Abstract Background Studies indicate that people with schizophrenia and first-episode psychosis experience deficits in their ability to accurately detect and display emotions through facial expressions, and that functioning and symptoms are associated with these deficits. This study aims to examine how emotion recognition and facial emotion expression are related to functioning and symptoms in a sample of individuals at ultra-high risk, first-episode psychosis and healthy controls. Methods During fMRI, we combined the presentation of emotional faces with the instruction to react with facial movements predetermined and assigned. 18 patients with first-episode psychosis (FEP), 18 individuals at ultra high risk of psychosis (UHR) and 22 healthy controls (HCs) were examined while viewing happy, sad, or neutral faces and were instructed to simultaneously move the corners of their mouths either (a). upwards or (b). downwards, or (c). to refrain from movement. The subjects’ facial movements were recorded with an MR-compatible video camera. Results Neurofunctional and behavioral response to emotional faces were measured. Analyses have only recently commenced and are ongoing. Full results of the clinical and functional impact of behavioral and neuroimaging results will be presented at the meeting. Discussion Increased knowledge about abnormalities in emotion recognition and behaviour as well as their neural correlates and their impact on clinical measures and functional outcome can inform the development of novel treatment approaches to improve social skills early in the course of schizophrenia and psychotic disorders.

The accurate measurement of HbA2 is essential for the detection of β‐thalassaemia carriers and as no single calibrant is used by the various manufacturers of analysers, differences are seen in results obtained. The World Health Organization International Reference Reagent for HbA2 (WHO IRR 89/666) was made available to diagnostic laboratories in the 1980s and remains the only international reference material available. A previous study (2015) demonstrated that the WHO IRR remained suitable for use as an HbA2 standard as tested by 52 participants in the UK NEQAS Haematology Abnormal Haemoglobins Programme. This study was undertaken to include simultaneous analysis of three whole blood specimens over a range of HbA2 values with the WHO IRR and to include participants from laboratories outside of the UK.

IntroductionThe accurate determination of Hb A(2) is a key marker when screening for a -thalassaemia carrier. Data from external quality assessment (EQA) exercises have shown a lack of alignment of Hb A(2) quantitation both within and between methods. The only reference material available for Hb A(2) quantitative assay at the time of writing is the World Health Organization International Reference Reagent (89/666; WHO IRR) prepared in the 1980s and not validated for all current methodologies. MethodThe WHO IRR was analysed for Hb A(2) concentration by 52 laboratories using a representative range of high-performance liquid chromatography and capillary electrophoresis analysers. The results of the analysis were compared to those of a whole blood EQA specimen of similar Hb A(2) concentration, distributed in the same week. ResultsThe mean Hb A(2) value obtained for the WHO IRR was 5.17%, compared to the assigned value of 5.3%. The range of results returned was wide (4.0%-6.2%), with differences in the results observed by between and within analyser groups. A similar range of results was seen with the whole blood sample, although the bias observed between analyser types was different from that seen with the WHO IRR. ConclusionThe results may indicate a lack of commutability of the WHO IRR material, resulting from deterioration, matrix effects or changes in reagent formulation or calibration parameters. Further examination of the suitability of the WHO IRR (89/666) for continued use is required.

