TY - THES A1 - Staab, Charlotte T1 - Prädiktoren der Persistenz des ADHS T1 - Predictors of persistence of ADHD N2 - Die vorliegende Studie hatte das Ziel prädiktive Faktoren einer Persistenz von ADHS in das Erwachsenenalter ausfindig zu machen und den Einfluss von kindbezogenen, familiären und behandlungsbezogenen Eigenschaften auf den Verlauf und das Fortbestehen der ADHS-Symptomatik zu untersuchen. Das Untersuchungsgut bestand aus Patienten der Klinik und Poliklinik der Kinder- und Jugendpsychiatrie der Universität Würzburg. Das Gesamtkollektiv bestand aus 146 Patienten, deren Akten wir auswerteten. 67 Patienten (46%) konnten wir mittels WURS, DSM-IV-Kriterien, Anamnesebogen, SKID-I und SKID-II im Erwachsenenalter nachexplorieren. Der Katamnesezeitraum betrug ein Jahr, vom 04.11.2002 bis zum 03.11.2003. Die ehemaligen Patienten waren zum Katamnesezeitpunkt durchschnittlich 28 Jahre alt. Bei der Suche nach prädiktiven Faktoren für eine Persistenz der ADHS-Symptomatik in das Erwachsenenalter konnten wir trotz der Studien, welche die Wichtigkeit ungünstiger psychosozialer Faktoren für den Verlauf des ADHS belegen (Biederman et al 1996, Hart et al 1995, 1991c, Fischer et al 1993, Taylor et al 1991, Weiss und Hechtman 1986, Gittelman et al 1985, Hechtman et al 1984, Loney et al 1981), keine Prädiktoren einer Persistenz der ADHS-Symptomatik finden. Unsere Ergebnisse lassen sich dahingehend erklären, dass es sich beim ADHS um eine primär genetisch determinierte Störung handelt, welche in ihrem Verlauf von verschiedensten intervenierenden Faktoren beeinflusst wird. Es handelt sich um ein komplexes Zusammenspiel von zu Grunde liegenden biologischen Faktoren mit verschiedenen Gen-Umwelt-Interaktionen, ein Zusammenspiel von Individuum mit seiner Persönlichkeit und eigenen Coping-Strategien, sowie der Art des Umfeldes und deren Reaktion auf das Verhalten des Betroffenen. Daher besteht keine Möglichkeit den Verlauf von ADHS anhand von Eigenschaften, welche zu einem einzigen Zeitpunkt (bei Erstvorstellung) erfasst wurden vorherzusagen. In unserer Stichprobe wurde eine Achse-I-Diagnose bei der Hälfte der mit dem SKID-I-Interview nachuntersuchten Probanden gestellt. Entsprechend unserer Annahme, dass Erwachsene mit vielen Symptomen des ADHS einen ungünstigeren Verlauf mit mehr Achse-I-Störungen nehmen, fanden sich diese Störungen zu etwa zwei Dritteln bei den Erwachsenen mit mehr als 6 fortbestehenden Symptomen des ADHS, während kein Erwachsener ohne Symptome des ADHS eine Achse-I-Diagnose hatte. Bei 61% (n=36) der mit dem SKID-II-Interview nachexplorierten Patienten wurde die Diagnose einer Persönlichkeitsstörung gestellt. Am häufigsten fanden sich die Diagnosen einer dissozialen (21%), einer selbstunsicher-vermeidenden (21%), einer negativistischen (18%), einer narzisstischen (14%) und einer emotional–instabilen Persönlichkeitsstörung (9%). Bemerkenswert ist, dass sich keiner der Erwachsenen unserer Studie aktuell in psychiatrischer Behandlung befand. Dies steht im Kontrast zu der meist fortbestehenden Restsymptomatik des ADHS und der hohen Rate komorbider Achse-I- und Achse-II-Störungen, welche mit psychosozialen Beeinträchtigungen einhergehen. Eine kontinuierliche, über das Kindesalter hinausreichende Betreuung von Patienten mit ADHS, sowie eine ausführliche Aufklärung könnten einem solchen ungünstigen Verlauf entgegenwirken. Eine adäquate Behandlung Erwachsener mit ADHS ist nur möglich, wenn Komorbiditäten berücksichtigt und gleichzeitig mitbehandelt werden. Weitere epidemiologische und neurobiologische Studien mit einem größeren Kollektiv sind notwendig zum Auffinden von Einflussfaktoren auf den Verlauf des ADHS und zur Klärung der Komorbiditätsbeziehungen des ADHS. N2 - Aim of the following study was the finding of predictors of persistence of ADHD into adulthood. Therefore we examined patients who were diagnosed an ADHD in childhood at a mean age of 28 years. Patients were interviewed for actual social function, psychiatric and personality disorders. Persistence of symptoms into adulthood could not be predicted with childhood attributes. This confirms the strong influence of genetics in persistent ADHD as well as the influence of environmental and social factors. More than 