Roberto D'Amelio

Kombinierte Anwendung von Tinnitusretrainingtherapie (TRT) und Gruppenverhaltenstherapie

ZusammenfassungHintergrund. Untersucht wurde der therapeutische Effekt einer Tinnitusretrainingtherapie (TRT) in Kombination mit einer zusätzlichen kognitiv-behavioralen Gruppentherapie. Patienten und Methode. 95 Patienten im Alter von 17–73 Jahren mit chronischem Tinnitus nahmen an der Studie teil. 16 Teilnehmer dienten als Wartekontrollgruppe. Die 79 Therapieteilnehmer wurden 3 Gruppen zugeordnet, wobei die Patienten der Gruppe 1 mit Rauschgeneratoren und die der Gruppe 2 mit Hörgeräten versorgt wurden. Die Patienten der Gruppe 3 wurde nicht apparativ versorgt. Alle Patienten nahmen an einer 3-monatigen Gruppenverhaltenstherapie teil. Ein Tinnituscounseling und ausführliche audiologische sowie testpsychologische Untersuchungen wurden durchgeführt. Ergebnisse. Bei 64,5% der Patienten zeigte sich nach der initialen Gruppenverhaltenstherapie eine Verbesserung. Im Gegensatz dazu trat in der Wartekontrollgruppe keine signifikante Veränderung auf. Der Erfolg konnte über den Beobachtungszeitraum gehalten werden. Signifikante Einflüsse der Noiserversorgung konnten nicht gefunden werden. Schlussfolgerung. Die Kombination von TRT mit kognitiv-behavioraler Gruppentherapie stellt ein wirksames therapeutisches Konzept bei Patienten mit chronisch dekompensiertem Tinnitus dar.AbstractBackground. The study evaluates the effectiveness of a Tinnitus Retraining Therapy as combined with a cognitive behavioral group therapy. Patients and methods. 95 patients suffering from chronic tinnitus (mean age 49,3 years) were included. 16 of these 95 participants served as a waiting list control group. The participants were divided into 3 treatment groups. Group 1 was fitted with wideband noise generators, group 2 with hearing aids. The 3rd group was not supplied with any device. After a detailed audiological and psychological examination and tinnitus counseling all patients took part in a cognitive behavioral therapy for a period of 3 months. Results. 64,5% of our patients improved significantly after the initial group therapy. In contrast, the patients of the waiting list control group showed no significant improvement. This initial treatment effect could be maintained over the period of control. We were unable to show significant advantages of noise generators as compared to cognitive behavioural group therapy alone. Conclusion. The Tinnitus Retraining Therapy combined with a cognitive behavioral group therapy is an effective treatment in patients with chronic tinnitus.

Objective Quantification of the Tinnitus Decompensation by Synchronization Measures of Auditory Evoked Single Sweeps

Large-scale neural correlates of the tinnitus decompensation might be used for an objective evaluation of therapies and neurofeedback based therapeutic approaches. In this study, we try to identify large-scale neural correlates of the tinnitus decompensation using wavelet phase stability criteria of single sweep sequences of late auditory evoked potentials as synchronization stability measure. The extracted measure provided an objective quantification of the tinnitus decompensation and allowed for a reliable discrimination between a group of compensated and decompensated tinnitus patients. We provide an interpretation for our results by a neural model of top-down projections based on the Jastreboff tinnitus model combined with the adaptive resonance theory which has not been applied to model tinnitus so far. Using this model, our stability measure of evoked potentials can be linked to the focus of attention on the tinnitus signal. It is concluded that the wavelet phase stability of late auditory evoked potential single sweeps might be used as objective tinnitus decompensation measure and can be interpreted in the framework of the Jastreboff tinnitus model and adaptive resonance theory.

Tinnitus: distinguishing between subjectively perceived loudness and tinnitus-related distress.

Objectives Overall success of current tinnitus therapies is low, which may be due to the heterogeneity of tinnitus patients. Therefore, subclassification of tinnitus patients is expected to improve therapeutic allocation, which, in turn, is hoped to improve therapeutic success for the individual patient. The present study aims to define factors that differentially influence subjectively perceived tinnitus loudness and tinnitus-related distress. Methods In a questionnaire-based cross-sectional survey, the data of 4705 individuals with tinnitus were analyzed. The self-report questionnaire contained items about subjective tinnitus loudness, type of onset, awareness and localization of the tinnitus, hearing impairment, chronic comorbidities, sleep quality, and psychometrically validated questionnaires addressing tinnitus-related distress, depressivity, anxiety, and somatic symptom severity. In a binary step-wise logistic regression model, we tested the predictive power of these variables on subjective tinnitus loudness and tinnitus-related distress. Results The present data contribute to the distinction between subjective tinnitus loudness and tinnitus-related distress. Whereas subjective loudness was associated with permanent awareness and binaural localization of the tinnitus, tinnitus-related distress was associated with depressivity, anxiety, and somatic symptom severity. Conclusions Subjective tinnitus loudness and the potential presence of severe depressivity, anxiety, and somatic symptom severity should be assessed separately from tinnitus-related distress. If loud tinnitus is the major complaint together with mild or moderate tinnitus-related distress, therapies should focus on auditory perception. If levels of depressivity, anxiety or somatic symptom severity are severe, therapies and further diagnosis should focus on these symptoms at first.

