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Biomedical subjects

H D Brenner

Publications and source records attributed to H D Brenner.

At least 37 records · Page 2Linked to original sources
PubMed1994

Cognitive therapy with schizophrenic patients: conceptual basis, present state, future directions.

Schizophrenia may nowadays be most readily understood as a systemic disorder in which changes in the brain structure underlie individual cognitive abnormalities which for their part interact with environmental factors at the onset of the illness and during its course. From this, one may deduce the rationale for cognitive therapy for schizophrenic patients. Existing approaches may be systemised as direct, indirect and combined procedures. The latter are based on the assumption of the pervasive effects of elementary and complex cognitive dysfunctions at the levels of open behaviour. However, in a mirror-design study with 21 schizophrenic patients according to DSM-III-R in which the effects of various intervention sequences were examined, it was not possible to find confirmation for this. This and other open questions have led to doubts expressed in current literature concerning the utility of cognitive therapy, especially with respect to the locus, nature and malleability of cognitive disorders, as well as the possibility of generalizing cognitive improvements. The latter are discussed in detail and possible future directions in cognitive therapy for schizophrenic patients are shown.

Adult↗
PubMed1994

[The new role of psychiatry in the management of mentally retarded patients].

The areas of remedial education and special education have profoundly changed the psychiatric care of mentally retarded persons. Desinstitutionalisation, normalisation and integration are widely recognised concepts today and have since gained relatively substantial empirical support. Definition of these concepts has been broadened to include consideration of the optimal management of environmental conditions as an integral part of the comprehensive living environment. The systemic-ecological approach dislodges psychiatry from its central position in the treatment of the mentally ill retarded, and invests a greater degree of trust in remedial educations and special education. Effective treatment thus involves a joint effort on the part of various mental health professionals working towards a common goal, grounded on the coexistence of mental retardation and mental illness. Psychotherapy should be devised so as to address cognitive deficits no longer considered to be contraindicative to the therapy process. The purpose of pharmacotherapy is to finetune psychotropic medication with pedagogical, psychoeducational and psychotherapeutic methods. Although community-based mental health delivery systems and comprehensive (institutional based) services both show promise for the care and treatment of mentally retarded persons there is evidence for the particular viability of the latter model due to prevailing present conditions and to the aspect of cost effectiveness, particularly due to its utility in promoting still acquisition relevant to workers in this field of mental health.

Activities of Daily Living↗
PubMed1993

[Empirical study of a physically oriented therapy with schizophrenic patients].

Ten predominantly chronic schizophrenics were given body therapy, including massage to the feet, back and neck. The aim of the therapy was to increase patients' awareness of their own bodily limits. This objective is based on the view that schizophrenia is a problem of delimitation, that psychic problems have their physical embodiment, and that problems of delimitation can therefore be tackled at the physical level by enhancing the patients' ability to experience their own bodily limits. The relaxing effect of the therapy is indicated in physiological measurements of skin conductance and heart rate, plus patients' self-perceptions. The close physical presence of the therapist did not trigger any anxiety conditions. The study shows that this body-oriented therapy is worthy of consideration as a method for giving schizophrenic patients a greater awareness of their own bodily limits.

Adult↗
PubMed1992

Treatment of cognitive dysfunctions and behavioral deficits in schizophrenia.

Integrated Psychological Therapy (IPT) is a structured intervention program that prescribes steps to remediate cognitive and behavioral dysfunctions that are characteristic of the psychopathology of schizophrenia. Evaluative studies of IPT indicated that the program improved schizophrenic patients' elementary cognitive processes such as attention, abstraction, and concept formation but that patients' performance was still below the normal range. The clinical utility of IPT will depend on studies that document the hierarchical generalization of improvements from the cognitive to the social and symptomatic levels of functioning.

Antisocial Personality Disorder↗
PubMed1990

Defining treatment refractoriness in schizophrenia.

