The progressive nature of concentration camp syndrome in former prisoners of Nazi concentration camps – Not just history,but the important issue of contemporary medicine

Constant stress, slave labor, tortures, and starvation all affected the health of concentration camp prisoners, contributing to multimorbidities, increased mortality and accelerated development of chronic illnesses, what we have shown in an earlier publication. The interrelated somatic and psychological symptoms gave rise to concentration camp syndrome (KZ-syndrome), which has many features of PTSD, occurring frequently nowadays. The paper attempts at assessing the influence of concentration camp conditions on functional disorders in each system of the human body, occurring in KZ-syndrome, and at demonstrating the progressive nature of the syndrome. A retrospective assessment of the former prisoners' health after 5 and 30 years following their leaving camps was performed based on medical records and surveys. The materials included 250 former prisoners who underwent medical examination in 1950, i.e. 5 years after leaving the camp, of whom 120 former prisoners survived and were examined and surveyed in 1975, i.e. 30 years after leaving the camp. KZ-syndrome was shown to occur in 58.8% of former prisoners 5 years after leaving the camp, and in 77.5% after 30 years (p < 0.001), which confirms the syndrome's chronic and progressive nature. Pathological sequels of internment in concentration camps, in the form of KZ-syndrome, were observed in most former prisoners. Over time, the number of morbidities and the intensity of symptoms increased, which indicates that the syndrome has a chronic and progressive nature. KZ-syndrome is a multi-organ disorder, with numerous chronic comorbidities exacerbating the progression.     

Repressed memories. When are they real? How are they false?

The precise mechanisms by which such false memories are constructed awaits further research. Much is left to learn about the degree of confidence and the characteristics of false memories created in these ways. We have more to learn about the types of individuals who are particularly susceptible to these forms of suggestion, and conversely, who is resistant. As we are learning more, it is probably important to heed the cautionary tale in the data already obtained; mental health professionals, interviewers, and others need to know how much they can potentially influence participants in research, clinical, and forensic contexts and take care to avoid that influence when it might be harmful. Periodic re-reading of Shakespeare's A Midsummer Night's Dream, with a small substitution (change "poet" to "therapist" or to "biased interviewer"), might help keep these important ideas in mind, reminding us how hard it can sometimes be to distinguish a bush from an imagined bear: The poet's eye, in fine fanciful rolling, Doth glance from heaven to earth, from earth to heaven; And as imagination bodies forth The forms of things unknown, the poet's pen Turns them to shapes and gives to airy nothing A local habitation and a name. Such tricks hath strong imagination, that if it would but apprehend some joy, it comprehends some bringer of that joy; Or in the night, imagining some fear, How easy is a bush supposed a bear!     

Mechanisms of mitoxantrone in multiple sclerosis--what is known?

The recent publication of the MIMS-study (Mitoxantrone In Multiple Sclerosis) and the approval of several health authorities support the use of mitoxantrone in patients with active relapsing-remitting or secondary progressive multiple sclerosis. This review provides information on data thus far present on the putative mechanisms of action of mitoxantrone in the immunopathogenesis of this disabling disease.     

Precursors of neurons,neuroglia, and ependymal cells in the CNS: what are they? Where are they from? How do they get where they are going?

Neurons, neuroglia (astrocytes and oligodendrocytes), and ependymal cells are three distinct categories of neural cells in the central nervous system. In the mature brain and spinal cord, the classical histological criteria define these cells by their microscopic structure very well. During development, the precursors for all of these cells reside within the epithelium of the neural plate and its successor, the neural tube. These precursor cells are the undifferentiated, primitive neuroepithelium of the classical literature. As the cerebral vesicles enlarge and their walls thicken, the primitive neuroepithelial cells elongate, maintaining a radial orientation until they migrate. Although many, but not all, of these cells span the extent of the ventricular wall, they are the precursors of neurons, neuroglia, and ependymal cells. Thus, it is useful to retain their classical designation as primitive neuroepithelial cells and to treat them as neural precursor cells. Neural precursor cells are neither neuroglia nor neurons. It is not appropriate to call them radial glial cells anymore than it is to call them radial neuronal cells. The term "radial glia" has long been used to describe the mature, elongated astrocytes, represented by Bergmann cells in the cerebellum and Müller cells in the retina. Inevitably, during development, transitional forms between neural precursor cells and the neurons, neuroglia, and ependymal cells will occur. Such transitional cells are known as neuroblasts, glioblasts, or ependymoblasts, even though they may be postmitotic. Alternative terms are "immature neurons," "immature neuroglia," and "immature ependymal cells." The migration of many neural precursor cells is accomplished by translocation rather than free cellular locomotion. There is both direct and indirect evidence to document the translocation of the nuclear/perikaryal/somal complex through the leading process of primitive neuroepithelial cells. This is conspicuous in the neocortex, where the discrete radial arrangement of pyramidal cells may result from translocation of neuroblasts, while their leading processes still contact the pial surface. Migration by translocation occurs throughout the CNS. GLIA 43:6-18, 2003.     

