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It is far from clear how comorbidity changes during alcoholism treatment. This study investigates: (1) the course of comorbid Axis I disorders in chronic alcoholics over 2 years of controlled abstinence in the outpatient long-term intensive therapy for alcoholics (OLITA) and (2) the effect of comorbid Axis I and II disorders in this group of patients on subsequent drinking outcome over a four-year follow-up. This prospective treatment study evaluates psychiatric variables of 89 severely affected chronic alcohol dependent patients on admission (t₁), month 6(t ₂), 12 (t₃) and 24 (t₄). Drinking outcomes have been analyzed from 1998 to 2002. On admission, 61.8\% of the patients met criteria for a comorbid Axis I disorder, 63.2\% for a comorbid personality disorder. Axis I disorders remit from t₁ (59.0\% ill), t₂ (38.5\%), t₃ (28.2\%) to t₄ (12.8\%) (p < 0.0001). Anxiety disorders remit more slowly from t, (43.6\%) to t₃ (20.5\%, p=0.0086), whereas mood disorders remit early between t₁ (23.1\%) and t₂ (5.1\%, p=0.0387) with a slight transient increase at t₃ (10.3\%). During the four-year follow-up, the cumulative probability of not having relapsed amounts to 0.59. Two predictors have a strong negative impact on abstinence probability: number of inpatient detoxifications (p=0.0013) and personality disorders (p=0.0106). The present study demonstrates a striking remission of comorbid Axis I disorders upon abstinence during comprehensive long-term outpatient alcoholism treatment. The presence of an Axis II rather than an Axis I disorder on admission strongly predicts drinking outcome over a four-year follow-up. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

Objective: The aim of the present study was to identify psychosocial risk factors for the incidence of recurrent headache (HA) in children/adolescents (8–15 years). Method: In 2003 (Wave 1) a representative, population-based sample of 8800 parents was mailed a questionnaire. Those who took part were asked to participate again one year later (Wave 2). Of the parents originally contacted, 47.3\% participated in both surveys. Potential risk factors concerning the areas ‘schoolʼ and ‘emotional and behavioural problemsʼ were collected in Wave 1. Binary logistic regression analyses were performed to assess their predictive value for HA in Wave 2. Results: Univariable regression analyses showed that for boys and girls most of the predictor variables influenced the incidence of recurrent HA, but only to a very low extent. When all variables were assessed jointly in a multivariable model, these factors lost their predictive power for boys. For girls, ‘academic problemsʼ and ‘dysfunctional stress copingʼ were shown to increase the chance for the incidence of recurrent HA. Discussion: In contrast to previous findings, school-related factors and emotional and behavioural problems failed to predict HA in boys, and only two factors appeared relevant with regard to girls. This might be due to the strict unidirectional design, which focussed exclusively on the incidence of HA. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

The aim of this study was to estimate prevalence rates of different types of primary headache in 9- to 14-year-old children in a population-based sample. Case definition was based on International Classification of Headache Disorders (ICHD) criteria. The possibility of implementing these criteria within a questionnaire format, which has been regarded as problematic by some authors, was the main focus of the study. A questionnaire was sent to children and adolescents in 6400 randomly drawn families in southern Lower Saxony. Valid questionnaires were returned by 61.1\% of the sample. The overall prevalence rate for tension-type headache (TTH) (criteria C and D) was 17.6\% and for migraine (criteria B, C and D) 13.1\%. Despite the use of abridged criteria for headache classification, 35.5\% of all children reported headache that could not be classified using the ICHD criteria. The response behaviour of these children indicated that they had difficulties reporting symptoms that were defining for migraine or TTH. The classifiability of headache does not seem to be dependent on age or frequency of headache, but rather on the number of ‘I don't knowʼ answers given regarding headache characteristics. It is likely that studies reporting prevalence rates that are limited to migraine and or TTH diagnoses underestimate the true prevalence of headache in children and adolescents. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