50% of the interviewed patients got a psychiatric diagnosis and more than 60% a personality disorder. Most of the patients showed significant social problems but none of them actually was in psychiatric care. This confirms the need of an adequate diagnosis and treatment not only in children but also in adults. KW - ADHS KW - Erwachsenenalter KW - Prädiktoren KW - Peristenz KW - ADHD KW - adults KW - adulthood KW - predictors KW - persistence Y1 - 2006 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-22424 ER - TY - THES A1 - Langguth, Jan-Philipp T1 - Prädiktoren der generischen und krankheitsspezifischen Lebensqualität bei Patienten mit chronischer Herzinsuffizienz T1 - Predictors of generic and disease-specific health-related quality of life in patients with chronic systolic heart failure N2 - No abstract available KW - Lebensqualität KW - Herzinsuffizienz KW - Depression KW - Prädiktoren KW - Lebensqualitätsfragebögen KW - heart failure KW - health related quality of life KW - depression KW - predictors Y1 - 2009 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-37153 ER - TY - JOUR A1 - Neugebauer, Hermann A1 - Heuschmann, Peter U. A1 - Jüttler, Eric T1 - DEcompressive Surgery for the Treatment of malignant INfarction of the middle cerebral arterY - Registry (DESTINY-R): design and protocols JF - BMC Neurology N2 - Background: Randomized controlled trials (RCT) on the treatment of severe space-occupying infarction of the middle cerebral artery (malignant MCA infarction) showed that early decompressive hemicraniectomy (DHC) is life saving and improves outcome without promoting most severe disablity in patients aged 18-60 years. It is, however, unknown whether the results obtained in the randomized trials are reproducible in a broader population in and apart from an academical setting and whether hemicraniectomy has been implemented in clinical practice as recommended by national and international guidelines. In addition, they were not powered to answer further relevant questions, e. g. concerning the selection of patients eligible for and the timing of hemicraniectomy. Other important issues such as the acceptance of disability following hemicraniectomy, the existence of specific prognostic factors, the value of conservative therapeutic measures, and the overall complication rate related to hemicraniectomy have not been sufficiently studied yet. Methods/Design: DESTINY-R is a prospective, multicenter, open, controlled registry including a 12 months follow-up. The only inclusion criteria is unilateral ischemic MCA stroke affecting more than 50% of the MCA-territory. The primary study hypothesis is to confirm the results of the RCT (76% mRS <= 4 after 12 months) in the subgroup of patients additionally fulfilling the inclusion cirteria of the RCT in daily routine. Assuming a calculated proportion of 0.76 for successes and a sample size of 300 for this subgroup, the width of the 95% CI, calculated using Wilson's method, will be 0.096 with the lower bound 0.709 and the upper bound 0.805. Discussion: The results of this study will provide information about the effectiveness of DHC in malignant MCA infarction in a broad population and a real-life situation in addition to and beyond RCT. Further prospectively obtained data will give crucial information on open questions and will be helpful in the plannig of upcomming treatment studies. KW - registry KW - quality of life KW - territory infaction KW - brain edema KW - hemicraniectomy KW - multicenter KW - crantiectomy KW - predictors KW - stroke KW - trial KW - decompressive surgery KW - ischaemic stroke KW - malignant MCA infarct Y1 - 2012 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-133892 VL - 12 IS - 115 ER - TY - JOUR A1 - Grube, Maike Miriam A1 - Koennecke, Hans-Christian A1 - Walter, Georg A1 - Meisel, Andreas A1 - Sobesky, Jan A1 - Nolte, Christian Hans A1 - Wellwood, Ian A1 - Heuschmann, Peter Ulrich T1 - Influence of Acute Complications on Outcome 3 Months after Ischemic Stroke JF - PLOS ONE N2 - Background: Early medical complications are potentially modifiable factors influencing in-hospital outcome. We investigated the influence of acute complications on mortality and poor outcome 3 months