Die therapierefraktäre Angina pectoris ist in der Behandlung von Patienten mit koronarer Herzkrankheit (KHK) ein häufiges Phänomen, erzeugt einen hohen Leidensdruck und beansprucht das Gesundheitssystem in hohem Maße. Die Entwicklung neuer Therapiekonzepte ist aus diesem Grund von besonderer Bedeutung. In dieser Studie wurde untersucht, ob ein professionelles, strukturiertes Humortraining einen Effekt auf die Beschwerdesymptomatik von Patienten mit therapierefraktären Beschwerden hat. Im Rahmen dieser Studie wurden im Zeitraum von 2013 bis 2014 insgesamt 35 Patienten mit stabiler KHK eingeschlossen. Der Studieneinschluss erfolgte bei therapierefraktären Beschwerden (CCS[Canadian Cardiovascular Society]-Stadium II–IV) trotz maximaler antianginöser Therapie und Ausschöpfung jeglicher Revaskularisationsoptionen. 25,8 % der Patienten hatten einen Myokardinfarkt in der Vorgeschichte. Im Rahmen der Studie erfolgte ein professionelles Humortraining über 7 Wochen. Zur Beurteilung des Effekts des Humortrainings wurden vorher und nachher folgende Untersuchungen durchgeführt: Belastungs-EKG, Haarsegmentanalyse mit Kortisolbestimmung, Beck-Depressions-Inventar(BDI)-Fragebogen, Trierer Inventar zum chronischen Stress (TICS), State-Trait-Heiterkeits-Inventar (STHI-S/T). Von 31 der ursprünglichen 35 rekrutierten Patienten wurde die Studie erfolgreich beendet. Der Altersdurchschnitt lag bei 65,5 Jahren mit 94,5 % weiblichen Probanden. Im STHI-S-Fragebogen zeigte sich im Vergleich der Daten vor und nach dem Humortraining eine signifikante Verbesserung der Erheiterbarkeit (prä: 23,3 ± 5,4, post: 27,5 ± 5; p = 0,03). Dieser Effekt war noch deutlicher bei einer Subgruppenanalyse zu sehen, in der nur die weiblichen Studienteilnehmer berücksichtigt wurden (prä: 23,6 ± 5,5, post: 27,7 ± 4,6; p = 0,003). Im BDI zeigte sich im Vergleich der Daten vor und nach dem Humortraining eine deutliche Verbesserung (prä: 14,6 ± 8,1, post: 11,0 ± 6,5; p = 0,064). Diese war bei Analyse der 29 Frauen statistisch signifikant (prä: 13,1 ± 6,4, post: 9,9 ± 4,6; p = 0,037). Die Haarsegmentanalyse ergab bei Probanden mit erhöhten Werten vor dem Humortraining (>25. Perzentile, n = 22) eine signifikante Reduktion der Haarkortisolkonzentration (prä: 6,54 [3,78–12,12] pg/mg, post: 3,65 [2,82–7,68] pg/mg; p = 0,029). Patienten mit therapierefraktärer Angina pectoris bei KHK profitieren von einem professionellen Humortraining. Dies konnte durch einen signifikanten Abfall der Kortisolkonzentration in der Haarsegmentanalyse, eine Verbesserung in der Erheiterbarkeit im STHI-S sowie eine signifikante Verbesserung im BDI gezeigt werden.

The importance of hemoglobin A(2) (HbA(2)) as an indicator of the presence of S-thalassemia was established many years ago. However, clinical application of recommended HbA(2) cut off values is often hampered due to poor equivalence of HbA(2) results among methods and laboratories. Thus, the IFCC standardization program for HbA(2) was initiated in 2004 with the goal of achieving a complete reference system for this measurand. HbA(2) standardization efforts are still in progress, including the development of a higher-order HbA(2) reference measurement procedure and the preparation of a certified reference material in collaboration with the IRMM. Here, we review the past, present and future of HbA(2) standardization and describe the current status of HbA(2) testing. (C) 2016 Elsevier B.V. All rights reserved.

Humor and laughter are integral parts of human life and communication - and so of course they occur in medical contacts.Humor is defined as a personality based cognitive emotional style of processing situations, characterized by the ability to find positive aspects even in negative situations, and the ability to communicate this point of view to others and to cheer them up. Humor can support healing processes and coping with illness. Humor and jokes reduce anxiety and stress (for patients and doctors). Humorous people have a more realistic, flexible and less fearful behaviour. Humor helps to overcome negative experience. Humor can help the patient to gain new views towards the disease and a healthy distance towards occurring symptoms. Humor improves the relationship between patient and doctor. But beware: jokes can also be used to express fears, aggression or shame. Therefore it is worthwhile to listen carefully to what patients want to express. Humor reduces the risk of burnout. In contact with patients, it is important to give their humor room, to use it and respond to it, more than making jokes. Humor can be trained. Humor training and creation of a humorous atmosphere in health care facilities should also be supported by health insurance funds, institutions' sponsors and public authorities.

