[Considerations on the diagnostic decision making process using neurology as an example].
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Biomedical subjects
Publications and source records attributed to F Strian.
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The course of the depressive mood during depressive phases was measured by a self-rating mood scale and analyzed by various algorithms. Agitated, depressed patients often reveal a continuous decline in the depressive mood; retarded, depressed patients, on the other hand, often show brief and marked fluctuations in mood during remission. Although various effects occur due to treatment, especially differences between the effects of electroconvulsive therapy (ECT) and antidepressants, the described changes in mood appear to be predominantly due to psychomotor activation. The relationship between these courses of depression is discussed and interpreted on the basis of biochemical and psychopharmacologic findings.
In 105 patients with endogenous depression treated with antidepressants or ECT the course of the depressive state was evaluated by means of a self-rating mood scale (Befindlichkeits-Skala by von Zerssen). The scale was filled out every second day. The course of the depressive mood was computed by various algorithms for each patient. Two different courses of depressive mood could be identified: some patients showed a relatively continuous decline in the depressive mood, whereas others showed strong fluctuations. Although there were some correlations between type of treatment and extent of mood swings, other factors also seemed to be relevant. Thus, there appears to be an interaction between treatment effects and spontaneous rhythms.
The effects of ECT, amitriptyline, clomipramine, maprotiline and desipramine on the course of endogenous depression were compared in 105 patients using repeated self-administered mood questionnaires as the outcome measure. Remission was more rapid after ECT therapy than psychopharmacological treatment, but the absolute improvement did not differ significantly between ECT and other somatic therapies. Improvement in response to clomipramine was more rapid than to other psychopharmacological agents, and did not differ from that in response to ECT. The advantages and disadvantages of ECT for endogenous depression are discussed.
The learning model of anxiety by Mowrer and Miller has significantly influenced the development of theories in clinical psychology and psychosomatic medicine as well as the development of behavioral therapies. This concept, however, is insufficient in explaining factors effective in psychophysiological conditioning experiments, behavioral therapies, and in animal experiments of anxiety conditioning. This study discusses new learning theoretical concepts intending to explain the development and persistence of anxiety states. Therewith the various effects of cognitive, psychobiological, and situational factors on each other are of special significance. Therefore in studying the causes of anxiety states in clinical psychology the different components of anxiety dealt with in these theories have to be considered.
The anxiolytic and sedative properties of a thienodiazepine (clotiazepam) were investigated in 40 healthy subjects with varying degrees of arousal and with the aid of specific anxiety-inducing conditions. A cross-over design with a double blind technique was used. EEG, heart and respiratory rate, peripheral pulse volume and skin resistance were measured during the anxiety-inducing conditions with the visualization of neutral and fearful situations as well as with the threat of shock. The mood, physical sensations and behaviour tendencies of the test subjects were determined by self-rating questionnaires. The anxiolytic and sedative effects of the thienodiazepine under study were able to be differentiated as far as subjective perception and autonomic responses were concerned. The development of sedative and anxiolytic effects is dependent on the subject's state of arousal. Situations involving the anticipation of anxiety are sufficient as proof of pharmacogenic anxiolysis. The tranquilizer reduces anxiety and physical tension, but does not influence the timing of autonomic readiness responses, and thus does not affect the coping strategies.
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The interaction of anxiety and autonomic activation as a factor in the development and persistency of pathological anxiety was investigated with the aid of self-rating procedures and a habituation experiment. The state of activation was varied systematically in 40 normal subjects by various experimental conditions and by the administration of a tranquilizer. The degree of anxiety and activation were able to be differentiated in the investigated range of mean attentiveness. Anxious expectancy is perceived in particular as subjective anxiety. Fatigue and sedation, on the other hand, demonstrate subjective and autonomic desactivation. Corresponding differences can be demonstrated for the anxiolytic and sedative effects of tranquilizers. The time course of habituation is a more exact indicator than the amplitude of the orienting response. Cognitively provoked apprehensiveness, thus, appears to be qualitatively different as compared to psychoautonomically caused anxieties of psychiatric disorders.
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