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Zusammenfassung Hintergrund und Zielstellung Zahlreiche Studien belegen, dass Psychotherapie wirkt. Sie findet in unterschiedlichsten Settings statt, die Datenlage dazu ist derzeit in Österreich noch ausbaufähig. Verhaltenstherapie stellt im 6‑wöchigen Kurzzeit-Setting der vorgestellten ambulanten medizinisch-psychiatrischen Rehabilitation das zentrale Behandlungselement dar und wird in Hinblick auf Wirksamkeit und Nachhaltigkeit evaluiert. Die Bewertung basiert auf „Patient reported Outcomes“. Weil mehr als ¾ der RehabilitandInnen von einer depressiven Erkrankung betroffen sind, wird das Beck Depressionsinventar als primary Outcome gewählt. Methodik Die Befragung erfolgt schriftlich bei Behandlungs-Beginn und -Ende sowie ein Jahr danach. Von 837 PatientInnen (64 % weiblich, ø 45,25 Jahre alt) leiden 76,6 % unter einer depressiven Erkrankung, dabei haben 47,2 % einen chronischen und 29,4 % einen nicht-chronischen Verlauf. Ergebnisse Differenziert nach Ausgangsbelastung zeigen sich ein Jahr nach Behandlungsende große, aber unterschiedliche Effekte. Bei PatientInnen mit stärkerer Ausgangssymptomatik finden sich größere Effekte. Die Nachhaltigkeit ist jedoch bei chronifizierten PatientInnen etwas geringer. Ein Fünftel der PatientInnen erfüllt bei Behandlungsende und ein Jahr später das Kriterium der klinischen Signifikanz und kann als „geheilt“ klassifiziert werden. Zusätzlich sind am Ende der Behandlung 23 % und ein Jahr später 18 % signifikant gebessert. Bei einem kleinen Teil kommt es zu Verschlechterungen, diesen PatientInnen sollte verstärkt Aufmerksamkeit geschenkt werden. Fazit Verhaltenstherapeutische Gruppen- und Einzeltherapien in Kombination mit weiteren therapeutischen Angeboten in der ambulanten psychiatrischen Rehabilitation sind nachhaltig wirksam. Auch wenn ein Jahr nach Ende der Behandlung bei anfangs stark depressiven RehabilitandInnen immer noch große Effekte nachweisbar sind, zeigt sich die dringende Notwendigkeit einer nachfolgenden psychotherapeutischen Begleitung im niedergelassenen Bereich oder im Rahmen der Phase 3 Rehabilitation.

Zusammenfassung Hintergrund Zur Bewertung des Behandlungserfolgs bei depressiven Symptomen stehen unterschiedliche statistische Methoden zur Verfügung. Effektgrößen, prozentuale Verbesserung, signifikante Verbesserung und klinisch signifikante Verbesserung sind gängige Methoden zur Bewertung von Behandlungsergebnissen basierend auf „Patient Reported Outcomes“. Fragestellung Wie unterscheiden sich die Behandlungsergebnisse in Abhängigkeit von der verwendeten Methode? Methodik Für N = 3018 Patienten einer ambulanten psychiatrischen Rehabilitationsklinik wurden Verbesserungen anhand von Effektgrößen, prozentuellen Veränderungen, signifikanten und klinisch signifikanten Veränderungen im Beck Depressions-Inventar (BDI-II) berechnet. Ergebnisse Für die Gesamtgruppe zeigt sich ein gut mittlerer Effekt von d = 0,62, der nach Ausschluss von zum Zeitpunkt der Aufnahme nicht depressiven (euthymen) Patienten als groß bewertet werden kann (d = 0,79). Die stärkste Aussagekraft für die Symptomreduktion der Depression hat die Methode der klinischen Signifikanz, bei einem Cut-off von 13 Punkten wurden 23 % als klinisch signifikant und weitere 19,3 % als signifikant gebessert klassifiziert. Bei der Methode der prozentuellen Verbesserung erreichten 30,4 % der Patienten einen Wert von mindestens 50 %. Schlussfolgerungen Effektgrößen geben einen groben Überblick über den Behandlungserfolg eines Patientenkollektivs ohne Berücksichtigung des Endzustands und der Variabilität innerhalb des Kollektivs. Die prozentuelle Veränderung scheint eher für die Kontrolle des Ansprechens auf eine Behandlung geeignet zu sein. Ergebnisse zur klinischen Signifikanz geben am transparentesten Auskunft über signifikante Verbesserungen und den Wechsel vom dysfunktionalen in den funktionalen Bereich.