Theoretical background: Research initiated by Pennebaker and collegues on self-disclosure and the beneficial influence of emotional expression, when writing about past stressful events, forms the theoretical basis of the presented studies. According to Pennebaker, findings from a large number studies have demonstrated and confirmed the positive effect of disclosure, a brief and economical intervention, on long-term measures of health. Method: The aim of the first study was to replicate the Pennebaker and Beall (1986) study with the expectation of corroborating the effects described by the authors. In addition to the measures employed in the original study, a number of essay variables and personality characteristics, viewed as potentially possessing a moderator function for the outcome variables, were examined. In the second study the experimental condition was varied by implementing 'coping' and 'helping' instructions, in addition to the original disclosure condition, with the goal of achieving - via activation of resources - even more pronounced effects. Results: In neither the first nor the second study could the expected beneficial effects of disclosure on long-term health measures (e.g., medical visits) be corroborated. The additional measures, essay variables and personality characteristics, explain virtually null variance in the outcome variables. Changes in parameters for stress reactions (e. g., intrusions) were found. These changes were particularly pronounced under activation of pro-social motivation (helping condition). Conclusions: Repeated, albeit brief, writing about past stressful events in an emotionally expressive manner does not lead to long-term positive health consequences. It seems, however, to promote better processing of stressful experience. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

Background: In order to enhance patients' active participation in increasingly standardized therapies, treatment goals of disorder-specific manuals need to be aligned with the goals of the targeted patients. Objective: To clarify whether different psychopathological disorders differ 1. with respect to typical treatment goals, 2. in the proportion of goals that focus explicitly on symptoms that are essential for the diagnoses and 3. in the strength of the association between pursuing these core-symptom-related treatment goals and subsequent improvement on the primary diagnose. Method: Primary treatment goals of 1253 inpatients undergoing cognitive behavioral therapy were compared according to presenting disorder. Treatment goals were assessed as they were formulated by the patient and classified according to the categories of the Bern Inventory of Treatment Goals (BIT-T, Grosse Holtforth & Grawe 2001, 2002). Results: Treatment goals of patients with affective disorders are significantly more heterogeneous than those of patients suffering from anxiety disorders; whose goals are more heterogeneous than those of patients suffering from chronic pain syndrome. The proportion of treatment goals that refer explicitly to depressive behavior, anxiety or chronic pain, respectively, increases constantly over these three groups. Focusing on these core-symptom related goals was significantly associated with higher therapist ratings of the improvement on the primary diagnoses for patients with anxiety disorders only. Conclusions: First, depending on the presenting disorder, standardized treatments should allow for a more or less flexible setting of treatment goals, and second for a more or less strict focus on disorder-specific core-symptoms. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

Background: 10\% to 30\% of all children worldwide suffer from headaches at least once a week, potentially constituting a serious health problem that may lead to impairment in multiple areas. Therefore, one aim of the epidemiological longitudinal study 'Children, Adolescents, and Headache' (KiJuKo) is the study of potential risk factors for the development of recurrent headaches. Methods: In the first survey (2003), questionnaires were sent to 8800 households with a child between 7 and 14 years of age. Three further surveys followed, one each year from 2004 to 2006. A number of predictors having to do with family characteristics and leisure activities were identified on the basis of the first survey and were then studied in the second survey (n = 2952) with respect to their influence on the new occurrence of headaches. Results: The risk of developing recurrent headaches between the first and the second survey was elevated by a factor of approximately 1.8 for boys who experienced quarrels in the family more than once per week, and by a factor of 2.1 for boys who only 'sometimes' had free time for themselves. The risk of developing recurrent headaches was 25\% higher in girls whose parentsʼ behavior towards the child positively or negatively reinforced the occurrence of headaches. Conclusions: These findings are in accordance with those of other studies showing that, for boys, the frequency of quarreling in the family and the extent of leisure time are major factors in the development of recurrent headaches. For girls, the manner in which the parents respond to the child's headache seems to be important. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

