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Resective epilepsy surgery is to date the most effective treatment for focal medication-resistant epilepsy. In multiple retrospective studies the median percentage for remaining seizure-free is approximately 60–65%, depending on the epilepsy syndrome . Surgery for epilepsy was pioneered by Penfield in the first part of the twentieth century and has been refined since, with advanced imaging and neurophysiologic recordings . Despite the obvious success, surgery remains underutilized [1,3]. If seizures are focal in onset and medication resistant, which is defined by the ILAE as having failed two anti-epileptic medications at standard doses, surgical evaluation at a specialized centre is indicated .
Sketching and prototyping are parts of a ‘reflective conversation with materials of a design situation’ (Schön, 1992). To support this conversation, we developed a reflective tool -the Reflection Canvas- that facilitates reflection activities through sketching and prototyping on the one hand and verbalisation on the other. We introduced the reflective tool to design students. Based on observation and answers from a questionnaire data reveal that guided reflection structured the process in a helpful way. It also turned out students had difficulties to switch from visualisation to verbalisation.
Attachment and companionship are fundamental basic needs of human beings and contribute the feeling of security and social affiliation. It is assumed that dysfunctional attachment behaviour in people with Borderline Personality Disorder leads to difficulties in the interpersonal contact. Unsecure and especially disorganized manners of attachment seem to be frequently represented by mentally ill people. In this study the release of oxytocin according to attachment relevant situations was investigated and attachment representations of people with BPD have been analysed.
In order to determine attachment representations of healthy people and of people with BPD we used the validated ‘Adult Attachment Projective’/ ‘AAP’ by George, West and Pettem (1999). The projective contains eight contour drawings of attachment relevant situations. The participant should make up a story of each picture, which was evaluated by its coherence, its content and the used defence mechanisms. Attachment representations of 30 patients with BPD were surveyed. Furthermore we measured the release of oxytocin evoked by an activation of the attachment system via the ‘AAP’ in 10 healthy people. Therefor blood drawings were performed at four different points of time.
Here, we present pilot data on oxytocin measures induced via the ‘AAP’. We could detect a decrease of oxytocin in healthy people caused by an activation of the attachment system. Moreover attachment representations of patients with BPD will be presented and discussed. These preliminary data could lead to further studies on a possible dysregulation of the attachment- and the oxytocin system of people with BPD.
Besides affective instability and identity diffusion, disturbances in social interactions are a core symptom of borderline personality disorder (BPD). Interpersonal problems in BPD have been suggested to be associated with oxytocin dysregulation. To directly address this hypothesis, we investigated oxytocin plasma levels during a social exclusion (ostracism) paradigm in female BPD patients.
Twenty-two female BPD patients (diagnosed according to DSM-IV) and twenty-one healthy controls matched for gender, age, and education underwent repeated neuroendocrine measurements in a standardized laboratory setting during the Cyberball paradigm, a virtual balltossing game that evokes a social exclusion situation. Emotional reactions were assessed and oxytocin and cortisol levels measured at baseline and 5, 15, and 40 min after Cyberball.
After social exclusion, oxytocin plasma levels were lower in BPD patients than in healthy controls, whereas cortisol levels did not differ between groups. BPD patients showed distinct differences in emotion regulation compared to healthy participants and reacted to social exclusion with an increase of other-focused negative emotions, particularly anger and contempt.
Our pilot study suggests that the oxytocin system shows a differential response to social exclusion in BPD patients compared to healthy controls. This difference may be related to the high rejection sensitivity of BPD patients and their difficulties in resolving social conflict.
Ostracism (social exclusion) has been found to be a remarkable stress factor to mentally ill people with difficulties in situations of social interaction. In an earlier study it was found that patients with borderline personality disorder (BPD) showed differences in oxytocin dysregulation by having lower oxytocin plasma levels during a social exclusion paradigm (Jobst et al., 2013, submitted). To our knowledge, this is the first study investigating neuroendocrinological changes of social exclusion in chronically depressed patients. Chronic depression (CD) is associated with poor social functioning and behavioral interpersonal problems which are considered to be based on the non-responsiveness of CD patients to environmental consequences.
To manipulate a situation of social exclusion we used the Cyberball Paradigm, a virtual ball tossing game which has been well validated and applied in numerous previous studies on the effects of social exclusion. 19 CD patients (according to DSM-IV) and 19 healthy controls matched for gender, age and education underwent repeated neuroendocrine measurements in a standardized laboratory setting during the Cyberball Paradigm. Assessments of psychological variables as well as measurements of oxytocin plasma levels were performed at baseline, 5 min, 15 min and 40 min after Cyberball.
As an association of interpersonal problems in BPD with oxytocin dysregulation has been found, we suggest differences in changes of oxytocin levels in a social exclusion situation in CD patients versus healthy subjects. The data will be presented and discussed in relation to specific interpersonal problems of patients suffering from CD.
Chronically depressed patients show considerably impaired interpersonal features, which could be explained by a reduced Theory of Mind (ToM) ability.
