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Ziel: Untersucht wurden Faktoren, die das Einschreibeverhalten von Patienten im Rahmen eines Projekts der integrierten Versorgung beeinflussen. Methode: Die Einschreiberaten wurden hinsichtlich Geschlecht und Hauptdiagnose analysiert. Ergebnisse: Die Einschreiberate betrug 59,3 %. Die Diagnose konnte 24,1 % der Variation des Einschreibeverhaltens aufklaren, das Geschlecht beeinflusste dieses nicht signifikant. Die hochste Quote zeigten Patienten mit affektiven Storungen, wohingegen Patienten mit einer F2-Diagnose sich nur zu 34,6 % einschrieben. Schlussfolgerungen: Ein Modell mit Einschreibenotwendigkeit ist fur die Psychiatrie nur bedingt geeignet.

This pilot study aimed to evaluate and examine an instrument that integrates relevant aspects of cross-sectoral (in- and outpatients) mental health care, is simply to use and shows satisfactory psychometric properties. The development of the scale comprised literature research, held 14 focus groups and 12 interviews with patients and health care providers, item-pool generation, content validation by a scientific expert panel, and face validation by 90 patients. The preliminary scale was tested on 385 patients across seven German hospitals with cross-sectoral mental health care (CSMHC) as part of their treatment program. Psychometric properties of the scale were evaluated using genuine and transformed data scoring. To check reliability and postdictive validity of the scale, Cronbach’s alpha coefficient and multivariable linear regression were used. This development process led to the development of an 18-item scale called the “Scale for Evaluation of Psychiatric Integrative and Continuous Care (SEPICC)” with a two-point and five-point response options. The scale consists of two sections. The first section assesses the presence or absence of patients’ experiences with various CSMHC’ relevant components such as home treatment, flexibility of treatments’ switching, case management, continuity of care, cross-sectoral therapeutic groups, and multi-disciplinary teams. The second section evaluates the patients’ opinions about these relevant components. Using raw and transformed scoring resulted into comparable results. However, data distribution using transformed scoring showed a smaller deviation from normality. For the overall scale, the Cronbach’s alpha coefficient was 0.82. Self reported experiences with relevant components of the CSMHC were positively associated with the patients approval of these components. In conclusion, the new scale provides a good starting point for further validation. It can be used as a tool to evaluate CSMHC. Methodologically, using transformed data scoring appeared to be preferable because of a smaller deviation from normality and a higher reliability measured by Cronbach’s alpha.

Background: The ‘gold standard’ for clinical studies is a randomised controlled trial usually comparing specific treatments. If the scientific study expands to strategy comparison with each strategy including various treatments, the research problems are increasingly complicated. The strategy debate in the psychiatric community is the starting point for the development of our new design. It is widely accepted that second-generation antipsychotics are the therapy of choice in the treatment of schizophrenia. However, their general superiority over first-generation antipsychotics could not be demonstrated in recent randomised controlled trials. Furthermore, we are becoming increasingly aware that the experimental conditions of randomised controlled trials, as in the European First Episode Schizophrenia Trial and Clinical Antipsychotic Trials of Intervention Effectiveness Phase 1 studies, may be inappropriate for psychiatric treatments. The high heterogeneity in the patient population produces discrepancies between daily clinical perception and randomised controlled trials results. The patient-oriented approach in the Cost Utility of the Latest Antipsychotic drugs in Schizophrenia Study reflects everyday clinical practice. The results, however, are highly dependent on the physicians’ preferences. The goal of the design described here is to take an intermediate path between randomised controlled trials and clinical studies such as Cost Utility of the Latest Antipsychotic Drugs in Schizophrenia Study, combining the advantages of both study types. Methods: The idea is to randomise two treatment pairs each consisting of one first-generation antipsychotic and one second-generation antipsychotic in a first step and subsequently, to involve the investigators in deciding for a pair most appropriate to the patients’ needs and then to randomise the allocation to one drug (first-generation antipsychotic or second-generation antipsychotic) of that chosen pair. This idea was first implemented in the clinical trial, the Neuroleptic Strategy Study, with a randomised design comparing efficacy and safety of two different strategies: either to use first-generation antipsychotics (haloperidol and flupentixol) or second-generation antipsychotics (olanzapine, aripiprazole and quetiapine) in patients suffering from schizophrenia. Results: In the course of the Neuroleptic Strategy Study, feasibility of this design was demonstrated. All aspects of the new design were implemented: randomisation process, documentation of responses from investigators as well as patients and drug logistic experience. In implementing the design, furthermore, we could investigate its theoretical properties. The physicians’ preferences for specific drugs used for the respective patients were analysed. Conclusion: The idea of patient-oriented randomisation can be generalised. In light of the heterogeneity and complexity of patient–drug interaction, this design should prove particularly useful.