Abstract Humor and laughter are integral parts of human life and communication – and so of course they occur in medical contacts. Humor is defined as a personality based cognitive emotional style of processing situations, characterized by the ability to find positive aspects even in negative situations, and the ability to communicate this point of view to others and to cheer them up. Humor can support healing processes and coping with illness. Humor and jokes reduce anxiety and stress (for patients and doctors). Humorous people have a more realistic, flexible and less fearful behaviour. Humor helps to overcome negative experience. Humor can help the patient to gain new views towards the disease and a healthy distance towards occurring symptoms. Humor improves the relationship between patient and doctor. But beware: jokes can also be used to express fears, aggression or shame. Therefore it is worthwhile to listen carefully to what patients want to express. Humor reduces the risk of burnout. In contact with patients, it is important to give their humor room, to use it and respond to it, more than making jokes. Humor can be trained. Humor training and creation of a humorous atmosphere in health care facilities should also be supported by health insurance funds, institutions' sponsors and public authorities.

No AccessHumor, Gesundheit und psychische ErkrankungenEin BeipackzettelBarbara WildBarbara Wildhttps://doi.org/10.13109/9783788732714.50SectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinkedInRedditEmail About Previous chapter Next chapter FiguresReferencesRelatedDetailsCited byBesondere Herausforderungen Download book coverTheologie Interdisziplinär 1. AuflageISBN: 978-3-7887-3167-0 eISBN: 978-3-7887-3271-4HistoryPublished online:May 2017 PDF download

A 5-year-old English girl presented with anemia. A complete blood count showed RBC 3.85 × 1012/l, hemoglobin concentration (Hb) 87 g/l, MCV 81 fl, MCH 22.5 pg, MCHC 278 g/l, red cell distribution width 25.7, and reticulocyte count 443 × 109/l (11.5%). Her blood film showed irregularly contracted cells and basophilic stippling (images). There were also polychromatic macrocytes, occasional cells with hemoglobin retracted to one side of the cell and occasional cells with siderotic granules. There was no history of exposure to drugs or other oxidants. Further tests were, therefore, done. High performance liquid chromatography (HPLC) on a BioRad variant instrument showed a peak in the hemoglobin S window (retention time 4.6 min) measuring 7.4%. No abnormal band was apparent on cellulose acetate electrophoresis at alkaline pH or agarose gel electrophoresis at acid pH. However on isoelectric focusing a variant hemoglobin was identified, which separated from hemoglobin A and comprised about half of the total hemoglobin. A heat test for an unstable hemoglobin was positive. Electrospray tandem mass spectrometry identified a novel hemoglobin variant, β101(Glu→Ala), which we designated hemoglobin St Mary's 1, subsequently also referred to as hemoglobin Youngstown. Bone marrow examination showed dyserythropoiesis and 30% ring sideroblasts. Her father, who had an Hb of 143 g/l, a reticulocyte count of 93 × 109/l and smaller numbers of irregularly contracted cells, was found to be a carrier of the same variant hemoglobin. The explanation for the low percentage abnormal peak on HPLC is that this represents denatured hemoglobin St Mary's, the intact variant hemoglobin having the same retention time as hemoglobin A. Irregularly contracted cells suggest a limited range of diagnostic possibilities: defects of the pentose shunt, exposure to endogenous or exogenous oxidants, or a hemoglobinopathy (hemoglobin C, hemoglobin E or an unstable hemoglobin). Small numbers can also be seen in β thalassemia heterozygosity. Dyserythropoiesis can be a feature of a hemoglobinopathy.