Addressing the need for research on the nature of refractoriness to antipsychotic drug therapy exhibited by a substantial minority of schizophrenic patients, Philip R.A. May and Sven Jonas Dencker instigated an international study group to discuss this problem, beginning with the International Congress of Neuropsychopharmacology in Göteborg, Sweden, in 1980. The study group subsequently met in Haar, Federal Republic of Germany, in 1985; in Banff, Canada, in 1986; and again in Telfs, Austria, in 1988. The study group set three objectives: (1) to clarify the concept of treatment resistance or refractoriness; (2) to suggest criteria for defining or rating the degree of treatment refractoriness; and (3) to explore the role of psychosocial and drug therapies in increasing the responsiveness of the treatment refractory patient. This position article represents a distillation of the study group's efforts to define treatment refractoriness in schizophrenia.

Activities of Daily Living↗
PubMed1990

[Psychophysiologic abnormalities in schizophrenia: some implications for therapy].

On the basis of several studies, some psychophysiological activation abnormalities in schizophrenia are explained. These abnormalities give rise to at least three therapeutic aims: (1) As some psychophysiological systems may be under- and others overaroused in schizophrenic patients compared to normal controls, therapeutic interventions should approach the systems selectively. (2) The ability to modulate the psychophysiological activation, which is diminished in schizophrenic patients, should be improved. (3) Schizophrenic patients need a more differentiated perception of their own state of activation. These aims contrast somewhat with past therapeutic studies, which tried to change activation for the purpose of tension reduction. It seems advisable to link basic psychophysiological research more closely to the development of therapies.

Adult↗
PubMed1987

On autoprotective efforts of schizophrenics, neurotics and controls.

Autoprotective efforts of schizophrenics have hardly been systematically investigated until now, although the role of coping processes in regard to numerous psychic disorders is increasingly recognized. The investigation of autoprotective efforts, however, is of special significance in view of the different current formulations of the vulnerability stress concept of schizophrenia. Thus the cognitive disorders in the sense of information processing deficits among schizophrenics deserve our special attention, since they are described consistently as vulnerability characteristics and as cause of a heightened susceptibility to stress, and since they can be considered an explanatory basis for a wide range of subjectively experienced basic disorders of schizophrenia. In the present study the two disorder dimensions and the corresponding autoprotective efforts were investigated among 60 schizophrenic patients, 30 neurotic patients and 30 healthy controls. The schizophrenic patients had both significantly more experimental psychologically operationalized dysfunctions in information processing and subjectively experienced basic disorders. However, we found no correlation between the two levels of investigation. This may mainly be attributed to the fact that on the level of subjective experience the primary disorder, the perception of the disorder and the individual response to the disorder cannot be differentiated unequivocally. All of the schizophrenic patients reported consciously performed autoprotective efforts in regard to basic disorders. In this connection it is of interest that the schizophrenic patients had a significantly higher percentage of problem solving oriented attempts in comparison with the two non-schizophrenic comparison groups, and that this percentage even increased by a progressive amount of disorders. The schizophrenic patients experienced basic disorders with much more emotional tension and existential, ego-threatening anxiety. They were interpreted by the schizophrenic patients as danger signals, by the neurotic patients, however, predominantly as concomitant symptoms of their neurosis, whereas healthy persons comprehended them within the framework of ordinary psychological explanatory models. The relevance of these results in regard to further research in autoprotective efforts of schizophrenic patients and in their possible therapeutic implications is discussed.

Adaptation, Psychological↗
PubMed1986

Problem patients in a psychiatric inpatient setting. An explorative study.

A total of 26 psychiatric inpatients (5.8% of all admissions) in an intensive treatment unit were identified as problem patients by nursing personnel. Reasons for such identification were behavioral pathology of the patient, difficulties of the staff in the relationship with the patient, and insufficient therapeutic progress, and the use of inappropriate therapeutic methods. Compared with a control group, the problem patients were psychotics or personality disorders. They presented more behavioral pathology, were prescribed more medication, and experienced decisively longer hospitalizations, although they profited less from their hospitalization. Follow-up investigation revealed that the majority did not earn their own living, otherwise they were no more poorly socially adapted than the discharged controls. The suicide proneness of problem patients was high. In the treatment of these patients the necessity of adapting the therapeutic standards and expectations is of the utmost importance.

