Summary:Purpose: To compare self-regulation of lowfrequency EEG components (slow cortical potentials, SCPs) with other methods of seizure control for patients with drugrefractory partial epilepsy and to separate the real anticonvulsive effect from placebo effects.Methods: Results of a treatment program of SCP selfregulation (experimental group) are compared with two groups of patients, one of which learned self-control of respiratory parameters (end-tidal CO 2 and respiration rate: RES group); the other received medication with new anticonvulsive drugs (AEDs) in combination with psychosocial counseling (MED group). Clinical, cognitive, behavioral, and personality measures were assessed before and after treatment. In addition, to control for placebo responses, patients repeatedly estimated their beliefs in the efficiency of the respective treatment, their satisfaction and expectations, and the quality of the relationship with their therapists.Results: SCP and MED groups showed a significant decrease of seizure frequency, but the RES group did not. Clear positive changes in the sociopsychological adjustment were obtained in all three groups, with the maximal improvement being attained in the RES group.Conclusions: All kinds of therapy result in considerable improvement of patients' emotional state, which may in part be due to potential placebo effects; however, this improvement is not related to the quality of the therapeutic effect proper (i.e., seizure reduction). Traditional double-blind control group designs are inappropriate for behavioral interventions or treatments with psychoactive pharmacologic drugs. Rather, specific tests can be developed to control the placebo effect and to separate it from the genuine therapeutic effects.
The aim of the study was to identify psychopathological similarities and differences in borderline personality disorder (BPD) and schizophrenia. We compared 23 female patients with a BPD and 21 female patients with schizophrenia according to auditory verbal hallucinations (AVHs), dissociation, childhood trauma, and additional psychotic symptoms. The character of AVH was similar with regard to commenting voices, location, and foreign voices. Major differences were found in the prevalence of negative symptoms, bizarre delusions, and formal thought disorder. These characteristics were more frequent in schizophrenia and negatively correlated with childhood traumatization. A history of childhood traumatization and dissociative symptoms was significantly more frequent in BPD. AVHs in BPD and schizophrenia are not distinguishable in terms of the historically grown criteria in Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision for diagnosing schizophrenia. Other symptoms such as delusions, negative symptoms, formal thought disorder, and dissociative psychopathology could help to differentiate between both groups.
Background:For a reduction in the use of coercive interventions it will be necessary to identify patients at risk. The aim of this study was to explore the impact of basic patient characteristics at admission, history within 24 hours before admission, and living conditions on the risk of experiencing coercive measures, controlling for ward characteristics in a multi-level approach.Methods:Patient characteristics of 3389 patients (1920 women) who had received inpatient treatment in 2007, data relating to coercive measures, and ward characteristics were extracted from the clinical basic documentation.Results:Patients with aggressive behaviour in the 24 hours prior to admission had a three times higher risk of coercive measures compared to non-aggressive patients. Severity of illness increased the risk of coercion markedly. With each level of severity, the risk of coercion was doubled. Voluntariness of stay appeared to be the best protective factor against coercive measures. If a patient stayed voluntarily, this reduced the risk of coercion by more than two thirds. No impact was found for living conditions.Conclusions:To identify patients at risk, it is most important to intensively monitor patients with aggressive behaviour prior to admission and patients with a greater severity of psychopathological symptoms.
Background: Self-directed and other violence as well as subsequent coercive interventions occur in a substantial proportion of patients with personality disorders during in-patient treatment. Different strategies may be required to reduce coercive interventions for patients of different diagnostic groups.
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