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Even though hearing and vestibular disorders at high altitude have been reported since 1938, their reasons are still unknown. During the Audimont Research Expedition the risk for cochlear and vestibular sensory cells has been quantified by otoacoustic emissions and videonystagmography. Vestibular disorders could not be observed up to 7050 meters. However, the outer hair cells in the inner ear showed a reduction of emissions at increasing height. The pattern of the inner ear reply, depending on the altitude, complies with an increase of the perilymphatic pressure. As the perilymphatic space corresponds directly to the subarachnoid space, the limitation of hearing thus appears to be a direct consequence of raised intracranial pressure.

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OBJECTIVES: Therapy adherence was examined within a sample of 145 imprisoned male juveniles with regard to factors of influence, structure and predictability. METHODS: Predictors included biographic data, expectations with regard to therapy, personality traits (measured with the FPI-R) and psychological impairment (investigated by means of the Symptom Checklist). Therapy adherence as a criterion can be divided into the following dimensions: affliction, dissatisfaction, requests for change and help, and expectations of success. RESULTS: Within the sample a clear impairment of biographical and psychological data, as well as of personality traits was found. Values were average for expectations regarding therapy and therapy adherence, while two thirds of the sample were willing to undergo treatment during imprisonment. CONCLUSIONS: Therapy adherence proved to be a one-dimensional construct, best predicted by emotional instability, followed by the symptom score, expectations regarding therapy and inhibition. Dividing the entire sample into subgroups, significant differences were found mainly for psychological test data and less so for the construct of therapy adherence.

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The progress of work in adaptation axis I of OPD (operationalized psychodynamic diagnostic) to axis I OPD-CA (children and adolescents) is delineated. The items are now classified as subjective dimensions, resources and preconditions for treatment. Overlapping with the multi-axial classification for children and adolescents as used in Germany (MAS) was eliminated and important items for child and adolescent psychiatric and psychotherapeutic treatment were added. In the field of personal dimensions only subjective impairment will be covered. Resources were accentuated for the benefit of peer relationships. Motivation for treatment is now differentiated between a more global motivation for change and motivation for psychotherapeutic treatment. In order to reduce ambiguity the term of compliance was transformed into ability for therapeutic agreement. The possibility of realization of therapeutic indication was added.

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One of the most consistently reported findings in depression has been leucocytosis. In 33 in-patients with major depressive disorder, we assessed white blood cell count (WBC) and lymphocyte subsets four times over a period of 6 weeks. The control group consisted of 44 healthy subjects. Shortly after admission, we detected significant increases in the numbers of leucocytes, granulocytes, platelets and monocytes in the depressed patients. Patients who recovered well during hospitalization showed a decrease in monocyte counts, whereas those with slower clinical improvement had significantly higher monocyte counts than the control group. This longitudinal study demonstrates that monocytes may play a role in the acute phase of depression and could provide an explanation for immunological dysfunction in depressive states.

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Twenty-seven inpatients with major depression were examined four times within 6 weeks to assess CD56+ natural killer (NK) cell counts by flow cytometry and to assess the related lymphokines interleukin-2 and interferon-gamma in a whole blood assay after mitogen stimulation with phytohemagglutinin (PHA). The patient showed significantly higher counts of the fraction of 56+ NK cells and a greater lymphokine response to PHA than the controls. A significant correlation between lymphokine secretion and CD56+ cell counts was detected in the patients' acute clinical stage, but not in healthy controls or in patients after clinical improvement.

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One, as yet unemployed, approach to investigating immunology in depression is the assessment of the cytokine production by leucocytes, which would allow the determination of immune response under standardized conditions. Thus we measured the production of mitogen-induced cytokines (IL-1 beta, IL-2, IL-6, IL-10, interferon-gamma) and sIL-2R in a whole blood assay, and serum protein levels such as C-reactive protein (CRP), haptoglobin (Hp) and alpha 2-macroglobulin (alpha 2 M) in a longitudinal 6-week study in an attempt to assess leucocyte function during and after acute clinical stage of depression in 39 patients. Shortly after admission to hospital we found higher levels of all measured cytokines in the patients. Serum protein levels were significantly higher in the patients than in controls, and decreased over the study period. Whereas slightly elevated monokine levels in patients tended to reach control values, lymphokines showed a significant decrease over the 6 weeks as compared to baseline. These results suggest that the increase in immune activity seen at the beginning of the study may be followed by a suppressed cell-mediated immune function.

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