The aim of this study was to examine whether chronically depressed patients are impaired in their ToM performance compared to a healthy control group in three different components of ToM: the social cognitive and social perceptual component as well as the ability to take someone else's visual perspective.
32 chronically depressed patients (DSM-IV) were compared to 32 matched healthy controls. ToM abilities were assessed by a cartoon picture story test (CT), the ‘Perspective task’ (PT) and the ‘Reading the mind in the Eyes’ test (RMET). In addition, information about depression severity, childhood trauma and executive functioning (working and logical memory) was assessed for both groups.
Patients mentalized significantly less frequently than healthy controls in the CT (Mann-Whitney-U=340,50, p<0,05). Furthermore, the CT was significantly correlated with the RMET (patients: r=0,46, p<0,05; controls: r=0,57, p<0,01). We didn’t find any significant difference between both groups in the RMET (p>0,05). In the PT, patients showed significantly lower scores than controls (t(35,68)=2,10, p<0,05). There wasn’t any significant correlation between the three ToM tests and severity of depression, duration of illness or childhood trauma (p>0,05).
Our results suggest that chronically depressed patients show deficits in their social cognitive ToM ability compared to controls, whereas their social perceptual ToM ability seems to be unimpaired. As to the capacity to take someone else's perspective, our results suggest that chronically depressed patients present significant deficits.
Patients with chronic depression (CD) by definition respond less well to standard forms of psychotherapy and are more likely to be high utilizers of psychiatric resources. Therefore, the aim of this guidance paper is to provide a comprehensive overview of current psychotherapy for CD. The evidence of efficacy is critically reviewed and recommendations for clinical applications and research are given.
We performed a systematic literature search to identify studies on psychotherapy in CD, evaluated the retrieved documents and developed evidence tables and recommendations through a consensus process among experts and stakeholders.
We developed 5 recommendations which may help providers to select psychotherapeutic treatment options for this patient group. The EPA considers both psychotherapy and pharmacotherapy to be effective in CD and recommends both approaches. The best effect is achieved by combined treatment with psychotherapy and pharmacotherapy, which should therefore be the treatment of choice. The EPA recommends psychotherapy with an interpersonal focus (e.g. the Cognitive Behavioural Analysis System of Psychotherapy [CBASP]) for the treatment of CD and a personalized approach based on the patient's preferences.
The DSM-5 nomenclature of persistent depressive disorder (PDD), which includes CD subtypes, has been an important step towards a more differentiated treatment and understanding of these complex affective disorders. Apart from dysthymia, ICD-10 still does not provide a separate entity for a chronic course of depression. The differences between patients with acute episodic depression and those with CD need to be considered in the planning of treatment. Specific psychotherapeutic treatment options are recommended for patients with CD.
Patients with chronic forms of depression should be offered tailored psychotherapeutic treatments that address their specific needs and deficits. Combination treatment with psychotherapy and pharmacotherapy is the first-line treatment recommended for CD. More research is needed to develop more effective treatments for CD, especially in the longer term, and to identify which patients benefit from which treatment algorithm.
In contrast to almost all other invertebrate phyla that constructed biomineralized skeletons during the “Cambrian explosion” and maintained them during the entire fossil record, ascidian tunicates evolved this protective and stabilizing advantage only during the Permian, although soft-bodied representatives of this subphylum made their first appearance already in the early Cambrian. It remains enigmatic why these compound calcareous skeletons persisted only until the Late Triassic, subsequently followed by less-rigid internal skeletons from the Lower Jurassic onwards, which consist of scattered isolated spicules only. In addition to recently described aragonitic ascidian exoskeletons from the Permian and Triassic, new discoveries of similar, but colonial ascidian compound endoskeletons in the lower Carnian exhibit a short-living branch of this group, which moreover contain the first indubitable calcareous spicules. The latter are embedded in the solid endoskeleton, which is composed of polygonal aragonitic plates with smooth outer and zigzag lined inner boundaries. They consist of irregular, parallel (orthogonal), or fan-shaped (clinogonal) arrangements of acicular aragonite crystals. The following taxa are described as new: order Cassianomorpha new order with the family Cassianosomidae new family and the genus Toscanisoma new genus with the species T. multipartitum new species and T. triplicatum new species.
Background: Based on the vulnerability model, several studies indicate that low self-esteem seems to contribute to depressive symptoms. Aims: The aim of this study was to treat depressive symptoms in a cognitive behavioural group therapy, focusing on the enhancement of self-esteem, and to explore co-variation in depressive symptoms and the level of self-esteem. Method: The Multidimensional Self-esteem Scale (MSWS) and the Beck Depression Inventory (BDI) were administered to 147 psychiatric in-patients with current depressive symptoms due to an affective disorder (major depression, bipolar I, dysthymia). Self-esteem was measured pre-treatment (t0) and post-treatment (t4, after 5 weeks of eight group sessions); the BDI was applied weekly. A linear mixed growth analysis was conducted to estimate the change in depressive symptoms including interactions with self-esteem. Results: Within the 5 weeks of group therapy, depressive symptoms showed a linear decline, which was stronger for patients with higher gains in self-esteem between t0 and t4. Self-esteem at t0 was unrelated to the change in depression but predicted self-esteem at t4. Conclusions: Treating depressive symptoms in a cognitive behavioural group therapy in a naturalistic setting might have a positive effect on the process of recovery. Moreover, depressive symptoms and level of self-esteem seemed to co-vary.