Aims: The hippocampus (HC) is characterized by high vulnerability to noxious influence, but also by a considerable regenerative potential. Although deficits in HC-related functions are among the most commonly reported cognitive sequelae in alcoholism, little and conflicting information is available concerning regeneration upon abstinence. The present study has been designed to evaluate (i) the frequency of measurable dysfunction in so called HC tests and (ii) its predictive value for risk to relapse in a cohort of 50 severely affected chronic alcoholic patients and (iii) to monitor recovery of HC-related functions upon strict abstention from alcohol. Methods: Patients underwent a 2-year neuropsychological follow-up including HC-associated tests (Verbal Learning Test, VLT; Nonverbal Learning Test, NVLT; 'City Map Test' of Learning and Memory Test, LGT-3), as well as tests of intelligence and attention in the framework of OLITA (Outpatient Long-Term Intensive Therapy for Alcoholics), a programme with careful abstinence monitoring. Results: At study entry, 30/50 (60\%) alcoholics had HC dysfunction which tended to predict a lower long-term abstinence probability (P = 0.058). Of the subgroup that could be followed under conditions of strictly monitored alcohol abstinence (n = 32; age 44.7 ± 6.2 years; 23 men, 9 women), 53\% (17/32) exhibited distinct HC dysfunction at inclusion which returned to normal after 2 years. Patients with initially normal HC function (9/32) and patients with additional brain damage of different aetiologies (6/32) failed to show improvement on HC-related tests. While the former displayed stably normal HC test performance, the latter remained on a performance level below normal. Conclusions: Demonstrating slow but remarkable regeneration of HC functions upon strict abstention from alcohol, our data strongly support abstinence-oriented long-term treatment of alcoholics. The absence of functional recovery in patients with additional causes of brain damage might be explained by the 'dual hit' exhausting the regenerative potential of the HC. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

Presents a study which aims to examine the effectiveness of a telephone-based peer support intervention to reduce depressive symptoms and improve social support in women with coronary heart disease (CHD). The study found no influence of telephone-based peer support on depressive symptoms and perceived social support in women with CHD. However, the study postulated that screening for psychological distress with feedback to patients by a professional might be helpful to initiate search for help and thus improves perceived social support. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

Examined whether a specific migraine-related psychophysiological response stereotype occurred under conditions of stress, recovery, and relaxation in 37 migraine sufferers (nonheadache state) and 44 normal controls. Two stressors were presented (industrial noise and a social discomfort situation), followed by a recovery period. Relaxation was induced by verbal instructions accompanied by soft music. Pulse volume amplitude (fronto-temporal and digital), skin temperature (fronto-temporal and digital), and skin resistance responses were assessed. Results showed no group differences in responses to the stressors. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

Headache is the most common pain problem in children and adolescents and, in a considerable proportion, a source of suffering and disability. Medical intervention mainly relies on abortive pharmacological agents (analgesics and antimigraine drugs). Psychological therapies aim at the prevention of headache episodes and the modifications of cognitive-emotional and cognitive-behavioral processes influencing pain. Three main forms of therapy have been evaluated in randomized controlled trials and reviewed in meta-analyses: relaxation training, biofeedback and multimodal cognitive-behavioral therapy. So far there is only scarce evidence on hypnosis and acceptance and commitment therapy, although they seem to be promising. Evidence demonstrates that psychological therapies are efficacious, and that clinically relevant improvement is found in approximately 70\% of the treated children at follow-up examination. Future research needs to focus on mechanisms of change, and to extend its view of effects induced by therapy beyond headache improvement to indicators of quality of life. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

Psychologically based interventions such as relaxation training, biofeedback and cognitive-behavioural therapy are increasingly discussed as options for the treatment of migraine and tension-type headache in children and adolescents. In order to determine the state of evidence regarding the efficacy of these treatments, a meta-analysis of randomized controlled studies was conducted. In a comprehensive literature search including data from 1966 to 2004, 23 studies were found meeting the inclusion criteria. Due to the application of the random effects model, generalization of the results is possible. Specific statistical procedures were used to account for a possible publication bias. Significantly more patients improved to a clinically relevant extent (headache reduction ≥50\%) in treatment conditions compared with waiting list conditions (high effect sizes). Long-term stability was also confirmed. The analysed treatments lead to improvement (up to 1 year) in headache status in children and adolescents with primary headache. However, more well-designed studies are needed to support and consolidate the conclusions of this meta-analysis and to compare the effects of psychological treatment with those of prophylactic medical interventions (in migraine), to examine potential differences between treatments, to identify moderators of efficacy and to determine effects of treatment on other health-related variables such as quality of life. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

