Leo Linzmayer

Psychometric- and Quality-of-life Assessment in long-term Glioblastoma survivors

AbstractBackground: Multimodal treatment of patients with glioblastoma multiforme (GBM) allows an increasing number of patients to survive beyond one year. On account of various neurological and psychophysiological impairments, however, these patients may not benefit in terms of quality of life (QOL). We evaluated the subjective QOL, clinical psychophysiological and cognitive functions in patients with GBM surviving 18 months after diagnosis. Patients and methods: Thirteen patients underwent psychophysiological and psychometric measurements for central-nervous activation, habituation of skin-conductance reaction, crystallized intelligence, verbal and psychovisual memory. QOL was assessed by the symptom check-list for somatization (SCS-Score). Results: We found various impairments such as central-nervous deactivation (n = 9) or high activation (n = 3), psychovegetative overexcitement (n = 3) or attenuation (n = 1), reduced verbal (n = 5) and/or psychovisual (n = 5) memory and loss in attention (n = 7) or concentration (n = 5). Severe physical symptoms (grade 5) were fatigue, convulsion, headache, nausea and micturition difficulties. Eleven patients expressed high satisfaction with life in general, whereas only 4 were satisfied with their general state of health. All patients were independent and 8 patients returned to work. Conclusion: Despite various psychophysiological and cognitive impairments, subjective QOL appears mostly unaffected in this patient setting.

Long-Term Functional Effects of Aneurysmal Subarachnoid Haemorrhage with Special Emphasis on the Patient's View

Summary Although physical and emotional dysfunction appears to be quite frequent even among independent survivors of aneurysmal subarachnoid haemorrhage (SAH), these symptoms may easily be missed on routine follow-up examinations. To assess the long-term functional effects of SAH and to outline possible treatment approaches, a cross-sectional study using multidimensional measures of relevant areas of function was performed on 40 independent survivors. After an average follow-up period of 22 months, patients were selected and enrolled following a pre-designed protocol. The comprehensive test battery consisted of subjective and objective measures of physical, psychological and social function and relationships between the different levels of assessment were calculated. We found a considerable proportion of cognitive, emotional and physical dysfunction in this sample, but on the subjective level, the majority of the patients stated satisfaction with life in general. Mild cognitive dysfunction was frequently missed and causes distress in the family. Mild to moderate depression was underdiagnosed, although such an emotional dysfunction influences working capacity and quality of life. Referral to rehabilitation centers appears to be restricted to patients with severe impairments. Our results help to alert the neurosurgeon to these possible symptoms and show the urgent need for a prospective, interdisciplinary and multidimensional follow-up of SAH survivors.

Neuropsychological findings and psychiatric symptoms in HIV-1 infected and noninfected drug users

Reports available on the extent and incidence of cognitive deficits in human immunodeficiency virus (HIV-1) patients are variable. To assess the influence of drug abuse and psychiatric symptoms on the extent of the cognitive deficit, we examined 42 drug-addicted HIV-1 patients and compared them with a group of seronegative drug addicts (n = 31) as well as with a group of healthy controls (n = 50), using a psychometric test battery and standardized psychiatric scales. We found no significant difference in the extent and incidence of cognitive deficits in the group of HIV-1 patients as compared with the seronegative drug addicts. Both groups, however, differed from the normal population group. Remarkable depressive symptoms were found in the HIV-1 infected patient group. We assume that long-term drug abuse contributes markedly to the cognitive deficit of HIV-1 patients, which is further influenced by depressive symptoms.

Psychophysiological reactions in methadone maintenance patients do not correlate with methadone plasma levels

In methadone maintenance therapy methadone plasma concentrations of 400 ng/ml are necessary to suppress any further opiate action and to provide stabilized maintenance. In a controlled study we have searched for a differentiation in autonomous activation between patients having low and high methadone plasma levels, using static and dynamic pupillometry and habituation of skin conductance response. Results show that there is no difference in psychophysiological response between patients with high (>400 ng/ml) or low (<400 ng/ml) plasma levels of methadone. This indicates that there is no reduction in behavioral arousal in patients with high plasma methadone levels. On the basis of these findings, there is no rationale to maintain patients on plasma levels below 400 ng/ml.