This article examines perceptions and practices of habitual usury, a crime
consisting of lending above the legal rate of interest on multiple occasions, in
early nineteenth-century France using descriptions of usury trials found in the
popular legal periodical the Gazette des Tribunaux. Following
the French Revolution, French law legitimized lending at interest in principle,
but punished ‘habitual usurers’ who ‘made a
profession’ from lending above the legal limit. The decades that followed
witnessed striking growth in banking, joint-stock companies and other financial
institutions. Highlighting the connections between cultural constructions of the
usurer and the actual processes deemed usurious, this article seeks to
understand a paradox: that usury was deemed omnipresent in French society yet it
was rarely prosecuted. By examining how habitual usury was defined and
prosecuted in French courtrooms, this article shows how habitual usurers both
validated and undermined stereotypical notions of predatory lending behavior
found in popular culture of the time. Habitual usury trials also reveal the
actual practices that allowed those excluded from formal financial networks to
participate in the growth of capitalist relations. This article argues that the
nineteenth-century obsession with the usurer can be explained by the crucial
role played by usurious practices in the credit economy of the period. As such,
prosecution of usury tended to focus on the character of the usury rather than
the actual practice of illegal lending. This article suggests that by
occasionally prosecuting particularly egregious ‘immoral’
moneylenders, the legal system and journals like the Gazette des
Tribunaux worked to keep credit accessible to the
Both states that constituted the Austro-Hungarian Monarchy issued considerable amounts of perpetual bonds from the 1870s to World War I. These bonds constituted the greater part of the state debt, which was relatively larger in Hungary than in Austria. Movements in bond prices were not uniform for different kinds of securities such as gold bonds, paper bonds and bonds of the common debt of the pre-1867 era. Price movements and movements in the spread between Hungarian and Austrian bond yields followed a stochastic trend. Most fiscal factors such as the share of the state debt, and of state expenses, in GDP, the share of state consumption in overall state expenses, the relation between the debt service and the tax revenues, or the deficit in the state budget, had little or no impact. The conversion of debt instruments reveals a high degree of efficiency on the part of investors. Political crises affected relative price movements in the short run but were unimportant in the context of the middle- and long-term development. Throughout the period, Hungarian bonds as compared to Austrian bonds had lower prices in the Vienna Stock Exchange, suggesting a preference of Viennese investors for domestic securities independently from economic and political circumstances.
This article documents and analyses monetary reform in Bulgaria, Greece, Serbia and Romania from 1815 (Serbian autonomy within the Ottoman Empire) to 1910, when Greece became the last country in the region to join the gold standard. It explains the five key steps towards monetary reform which the four countries took in the same chronological order, and asks why national coinage and the foundation of a bank of note issue came late in the reform process. The South-East European countries tried to emulate West European prototypes, yet economic backwardness meant such institutions were often different from the outset, remained short-lived or both.
This article studies how the emergence of new political elites and changes in land tenure relationships shaped the socio-economic profile of local credit markets in the Ottoman Balkans between the late seventeenth and early nineteenth centuries. By using probate inventories and court records for the cities of Salonika (including Karaferye), Vidin and Ruse, I compare how the expansion of tax-farming institutions and the concentration of land ownership influenced the social characteristics of lending activities. I find that, in spite of institutional and political similarities, the evolution of local credit markets did not follow a homogeneous pattern. Contrary to the consensus view in the existing literature, local political and military elites, which most tax farmers and large landowners belonged to, did not play a dominant role as moneylenders. Civilians (such as merchants and artisans) together with other social groups, including janissaries and religious functionaries, provided the bulk of informal credit to local communities (including elites) in the three urban areas.
This study demonstrates the existence of a private, informal and lively credit
market in rural Sweden during the 1840s, a period that predates the development
of a modern banking system. The market, mainly based on private promissory
notes, was concentrated in the hands of a limited number of wealthy farmers who
specialized in lending, They facilitated access to credit to well-off farmers,
regardless of whether they owned their farms or leased taxed land. By using
information from probate inventories, the article analyses the wealth portfolio
and characteristics of the lending business of the largest creditors
(‘parish bankers’) in a judicial district of southern Sweden in
1841–5. The heart and soul of their business was an intimate knowledge of
borrowers’ creditworthiness and mutual trust, as typical of local credit
networks. The article also explores the existence of an intergenerational
transmission of parish banking business – a dimension of private lending
that opens an original path of research on local credit markets in early modern