Can the patient-physician relationship survive in the era of managed care?

The author discusses the history of the patient-physician relationship and considers how recent developments in the health care system have affected the viability of that relationship. He first considers the justification for maintaining such a relationship and concludes that the patient-physician relationship must be preserved because it has a long history, is humane and ethical, and is cost effective. The author then reviews the ethical basis that forms the foundation of the patient-physician relationship. He discusses issues related to competency, commitment, compassion, equanimity, and patient advocacy. The article concludes with a consideration of the medical-ethical dilemmas created in the patient-physician relationship by managed care.     

The assimilation of problematic experiences in linguistic therapy of evaluation: How did maría assimilate the experience of dizziness?

Abstract

The assimilation model proposes eight stages through which patients with problematic experiences pass during assimilation, ranging from suppression or dissociation to mastery. These are summarized in the Assimilation of Problematic Experiences Scale (APES). The assimilation model and the APES have been developed through intensive qualitative study of significant therapeutic events. This article describes the process of assimilation of the problematic experiences of dizziness in a patient, María, treated with linguistic therapy of evaluation. All treatment sessions were analyzed with the goals of describing the process of assimilation and connecting this process with the therapeutic change. The results showed that the assimilation process includes setbacks within a general pattern of progress through the APES stages. The process of assimilation was associated with the changes in María's life.

Zusammenfassung

Die Assimilation problematischer Erfahrungen in linguistischer Bewertungstherapie: Wie hat Maria ihre Erfahrungen von Schwindel assimiliert?

Das Assimilationsmodell geht von acht Stadien aus, die Patienten mit problematischen Erfahrungen durchlaufen, angefangen bei der Unterdrückung oder Dissoziation bis hin zur Problembewältigung. Diese Stadien sind in den Skalen für problematische Erfahrungen (Assimilation of Problematic Experiences Scales, APES) zusammengefasst. Das Assimilationsmodell und APES wurden mithilfe von intensiven qualitativen Studien zu signifikanten therapeutischen Geschehnissen entwickelt. Dieser Artikel beschreibt den Assimilationsprozess der problematischen Erfahrungen von Schwindel einer Patientin, Maria, die mit linguistischer Bewertungstherapie behandelt wurde. Alle Behandlungssitzungen wurden analysiert mit dem Ziel, den Prozess den Assimilationsprozess zu beschreiben und diesen Prozess mit durch die Therapie bewirkten Veränderungen in Verbindung zu bringen. Die Ergebnisse zeigten, dass der Assimilationsprozess bei einem allgemeinen Fortschritt durch die APES-Stadien auch Rückschritte einschließt. Der Assimilationsprozess war mit Veränderungen im Leben von Maria verbunden.

Résumé

L'assimilation d'expériences problématiques en thérapie linguistique d’évaluation: comment Maria a-t-elle assimilé son expérience de vertige??

Le modèle d'assimilation propose 8 phases par lesquelles des patients avec des expériences problématiques passent en cours d'assimilation, allant de la suppression ou de la dissociation à la maîtrise. Celles-ci sont résumées dans l'Echelle d'Assimilation d'Expériences Problématiques (APES). Le modèle d'assimilation et l'APES ont été développés par l’étude qualitative intense d’événements thérapeutiques significatifs. Cet article décrit le processus d'assimilation des expériences problématiques avec le vertige chez la patiente Maria qui a été traitée par la thérapie linguistique d’évaluation. Toutes les séances du traitement étaient analysées dans le but de décrire le processus d'assimilation et de connecter ce processus avec le changement thérapeutique. Les résultats montrent que le processus d'assimilation inclut des reculs qui font partie d'un pattern général de progrès à travers les phases APES. Le processus d'assimilation était associé avec les changements dans la vie de Maria.

Resumen

Asimilación de experiencias problemÁticas en la terapia de evaluación lingüística: ¿cómo maría asimiló la experiencia de vértigo?

El modelo de asimilación propone 8 etapas por las que transitan los pacientes con experiencias problemáticas a fin de asimilarlas, las que van desde la supresión o disociación hasta su dominación. Estas están resumidas en la Escala de Asimilación de Experiencias Problemáticas (APES). El modelo de asimilación y el APES han sido desarrollados a lo largo de un estudio cualitativo intensivo de acontecimientos significativos terapéuticos. Este artículo describe el proceso de asimilación de las experiencias problemáticas de vértigo de una paciente, María, tratada con una terapia de evaluación lingüística. Todas las sesiones se analizaron con el objeto de describir el proceso de asimilación y de conectarlo con el cambio terapéutico. Los resultados muestran que, a través de las etapas de APES, el proceso de asimilación incluye retrocesos dentro de una pauta general de progreso. El proceso de asimilación se asoció con los cambios en la vida de María.