Naloxone induces miosis in normal subjects

In a placebo-controlled trial, pupillary constriction was measured in healthy non-addicted subjects and in opiate addicts by using static computer-assisted pupillometry. In contrast to earlier reports, a clear-cut pupillary constriction was observed in healthy persons after a single intravenous injection of 0.4 mg naloxone. No significant changes of pupillary size were recorded in the same subjects after the administration of a placebo. In methadone-maintained subjects, the IV administration of 0.4 mg naloxone caused a significant pupillary dilatation. From these data it can be concluded that naloxone seems to have a central pharmacological action not only in opiate addicts, but also in healthy persons. This is demonstrable by studying the miotic response.

Testing Drugs for Impaired Brain Function in Old Age: On the Effects of a Single Dose of Bifemelane using Topographic Mapping of EEG and Event‐Related Potentials (P300) and Psychometric Measurements in Healthy Elderly Subjects

Clinical studies have demonstrated that bifemelane hydrochloride [4‐(o‐benzylphenoxy)‐N‐methylbutylamine hydrochloride] can improve cognitive functions in patients with various types of dementia. To elucidate specific mechanisms which may underlie the clinical benefit, the effects of bifemelane were investigated by means of computerized electroencephalography (EEG), event‐related potentials (P300) and psychometry. Eighteen healthy elderly subjects, aged between 60 and 73 years, were included in a double‐blind, placebo‐controlled crossover study. Each subject received a single dose of 150 mg bifemelane or placebo with an interval of 1 week in between. EEG and psychometric investigations were carried out before and 2, 4, 6, and 8 h after drug administration, ERP investigations only before and 3 h after drug administration. Descriptive data analysis of the EEG showed that 150 mg bifemelane accelerated the centroid of the total frequency band, induced a significant reduction of the absolute delta+theta power and increased the absolute beta power most markedly 6 h after drug intake. Topographic analyses of ERP amplitudes showed that bifemelane did not effect ERP amplitudes. While N1, P2 and N2 latencies were not changed after bifemelane, P300 latency was shortened significantly. Psychometric investigations did not show significant or consistent effects on noopsychic and thymopsychic functions. In conclusion, bifemelane affected EEG in the sense of improved vigilance. The reduction of P300 latency may be interpreted as accelerated stimulus evaluation time, therefore indicating a beneficial effect of bifemelane on cognition at this stage of information processing.

Habituation of skin conductance response in a methadone population

By measurement of the habituation to the skin conductance response (SCR) no reduction of activation could be observed between stable patients in methadone maintenance therapy and healthy normal subjects, but significant differences were obtained between the well-performing group and poly-drug users treated with methadone. The findings are discussed within the context of previous research on outcome of methadone maintenance. Measurement of habituation to SCR is a useful instrument for detecting polydrug addicts in methadone maintenance programmes.

Activation, Deactivation, Depression: Psychosomatic In-Patient Therapy

In the discussion of psychologically caused physical diseases — this being a very short and rough definition of psycho-somatic diseases, the concept of psycho-genesis has the same basic issues as psycho-physiological descriptions. When we say that a physical disease is a response to a psychological stimulus, we use the word stimulus in two ways: 1) As an external sensory stimulus mediated through peripheral sense-organs or as an internal cognitive stimulus.2) As a particular pattern of activity in the central-nervous system. In the first understanding, the body dysfunction is attributed to the external-sensory stimulus. In the second understanding, there is the implication that a psychologically described state, is the cause or the effect of a physically described state. While we agree with Graham (1954), Wolff (1950) and other authors, that the stimulus issue is a more rewarding and productive one than the state issue, our investigations are very much concerned with particular patterns of activity in the CNS and the vegetative NS and the linking of this activation-deactivation patterns to somatic dysfunction. The terms activation and arousal are mostly used as synonyms; when we use them here, we do it in the understanding of Pribram & Mc-Guiness (1975): 1) arousal as an autonomous and central nervous phasic reaction to an incoming stimulus; 2) activation as the sum of the phenomena describing the tonic response — and reaction — ability, as well as the dynamically described process of these changes taking place.