49 research outputs found
Toward DSM-V: New approaches for the classification of personality disorders
No full textDie Unzulänglichkeiten der bestehenden kategorialen Klassifikationssysteme für Persönlichkeitsstörungen haben die maßgeblichen Gremien zur Vorbereitung des DSM-V veranlasst, dimensional konzipierte alternative Repräsentationsformen für Persönlichkeitsstörungsmerkmale zu prüfen. Vier mögliche Strategien werden dazu vorgeschlagen: 1. dimensionale Repräsentationen der bestehenden Kategorien; 2. eine dimensionale Reorganisation der diagnostischen Kriterien; 3. Orientierung an nicht klinischen Modellen der Persönlichkeit; 4. integrative Modelle für Persönlichkeitsmerkmale, Achse I- und Achse II-Störungen. Im Zusammenhang mit den dimensionalen Klassifikationsvorschlägen werden außerdem zwei weitere relevante Aspekte diskutiert: Zum Einen die Frage der Stabilität und Veränderbarkeit von Persönlichkeits-(störungs)merkmalen und damit einhergehend auch die Frage nach ntsprechenden Vorläufern in Kindheit und Jugend; zum Anderen die Frage nach den neurowissenschaftlich begründbaren Bedingungen einer Klassifikation, die sich in Form eines Endophänotypenansatzes integrieren lassen. Die Überlegungen führen zu einem heuristischen Rahmenmodell, das von der Vision eines ätiologisch begründeten Klassifikationssystems für Persönlichkeitsstörungen (und darauf aufbauend auch für andere psychiatrische Syndrome) geleitet wird.
Schlagwörter
Persönlichkeitsstörungen - Persönlichkeitsdimensionen - Verhaltensgenetik - Entwick-
lungsperspektiveDissatisfaction with the existing categorical classification system for personality disorders has stimulated DSM-V Research Planning Work Groups to check alternative dimensional representations. Four different strategies have been suggested: 1. dimensional representations of existing categories; 2. dimensional reorganization of diagnostic criteria; 3. integration of personality disorders with dimensional models of general personality structure; 4. identification of spectra of dysfunction cutting across personality, axis I and axis II disorders. Together with models of dimensional classification two further relevant aspects are discussed: First, the question of stability and changeability of personality (disorder) and thus the question of childhood and adolescence antecedents. Second, the search for neuroscientific foundations of personality disorder traits that can be integrated by an endophenotypic approach. These considerations imply a heuristic framework guided by the vision of an etiologically based classification system for personality disorders (and possibly other psychiatric syndromes).
Keywords
Personality disorders - personality dimensions - behaviour genetics - developmental perspectiveunknownunknow
Melanoma brain metastases – Interdisciplinary management recommendations 2020
No full textMelanoma brain metastases (MBM) are common and associated with a particularly poor prognosis; they directly cause death in 60-70% of melanoma patients. In the past, systemic treatments have shown response rates around 5%, whole brain radiation as standard of care has achieved a median overall survival of approximately three months. Recently, the combination of immune checkpoint inhibitors and combinations of MAP-kinase inhibitors both have shown very promising response rates of up to 55% and 58%, respectively, and improved survival. However, current clinical evidence is based on multi-cohort studies only, as prospectively randomized trials have been carried out rarely in MBM, independently whether investigating systemic therapy, radiotherapy or surgical techniques. Here, an interdisciplinary expert team reviewed the outcome of prospectively conducted clinical studies in MBM, identified evidence gaps and provided recommendations for the diagnosis, treatment, outcome evaluation and monitoring of MBM patients. The recommendations refer to four distinct scenarios: patients (i) with 'brain-only' disease, (ii) with oligometastatic asymptomatic infra- and extracranial disease, (iii) with multiple asymptomatic metastases, and (iv) with multiple symptomatic MBM or leptomeningeal disease. Changes in current management recommendations comprise the use of immunotherapy - preferably combined anti-CTLA-4/PD-1-immunotherapy - in asymptomatic MBM minus/plus stereotactic radiosurgery which remains the mainstay of local brain therapy being safe and effective. Adjuvant whole-brain radiotherapy provides no clinical benefit in oligometastatic MBM. Among the systemic therapies, combined MAPK-kinase inhibition provides, in BRAF(V600)-mutated patients with rapidly progressing or/and symptomatic MBM, an alternative to combined immunotherapy
Antisaccade performance in patients with obsessive-compulsive disorder and unaffected relatives: further evidence for impaired response inhibition as a candidate endophenotype
No full textCognitive dysfunctions such as inhibitory deficits and visuospatial abnormalities are often found in patients with obsessive-compulsive disorder (OCD). Recent findings in unaffected relatives indicate that response inhibition and other neuropsychological functions may also constitute endophenotypes of OCD. In the present study, 30 OCD patients, 30 first-degree relatives, and 30 healthy control subjects were assessed using a comprehensive neuropsychological test battery. A subsample of 21 subjects of each group also performed an antisaccade task. The samples were matched according to age, gender, education, and verbal intelligence. The OCD patients and the unaffected OCD relatives showed increased antisaccade error rates compared with the healthy control group (p = 0.003, p = 0.028, respectively). Significantly prolonged antisaccade latencies as compared to prosaccade latencies were only found in the OCD patients compared with the healthy control group (p = 0.019). Only OCD patients but not the unaffected OCD relatives were impaired with regard to visuospatial functions, problem-solving, and processing speed. Antisaccade errors did not correlate with severity of OCD or depressive symptoms. This study confirms inhibitory deficits, as indicated by increased antisaccade error rates, as a candidate endophenotype of OCD. In agreement with previous findings from imaging studies, our data suggest that functional abnormalities in frontostriatal and parietal cortical regions form part of the vulnerability for OCD.Deutsche Forschungsgemeinschaft (DFG
Harm avoidance in subjects with obsessive-compulsive disorder and their families
No full textIntroduction: This study investigates the role of harm avoidance (HA) as a possible risk factor in the familiality of obsessive-compulsive disorder (OCD). HA is considered to be a genetically influenced personality trait with an increasingly understood neuroanatomical basis. Method: 75 subjects with OCD from hospital sites and a community sample and their 152 first degree relatives and 75 age and sex matched controls with their 143 first degree relatives were evaluated with structured clinical interviews (DSM-IV). HA was assessed with Cloninger's Tridimensional Personality Questionnaire (TPQ). Results: Subjects with OCD had higher scores of HA than controls (p <= 0.001). First degree relatives of OCD cases also showed higher HA than relatives of control subjects (p=0.001). These results remained stable when comparing only OCD subjects versus controls (p <= 0.001) and relatives of OCD cases versus relatives of controls (p=0.005) without current comorbid disorders. Limitations: The investigation of HA alone does not allow to disentangle the transmission of biological versus psychological factors related to an elevated level of anxiety in families of OCD cases. Conclusion: This is the first study to extent previous findings of elevated HA in OCD cases to their first degree relatives. Thus, HA may partially mediate the familial risk for OCD. (C) 2007 Elsevier B.V. All rights reserved
Effects of psychosocial interventions on quality of life in adult cancer patients: meta analysis of 37 published controlled outcome studies
No full textNeurocognitive Indicators of Clinical High-Risk States for Psychosis: A Critical Review of the Evidence
No full textNeurocognitive Indicators of Clinical High-Risk States for Psychosis: A Critical Review of the Evidence
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