Background: When investigating the neurobiology of suicidal behavior, Monoamino Oxidase A (MAOA) is one of the prime suspects to consider. Interestingly, MAOA dysregulation has also been associated with violent behavior in previous publications. In the present study, we aimed to establish an association between polymorphisms of the MAOA gene and methylation status of the MAOA gene Exon I, and suicide attempts with violent methods in a sample of affective disorder patients.Methods: Eight hundred fourteen Caucasian affective disorder patients were assessed at the Department of Psychiatry and Psychotherapy of the Medical University Vienna, the Karl Landsteiner University for Health and Science and Zentren für seelische Gesundheit, BBRZ-Med Leopoldau. An assemblage of psychiatric interviews was performed (e.g., SCAN, HAMD, SBQ-R, CTQ) and DNA samples of peripheral blood cells were collected for Sequenom MassARRAY® iPLEX Gold genotyping and Multiplexed and Sensitive DNA Methylation Testing.Results: Female affective disorder patients with a history of violent suicide attempt were found to have a significantly increased frequency of the AA genotype in the rs5906957 single nucleotide polymorphism (p = 0.003). Furthermore, the MAOA gene exon I promoter region showed significantly decreased methylation in female violent suicide attempter(s) as opposed to female affective disorder patients who had no history of suicide attempt or no history of suicide attempt with violent method.Limitations: The small sample size hampers to reveal small genetic effects as to be expected in psychiatric disorders.Conclusions: This study offers promising findings about associations between the MAOA gene and violent suicide especially in women.

This phase 1 trial (NCT01938846) determined the maximum tolerated dose (MTD) of the mTOR serine/threonine kinase inhibitor, BI 860585, as monotherapy and with exemestane or paclitaxel in patients with advanced solid tumors. This 3+3 dose-escalation study assessed BI 860585 monotherapy (5&ndash, 300 mg/day, Arm A), BI 860585 (40&ndash, 220 mg/day, Arm B) with 25 mg/day exemestane, and BI 860585 (80&ndash, Arm C) with 60&ndash, 80 mg/m2/week paclitaxel, in 28-day cycles. Primary endpoints were the number of patients with dose-limiting toxicities (DLTs) in cycle 1 and the MTD. Forty-one, 25, and 24 patients were treated (Arms A, B, and C). DLTs were observed in four (rash (n = 2), elevated alanine aminotransferase/aspartate aminotransferase, diarrhea), four (rash (n = 3), stomatitis, and increased gamma-glutamyl transferase), and two (diarrhea, increased blood creatine phosphokinase) patients in cycle 1. The BI 860585 MTD was 220 mg/day (Arm A) and 160 mg/day (Arms B and C). Nine patients achieved an objective response (Arm B: Four partial responses (PRs), Arm C: Four PRs, one complete response). The disease control rate was 20%, 28%, and 58% (Arms A, B, and C). The most frequent treatment-related adverse events (AEs) were hyperglycemia (54%) and diarrhea (39%) (Arm A), diarrhea (40%) and stomatitis (40%) (Arm B), fatigue (58%) and diarrhea (58%) (Arm C). The MTD was determined in all arms. Antitumor activity was observed with BI 860585 monotherapy and in combination with exemestane or paclitaxel.

Brain imaging techniques have provided substantial insight into the pathophysiology of hepatic encephalopathy (HE). Magnetic resonance imaging gave hint to the fact that there is an increased deposition of manganese especially in the basal ganglia. Single photon emission computed tomography (SPECT) and positron emission tomography (PET) showed that the preference of the basal ganglia might be due to differences in regional cerebral blood flow and an additional redistribution of blood flow from the cortex to subcortical regions in cirrhotics. PET studies using ammonia as tracer showed that the cerebral metabolism of ammonia and the permeability of the blood brain barrier for ammonia is increased in cirrhotic patients compared to healthy controls. The regional ammonia supply is in accordance with the regional blood flow. In accordance with these findings fluorodesoxyglucose-PET-studies of the brain in cirrhotics showed characteristic alterations of glucose utilisation in the patients with a relative decrease of the glucose utilisation of the cingulate gyrus, the frontomedial, frontolateral, and parieto-occipital cortex, while the glucose utilisation of the basal ganglia, the hippocampus, and the cerebellum was relatively increased. These findings fit well with the clinical characteristics of early stages of HE such as deficits in attention, visuo-spatial orientation, visuo-constructive abilities, motor speed, and accuracy.

