Krankheitsbewältigung bei multipler Sklerose

Zusammenfassung Obwohl ein erheblicher psychosozialer Versorgungsbedarf bei Patienten mit multipler Sklerose (MS) unstrittig ist, stehen die theoretische Aufarbeitung belastender Aspekte des Krankheitsverlaufs wie die Entwicklung standardisierter Interventionsmaßnahmen nach wie vor am Beginn. In vorliegendem Beitrag werden Konzepte und Modelle der Krankheitsbewältigung als geeigneter theoretischer Bezugsrahmen charakterisiert. Im Anschluss an eine knappe Bestandsaufnahme von Versorgungsbedarf und vorhandenen Versorgungsansätzen werden zunächst kurz Modelle der Krankheitsbewältigung (Coping) vorgestellt, die zur Abbildung spezifischer belastender Folgen der MS geeignet erscheinen. Weiterhin werden in einer Befundübersicht neuere Ergebnisse bewältigungsorientierter Forschung dargestellt, die auch erste Berichte zur Evaluation von Bewältigungstrainings einschließen. Ferner werden Ziele und Techniken, die als Bausteine eines umfassenden Trainings zur Bewältigung von Folgen der MS unverzichtbar erscheinen, erörtert. Abschließend werden offene Forschungsfragen, die die Gestaltung von Bewältigungstrainings betreffen, diskutiert.     

Upper limb movement analysis during gait in multiple sclerosis patients

PurposeGait disorders in multiple sclerosis (MS) are well studied; however, no previous study has described upper limb movements during gait. However, upper limb movements have an important role during locomotion and can be altered in MS patients due to direct MS lesions or mechanisms of compensation. The aim of this study was to describe the arm movements during gait in a population of MS patients with low disability compared with a healthy control group.MethodsIn this observational study we analyzed the arm movements during gait in 52 outpatients (mean age: 39.7 ± 9.6 years, female: 40%) with relapsing-remitting MS with low disability (mean EDSS: 2 ± 1) and 25 healthy age-matched controls using a 3-dimension gait analysis.ResultsMS patients walked slower, with increased mean elbow flexion and decreased amplitude of elbow flexion (ROM) compared to the control group, whereas shoulder and hand movements were similar to controls. These differences were not explained by age or disability.ConclusionUpper limb alterations in movement during gait in MS patients with low disability can be characterized by an increase in mean elbow flexion and a decrease in amplitude (ROM) for elbow flexion/extension. This upper limb movement pattern should be considered as a new component of gait disorders in MS and may reflect subtle motor deficits or the use of compensatory mechanisms.     

外显与内隐刻板印象的分布式表征及其激活过程——基于认知神经科学视角的探索

刻板印象是人们有关群体的行为特征与特质属性信念化的认识, 它多以语义图式形式存储于长时记忆中。依据激活过程中意识参与程度的不同, 刻板印象具有内隐和外显两种表现型。不同于双加工理论“自动激活+认知控制”的研究视角, 本项目计划从内隐/外显记忆的多重记忆系统模型出发, 试图检验内隐与外显刻板印象在表征机制和激活过程上的差异。现有的多重记忆系统模型虽能解释内隐和外显刻板印象在记忆存储与提取上的机制差别, 但却无法阐释二者语义表征带有的心理理论特性以及二者的认知控制过程。有鉴于此, 本项目拟吸收“镜像系统−心理化系统”模型和双加工理论各自在特质与信念加工以及刻板印象认知控制上的理论优势, 深入探索内隐和外显刻板印象的分布式表征机制。借助ERP技术的时间过程优势和fMRI技术的脑区动态因果建模优势, 研究结果将最终揭示刻板印象分布式语义表征的动态加工机制。     

Ketamine as a primary predictor of out-of-body experiences associated with multiple substance use

Investigation of “out-of-body experiences” (OBEs) has implications for understanding both normal bodily-self integration and its vulnerabilities. Beyond reported associations between OBEs and specific brain regions, however, there have been few investigations of neurochemical systems relevant to OBEs. Ketamine, a drug used recreationally to achieve dissociative experiences, provides a real-world paradigm for investigating neurochemical effects. We investigate the strength of the association of OBEs and ketamine use relative to other common drugs of abuse. Self-report data (N = 192) from an online survey indicate that both lifetime frequency of ketamine use and OBEs during ketamine intoxication were more strongly related to the frequency of OBEs and related phenomena than other drugs. Moreover, the apparent effects of other drugs could largely be explained by associated ketamine use. The present results, consistent with the role of NMDA receptors in OBEs, should encourage future studies of the role of neurochemical systems in OBEs.     