Malonic acid diamides with two long hydrophobic alkyl chains and a basic polar head group as a new class of non-viral gene transferring compounds have shown high transfection efficiency and moderate toxicity. Based on the results obtained with saturated and unsaturated alkyl residues new derivatives with a more complex head group structure have been synthesized. For this purpose, cationic respectively basic groups were introduced by one or two lysine residues bound via tris(aminoethyl)amine spacer to the malonic acid diamide backbone. By studying in vitro gene delivery an increase of transfection efficacy was observed when using lipids with at least one unsaturated alkyl chain. This leads to cationic lipids exhibiting comparable or even higher transfection efficacies compared to the commercially available transfection agents LipofectAmine™ and SuperFect™. Phase transitions and phase structures of selected compounds have been analyzed and discussed in terms of transfection abilities. Particle size and zeta potential of liposomes and lipoplexes were also determined.

Aims: This study aims to investigate sleep quality and the subjective dream experience in alcohol-dependent patients during withdrawal and abstinence compared with healthy controls. Methods: Thirty-seven patients with alcohol dependency and 35 healthy control subjects were asked to fill in several questionnaires and to give information about their subjective sleep and dream experiences. Twelve patients participated in a follow-up interview 4 weeks later. Results: Sleep quality is impaired in alcohol-dependent patients during detoxication, and the subjective dream experience is more negatively toned compared with healthy controls. Both sleep quality and dream experience improves slightly after 4 weeks of abstinence. Patients with alcohol dependency during withdrawal and abstinence dream significantly more often about alcohol. However, none of the abstinent alcohol-dependent patients dreamt about alcohol during withdrawal. Conclusions: This study shows that the subjective sleep and dream quality is strongly impaired in patients with alcohol dependency. Differences in the dream experience between alcohol-dependent patients and healthy controls are in accordance with the continuity hypotheses of dreaming. The hypothesis of dreaming about alcohol as a compensatory effect, however, could not be confirmed.

Gene delivery using nonviral approaches has been extensively studied as a basic tool for intracellular gene transfer. Despite intensive research activity, the aim of creating a vector which meets all necessary demands has still not been reached. One possibility to solve the nonviral vector associated problem of low transfection efficacy is the development of new cationic amphiphiles. Therefore, the non-glycerol-based cationic lipids 1-9 have been synthesized and tested for in vitro gene delivery experiments. The backbone structure of the lipids consists of a malonic acid diamide with two long hydrophobic chains. The degree of saturation of the hydrophobic chains and the structure of the polar cationic headgroup were varied. The preparation follows an easy process and facilitates the trouble-free insertion of different alkyl chains. By studying in vitro gene delivery an increase of transfection efficacy was observed when using at least one unsaturated alkyl chain in the hydrophobic part and lysine or bis(2-aminoethyl)aminoethylamid as hydrophilic headgroup. This leads to cationic lipids exhibiting comparable or even higher transfection efficacies compared to the commercially available LipofectAmine and SuperFect.

(2010). Repressed and Formative. Comments on the Material Content of the Unconscious. Intellectual History Review: Vol. 16, No. 1, pp. 145-153.

