Das Symptom Schwindel im Fokus der Psychiatrie

Das Symptom Schwindel wird in der klinischen Praxis organisch meist regelrecht durch die zuständige Fachrichtung abgeklärt. Ein möglicher psychiatrischer Impact im Symptom Schwindel wird oft übersehen und somit vernachlässigt. Die Folge ist ein Persistieren und Chronifizieren einer Symptomatik, die unter dem Namen phobischer Schwindel bekannt ist. Neuere Begriffe wie die somatische Symptomstörung des DSM‑5 und der heute stigmatisierende Begriff des somatoformen Schwindels werden in diesem Fallbericht klinisch und theoretisch umrissen. Sofern der phobische Schwindel richtig diagnostiziert wird, kann im Rahmen eines Gesamtbehandlungsplanes unter Einbeziehen von Physiotherapie, dem Erlernen von Angstbewältigungsstrategien und adäquater Aufklärung und Information des Betroffenen konkret an Beschwerden gearbeitet werden. Voraussetzung dafür ist ein interdisziplinäres Denken beim behandelnden Arzt. Im Fallbericht geht es um einen älteren Patienten, der neben schwerwiegenden körperlichen Ursachen für Schwindelsymptome letztlich einen phobischen Schwindel bietet, der nach der richtigen Diagnosestellung umfassend behandelt werden kann.     

Spatial learning and memory is preserved in rats after early development in a microgravity environment

This study evaluated the cognitive mapping abilities of rats that spent part of their early development in a microgravity environment. Litters of male and female Sprague-Dawley rat pups were launched into space aboard the National Aeronautics and Space Administration space shuttle Columbia on postnatal day 8 or 14 and remained in space for 16 days. These animals were designated as FLT groups. Two age-matched control groups remained on Earth: those in standard vivarium housing (VIV) and those in housing identical to that aboard the shuttle (AGC). On return to Earth, animals were tested in three different tasks that measure spatial learning ability, the Morris water maze (MWM), and a modified version of the radial arm maze (RAM). Animals were also tested in an open field apparatus to measure general activity and exploratory activity. Performance and search strategies were evaluated in each of these tasks using an automated tracking system. Despite the dramatic differences in early experience, there were remarkably few differences between the FLT groups and their Earth-bound controls in these tasks. FLT animals learned the MWM and RAM as quickly as did controls. Evaluation of search patterns suggested subtle differences in patterns of exploration and in the strategies used to solve the tasks during the first few days of testing, but these differences normalized rapidly. Together, these data suggest that development in an environment without gravity has minimal long-term impact on spatial learning and memory abilities. Any differences due to development in microgravity are quickly reversed after return to earth normal gravity.     

Emotional intensity of idiographic sad memories in depression predicts symptom levels 1 year later

When cued with generic happy and sad words, depressed individuals have been found to articulate contextually impoverished memories of autobiographical events. Although this pattern predicts a worse symptomatic course of disorder in some depressed samples, longitudinal findings with the cue-word paradigm are inconsistent. To address the etiological significance of autobiographical memories outside the cue-word paradigm, the authors used an idiographic interview in which depressed participants generated memories of their happiest and saddest lifetime events. Each memory was coded for detail and emotional intensity. At a 1-year follow-up, participants' levels of depressive symptoms were reassessed. Lower emotional intensity of saddest memories predicted higher levels of depressive symptoms at follow-up. Several implications for understanding sadness and emotional disclosure in depression are discussed.     

Genetic Cancer Risk Assessment and Counseling: Recommendations of the National Society of Genetic Counselors

These cancer genetic counseling recommendations describe the medical, psychosocial, and ethical ramifications of identifying at-risk individuals through cancer risk assessment with or without genetic testing. They were developed by members of the Practice Issues Subcommittee of the National Society of Genetic Counselors Cancer Genetic Counseling Special Interest Group. The information contained in this document is derived from extensive review of the current literature on cancer genetic risk assessment and counseling as well as the personal expertise of genetic counselors specializing in cancer genetics. The recommendations are intended to provide information about the process of genetic counseling and risk assessment for hereditary cancer disorders rather than specific information about individual syndromes. Key components include the intake (medical and family histories), psychosocial assessment (assessment of risk perception), cancer risk assessment (determination and communication of risk), molecular testing for hereditary cancer syndromes (regulations, informed consent, and counseling process), and follow-up considerations. These recommendations should not be construed as dictating an exclusive course of management, nor does use of such recommendations guarantee a particular outcome. These recommendations do not displace a health care provider's professional judgment based on the clinical circumstances of a client.     