Objective: Vertigo symptoms can lead to more or less vertigo-related handicap. This longitudinal study investigated whether depression, anxiety, and/or somatization mediate the relationship between vertigo symptoms and vertigo-related handicap. Methods: N = 111 patients with vertigo/dizziness provided complete data on the following measures: Vertigo symptoms at baseline, depression at 6-month follow-up, anxiety at 6-month follow-up, somatization at 6-month follow-up, and vertigo handicap at 12-month follow-up. Mediation analyses with bootstrapping were performed to investigate the mediating role of anxiety, depression, and somatization in the relationship between vertigo symptoms and vertigo-related handicap. Results: When the mediating role of anxiety, depression, and somatization was evaluated separately from each other in single mediation models, the effect vertigo symptoms at baseline exerted on vertigo-related handicap at 12-month follow-up was significantly mediated by depression at 6-month follow-up (p < 0.05), by anxiety at 6-month follow-up (p < 0.05), as well as by somatization at 6-month follow-up (p < 0.05). When statistically controlling for the other mediators in a multiple mediator model, only depression at 6-month follow-up mediated the effect of vertigo symptoms at baseline on vertigo-related handicap at 12-month follow-up (p < 0.05). Conclusion: Psychological distress is an important mechanism in the process how vertigo symptoms lead to vertigo-related handicap. (PsycINFO Database Record (c) 2017 APA, all rights reserved)

According to self-report and unsystematic observational data adult patients with attention-deficit/hyperactivity disorder suffer from increased vulnerability to daily life stressors. The present study examined psychological and physiological stress responses in adult ADHD subjects in comparison to healthy controls under laboratory conditions. Thirty-six subjects (18 patients with DSM-IV ADHD diagnosis, 18 sex- and age-matched healthy controls) underwent the Trier Social Stress Test (TSST; Kirschbaum, C., Pirke, K.-M., Hellhammer, D.H., 1993. The 'Trier Social Stress Test'&ndash;a tool for investigating psychobiological stress responses in a laboratory setting. Neuropsychobiology 28, 76-81), a standardized psychosocial stress protocol which contains a stress anticipation phase and a stress phase with a free speech assignment and subsequent performance of a mental arithmetic. Physiological stress measures were salivary cortisol as an indicator of the HPA axis, heart rate (HR), and time- and frequency-domain heart rate variability (HRV) parameters. Subjective stress experience was measured via self-report repeatedly throughout the experimental session. In line with previous theoretical and empirical work in the field of childhood ADHD, it was hypothesized that the ADHD and control group would exhibit comparable baseline levels in all dependent variables. For ADHD subjects, we expected attenuated responses of the physiological parameters during anticipation and presence of the standardized stressor, but elevated subjective stress ratings. Hypotheses were confirmed for the baseline condition. Consistent with our assumptions in regard to the psychological stress response, the ADHD group experienced significantly greater subjective stress. The results for the physiological variables were mixed. While ADHD subjects revealed an attenuated HR during the stress phase, no significant group differences were found for the other parameters, although a trend was observed for both the low frequency/high frequency (LF/HF) ratio of the HRV power spectral analysis and salivary cortisol (the latter possibly indicating generally lower cortisol levels in ADHD subjects). In summary, the present findings are the first to demonstrate a significant alteration of a specific physiological stress measure (HR) and, more clearly, of psychological aspects of the stress response in adults suffering from ADHD. In regard to the physiological stress response, it is recommended that future studies employ larger sample sizes and a more comprehensive range of physiological stress parameters. Additionally, the issue of transferability of laboratory results to real life stressors needs to be addressed. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