Summary Background Whether or not second-generation antipsychotics (SGAs) represent an advantage over first-generation antipsychotics (FGAs) in the treatment of schizophrenia is not certain. Effectiveness studies published in the past 10 years have not unequivocally confirmed the superiority of SGAs over FGAs. We aimed to compare quality of life in patients with schizophrenia on an FGA strategy with those on an SGA strategy. Methods In the multicentre, randomised, double-blind Neuroleptic Strategy Study (NeSSy), we recruited participants (aged 18–65 years) with schizophrenia (ICD-10: F20.X) who required treatment initiation or a change in treatment, from 14 psychiatric university hospitals and state hospitals in Germany. Double randomisation allowed for restricted selection of a treatment within each antipsychotic drug group (FGA or SGA) for an individual patient: first, patients were assigned with a random number table to two of six possible drug pairs, each pair consisting of an FGA (haloperidol [3–6 mg] or flupentixol [6–12 mg]) given orally and an SGA (aripiprazole [10–20 mg], olanzapine [10–20 mg], or quetiapine [400–800 mg]) given orally, and the investigator then selected which pair was best suited to the patient; a second, double-blind random assignment allocated either the FGA or the SGA from the investigator-chosen pair to the patient. Treatment duration was 24 weeks. Primary outcomes were change from baseline to week 24 in quality of life (SF-36) and clinical global impression (CGI-I), analysed in all randomly assigned patients who received at least one dose of the study drug. Safety was assessed in a safety set, consisting of all randomly assigned patients who received at least one dose of the study drug, coinciding with the set of the efficacy analyses. The study is registered with ClinicalTrials.gov, number NCT01164059; German Clinical Trials Register, number DRKS00000304; WHO ICTRP, number U1111–1112–9727; and EudraCT, number 2009–010966–47. Findings Between April 1, 2010, and May 31, 2013, 149 patients were randomly assigned, 69 to FGA treatment and 80 to SGA treatment. 136 patients received at least one dose of study drug (63 in the FGA group, 73 in the SGA group). Mean area under the curve (AUC) values of SF-36 were significantly higher in the SGA group than in the FGA group (85·1 [SD 14·7] vs 79·7 [17·3], p=0·0112). Mean AUC values for CGI-I scores decreased in both groups, but were not significantly different between the two groups (3·39 [SD 0·89] in the FGA group vs 3·26 [0·92] in the SGA group, p=0·3423). 30 (48%) of 63 patients given FGAs had at least one adverse event compared with 42 (57%) of 73 patients given an SGA (p=0·3019); the most common were nervous system disorders (18 [60%] of 30 in the FGA group vs 19 [45%] of 42 in the SGA group) and psychiatric disorders (ten [33%] vs 16 [38%]). One patient died after cessation of study drug (olanzapine), most likely as a result of an illicit drug overdose. The increase in body-mass index (BMI) was significantly higher in the SGA group than in the FGA group (p=0·0021 at week 6 and p=0·0041 at week 24). Interpretation Improvement of patient-reported quality of life was significantly higher in patients with schizophrenia given SGAs than in those given FGAs, when treatment selection was individualised. This advantage, however, has to be weighed against the potential metabolic adverse effects of some SGAs. Funding German Federal Ministry of Education and Research.

Reduction of the eta-deformed sigma model on AdS(5) x S-5 to the two-dimensional squashed sphere (S-2)eta can be viewed as a special case of the Fateev sausage model where the coupling constant v i ...

Um das Jahr 1938 wurden im Revier Lemnitz, wie auch in anderen Revieren des Vogtlandes, sogenannte Grune Augen (kleinflachige Pflanzungen der Rotbuche (Fagus sylvatica L.) innerhalb groser Nadelwaldkomplexe) angelegt. In vorliegender Arbeit wurde untersucht, welchen Einfluss die Buchen im Vergleich zu den benachbarten Fichten (Picea abies [L.] KARST.) nach 60 Jahren auf den Boden haben und welche Wuchsleistung sie erreichen. Dazu wurden zehn Stichprobenpaare ausgewahlt.

Anhedonia is a negative symptom that has not always been given attention in schizophrenic patients. While phenomenologically orinted psychiatrists noticed a certain lack of emotional vivacity in schizophrenic patients, schizophrenia theory in the tradition of Bleuler emphasized a different facet of schizophrenic psychopathology. It held that the retreat into wishful fantasies, autism, is a fundamental symptom of schizophrenia. Bleuler's concept of schizophrenic psychopathology was based on J. H. Jackson's evolutionary account of mental disorders. In this view, mental diseases represent a dissolution of evolutionary progress and lead to the manifestation of primitive traits in `modem' patients. This article argues that the resulting analogies perceived between schizophrenics and `primitive' people lead to an overemphasis on wishful, irrational thinking and to the neglect of anhedonia, the inability to experience pleasure. Moreover, socially unacceptable desires were rediscovered in these supposedly `primitive' individuals. This situation changed fundamentally only after social and historical transformations occurred that shifted the center of psychiatric research from Germany to the United States and from an emphasis on the rational control of desires to the use of social reward in ensuring social conformity. As a consequence, Rado and Meehl placed anhedonia at the heart of their schizophrenia theories. Current developments in social interaction seem to stimulate another shift in schizophrenia theory, de-emphasizing social reward and providing room for a differentiated assessment of anhedonia in schizophrenia.