Impaired odor recognition memory in patients with hippocampal lesions

In humans, impaired recognition memory following lesions thought to be limited to the hippocampal region has been demonstrated for a wide variety of tasks. However, the importance of the human hippocampus for olfactory recognition memory has scarcely been explored. We evaluated the ability of memory-impaired patients with damage thought to be limited to the hippocampal region to recognize a list of odors. The patients were significantly impaired after a retention delay of 1 h. Olfactory sensitivity was intact. This finding is in agreement with earlier reports that rats with hippocampal lesions exhibited memory impairment on an odor delayed nonmatching to sample task (after 30 min and 1 h) and that patients with damage thought to be limited to the hippocampal region were impaired on an odor span memory task. Olfactory recognition memory, similar to recognition memory in other sensory modalities, depends on the integrity of the hippocampal region.     

The placebo effect in popular culture

This paper gives an overview of the placebo effect in popular culture, especially as it pertains to the work of authors Patrick O’Brian and Sinclair Lewis. The beloved physician as placebo, and the clinician scientist as villain are themes that respectively inform the novels, The Hundred Days and Arrowsmith. Excerpts from the novels, and from film show how the placebo effect, and the randomized clinical trial, have emerged into popular culture, and evolved over time. An earlier version of this paper was presented at an international conference, “Placebo: Its Action and Place in Health Research Today,” held in Warsaw, Poland on 12–13 April, 2003.     

Information search in the laboratory and on the Web: With or without an experimenter

The focus of this study is the effect of the location (laboratory vs. Web) of experiments on active information searchin decision-making tasks. In two experiments, participants were confronted with two different search method versions (list vs. keyword) for acquiring information about a task from a database. The amount and type of information gathered and the time required for task completion were measured. In Experiment 1, significantly more information was searched for in the laboratory than on the Web when the list version was employed, whereas there was no difference between locations in the keyword version. In Experiment 2, the participants were assigned randomly to the Web or the laboratory condition. The results of Experiment 1 were replicated. Whereas location (and the presence or absence of an experimenter) had an effect on the absolute amount of information gathered in both experiments, the relative distribution and type of information items did not differ.     

Applying Utilization Management Principles to a Comprehensive Service System for Children with Emotional and Behavioral Disorders and Their Families: A Feasibility Study

The Comprehensive Services Act for At Risk Youth and Families of Virginia (CSA), is a service, funding, and organizational reform initiative designed to improve the provision of child centered and family focused services within a community setting. We conducted this study in order to assess the feasibility of applying utilization management principles to the CSA in order to improve the appropriateness, quality, and cost effectiveness of this service delivery system. Data were gathered through focus groups, surveys, clinical profiling, and analysis of costs, and service utilization. While overall program costs increased since inception of the program, the costs per child served rose less than the rate of inflation. CSA appeared to be serving children with a high degree of emotional and behavioral difficulties. There was considerable variation among localities in placement patterns. A majority of survey and focus group respondents were willing to consider the application of utilization management principles to the CSA as long as decision making remained within localities. We concluded that there is a constructive role for utilization management approaches to improve the appropriateness and quality of services as well as enhancing efficiency in child mental health.     

Vertical individualism and injustice: The self‐restorative function of revenge

In the current paper, we examine the role of vertical individualism in determining revenge behavior following an injustice. Drawing on existing theory and research, we hypothesized that victims who are more vertically individualistic will be more likely than those who are less vertically individualistic to engage in revenge following the experience of injustice as a means of restoring self‐esteem. The results from three studies—employing different methodologies and operationalizations of revenge—support our reasoning. Moreover, two of the studies provide support for the proposed self‐esteem maintenance mechanism underlying the relation between vertical individualism and revenge. Although much research in psychology and organizational justice has demonstrated that the experience of injustice can threaten one's identity, our data are the first to demonstrate that responding to injustice can restore people's self‐esteem to homeostasis. The present studies thus demonstrate that in some instances revenge may have an intrapsychic benefit for the victim, which helps to explain why some people engage in revenge despite possible negative interpersonal consequences. We discuss implications of our findings for social and organizational justice theory and for potentially mitigating revenge reactions to injustice. Copyright © 2012 John Wiley & Sons, Ltd.