Siegfried Gauggel

Awareness of activity limitations, goal setting and rehabilitation outcome in patients with brain injuries.

Primary objective: To examine the relationship between self-awareness, goal setting ability (i.e. ability to set realistic goals) and performance/outcome in a cognitive task and for rehabilitation. Research design: Regression analyses were conducted to compare the predictive power of self-awareness and demographic/neuropsychological variables on goal setting ability and performance/outcome. Methods and procedures: Self-awareness of 63 patients with brain injuries was measured by direct clinicians’ rating and the difference between patient and staff ratings in a questionnaire. Results: The awareness measures predicted 32% of the variance for goal setting ability in the rehabilitation context but only 4% of the goal setting variance in the cognitive task. Similarly, self-awareness predicted 33% of the variance for rehabilitation outcome but only 5% of the performance in the cognitive task. Conclusions: Self-awareness seems to be related to goal setting ability and outcome in a long-term rehabilitation process but less in short-term experimental tasks.

Awareness of activity limitations and prediction of performance in patients with brain injuries and orthopedic disorders

The aim of this study was to compare the accuracy of performance predictions in experimental tasks with patients awareness of activity limitations. Participants were 24 patients with brain injuries (i.e., traumatic brain injury and cerebrovascular disorders) and 22 patients with orthopedic disorders. Prediction of performance was examined in a memory task (word list learning) and a motor task (finger tapping). Awareness of activity limitations was measured by comparing patients self-ratings and staff ratings in the Patient Competency Rating Scale (PCRS). Results for the PCRS showed that patients with orthopedic disorders underestimated and patients with brain injuries (i.e., patients with TBI) overestimated their level of functioning in the total scale and the social/emotional subscale in comparison to staff ratings. Both patient groups agreed with staff ratings in physical/basic self-care items. In the predicted performance tasks a similar pattern could be observed: None of the groups showed an overestimation of performance in the motor task, whereas patients with brain injuries overestimated their competency in the memory task. However, the agreement between both awareness measures (PCRS, predicted performance) was only low, which indicates that they might measure different aspects or levels of self-awareness.

Catecholamine functioning in children with traumatic brain injuries and children with attention-deficit/hyperactivity disorder

Recent studies suggest that children with attention-deficit/hyperactivity disorder (ADHD) and children with traumatic brain injuries (TBI) show changes in similar neuronal networks, including the dopaminergic (DA) and norepinephrinergic (NA) systems. Therefore, indirect measures of catecholamine activity were assessed. Twenty-six children with TBI, 31 children with ADHD, and 26 normal controls, 8 to 12 years of age, were investigated with a 90-min cognitive test battery. Before and after the tests, urine samples were collected to measure catecholamine activity in response to cognitive stress. Spontaneous eyeblinking as an indirect measure of DA activity was counted. Children with TBI and ADHD excreted significantly more normetanephrine in resting situations and less epinephrine (EPI) after cognitive stress, and showed a decreased blink rate compared to normal controls. Children with TBI also showed a higher excretion of metanephrine in the resting situation in comparison to children with ADHD and controls. Whereas children with ADHD showed a higher tonic activity of the NA system and a less adaptive EPI excretion in response to cognitive stress, children with TBI seem to be additionally impaired in their tonic EPI excretion. Our study provides further support for similar but also different neurobiochemical characteristics in both groups.

Factor Analysis of the Expanded Prostate Cancer Index Composite in a Patient Group after Primary (External Beam Radiotherapy and Permanent Iodine-125 Brachytherapy) and Postoperative Radiotherapy for Prostate Cancer