Resumo

A Assimiliação de Experiências Problemáticas em Terapia Linguística de Avaliação: Como é que a Maria assimilou a experiência de tonturas

O modelo de assimilação propõe 8 estádios através dos quais o paciente com experiências problemáticas tem que passar durante a assimilação, desde da supressão ou dissociação até à mestria. Estes são sumariados na Escala de Assimilação de Experiências Problemáticas (EAEP). O modelo de assimilação e a EAEP têm sido desenvolvidos através do estudo qualitativo intensivo de acontecimentos terapêuticos significativos. Este artigo descreve o processo de assimilação de experiências problemáticas de tonturas numa paciente, a Maria, tratada com terapia linguística de avaliação. Analisaram-se todas as sessões de tratamento com o objectivo de descrever os processos de assimilação e relacionar estes processos com a mudança terapêutica. Os resultados demonstraram que o processo de assimilação inclui retrocessos dentro de um padrão geral de progresso através dos estádios da EAEP. O processo de assimilação foi associado com as mudanças na vida da Maria.

Sommario

L'assimilazione delle esperienze problematiche nella Terapia Linguistica della Valutazione: come Maria ha assimilato l'esperienza delle vertigini?

Il modello dell'assimilazione propone 8 stadi attraverso i quali i pazienti con esperienze problematiche passano durante l'assimilazione, estendendosi dalla soppressione o dissociazione al padroneggiamento.

Questi sono riassunti nell'Assimilation of Problematic Experiences Scale (APES).

Il modello dell'assimilazione e l'APES sono stati sviluppati attraverso uno studio qualitativo intensivo di eventi terapeutici significativi.

Questo articolo descrive il processo dell'assimilazione delle esperienze problematiche delle vertigini in un paziente, Maria, trattata con la terapia linguistica della valutazione.

Tute le sedute di trattamento sono state analizzate con gli obiettivi di descrivere il processo dell'assimilazione e connettere questo processo con il cambiamento terapeutico.

I risultati hanno mostrato che il processo dell'assimilazione include battute di arresto all'interno di un modello generale di progresso attraverso gli stadi APES. Il processo dell'assimilazione è stato associato con i cambiamenti nella vita di Maria.

     

Does change in distress matter? Mechanisms of change in prolonged exposure for PTSD

Background and objectives

Clinically, many individuals persist in prolonged exposure therapy (PE) for chronic PTSD despite continuing distress during recounting of the trauma memory (imaginal exposure). Theorists suggest that distress reduction is necessary for successful treatment outcome (e.g., Foa & Kozak, 1986), while others suggest otherwise (e.g., Craske et al., 2008). This study examined clinically reliable changes in distress, relations to broad clinical outcomes, and whether homework adherence affected this relationship.

Method

In 116 patients with PTSD, first to last imaginal exposure sessions' peak and average distress was examined, calculating reliable change in distress. Homework adherence and helpfulness were examined. At post-treatment, PTSD symptoms (re-experiencing, avoidance, hyperarousal), depression, and functioning were examined.

Results

Patients exhibited a lack of reliable change in distress (64.7%) more than a reliable change in distress (35.3%). Although no difference in post-treatment PTSD diagnostic status, individuals experiencing a reliable change in distress reported lower PTSD severity (re-experiencing, hyperarousal), depression, and better functioning. Further, perceived helpfulness of imaginal homework had an indirect effect on this relationship.

Limitations

This study did not utilize a distress tolerance self-report measure; however, examined self-reported distress during imaginal exposure.

Conclusions

Results are encouraging for clinicians treating PTSD with PE, arguing that lack of reliable change in distress to the trauma memory does not result in treatment failure. Patient “buy in” to homework, rather than amount completed, was related to the process of distress reduction. Results suggest that distress reduction in imaginal exposure is not a key mechanism underlying therapeutic change in PE.     

Age-related variables in childhood epilepsy: How do they relate to each other and to quality of life?

How do age of onset and duration of epilepsy correlate with each other and with patient-reported outcomes? To address this question, we explored whether age of onset, duration, and proportion of life with epilepsy are either similar or relatively independent variables that can be used as markers on how children experience the complexity of epilepsy and adjustment.Three hundred ninety-one Canadian and 266 Hong Kong youth with epilepsy completed the childhood epilepsy-specific quality of life (QOL) measure (CHEQOL-25). Each cohort was separately stratified by tertiles for age of onset, life proportion with epilepsy, and duration of epilepsy. Pearson's r was used for correlation analysis.The epilepsy age-related variables correlated strongly with each other among children with epilepsy onset ≤ 4 years (r = 0.53–0.66). The correlation between these variables was weaker with an onset ≥ 9 years (r = 0.22–0.35). Correlation with QOL was clinically non-significant.These variables appear to measure the same phenomenon only in children with early epilepsy onset (< 4 years) and explain little variance in QOL.     