Difficulties in understanding irony and sarcasm are part of the social cognition deficits in patients with schizophrenia. A number of studies have reported higher error rates during comprehension in patients with schizophrenia. However, the relationships of these impairments to schizotypal personality traits and other language deficits, such as the comprehension of proverbs, are unclear. We investigated irony and proverb comprehension in an all-female sample of 20 schizophrenia patients and 27 matched controls. Subjects indicated if a statement was intended to be ironic, literal, or meaningless and furthermore rated the meanness and funniness of the stimuli and certainty of their decision. Patients made significantly more errors than controls did. Globally, there were no overall differences in the ratings. However, patients rated the subgroup of stimuli with answers given incorrectly as having significantly less meanness and in case of an error indicated a significantly higher certainty than controls. Across all of the study participants, performances in irony (r=-0.51) and proverb (r=0.56) comprehension were significantly correlated with schizotypal personality traits, suggesting a continuum of nonliteral language understanding. Because irony is so frequent in everyday conversations, this makes irony an especially promising candidate for social cognition training in schizophrenia.

BACKGROUND:We present a study aimed to define the analytical goals for the determination of hemoglobin A₂, a minor hemoglobin present in human blood normally accounting from 2.5 % to 3.3 % of total hemoglobin, and typically increased up to 6 % – 7 % in subjects carriers of β-thalassemia.METHODS:The analytical goals have been derived using two approaches, the first one based on biologic variation, and the second one based on the opinion of experts.RESULTS:The data obtained by studying 17 adult non-carrier healthy subjects, from whom we took blood samples every 2 weeks for 2.0 months, indicated a small intraindividual biologic variation (CV I of 0.7 % ), with respect to a larger between-subject variation (CV G of 7.7 % ). The minimum levels for imprecision, bias and total error derived from the analysis of these data were: 0.5 % , 2.9 % and 4.5 % , respectively. The limits derived from the opinion of experts were based on a questionnaire with three clinical cases, which was circulated among two teams of international experts, and on a discussion about the clinical needs. The average total error derived from such surveys ranged between 7.0 % and 9.5 % .CONCLUSIONS:The various methods to derive analytical performance goals gave different limits, thus indicating the need for an increased communication between clinicians and laboratory professionals on this matter.

Extent of cerebellar involvement in cognition and emotion is still a topic of ongoing research. In particular, the cerebellar role in humor processing and control of laughter is not well known. A hypermetric dysregulation of affective behavior has been assumed in cerebellar damage. Thus, we aimed at investigating humor comprehension and appreciation as well as the expression of laughter in 21 patients in the acute or subacute state after stroke restricted to the cerebellum, and in the same number of matched healthy control subjects. Patients with acute and subacute cerebellar damage showed preserved comprehension and appreciation of humor using a validated humor test evaluating comprehension, funniness and aversiveness of cartoons ("3WD Humor Test"). Additionally, there was no difference when compared to healthy controls in the number and intensity of facial reactions and laughter while observing jokes, humorous cartoons, or video sketches measured by the Facial Action Coding System. However, as depression scores were significantly increased in patients with cerebellar stroke, a concealing effect of accompanying depression cannot be excluded. Current findings add to descriptions in the literature that cognitive or affective disorders in patients with lesions restricted to the cerebellum, even in the acute state after damage, are frequently mild and might only be present in more sensitive or specific tests.