Clinical and histopathological findings hint at regional differences in the brain's sensitivity to metabolic changes in cirrhosis. The aim of the present study was to examine regional differences in cerebral ammonia metabolism in patients with cirrhosis and grade 0-to-I hepatic encephalopathy (HE). 13N-ammonia, 15O-water positron emission tomography (PET) and magnetic resonance imaging (MRI) were performed. Quantitative values of cerebral blood flow (CBF) and the initial cerebral ammonia uptake rate (K1) were derived for several regions of interest from images of the desired parameters after interactive coregistration with the patients' MRI-studies. CBF (mL/mL/min), K1 (mL/mL/min), and the ammonia extraction fraction (K1/CBF) showed marked regional variance with the highest levels in the thalamus, the lenticular nucleus, and the cerebellum. In conclusion, the regional differences in cerebral ammonia uptake correspond to the distribution of histopathological changes in the brain of patients with cirrhosis as well as clinical features of HE, characterized by signs of basal ganglia and cerebellar dysfunction with corresponding signs of functional impairment, especially of the frontal cortex and cingulate gyrus. (HEPATOLOGY 2004;40:73–79.)

2545Background: BI 860585 is a potent, selective ATP-competitive mTOR serine/threonine kinase inhibitor which has shown preclinical activity against various cancer types. This Phase I trial (NCT01938846) aims to determine the maximum tolerated dose (MTD) of BI 860585 as a single agent or combined with exemestane or paclitaxel in patients (pts) with advanced solid tumors. Methods: This study used a 3+3 design in 3 treatment arms (all in 28-day cycles): single-agent BI 860585 (5–300 mg/day; Arm A), BI 860585 (40–220 mg/day) combined with fixed-dose exemestane (25 mg/day; Arm B), and BI 860585 (80–160 mg/day) combined with paclitaxel (60 or 80 mg/m2/week; Arm C). MTD is defined as the highest dose at which ≤ 1 out of 6 pts experience a dose-limiting toxicity (DLT) during cycle 1. Results: To date, 41 pts have been treated in Arm A, 24 in Arm B and 17 in Arm C. DLTs have been observed in (n DLTs/n evaluable): 4/36 pts, and 4/20 pts in Arm A and B, respectively. No DLT has occurred in 12 pts in Arm C. DLTs (al...

The goal of this paper is to present the ergonomic process of an automotive company, whose focus is on the adapta- tion of the work conditions to the psychophysiological characteristics of its employees. The planning and the development of the ergonomic actions took place in three distinctive stages: ergonomic analysis of the work post (stage 1), ergonomic adapta- tions (stage 2) and Ergonomic Committee (stage 3). The activities started in June 2006 and have lasted to the current date, keeping a permanent improving process. The procedure adopted was based on the ergonomic analysis methodology proposed by Wisner (1994:1997) and the stages of the Ergonomic Analysis of Work presented in the 17 NR Regulatory Manual (MET, 2002). The paper's approach focused on the voluntary participation of workers from different areas and different hierarchical levels of the organization throughout all the stages of the process. The methodological procedures included descriptive re- search techniques, exploratory and qualitative research criteria, background and guidelines available in literature and legisla- tion, as well as company information. Among the main results it can be mentioned the satisfaction of the employees regarding the appropriate work conditions, cultural and organizational changes and the creation of an Ergonomic Committee in the com- pany.

This paper analyses the effect of an ergonomic intervention on the producivity of an electrical meter manufacture. Intevention included workstation and environmental analysis and design, work organization and product (the electrical meter) analysis and design. Problems were raised and commented with workers and managers. Solutions were discussed and two major decisions were taken: the assembly line would be replaced by a cell manufacturing system and workers would be trained for multifunctionality, i.e., they would be trained to work in all sections of the plant. Productivity tended to increase depending on the assemblage complexity and plant layout. Workers reported less fatigue and hiher motivation after ergonomic intervention.

For decades, insights into the pathophysiology of hepatic encephalopathy (HE) had to be achieved using animal models, such as the portacaval shunted rat, or cell cultures. However, recent developments in brain imaging techniques, such as magnetic resonance imaging (MRI), magnetic resonance spectroscopy (MRS), single photon emission tomography (SPECT) and positron emission tomography (PET) provide new opportunities to study in vivo structural and metabolic changes, or even altered neurotransmission, in the brain of patients with HE.