Does Rehabilitation Meet the Needs of Care and Improve the Quality of Life of Patients with Schizophrenia or Other Chronic Mental Disorders?

The effectiveness of a rehabilitation intervention (Boston University Model) was investigated in a one-year prospective naturalistic study among 35 clients with mainly psychotic or affective disorders and dependent on mental health care with at least one hospital admission in the past five years. Rehabilitation was successful in goal-attainment after 1 year (46% fully, 34% partly). Although rehabilitation did not make clients less dependent upon care, it decreased the number of needs and had a positive effect on the match between care needed and care provided. No evidence was found for a significant effect of rehabilitation clients' quality of life and functioning, although social functioning became more in line with the seriousness of psychiatric impairment.     

Intermodal spatial attention differs between vision and audition: an event-related potential analysis

Subjects were required to attend to a combination of stimulus modality (vision or audition) and location (left or right). Intermodal attention was measured by comparing event-related potentials (ERPs) to visual and auditory stimuli when the modality was relevant or irrelevant, while intramodal (spatial) attention was measured by comparing ERPs to visual and auditory stimuli presented at relevant and irrelevant spatial locations. Intramodal spatial attention was expressed differently in visual and auditory ERPs. When vision was relevant, spatial attention showed a contralateral enhancement of posterior N1 and P2 components and enhancement of parietal P3. When audition was relevant, spatial attention showed a biphasic fronto-central negativity, starting after around 100 ms. The same effects were also present in ERPs to stimuli that were presented in the irrelevant modality. Thus, spatial attention was not completely modality specific. Intermodal attention effects were also expressed differently in vision and audition. Taken together, the obtained ERP patterns of the present study show that stimulus attributes such as modality and location are processed differently in vision and audition.     

Multisensory processing and oscillatory gamma responses: effects of spatial selective attention

Here we describe an EEG study investigating the interactions between multisensory (audio-visual) integration and spatial attention, using oscillatory gamma-band responses (GBRs). The results include a comparison with previously reported event-related potential (ERP) findings from the same paradigm. Unisensory-auditory (A), unisensory-visual (V), and multisensory (AV) stimuli were presented to the left and right hemispaces while subjects attended to a designated side to detect deviant target stimuli in either sensory modality. For attended multisensory stimuli we observed larger evoked GBRs approximately 40–50 ms post-stimulus over medial-frontal brain areas compared with those same multisensory stimuli when unattended. Further analysis indicated that the integration effect and its attentional enhancement may be caused in part by a stimulus-triggered phase resetting of ongoing gamma-band responses. Interestingly, no such early interaction effects (<90 ms) could be found in the ERP waveforms, suggesting that oscillatory GBRs may be more sensitive than ERPs to these early latency attention effects. Moreover, no GBR attention effects could be found for the unisensory auditory or unisensory visual stimuli, suggesting that attention particularly affects the integrative processing of audiovisual stimuli at these early latencies.     

Changes in quality of life in chronic psychiatric patients: A comparison between EuroQol (EQ-5D) and WHOQoL

It has often been postulated that simple, short questionnaires are unable to reflect complex changes in well-being of individuals with chronic psychiatric disorders. To investigate these assumptions we included two recently developed instruments to measure quality of life (the WHOQoL-Bref and the EuroQoL EQ-5D) in a randomised control trial (RCT) in which two treatment conditions were compared. Aims of the study were to assess the sensitivity and validity of these quality of life (QoL)-instruments, to establish their relationship and to examine the predictors of changes in QoL. Subjective changes in QoL were measured on three assessments waves in a period of 18 months and compared to objective changes in psychopathology and social functioning in a sample of 76 chronic schizophrenic patients who participated in the RCT. Results indicated that both WHOQoL-Bref and EuroQoL EQ-5D are capable of detecting changes in QoL over time in physical and psychological well-being. The instruments partly measure the same aspects of QoL, indicated by 50% common variance on total scores. Reduction of positive psychotic symptoms appeared to be the most important factor in improving QoL. The weighted TTO-score of EuroQoL-5D, which is often used as an index in economic evaluations of health care, did however not correspond with these changes, which indicates that it is less sensitive to changes in social and psychological well-being. Its use as the core measure in (economic) health evaluation in the field of psychiatry therefore seems less appropriate.     