Adult↗
PubMed1984

Self-healing strategies among schizophrenics: attempts at compensation for basic disorders.

New experimental findings show that schizophrenics, as well as some of their non-schizophrenic relatives, manifest basic cognitive disorders defined in terms of variables from the field of experimental psychology. These basic disorders can be regarded as markers--if not, indeed, as psychological manifestations--of vulnerability to schizophrenia. They can be associated with subjectively experienced forms of non-clinically manifest impairments in psychological functioning. It was therefore hypothesised that schizophrenics, as well as non-schizophrenic subjects vulnerable to schizophrenia, will, in the course of learning processes, develop compensatory efforts which may be more or less effective. It is assumed that effective efforts of this kind will take on special significance in stress situations which would tend to elicit the occurrence of a schizophrenic episode. Effective efforts at compensation for basic disorders should be able to act as a 'buffer' against negative stressor effects (moderator function), thus reducing the danger of a psychotic breakdown. These compensation efforts were studied in 40 inpatients in remission after an acute schizophrenic episode. It was found that significant correlations exist between the extent of subjectively experienced basic disorders and the number and kind of conscious compensation attempts. Although the findings to date are of a preliminary and purely descriptive nature they would seem to justify further research.

Adaptation, Psychological↗
PubMed1984

Pharmacotherapy of agitational states in psychiatric gerontology: double-blind study: febarbamat-pipamperon.

The effects of febarbamat and pipamperon on agitational and aggressive states of patients with diffuse psycho-organic syndrome were compared in a double-blind study on patients over 60 years of age requiring nursing care. Such disorders, particularly in the field of psychiatric gerontology, represent an increasing problem. The neuroleptic agents hitherto prescribed for such agitational states are not only beset with serious side-effects (predyskinesia, drug-induced Parkinson syndrome, sedentary restlessness, postdyskinesia), but particularly with an unwanted suppression of the patients' reactions. It was therefore of particular interest to find out if febarbamat showed an equally good therapeutic effect on aggressive and agitational states, without causing these side-effects (especially suppression of cognitive performance). This could have a positive effect on social and other therapeutic activities. The test substances were therapeutically comparable in their effect on agitational and aggressive states. On the psychological level, febarbamat showed superiority in the cognitive performance parameters.

Aged↗
PubMed1983

Aldehyde oxidizing capacity of erythrocytes in normal and alcoholic individuals.

The acetaldehyde metabolizing capacity in blood of alcoholics and nonalcoholics was investigated by an improved head-space gas chromatographic method. Great individual and interindividual variability was observed. The mean acetaldehyde oxidizing capacity of 3.51 nmoles/min/ml erythrocyte suspension in alcoholics was significantly lower than the mean of 5.20 nmoles/min/ml in nonalcoholics. Furthermore, treatment of alcoholics with aldehyde dehydrogenase inhibitors reduced the acetaldehyde oxidizing capacity significantly (mean of 1.67 nmoles/min/ml). No acetaldehyde could be detected in blood of nonalcoholics who ingested 0.25 g ethanol/kg body weight whereas levels of 2-14 microM were detected in blood of alcoholics. After disulfiram, an elevation to 7-103 microM in blood of alcoholics was observed.

Acetaldehyde↗
PubMed1982

The influencing of cognitive and psychophysiological parameters through covert therapy procedures in drug addicts.

The effectiveness of a cognitive extinction technique has been examined in 10 opiate-dependent patients through a multifactorial approach. With the help of the method of semantic-differential it has been examined whether the position of drug-specific concepts was altered in the semantic space, in the sense of a change of attitude in the course of therapy. Relevant common concepts were used as a control. Taking into account the importance of psychophysiological factors upon the onset and course of drug addiction, we have examined the effectiveness of the therapy on the physiological level through the measurement of electrodermal activity and heart rate during the presentation of typical drug situations. For control purposes, measurements were made during presentation of non-drug-typical, but emotionally laden, situations. The results showed significant cognitive changes in the sense of a change of attitude and a significant reduction of the psychophysiological activation.

Arousal↗