Die reinen Gipsboden im Kyffhausergebirge und am Sudharzrand enthalten im Vergleich zu Silikatboden extrem viel Calcium und Schwefel und wenig Kalium und Aluminium. Trotzdem sind die untersuchten Birken(Betula pendula), Buchen(Fagus sylvatica) und Schwarzkiefern(Pinus nigra) auf den Gipsstandorten mit diesen Elementen relativ ausgeglichen ernahrt, was auf ein wirksames aktives Selektions- und Ausschlusvermogen dieser Waldbaume schliesen last. Die hohe Calciumkonzentration in der Bodenlosung behindert die Aufnahme der anderen untersuchten Nahrelemente nicht. Ein Kalium-Calcium-Antagonismus tritt nicht auf.

Describing the bosonic AdS_3 x S^3 particle and string in SU(1,1) x SU(2) group variables, we provide a Hamiltonian treatment of the isometry group orbits of solutions via analysis of the pre-symplectic form. For the particle we obtain a one-parameter family of orbits parameterized by creation-annihilation variables, which leads to the Holstein-Primakoff realization of the isometry group generators. The scheme is then applied to spinning string solutions characterized by one winding number in AdS_3 and two winding numbers in S^3. We find a two-parameter family of orbits, where quantization again provides the Holstein-Primakoff realization of the symmetry generators with an oscillator type energy spectrum. Analyzing the minimal energy at strong coupling we verify the spectrum of short strings at special values of winding numbers., Comment: 17 pages, v2: references changed, typos corrected, published in JPhysA

Motivated by the notorious difficulties in determining the first quantum corrections to the spectrum of short strings in AdS_5xS^5 from first principles, we study closed bosonic strings in this background employing a static gauge. In this gauge the world-sheet Hamiltonian density is constant along the extension of the string and directly proportional to the square of the spacetime energy. We quantize this system in a minisuperspace approach, in which we consider only a single AdS_5 string mode excitation next to an arbitrary particle like zero-mode contribution in the full AdS_5xS^5 background. We determine the quantum spectrum using this method to the next-to-next-to-leading order in the large 't Hooft coupling expansion. We argue for an ordering prescription which should arise from supersymmetrization and indeed recover the integrability based predictions for the spectrum of the lightest excitation, dual to the Konishi field scaling dimensions. The higher excitations fail to agree, but this is shown to be a consequence of the string mode truncation employed. Despite this simple setup, our system reveals intriguing features, such as a close connection to particles in AdS_6, classical integrability and preservation of the isometries of AdS_5xS^5 at the quantum level., 24 pages, 1 figure

We analyze dynamics of the AdS$_{N+1}$ particle realized on the coset SO$(2,N)/$SO$(1,N)$. Hamiltonian reduction provides the physical phase space in terms of the coadjoint orbit obtained by boosting a timelike element of ${\frak so}(2,N)$. We show equivalence of this approach to geometric quantization and to the SO$(N)$ covariant oscillator description, for which the boost generators entail a complicated operator ordering. As an alternative scheme, we introduce dual oscillator variables and derive their algebra at the classical and the quantum level. This simplifies the calculations of the commutators for the boost generators and leads to unitary irreducible representations of ${\frak so}(2,N)$ for all admissible values of the mass parameter. We furthermore discuss an SO$(N)$ covariant supersymmetric extensions of the oscillator quantization, with its realization for superparticles in AdS$_2$ and AdS$_3$ given by recent works., 21+1 pages; v2: typos corrected, references updated; v3: minor changes, matches published version