after ischemic stroke. Methods: Data were obtained from patients admitted to one of 13 stroke units of the Berlin Stroke Registry (BSR) who participated in a 3-months-follow up between June 2010 and September 2012. We examined the influence of the cumulative number of early in-hospital complications on mortality and poor outcome (death, disability or institutionalization) 3 months after stroke using multivariable logistic regression analyses and calculated attributable fractions to determine the impact of early complications on mortality and poor outcome. Results: A total of 2349 ischemic stroke patients alive at discharge from acute care were included in the analysis. Older age, stroke severity, pre-stroke dependency and early complications were independent predictors of mortality 3 months after stroke. Poor outcome was independently associated with older age, stroke severity, pre-stroke dependency, previous stroke and early complications. More than 60% of deaths and poor outcomes were attributed to age, pre-stroke dependency and stroke severity and in-hospital complications contributed to 12.3% of deaths and 9.1% of poor outcomes 3 months after stroke. Conclusion: The majority of deaths and poor outcomes after stroke were attributed to non-modifiable factors. However, early in-hospital complications significantly affect outcome in patients who survived the acute phase after stroke, underlining the need to improve prevention and treatment of complications in hospital. KW - hospital medical complications KW - quality-of-care KW - term mortality KW - Barthel-Index KW - rankin scale KW - risk-factors KW - trial KW - reliability KW - dependency KW - predictors Y1 - 2013 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-128362 SN - 1932-6203 VL - 8 IS - 9 ER - TY - JOUR A1 - Kübler, Andrea A1 - Blankertz, Benjamin A1 - Kleih, Sonja C. A1 - Kaufmann, Tobias A1 - Hammer, Eva M. T1 - Visuo-motor coordination ability predicts performance with brain-computer interfaces controlled by modulation of sensorimotor rhythms (SMR) N2 - Modulation of sensorimotor rhythms (SMR) was suggested as a control signal for brain-computer interfaces (BCI). Yet, there is a population of users estimated between 10 to 50% not able to achieve reliable control and only about 20% of users achieve high (80–100%) performance. Predicting performance prior to BCI use would facilitate selection of the most feasible system for an individual, thus constitute a practical benefit for the user, and increase our knowledge about the correlates of BCI control. In a recent study, we predicted SMR-BCI performance from psychological variables that were assessed prior to the BCI sessions and BCI control was supported with machine-learning techniques. We described two significant psychological predictors, namely the visuo-motor coordination ability and the ability to concentrate on the task. The purpose of the current study was to replicate these results thereby validating these predictors within a neurofeedback based SMR-BCI that involved no machine learning.Thirty-three healthy BCI novices participated in a calibration session and three further neurofeedback training sessions. Two variables were related with mean SMR-BCI performance: (1) a measure for the accuracy of fine motor skills, i.e., a trade for a person’s visuo-motor control ability; and (2) subject’s “attentional impulsivity”. In a linear regression they accounted for almost 20% in variance of SMR-BCI performance, but predictor (1) failed significance. Nevertheless, on the basis of our prior regression model for sensorimotor control ability we could predict current SMR-BCI performance with an average prediction error of M = 12.07%. In more than 50% of the participants, the prediction error was smaller than 10%. Hence, psychological variables played a moderate role in predicting SMR-BCI performance in a neurofeedback approach that involved no machine learning. Future studies are needed to further consolidate (or reject) the present predictors. KW - brain-computer interfaces KW - sensorimotor rhythms KW - predictors KW - visuo-motor coordination abilities KW - attentional impulsivity Y1 - 2014 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-113084 ER -