Background: The Expanded Prostate Cancer Index Composite questionnaire is widely used as a comprehensive assessment of health-related quality of life issues in prostate cancer management, distinguishing urinary, bowel, sexual, hormonal domains. The primary purpose of this study was to assess the factor structure of this questionnaire. Patients and Methods: A principal component analysis with orthogonal (varimax) rotation was conducted on data collected from 418 patients after primary (external beam radiotherapy and permanent iodine-125 brachytherapy) and postoperative radiotherapy for prostate cancer. Results: Health-related quality of life scores well demonstrated differences in subpopulations before radiotherapy and different toxicity profiles of specific radiotherapy concepts. The extraction of 12 factors accounted for 75.5% of the variance. With exception of the sexual domain, a strong dependence between the function in a domain and the related bother was found. The concept to discriminate urinary incontinence and urinary irritation/ obstruction subscales was supported. However, the items ‘bleeding with urination’ and ‘bloody stools’ have loaded on separate factors. After separation of the items of the function and bother subscales, a 4-factor solution was confirmed to be optimal, respectively. Conclusion: The obtained factor structure corresponds to the original Expanded Prostate Cancer Index Composite subscales. Minor divergences have been found, depicting especially items concerning ‘incontinence’ and ‘bleeding’ as distinct aspects of a domain.

Grundlagen und Empirie der Neuropsychologischen Therapie: Neuropsychotherapie oder Hirnjogging?

Zusammenfassung: Dieser Beitrag beschaftigt sich mit dem theoretischen Fundament und den empirischen Grundlagen neuropsychologischer Interventionen. Nach einem kurzen historischen Ruckblick werden die konzeptionellen Grundlagen einer neuropsychologischen Behandlung dargestellt und erlautert. Neuropsychologische Interventionen werden drei Therapiesaulen zugeordnet: Restitution, Kompensation und integrierten Verfahren. Restitution bezieht sich auf Masnahmen, mit denen gestorte neuronale Systeme wieder reaktiviert werden sollen. Kompensation beinhaltet den aktiven oder passiven Ausgleich von Funktionsdefiziten durch vorhandene Fahigkeiten. Hierzu zahlt nicht nur das Lernen neuer Strategien und der Einsatz von Hilfsmitteln, sondern auch die Veranderung von Erwartungen, Lebenszielen und andere kognitive Anpassungen. Integrierte Verfahren stellen Verfahren (z. B. operante Techniken) anderer Psychotherapierichtungen dar, die bei einer neuropsychologischen Behandlung Anwendung finden konnen und auf die Bedurfniss...

Effects of alcohol cue exposure on response inhibition in detoxified alcohol-dependent patients.

BACKGROUNDnThere is evidence that exerting self-control during alcohol craving can diminish performance on subsequent tasks that require self-control. Based on the resource depletion model (Muraven and Baumeister, 2000), we examined the influence of alcohol cue exposure on detoxified alcohol-dependent patients ability to inhibit ongoing responses.nnnMETHODSnTwenty alcohol-dependent patients were randomly assigned to an alcohol-cue exposure and a control-cue exposure condition and thereafter had to perform an inhibition task (i.e., stop-signal task).nnnRESULTSnParticipants who sniffed alcohol before performing the inhibition task reported a stronger urge to drink alcohol than the control group that sniffed water. Participants who sniffed alcohol were also impaired in their inhibitory performance but not in their noninhibitory performance on the stop-signal task.nnnCONCLUSIONSnThe urge to drink presumably reduced participants self-control, and this interfered with their ability to inhibit responding.

Prevalence of suicidal ideation and related risk factors in the German general population.

Abstract The present study aimed to determine the prevalence of suicidal ideation in a representative sample of the German general population and examined its relation to potential risk factors. The study sample consisted of 2509 persons. Mean age was 49.4 years (SD, 18.2 years; 55.8% women). Participants filled in the Hospital Anxiety and Depression Scale and two items from the Rasch-based Depression Screening measuring suicidal ideation. Suicidal ideation was reported by 8.0% (n = 211) of all participants. People reporting suicidal ideation were less likely to be married or living together with a partner and to have children aged 6 to 13 years and were more likely to be divorced. They reported significantly higher levels of a depressive syndrome (t = 17.78; p < 0.001) and an anxiety syndrome (t = 18.43; p < 0.001). The study showed high point prevalence for suicidal ideation in the general German population. In concordance with results from similar studies in other countries, living alone and reporting anxious and depressive syndromes was associated with suicidal ideation.