An integrable deformation of the well-known Neumann-Rosochatius system is studied by considering generalised bosonic spinning solutions on the eta-deformed AdS_5 x S^5 background. For this integrable model we construct a 4x4 Lax representation and a set of integrals of motion that ensures its Liouville integrability. These integrals of motion correspond to the deformed analogues of the Neumann-Rosochatius integrals and generalise the previously found integrals for the eta-deformed Neumann and (AdS_5 x S^5)_eta geodesic systems. Finally, we briefly comment on consistent truncations of this model., Comment: 25 pages, 1 figure; v2: published version

Cationic liposome/DNA complexes can be used as nonviral vectors for direct delivery of DNA-based biopharmaceuticals to damaged cells and tissues. To obtain more effective and safer liposome-based gene transfection systems, two cationic lipids with identical head groups but different chain structures are investigated with respect to their in vitro gene-transfer activity, their cell-damaging characteristics, and their physicochemical properties. The gene-transfer activities of the two lipids are very different. Differential scanning calorimetry and synchrotron small- and wide-angle X-ray scattering give valuable structural insight. A subgel-like structure with high packing density and high phase-transition temperature from gel to liquid-crystalline state are found for lipid 7 (N′-2-[(2,6-diamino-1-oxohexyl)amino]ethyl-2,N-bis(hexadecyl)propanediamide) containing two saturated chains. Additionally, an ordered head-group lattice based on formation of a hydrogen-bond network is present. In contrast, lipid 8 (N′-2-[(2,6-diamino-1-oxohexyl)amino]ethyl-2-hexadecyl-N-[(9Z)-octadec-9-enyl]propanediamide) with one unsaturated and one saturated chain shows a lower phase-transition temperature and a reduced packing density. These properties enhance incorporation of the helper lipid cholesterol needed for gene transfection. Both lipids, either pure or in mixtures with cholesterol, form lamellar phases, which are preserved after addition of DNA. However, the system separates into phases containing DNA and phases without DNA. On increasing the temperature, DNA is released and only a lipid phase without intercalated DNA strands is observed. The conversion temperatures are very different in the two systems studied. The important parameter seems to be the charge density of the lipid membranes, which is a result of different solubility of cholesterol in the two lipid membranes. Therefore, different binding affinities of the DNA to the lipid mixtures are achieved.

Investigation or DNA interactions with cationic lipids is of particular importance for the fabrication of biosensors and nanodevices. Furthermore, lipid/DNA complexes can be applied for direct delivery of DNA-based biopharmaceuticals to damaged cells as non-viral vectors. To obtain more effective and safer DNA vectors, the new cationic lipids 2-tetradecylhexadecanoic acid-{2-[(2-aminoethyl)amino]ethyl}amide (CI) and 2-tetradecyl-hexadecanoic acid-2-[bis(2-aminoethyl)amino]ethylamide (CII) were synthesized and characterized. The synthesis, physical-chemical properties and first transfection and toxicity experiments are reported. Special attention was focused on the capability of CI and CII to complex DNA at low and high subphase pH values. Langmuir monolayers at the air/water inter face represent a well-defined model system tostu dy the lipid/ DNA complexes. Interactions and ordering of DNA under Langmuir monolayers of the new cationic lipids were studied using film balance measurements, grazing incidence X-ray diffraction (GIXD) and X-ray reflectivity (XR). The results obtained demonstrate the ability of these cationic lipids to couple with DNA at low as well as at high pH value. Moreover, the observed DNA structuring seems not to depend on subphase pH conditions. An influence of the chemical structure of the lipid head group on the DNA binding ability was clearly observed. Both compounds show good transfection efficacy and low toxicity in the in vitro experiments indicating that lipids with such structure are promising candidates for successful gene delivery systems.

We consider the Hamiltonian reduction and canonical quantization of a massive AdS$_2$ superparticle realized on the coset OSP(1|2)/SO(1,1). The phase space of the massive superparticle is represented as a coadjoint orbit of a timelike element of $\mathfrak{osp}$(1|2). This orbit has a well defined symplectic structure and the OSP(1|2) symmetry is realized as the Poisson bracket algebra of the Noether charges. We then construct canonical coordinates given by one bosonic and one fermionic oscillator, whose quantization leads to the Holstein-Primakoff type realization of $\mathfrak{osp}$(1|2). We also perform a similar analysis and discuss new features and inconsistencies in the massless case., 19 pages; v2: typos corrected, references added, matches published version