Neural Synchronization Stability in the Tinnitus Decompensation

Neural correlates of psychophysiological tinnitus models in humans may be used for their neurophysiological validation as well as for their refinement and improvement to better understand the pathogenesis of the tinnitus decompensation and to develop new therapeutic approaches. In this study, we try to identify neural correlates of cortico-cortical top-down projections based on the Jastreboff tinnitus model combined with the adaptive resonance theory of Grossberg which has not been applied to the problem of tinnitus so far. In particular, the neural synchronization stability. In single sweep sequences of late auditory evoked potentials is evaluated by the wavelet phase coherence in the time-scale domain. The synchronization stability, which is according to the underlying model linked to the focus of attention on the tinnitus signal, discriminated between a group of compensated and decompensated tinnitus patients. It is concluded that top-down processes according to the adaptive resonance theory basically represent the influences of the limbic and autonomic nervous system in the Jastreboff tinnitus model. The neural correlates of these processes are globally reflected in the synchronization stability of late auditory evoked potentials and may be useful as objective tinnitus decompensation measure

Psychosozialer Notfall – Erregungszustände, Aggression und gewalttätiges Verhalten im Notarzt– und Rettungsdienst

A state of agitation occurs in 15-25% of all patients with mental disorder who are seen by pre-hospital emergency physicians (EPs) in the German emergency medical system. Additionally, there is an unknown number of calls due to injury subsequent to violence. Aggression against EPs and paramedics, however, is rare. This paper gives an overview on the models for the onset of aggression, the single stages of agitation and violence, and the stage-dependent steps for de-escalation and crisis intervention in the emergency situation. Action has to be determined but unexcited and, depending on the situation, swift but well coordinated, including psychopharmacotherapy.

Suicide and suicidality in emergency medicine

Emergency physicians, paramedics and the staff of the emergency room play an increasingly important role in the medical and psychological emergency treatment of patients after suicide attempts, as well as in the crisis intervention of persons with acute suicidal tendency. This article aims to give an overview of prevalence rates, method of suicide or attempted suicide, and the problems faced by EPs when treating these patients. In addition, concepts are presented which allow for an adequate risk assessment of suicidality and showing possibilities of primary crisis intervention.

Notärztliche Interventionen bei psychischen Krisen – Konzepte, Strategien und Vorgehensweisen

Psycho-social crisis intervention has emerged to be a routine treatment application in the pre-hospital emergency medical system in Germany. It is applied to both patients with psychiatric disorders and in psycho-social crises. For the latter, a psycho-physiological reaction is typical that can be treated with the BELLA concept. Psycho-social crisis intervention for the emergency physician must be regarded as psychological first-aid and is characterised by an immediate start, a limited time frame, consideration of security aspects, flexibility and a determination to pre-set goals and their achievements. We recommend to adequately document this complex service.

Large-scale inverse and forward modeling of adaptive resonance in the tinnitus decompensation.

Neural correlates of psychophysiological tinnitus models in humans may be used for their neurophysiological validation as well as for their refinement and improvement to better understand the pathogenesis of the tinnitus decompensation and to develop new therapeutic approaches. In this paper we make use of neural correlates of top-down projections, particularly, a recently introduced synchronization stability measure, together with a multiscale evoked response potential (ERP) model in order to study and evaluate the tinnitus decompensation by using a hybrid inverse-forward mathematical methodology. The neural synchronization stability, which according to the underlying model is linked to the focus of attention on the tinnitus signal, follows the experimental and inverse way and allows to discriminate between a group of compensated and decompensated tinnitus patients. The multiscale ERP model, which works in the forward direction, is used to consolidate hypotheses which are derived from the experiments for a known neural source dynamics related to attention. It is concluded that both methodologies agree and support each other in the description of the discriminatory character of the neural correlate proposed, but also help to fill the gap between the top-down adaptive resonance theory and the Jastreboff model of tinnitus

Agitation, aggression and violence in emergency medicine

A state of agitation occurs in 15-25% of all patients with mental disorder who are seen by pre-hospital emergency physicians (EPs) in the German emergency medical system. Additionally, there is an unknown number of calls due to injury subsequent to violence. Aggression against EPs and paramedics, however, is rare. This paper gives an overview on the models for the onset of aggression, the single stages of agitation and violence, and the stage-dependent steps for de-escalation and crisis intervention in the emergency situation. Action has to be determined but unexcited and, depending on the situation, swift but well coordinated, including psychopharmacotherapy.