The effect of goal setting on motor performance and motor learning in brain-damaged patients

We examined the effect of goal setting on the performance of 45 brain-damaged patients carrying out the Purdue Pegboard Test. Patients were randomly and equally allocated to two conditions: One in which a specific, high goal was assigned and one in which a “do your best” goal was given. Statistical analysis indicated that patients with a specific and high goal performed better than patients with a “do your best” goal. In addition, this improvement in performance did not disappear after a 10-minute break. As a further result of this study slight moderating influences of mood, self-efficacy, and memory performance on goal setting were found. Goal setting seems to be a useful technique to influence motivation (i.e., the intensity of behaviour) in brain-damaged patients.

Poor Sleep Quality is Associated with Depressive Symptoms in Patients with Heart Disease

BackgroundDepression in cardiac patients has gained importance due to increased mortality. Although sleep disturbances are a core symptom of depression, the prevalence and patterns of sleep disturbances in heart disease have hardly been examined regarding depression.PurposeThis cross-sectional study aims to examine sleep disturbances and depressive symptoms in consecutively admitted cardiac patients and depressed patients.MethodsTwo hundred four inpatients (113 male, 91 female) were examined: 94 cardiac inpatients (mean age 49.3u2009±u200914.3xa0years) with different heart diseases and 110 psychiatric inpatients (mean age 41.6u2009±u200913.0xa0years) with depressive disorders (DP). A depressive episode according to International Classification of Diseases (ICD)-10 was also diagnosed in 14 of the cardiac patients (DCP). The Pittsburgh Sleep Quality Index (PSQI) and the Beck Depression Inventory (BDI) were used to assess subjective sleep quality and severity of depressive symptoms.ResultsPoor sleep quality (PSQIu2009>u20095) was reported in all comorbid DCP (PSQI 12.00u2009±u20093.53, BDI 17.86u2009±u20094.28), in 60% of the 80 non-DCP (PSQI 5.59u2009±u20093.73, BDI 4.47u2009±u20093.07), and in 86.4% of the DP (PSQI 11.76u2009±u20094.77, BDI 27.11u2009±u200910.54). The cardiac inpatients showed a significant correlation between increased depressive symptoms and the PSQI components subjective sleep quality (ru2009=u20090.40) and daytime dysfunction (ru2009=u20090.34). Both sleep components were significant predictors of self-rated depression (R²u2009=u20090.404).ConclusionsMost cardiac patients experience poor sleep quality. Self-reported sleep disturbances in heart disease could serve as predictors of clinical or subclinical comorbid depression outside of a psychiatric setting in cardiology and other fields, and such patients should be referred to consultation-liaison psychiatry or polysomnography where sleep disorders like sleep apnea are suspected.

Do subjective measures of attention and memory predict actual performance? Metacognition in older couples.

Older individuals who recognize their cognitive difficulties are more likely to adjust their everyday life to their actual cognitive functioning, particularly when they are able to estimate their abilities accurately. We assessed self- and spouse-ratings of memory and attention difficulties in everyday life of healthy, older individuals and compared them with the respective test performance. Eighty-four older individuals (womens age, M = 67.4 years, SD = 5.2; mens age, M = 68.5 years, SD = 4.9) completed both the self and the spouse versions of the Attention Deficit Questionnaire and the Everyday Memory Questionnaire and completed two neuropsychological tests. Using the residual score approach, subjective metacognitive measures of memory and attention were created and compared with actual test performance. Significant associations between subjective and objective scores were found only for men and only for episodic memory measures. Men who underreported memory difficulties performed more poorly; men who overreported memory difficulties performed better. Mens recognition performance was best predicted by subjective measures (R² = .25), followed by delayed recall (R² = .14) and forgetting rate (R² = .13). The results indicate gender-specific differences in metacognitive accuracy and predictive validity of subjective ratings.