Neurophysiological methods allow the examination of cognitive-cortical functioning in patients with schizophrenia in its prodromal states. As revealed by previous studies, event-related potential components such as auditory evoked P300 associated with cognitive processes, such as attention and orientation, are known to be reduced in amplitude in acute and chronic as well as in medicated and unmedicated patients. It is, however, unclear whether a P300 amplitude reduction occurs before the schizophrenic psychosis is fully manifested. We studied patients in the prodromal phase of the schizophrenic disorder (i.e. subjects with an at-risk mental state showing attenuated psychotic symptoms or brief limited intermittent symptoms) as well as first-episode patients and chronic patients with schizophrenia and compared these groups to healthy subjects. The event-related P300 was recorded during an auditory oddball paradigm. Groups differed significantly from each other in the P300 amplitude at Pz (F(3/149)=2.532, p=0.02). Post-hoc tests revealed significantly lower P300 amplitudes of non-medicated prodromal (p=.03), first-episode (p=.01) and chronic patients (p=.001) compared to the healthy controls. The study revealed that there are neurophysiological changes as the reduction in P300 amplitudes begins early in schizophrenia at the prodromal phase, i.e. before a manifestation of full-blown psychosis, and that these changes seem to have a progressive course from prodromal to chronic state of schizophrenia as assumed in this cross-sectional study.

Objective Conditioning processes may convert neutral stimuli to drug-associated stimuli and create an implicit drug memory. Previous studies showed specific psychophysiological reactions to alcohol-associated stimuli differentiating alcohol-dependent subjects from healthy controls. This was shown in evoked potentials using visual and olfactory alcohol-related stimuli. Methods Our study examined the effects of complex alcohol-associated sounds in comparison to complex neutral sounds on electrophysiological event-related potentials and the self-report of craving. We assessed 10 detoxified alcoholics and 10 healthy controls in a cue-reactivity paradigm. Results Detoxified alcoholics demonstrated significantly higher alcohol stimulus-induced late P300 and late positive complexes. Subjective baseline craving and stimulus-induced craving only differed significantly between groups in terms of the craving dimension “relief of withdrawal symptoms”. Conclusions The results show that auditory stimuli attach importance to stimulus-induced craving in alcoholics. Therapeutic consequences will be discussed. Significance The study examined for the first time the effects of alcohol-associated auditory stimuli on alcohol craving and identifies learning processes as underlying neural mechanisms which support the assumption of an implicit addiction memory in alcoholics.

In patients with schizophrenia, early as well as late stages of information processing can be deficient. Therefore, it is important to determine the earliest occurrences of aberrant processing since deficits on these stages may cause abnormal processing on later, e. g. cognitive, levels. In order to investigate this issue in the visual domain, we studied one of the most basic feature integration mechanisms, namely feature fusion. Our results indicate that in schizophrenic patients this integration mechanism is qualitatively intact but reveals quantitative impairments that may influence later processing stages.

The aim of this essay is to show that a dialectically shaped theory of subjectivity is necessary for psychopathology. After introductory remarks about the tasks of psychopathology in general a critique of the so-called "anthropological psychiatry" leads to the finding that this theoretical framework is not sufficient to offer psychopathology a philosophical orientation in accord with the needs of our time. By analyzing the meaning of psychopathology the special dialectics involved are demonstrated, and a concept of subjectivity is elaborated using proposals by the Czech philosopher Milan Prucha.

Summary In a pot trial with quartz sand the water regime and CaNP supply as well as natural radiation were varied and the reaction of one and two-year-old spruce seedlings was tested under stress and normal conditions. An increasing supply of N, Ca, and water during development of the seedlings affects growth and quality of the seedlings in a decisive manner. In case of water shortage shade gives a favourable effect, in case of sufficient water supply root growth and needle mass are reduced. Good growth in light with sufficient water supply was observed in the first year and in the second respectively with the following nutrient content in the needles: % N 1.4 and 1.6 resp.; % Ca 0.4 and 0.8 resp.; % K 1.2 and 1.0 resp. with invariable K application. There is a tendency towards good growth under the conditions of relatively low transpiration intensity and relatively low Ca and K content in the needle. The N content in needles increases in case of Nand Ca application, water shortage and filhade. The content of N and K as well as that of Nand P in the needles takes an opposite course. As a rule, the transpiration intensity decreases under the conditions of shading and N application and increases with high Ca supply.