Models of community treatments in schizophrenia: do they travel?

OBJECTIVE: To explore the stability of conclusions from mental health services research across differing care systems. Contradictory results in different countries for similar studies of programmes for patients with schizophrenia have usually been attributed to poor replication. This paper explores whether these differing results can illuminate aspects of schizophrenia by examining the interaction of the disorder with the care context as an alternative explanation. METHOD: The findings of a large UK random controlled trial of intensive case management with such patients is compared to previous UK and US studies. RESULTS: Reduction of case-load size of psychotic patients did not significantly reduce their need for hospitalization in the context of locally available co-ordinated care. CONCLUSION: There is more to be gained in understanding complex disorders such as schizophrenia by interpreting the impact of context on treatment study outcomes than by simply dismissing contradictory findings as failures of implementation of either research or clinical practice.     

Activity rating scales in adult muscle disease: How well do they actually measure?

Introduction: In an accompanying study we reported on the content of several activity rating scales that have been used for muscle disease. To further aid in achieving consensus we conducted a systematic review to assess the quality of the 19 activity rating scales designed specifically for muscle disease. Methods: We analyzed the measurement properties and the feasibility of the 19 instruments. Several databases were searched for studies relating to the quality of the instruments under review. Two independent reviewers selected studies and assessed instrument quality using pre‐agreed criteria based on published frameworks. Results: We found that none of the 19 instruments have sufficiently comprehensive reporting of measurement or feasibility performance as would be required by regulatory authorities. Conclusions: Further work is required urgently to address these deficiencies of reporting or acquiring additional data. Until then, there will remain a major barrier for translational research to overcome. Muscle Nerve 50 : 24–33, 2014     

Numerical skills in children with Down syndrome. Can they be improved?

The present study aims to explore the impact of a numerical skills training program on the basic mathematical skills and logical thinking in children with Down syndrome (DS). The training program was built specifically for children with DS, bearing the strengths and weaknesses of their particular cognitive profile in mind. Two groups of children with DS took part in the study. All children were tested before and after the training on measures of numerical skills and logical thinking. One group of 27 children was trained in numerical skills twice a week for 2 months, for about 30 min per session. A control group of 9 children was not involved in any training session. After training, children in the intervention group performed better in numerical tests, while those in the control group did not. These results suggest that our training program is both feasible and effective for children with Down syndrome.     

The particles of the embryonic cerebrospinal fluid: How could they influence brain development?

During brain development, the embryonic cerebrospinal fluid (E-CSF) allows brain expansion and promotes neuroepithelial cell survival, proliferation or differentiation. Previous analyses of E-CSF content have revealed a high protein concentration and the presence of membranous particles. The role of these particles in the E-CSF remains poorly investigated. In this study we showed that the E-CSF contains at least two pools of particles: lipoproteins and exosome-like particles. We showed that these two populations of particles strongly interact with neuropithelial cells via an endocytic process, which display regional specificity along the developing neural tube. Finally, we explore and discuss the possibility that these interactions may influence brain development through the regulation of morphogen and growth factor signaling transduction.     

Reduced suppression or labile memory? Mechanisms of inefficient filtering of irrelevant information in older adults

Cognitive aging theories emphasize the decrease in efficiency of inhibitory processes and attention control in normal aging, which, in turn, may result in reduction of working memory function. Accordingly, some of these age-related changes may be due to faster sensory memory decay or to inefficient filtering of irrelevant sensory information (sensory gating). Here, event-related brain potentials and the event-related optical signal were recorded in younger and older adults passively listening to tone trains. To determine whether age differentially affects decay of sensory memory templates over short intervals, trains were separated by delays of either 1 or 5 sec. To determine whether age affects the suppression of responses to unattended repeated stimuli, we evaluated the brain activity elicited by successive train stimuli. Some trains started with a shorter-duration stimulus (deviant trains). Results showed that both electrical and optical responses to tones were more persistent with repeated stimulation in older adults than in younger adults, whereas the effects of delay were similar in the two groups. A mismatch negativity (MMN) was elicited by the first stimulus in deviant trains. This MMN was larger for 1- than 5-sec delay, but did not differ across groups. These data suggest that age-related changes in sensory processing are likely due to inefficient filtering of repeated information, rather than to faster sensory memory decay. This inefficient filtering may be due to, or interact with, reduced attention control. Furthermore, it may increase the noise levels in the information processing system and thus contribute to problems with working memory and speed of processing.