Objective: A prospective four-year study examined which components of addiction severity predicted time to relapse among 112 adults with chronic alcoholism who participated in a comprehensive outpatient treatment program. Methods: Recruited from emergency, inpatient, and outpatient facilities, patients were admitted into the program consecutively between March 1998 and June 2002. Alcohol abstinence was carefully monitored for four years from admission by regular contacts and urine and blood analyses. Alcoholism characteristics and personality disorders were assessed with structured interviews and the International Diagnostic Checklists for Personality Disorders. Results: Among a variety of potential variables, only presence of a personality disorder and chronicity of addiction were independently associated with a decrease of cumulative four-year abstinence probability. Conclusions: Their high predictive values suggest that chronicity and personality disorder rank among the most important characteristics of addiction severity. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

For understanding the heterogeneity of tinnitus, large samples are required. However, investigations on how samples recruited by different methods differ from each other are lacking. In the present study, three large samples each recruited by different means were compared: N=5017 individuals registered at a self-help web platform for tinnitus (crowdsourcing platform Tinnitus Talk), N=867 users of a smart mobile application for tinnitus (crowdsensing platform TrackYourTinnitus), and N=3786 patients contacting an outpatient tinnitus clinic (Tinnitus Center of University Hospital Regensburg). The three samples were compared regarding age, gender, and duration of tinnitus (month or years perceiving tinnitus; subjective report) using chi-squared tests. The three samples significantly differed from each other in age, gender, and tinnitus duration (p<.05). Users of the TrackYourTinnitus crowdsensing platform were younger, users of the Tinnitus Talk crowdsourcing platform had more often female gender, and users of both newer technologies (crowdsourcing and crowdsensing) had more frequently acute/subacute tinnitus (<3 months and 4-6 months) as well as a very long tinnitus duration (>20 years). Implications of these findings for clinical research are that newer technologies such as crowdsourcing and crowdsensing platforms offer the possibility to reach individuals hard to get in contact with at an outpatient tinnitus clinic. Depending on the aims and the inclusion / exclusion criteria of a given study, different recruiting strategies (clinic and / or newer technologies) offer different advantages and disadvantages. In general, study results might be increased when tinnitus study samples are recruited in the clinic as well as via crowdsourcing and crowdsensing.

The aims of the present study were the assessment of headache (HA) prevalence in German children and adolescents in the second year of a 4-year longitudinal study and the analysis of headache status change from year 1 to year 2. The original sample consisted of 8,800 households with a child aged 7-14 years. A total of 4,159 households responded in both year 1 and year 2, yielding 3,984 valid parent questionnaires. Data regarding various aspects of the child's HA history and general health were gathered via mailed questionnaires from the parents. Of the households returning valid parent questionnaires at survey 2, 48.9\% reported their child to have experienced headaches during the previous 6 months (53\% at survey 1). Weekly HA was reported for 6.5\% of the children, monthly or less frequent HA for 16.5\% and 25.9\%, respectively. With regard to headache diagnosis, 55.0\% of the children and adolescents with HA experienced tension-type HA (TTH) and 11.3\% migraine with or without aura (M). For more than half of the children and adolescents with HA (57.0\%) the frequency of head pain remained stable over the period of 1 year (i.e. same frequency category in years 1 and 2). Improved and worsened HA status regarding frequency of occurrence was found in 22.3\% and 20.7\% of the subjects, respectively. Thus, there was no definite trend towards an increase of HA episodes over the course of 1 year regarding the individual child or adolescent. The most stable type of HA was TTH. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