Hallucination focused integrative treatment: a randomized controlled trial

Improvements in psychopathology, subjective burden, and coping with voices after hallucination focused integrative treatment (HIT) were studied in chronic schizophrenic patients with persistent (> 10 years), drug-refractory auditory hallucinations. In a randomized controlled trial, routine care was compared with HIT pre- and posttreatment at a 9-month interval. Independent raters used semistructured interviews to assess burden, symptoms, and coping. Within-group improvements in both burden and psychopathology were most significant in the experimental group (p < 0.05) after treatment. HIT patients showed change in applied coping strategies, but it did not reach statistical significance. Type and (change in) number of coping strategies did not seem related to outcome. The results suggest that HIT is a cost-effective practice that positively affects mental state in general, subjective burden, quality of life, and social functioning.     

Orally active oxime derivatives of the dopaminergic prodrug 6-(N,N-di-n-propylamino)-3,4,5,6,7,8-hexahydro-2H-naphthalen-1-one. Synthesis and pharmacological activity

A series of racemic and enantiomerically pure oxime derivatives of the potential anti-Parkinson prodrug 6-(N,N-di-n-propylamino)-3,4,5,6,7,8-hexahydro-2H-naphthalen-1-one (1) were synthesized and pharmacologically evaluated. The oximes induced rotational behavior in the Ungerstedt rat rotation model for Parkinson's disease after oral administration. Especially the unsubstituted oxime ((-)-3) and the acetyl-oxime ((-)-10) induced a pronounced and long lasting effect. In this model, large individual differences were observed in responsiveness to treatment between rats. Though less potent than the parent prodrug, the oxime derivatives of (+/-)-1 and (-)-1 can be orally active, acting as cascade prodrugs.     

Reference points for radial head prosthesis size

PURPOSE: Metallic radial head implants are useful when the radial head cannot be repaired reliably and when either the elbow or the forearm is unstable. Problems arise when the radial head prosthesis is too thick, causing erosions of the capitellum and incongruity of the ulnohumeral joint. We used quantitative 3-dimensional computed tomography analysis to investigate the relative height of the radial head relative to the lateral edge and central ridge of the coronoid process as reference points for optimal insertion of a radial head prosthesis. METHODS: Seventeen computed tomography scans of the elbow were analyzed. The anatomic coronal plane of the forearm was determined using 3-dimensional images and a 2-dimensional image bisecting the articular surface of the radial head was created in this plane. The distance between the plane of the articular surface of the radial head and parallel planes at the most proximal aspect of the coronoid (the central ridge) and the lateral edge of the coronoid articular surface were measured. Negative values indicate the radial head is proximal to the coronoid. RESULTS: The average distance between the planes defined by the radial head articular surface and the coronoid central ridge was -0.8 mm. The average distance between the planes defined by the radial head articular surface and the lateral edge of the coronoid articular surface was -0.9 mm. CONCLUSIONS: Because the radial head was on average only 0.9 mm more proximal than the lateral edge of the coronoid process and because the key is to not overstuff the joint a useful general guideline would be to place the plane of the articular surface of the radial head even with or just slightly more proximal than the lateral edge of the coronoid articular surface. Considering the substantial variability of the normal height of the articular surface of the radial head with respect to that of the coronoid, preoperative radiographs of the opposite elbow may be useful to avoid overstuffing the elbow.     

Pharmacokinetics and pharmacodynamics analysis of transdermal iontophoresis of 5-OH-DPAT in rats: in vitro-in vivo correlation

Pharmacokinetics and dopaminergic effect of dopamine agonist 5-OH-DPAT in vivo were determined following transdermal iontophoresis in rats based on drug concentration in plasma (C(p)) and dopamine levels in striatum (C(DA)). Correlation of the in vitro transport with the pharmacokinetic-pharmacodynamic (PK-PD) profiles was characterized in the transport in dermatomed rat skin (DRS) and rat stratum corneum (RSC). The integrated in vivo PK-PD and in vitro transport models successfully described time course of C(p), C(DA), and in vitro flux in DRS and RSC. Population value of steady-state flux (J(ss)) in vivo (31 nmol/cm(2) . h with 95% confidence interval (CI) = 20-41) is closer to J(ss) in vitro in DRS (61 nmol/cm(2) . h, CI = 54-67) than in vitro J(ss) in RSC (98 nmol/cm(2) . h, CI = 79-117). On the other hand, skin release rate constant (K(R)) in vivo was similar to the K(R) in RSC (4.8/h, CI = 2.4-7.1 vs. 2.6/h, CI = 2.5-2.6). Kinetic lag time (t(L)) in vivo was negligible, which is close to in vitro t(L) in RSC (0.0 h, CI = 0.0-0.1). Based on nonlinear mixed-effect modeling, profiles of C(p) and C(DA) were successfully predicted using in vitro values of J(ss) in DRS with K(R) and t(L) in RSC. A considerable dopaminergic effect was achieved, indicating the feasibility to reach therapeutically effective concentrations of 5-OH-DPAT upon transdermal iontophoresis.