Ironic remarks are frequent in everyday language and represent an important form of social cognition. Increasing evidence indicates a deficit in comprehension in schizophrenia. Several models for defective comprehension have been proposed, including possible roles of the medial prefrontal lobe, default mode network, inferior frontal gyri, mirror neurons, right cerebral hemisphere and a possible mediating role of schizotypal personality traits. We investigated the neural correlates of irony comprehension in schizophrenia by using event-related functional magnetic resonance imaging (fMRI). In a prosody-free reading paradigm, 15 female patients with schizophrenia and 15 healthy female controls silently read ironic and literal text vignettes during fMRI. Each text vignette ended in either an ironic (n = 22) or literal (n = 22) statement. Ironic and literal text vignettes were matched for word frequency, length, grammatical complexity, and syntax. After fMRI, the subjects performed an off-line test to detect error rate. In this test, the subjects indicated by button press whether the target sentence has ironic, literal, or meaningless content. Schizotypal personality traits were assessed using the German version of the schizotypal personality questionnaire (SPQ). Patients with schizophrenia made significantly more errors than did the controls (correct answers, 85.3% vs. 96.3%) on a behavioural level. Patients showed attenuated blood oxygen level-dependent (BOLD) response during irony comprehension mainly in right hemisphere temporal regions (ironic>literal contrast) and in posterior medial prefrontal and left anterior insula regions (for ironic>visual baseline, but not for literal>visual baseline). In patients with schizophrenia, the parahippocampal gyrus showed increased activation. Across all subjects, BOLD response in the medial prefrontal area was negatively correlated with the SPQ score. These results highlight the role of the posterior medial prefrontal and right temporal regions in defective irony comprehension in schizophrenia and the mediating role of schizotypal personality traits.

Humor is a complex behavior which includes cognitive, affective and motor responses. Based on observations of affective changes in patients with cerebellar lesions, the cerebellum may support cerebral and brainstem areas involved in understanding and appreciation of humorous stimuli and expression of laughter. The aim of the present study was to examine if humor appreciation, perception of humorous stimuli, and the succeeding facial reaction differ between patients with cerebellar degeneration and healthy controls. Twenty-three adults with pure cerebellar degeneration were compared with 23 age-, gender-, and education-matched healthy control subjects. No significant difference in humor appreciation and perception of humorous stimuli could be found between groups using the 3 Witz-Dimensionen Test, a validated test asking for funniness and aversiveness of jokes and cartoons. Furthermore, while observing jokes, humorous cartoons, and video sketches, facial expressions of subjects were videotaped and afterwards analysed using the Facial Action Coding System. Using depression as a covariate, the number, and to a lesser degree, the duration of facial expressions during laughter were reduced in cerebellar patients compared to healthy controls. In sum, appreciation of humor appears to be largely preserved in patients with chronic cerebellar degeneration. Cerebellar circuits may contribute to the expression of laughter. Findings add to the literature that non-motor disorders in patients with chronic cerebellar disease are generally mild, but do not exclude that more marked disorders may show up in acute cerebellar disease and/or in more specific tests of humor appreciation.

Humor and laughter can positively influence mood, promote optimism and lead to a change of perspective. Six patients with major depression participated in a group training program specifically designed to enhance humor abilities. After 8 weeks of training, short-term mood improvement was observed and the patients considered themselves more capable of using humor as a coping strategy. Acquired humor skills also helped to sustain the patients' motivation throughout the training period. In light of these encouraging findings, further studies to compare the effectiveness of the humor training with the effectiveness of other types of intervention and to assess its potential long-term effects seem warranted.

AbstractThe use of nonliteral language in clinical assessment, especially testing the patients’ ability to interpret proverbs, has a long tradition in psychiatry. However, its diagnostic sensitivity and specificity in dementias is not yet clear. The aim of this review article is to examine the current evidence on nonliteral/figurative language (proverb, metaphor, metonymy, idiom, irony, sarcasm) comprehension in Alzheimer's disease and related disorders. A comprehensive literature search identified 25 studies (16 proverb, 3 metaphor, 0 metonymy, 5 idiom, 3 sarcasm) on nonliteral language comprehension in dementia. Studies predominantly indicate a deficit. Most studies investigated Alzheimer's dementia. Applied correctly, nonliteral language is a worthwhile diagnostic tool to evaluate language and abstract thinking in dementias. During assessment, familiarity testing (e.g., by asking “are you familiar with the proverb XY”) is obligatory. Still, future research is needed in several areas: evidence on decline of nonliteral language over the course of the illness is limited. So far, almost no studies delineated proverb comprehension in high risk populations such as patients with mild cognitive impairment. Currently, there is a lack of studies addressing performance in direct comparison to relevant differential diagnosis like older-age depression, delirium, brain lesion, or other psychiatric conditions. (JINS, 2011, 17, 207–218)