Background: A large number of population-based studies of chronic pain have considered neuropathic sensory symptoms to be associated with a high level of pain intensity and negative affectivity. The present study examines the question of whether this association previously found in non-selected samples of chronic pain patients can also be found in chronic pain patients with underlying pathology of neuropathic sensory symptoms. Methods: Neuropathic sensory symptoms in 306 patients with chronic pain diagnosed as typical neuropathic pain, radiculopathy, fibromyalgia, or nociceptive back pain were assessed using the Pain DETECT Questionnaire. Two separate cluster analyses were performed to identify subgroups of patients with different levels of self-reported neuropathic sensory symptoms and, furthermore, to identify subgroups of patients with distinct patterns of neuropathic sensory symptoms (adjusted for individual response bias regarding specific symptoms). Results: ANOVA (analysis of variance) results in typical neuropathic pain, radiculopathy, and fibromyalgia showed no significant differences between the three levels of neuropathic sensory symptoms regarding pain intensity, pain chronicity, pain catastrophizing, pain acceptance, and depressive symptoms. However, in nociceptive back pain patients, significant differences were found for all variables except pain chronicity. When controlling for the response bias of patients in ratings of symptoms, none of the patterns of neuropathic sensory symptoms were associated with pain and psychological factors. Conclusion: Neuropathic sensory symptoms are not closely associated with higher levels of pain intensity and cognitive-emotional evaluations in chronic pain patients with underlying pathology of neuropathic sensory symptoms. The findings are discussed in term of differential response bias in patients with versus without verified neuropathic sensory symptoms by clinical examination, medical tests, or underlying pathology of disease. Our results lend support to the importance of using adjusted scores, thereby eliminating the response bias, when investigating self-reported neuropathic symptoms by patients. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

Alzheimer's disease is a neurodegenerative disorder characterized by extracellular amyloid plaque deposits, mainly composed of amyloid-beta peptide and intracellular neurofibrillary tangles consisting of aggregated hyperphosphorylated tau protein. Amyloid-beta represents a neurotoxic proteolytic cleavage product of amyloid precursor protein. The progressive cognitive decline that is associated with Alzheimer's disease has been mainly attributed to a deficit in cholinergic neurotransmission due to the continuous degeneration of cholinergic neurons e.g. in the basal forebrain. There is evidence suggesting that other neurotransmitter systems including neuronal histamine also contribute to the development and maintenance of Alzheimer's disease-related cognitive deficits. Pathological changes in the neuronal histaminergic system of such patients are highly predictive of ensuing cognitive deficits. Furthermore, histamine-related drugs, including histamine 3 receptor antagonists, have been demonstrated to alleviate cognitive symptoms in Alzheimer's disease. This review summarizes findings from animal and clinical research on the relationship between the neuronal histaminergic system and cognitive deterioration in Alzheimer's disease. The significance of the neuronal histaminergic system as a promising target for the development of more effective drugs for the treatment of cognitive symptoms is discussed. Furthermore, the option to use histamine-related agents as neurogenesis-stimulating therapy that counteracts progressive brain atrophy in Alzheimer's disease is considered. This article is part of a Special Issue entitled ‘Histamine Receptors’.

Chronic tinnitus affects approximately 5\% of the population. Severe distress due to the phantom noise is experienced by 20\% of the tinnitus patients. This distress cannot be predicted by psychoacoustic features of the tinnitus. It is commonly assumed that negative cognitive emotional evaluation of the tinnitus and its expected consequences is a major factor that determines the impact of tinnitus-related distress. Models of tinnitus distress and recently conducted research propose differences in limbic, frontal and parietal processing between highly and low distressed tinnitus patients. An experimental paradigm using verbal material to stimulate cognitive emotional processing of tinnitus-related information was conducted. Age and sex matched highly (n = 16) and low (n = 16) distressed tinnitus patients and healthy controls (n = 16) underwent functional magnetic resonance imaging (fMRI) while sentences with neutral, negative or tinnitus-related content were presented. A random effects group analysis was performed on the basis of the general linear model. Tinnitus patients showed stronger activations to tinnitus-related sentences in comparison to neutral sentences than healthy controls in various limbic/emotion processing areas, such as the anterior cingulate cortex, midcingulate cortex, posterior cingulate cortex, retrosplenial cortex and insula and also in frontal areas. Highly and low distressed tinnitus patients differed in terms of activation of the left middle frontal gyrus. A connectivity analysis and correlational analysis between the predictors of the general linear model of relevant contrasts and tinnitus-related distress further supported the idea of a fronto-parietal-cingulate network, which seems to be more active in highly distressed tinnitus patients. This network may present an aspecific distress network. Based on the findings the left middle frontal gyrus and the right medial frontal gyrus are suggested as target regions for neuromodulatory approaches in the treatment of tinnitus. For future studies we recommend the use of idiosyncratic stimulus material. (PsycINFO Database Record (c) 2016 APA, all rights reserved)