms about sexual issues. The psychotherapist more often encounters the problematic effects of Internet pornography and cybersex, such as avoiding real life (offline) sexual and non-sexual social contacts, the stress on relationships (e.g. through cyber infidelity), intensifying fantasies and impulses that are harmful to oneself or others up to criminal behavior (e.g. use and circulation of child pornography). Describing a case history this review discusses the role of the Internet in the development of sexual addictive or compulsive symptomatology, including treatment options. Only a differentiated analysis of the chances and risks can counterbalance the increasing tendencies to demonize and pathologize the use of the Internet for sexual purposes.     

A functional neuroimaging analysis of the Trail Making Test-B: implications for clinical application

Recent progress has been made using fMRI as a clinical assessment tool, often employing analogues of traditional "paper and pencil" tests. The Trail Making Test (TMT), popular for years as a neuropsychological exam, has been largely ignored in the realm of neuroimaging, most likely because its physical format and administration does not lend itself to straightforward adaptation as an fMRI paradigm. Likewise, there is relatively more ambiguity about the neural systems associated with this test than many other tests of comparable clinical use. In this study, we describe an fMRI version of Trail Making Test-B (TMTB) that maintains the core functionality of the TMT while optimizing its use for both research and clinical settings. Subjects (N=32) were administered the Functional Trail Making Test-B (f-TMTB). Brain region activations elicited by the f-TMTB were consistent with expectations given by prior TMT neurophysiological studies, including significant activations in the ventral and dorsal visual pathways and the medial pre-supplementary motor area. The f-TMTB was further evaluated for concurrent validity with the traditional TMTB using an additional sample of control subjects (N=100). Together, these results support the f-TMTB as a viable neuroimaging adaptation of the TMT that is optimized to evoke maximally robust fMRI activation with minimal time and equipment requirements.     

Therapiekonzeption für traumatisierte Patienten mit schweren Persönlichkeitsstörungen

Comorbidity between severe personality disorder and posttraumatic stress disorder is a frequent clinical problem. Severe personality disorders are characterized by an impaired regulation of emotions, a low mentalization capacity and deficits in personality integration. For severe personality disorders and posttraumatic stress disorder, a variety of evidence-based treatment approaches of psychodynamic and cognitive-behavioral origin are available. However, a closer inspection of these treatment concepts shows that they do not sufficiently take the respective comorbid condition into account. No single concept is able to cover all problem areas presented by patients with this comorbidity. Therefore, an attempt is made to present an integrative psychodynamically oriented therapy concept for traumatized patients with personality disorders which contains elements from psychodynamic, cognitive-behavioral and other concepts. The phase structure of the concept clarifies the sequence hierarchy of the therapeutic interventions. The content of the five phases are: (1) safety, holding and strengthening of coping capacities, (2) emotion regulation and self-care, (3) mentalization and development of stable representations, (4) gentle trauma processing and (5) conflict-oriented psychotherapy and treatment of maladaptive relationship patterns.     

Patientensuizid im psychiatrischen Fachkrankenhaus

Suicide prevention especially with psychiatric inpatients is traditionally a very important aspect of psychiatric treatment. During the 1970s and 1980s there was a noticeable increase in so-called hospital suicides in Germany, especially suicides of schizophrenic inpatients. The number of psychiatric inpatient suicides has currently decreased again and a shift to more depressive suicides has also been observed. Furthermore questions which are asked in court are presented and discussed.     

Creation and End-Directedness

Does the act of creation show itself anywhere within the creation? A common contemporary ontology tends to see two possibilities for those who want to defend a notion of creation. The first is to argue that an original set of materials was brought into existence out of nothing by divine action a long time ago. The second, in the tradition of Paley, posits a specific divine action that oversees the development of some of the materials into entities with an end-directedness. Much contemporary energy focuses on the second possibility. The argument of the paper is that the ontology behind both of these possibilities, which limits itself to the notions of a creation of materials and the building of some of the materials into end-directed entities, conceals rather than reveals the idea of creation. The paper tries to show how an Aristotelian sense of nature, with its recognition of internal teleology and original spontaneity, offers a better starting point for coming up against the mystery of divine creative activity.