Multiple commitments in the Chinese context: Testing compatibility, cultural, and moderating hypotheses

This paper evaluates the contribution of the multiple constituencies of commitment framework in explaining work attitudes and behaviors in a sample of Chinese manufacturing workers. Findings suggest that the organization, the supervisor, and co-workers were seen by respondents as separate commitment foci. Although the various commitments were moderately positively correlated, they were related differently to the dimensions of organizational citizenship behavior and withdrawal cognitions, in a way which provides support for the “compatibility” hypothesis. There was only limited support for our “cultural” hypothesis. An analysis of interactions between commitments suggested that commitment to supervisor was a stronger positive predictor of protecting company resources and interpersonal harmony when commitment to work group was lower, providing partial support for our moderating hypotheses.     

Relationships between organizational justice, identification with organization and work unit, and group-related outcomes

This research examined the differential antecedents and consequences of organizational identification and work-unit identification. Specifically, we hypothesized that organization-focused procedural justice and distributive justice would be positively related to organizational identification, whereas supervisor-focused interactional justice would be positively related to work-unit identification. A further hypothesis was that organizational identification would relate to organization-focused outcomes (turnover intentions and extra-role behavior toward the organization), and work-unit identification to work-unit-focused outcomes (extra-role behavior toward the work unit). Our results from a sample of 160 employees of a research institution supported these hypotheses. In addition, we found some evidence that organizational identification and work-unit identification differentially mediated the relationships between organization-focused and supervisor-focused justice, and organization-focused and work-unit-focused outcomes. We discuss our findings in terms of their implications for social-identity research on organizational identification, and for research on organizational justice.     

Perceptions Among Child Welfare Staff when Modifying A Child Mental Health Intervention to be Implemented in Child Welfare Services

In order to increase access to child mental health evidence‐based interventions (EBIs) for vulnerable and hard‐to‐engage families involved in the child welfare (CW) system, innovative approaches coupled with input from service providers are needed. One potential solution involves utilizing task‐shifting strategies and implementation science theoretical frameworks to implement such EBIs in CW settings. This study examined perceptions among CW staff who were members of a collaborative advisory board involved in the implementation of the 4Rs and 2Ss Strengthening Families Program (4R2S) in CW placement prevention settings, utilizing task‐shifting strategies and the Practical, Robust, Implementation, and Sustainability Model. Advisory board members reported difficulties in engaging families, heavy workloads, and conflicting implementation initiatives. While 4R2S was perceived as generally aligned with their organization's mission, modifications to the intervention and to agency procedures were recommended to promote implementation success. Suggested modifications to the existing 4R2S training and supervision are discussed. Findings underscore the importance of understanding the experiences of CW service providers, which can inform future efforts to implement child mental health EBIs in CW services.     

A high-field functional MRI study of quadri-lingual subjects

We assessed six multilingual subjects by functional MRI using a Noun Verb Generation task in four different languages. We hypothesised that the degree of proficiency in each language would be related to the extent of functional activity measured in a region of interest analysis. Proficiency in each language was quantified using two neuropsychological tests. All four languages activated overlapping brain areas, corresponding to the major language regions. The number of activated voxels correlated with proficiency, so that the activated volume increased for languages in which a subject had poorer proficiency. Activation did not appear to be dependent on the age at which the language was learnt.     

An analysis of independence and interactions of brain substrates that subserve multiple attributes, memory systems, and underlying processes

It is proposed that memory is organized into event-based, knowledge-based, and rule-based memory systems. Furthermore, each system is composed of the same set of multiple attributes and characterized by a set of process oriented operating characteristics that are mapped onto multiple neural regions and interconnected neural circuits. Based on this theoretical model of memory, it is possible to investigate the independence and interaction among brain regions between any two systems for any of the proposed attributes or processes. This applies also to the investigation of independence and interactions between any two attributes within a system and between processes associated with a system for any of the proposed attributes. In this article, research evidence is presented to suggest that there are both dissociations and interactions between the hippocampus and caudate nucleus in mediating spatial and response attributes within the event-based memory system, between the hippocampus and the parietal cortex in subserving the spatial attribute within the event-based and knowledge-based memory systems, and between the hippocampus and the prefrontal cortex in subserving the spatial attribute within the event-based and rule-based memory systems.     

Acetylcholine modulation of neural systems involved in learning and memory

Extensive evidence supports the view that cholinergic mechanisms modulate learning and memory formation. This paper reviews evidence for cholinergic regulation of multiple memory systems, noting that manipulations of cholinergic functions in many neural systems can enhance or impair memory for tasks generally associated with those neural systems. While parallel memory systems can be identified by combining lesions with carefully crafted tasks, most—if not all—tasks require the combinatorial participation of multiple neural systems. This paper offers the hypothesis that the magnitude of acetylcholine (ACh) release in different neural systems may regulate the relative contributions of these systems to learning. Recent studies of ACh release, obtained with in vivo microdialysis samples during training, together with direct injections of cholinergic drugs into different neural systems, provide evidence that release of ACh is important in engaging these systems during learning, and that the extent to which the systems are engaged is associated with individual differences in learning and memory.