We present a clinical classification of central vestibular syndromes according to the three major planes of action of the vestibulo-ocular reflex: yaw, roll, and pitch. The plane-specific syndromes are determined by ocular motor, postural, and percep tual signs. Yaw plane signs are horizontal nystagmus, past pointing, rotational and lat eral body falls, deviation of perceived straight-ahead to the left or right. Roll plane signs are torsional nystagmus, skew deviation, ocular torsion, tilts of head, body, and perceived vertical in a clockwise or counterclockwise direction. Pitch plane signs are upbeat/downbeat nystagmus, forward/backward tilts and falls, deviations of the per ceived horizon. The thus defined vestibular syndromes allow a precise topographic analysis of brainstem lesions according to their level and side. Special emphasis is placed on the vestibular roll plane syndromes of ocular tilt reaction, lateropulsion in Wallenberg's syndrome, thalamic and cortical astasia and their association with roll plane tilt of perceived vertical. Recovery is based on a functionally significant central compensation of a vestibular tone imbalance, the mechanism of which is largely un known. Physical therapy may facilitate this central compensation, but this has not yet been proven in prospective studies.

Background: The Freiburger Personality Inventory (FPI-R) is a well established and proven instrument for the assessment of personality traits. Although personality is conceived as a stable trait, clinical experience indicates that impressive changes are found on personality scales during intensive treatment. Method A large sample of inpatients which were treated with cognitive-behavioral therapy for bulimia nervosa, tinnitus or anxiety disorder was evaluated concerning the question which items of the FPI-R were answered differently or identically before and after intensive therapy. Results: It could be found that items which cover aspects that are central to the therapy more often show changing answers. The use of conditional form and indefinite frequency adjuncts in the formulation of items evidently allowed a more differentiated weighting of pros and cons at the end of therapy. Effects of regression to the mean could be excluded as an explanation by empirical data. Conclusion: It can be concluded that changes in answering items before and after intensive therapy can be explained as specific effects of therapy.

Purpose: The goal of this treatment trial was to investigate the efficacy of an inpatient group therapy program specifically designed for patients suffering from Obsessive Compulsive Disorder (OCD, ICD 10, F 42). Methods: In the experimental group (EG; n = 14) the specific group therapy was carried out in addition to individual cognitive-behavioral therapy, the control group (KG; n = 16) received non-specific group therapy in mixed patient-groups in addition to individual therapy. 7 patients (EG = 3, KG = 4) received also Selective Serotonin re-uptake inhibitors (SSRIs). Y-BOCS, BDI, and STAI-X1 were performed pre- and post-treatment. Furthermore therapists' ratings and self ratings were taken. Results: At post-treatment both groups showed significant improvement of the symptomatology. For the EG the Y-BOCS mean was reduced from 23.64 to 11.35, for the KG from 23.81 to 12.81. The group comparison showed no significant differences (alpha = 0.05) in clinical measurements, therapists' and self ratings. However, there were significantly more responders (improvement >50%, Y-BOCS) in the EG and treatment duration was shorter by 15 days. Conclusions: Clinical outcome in the EG was not superior. However, the specific group therapy for OCD contributes to an economic and effective treatment.

Background: Workers on dredgers and lighters on rivers are exposed to the inhalation of aerosols and dusts. Objective: The aim of this study was to investigate effects of river silt aerosol and dust exposure on the respiratory health of dredging employees. Methods: Six era mi nations were performed over a period of 2 years at 4-monthly intervals in 54 seamen with higher silt aerosol exposure and 36 controls of the same employer. Results: No significant differences could be observed between the groups at any time of the study but there was an unexpected significant decrease in the age-corrected expiratory vital capacity (FVC), forced expiratory volume in 1 s (FEV1) and midexpiratory flow rate (MMEF25/75) over the six series in both groups. This may indicate a loss of effort of the participants in re-examinations since biological and technical influences were highly unlikely to be the cause of these findings. Conclusions: Ignoring this possible decline of effort in frequently repeated measurements may result in overestimating potential effects of occupational exposure. Copyright (C) 2000 S. Karger AG, Basel.

Background: There is a lack of evidence about the effectiveness of cognitive behavior therapies (CBT) in settings of routine clinical care as well as in the treatment of panic and comorbid disorders. Methods: We investigated a group-oriented CBT approach for 80 patients with panic disorder including 35 patients with current comorbid major depression. Assessments took place 6 months before treatment, at the beginning and end of treatment, and 1 year later. Structured interviews and multiple clinical self-rating scales were used. Results: Panic patients with comorbid major depression showed higher anxiety-specific and nonspecific pathology. The most striking benefits were in reducing avoidance behavior, while improvements concerning catastrophic beliefs were smaller, but still significant. For most self-rating scale results, patients with and without comorbid depression improved to a comparable degree. However, the end-state functioning of patients with panic disorder and current comorbid depression at admission is significantly lower than for patients with panic disorder alone, Conclusions: The results point to the necessity to develop and improve treatment approaches for patients with comorbidity of panic disorder and current major depression. Copyright (C) 2000 S.Karger AG, Basel.