Primary enduring negative symptoms in schizophrenia and major depression.

Abstract Primary enduring negative symptoms (PENS) were studied in 26 patients with DSM-III-R schizophrenia and in 94 patients with unipolar major depressive episodes 5 years after the index episode. PENS were assessed with the Schedule for Deficit Syndrome (SDS). Negative symptoms were also assessed with the Scale for Assessment of Negative Symptoms (SANS) and subclassified into primary and secondary according to the SDS. The frequency of PENS did not differ significantly between schizophrenics and non-schizophrenic patients. Enduring negative symptoms (regardless of whether primary or not) were more frequently observed in schizophrenia (65% according to the SDS, and 88% according to the S…

Interpretation und Folgerungen

Sowohl die Bevolkerungsumfrage als auch die Medienanalyse haben gezeigt, das die Anwendung von Psychopharmaka starker Ablehnung begegnet. Dies gilt jedenfalls, wenn man nach bestimmten Anwendungssituationen fragt. Uber die Grunde fur diese Ablehnung geben die Daten nur zum Teil Auskunft. Will man die Motivlage der Psychopharmakagegner naher beleuchten, ist man darauf verwiesen, uber die Motive und Einstellungen der Beteiligten Mutmasungen anzustellen und diese interpretativ mit den Untersuchungsergebnissen zu verknupfen. Dabei zeigt sich zunachst, das die Berichte uber Psychopharmaka in den Medien, die auffallend viele negative Aussagen enthalten, nach der rhetorischen Analyse auch mit eine…

Identification of minor affective disorders and implications for psychopharmacotherapy.

Five hundred general practice patients with functional complaints were studied with the Polydiagnostic Interview (PODI) to see whether DSM-IIIR criteria were able to specify affective disorders satisfactorily. Almost one third of the patients received the diagnosis of depression not otherwise specified (NOS). When Research Diagnostic Criteria were applied to these patients more than 70% received specific diagnoses. A modification of DSM-IIIR algorithms enabled us to further specify diagnoses in subjects with depression NOS. On the 17-item Hamilton Depression Scale many of these patients reached scores of 13 or more which is severe enough to justify a therapy trial with antidepressants.

Erste Ergebnisse einer Kombinationstherapie mit Moclobemid und kognitiver Verhaltenstherapie bei Panikstörung mit Agoraphobie

In der Studie wird die Wirksamkeit von Moclobemid, kognitiver Verhaltenstherapie und einer Kombination aus beidem bei der Behandlung von Panikstorung mit Agoraphobie untersucht. Die Hypothesen sind, das sowohl Moclobemid als auch kognitive Verhaltenstherapie einer Behandlung mit Placebo uberlegen sind und das eine Kombinationstherapie zu den besten Resultaten fuhrt. Von insgesamt 123 ambulanten Patienten mit der Diagnose Panikstorung mit Agoraphobie erfullen 55 die Studienkriterien und werden randomisiert einer der vier folgenden Therapiebedingungen zugeordnet: 1) Moclobemid und kognitive Verhaltenstherapie, 2) Moclobemid und Clinical Management, 3) Placebo und kognitive Verhaltenstherapie …

Brief depression among patients in general practice

Depression with substantial psychosocial impairment, but not qualifying as depressive disorder according to the standard diagnostic manuals, is frequent among primary care patients. Recurrent brief depression (RBD) is a diagnostic category intended to identify a major proportion of this group of patients. The WHO study on "Psychological Problems in Primary Health Care" was used as a vehicle to estimate the proportion of patients with this diagnosis and to evaluate the validity of this diagnosis as well as of alternative concepts of brief depression with multiple episodes. This study applies a two-stage sampling scheme; 300 patients also underwent an additional interview tailored for variant…

An interdisciplinary study towards a multiaxial classification of male sexual dysfunction

The classification of male sexual dysfunction (SD) was investigated in a multidisciplinary study involving a sample of 25 outpatients whose phenomenology, course and biologic comorbidity is described. All 25 patients were suffering from arousal disorders; 9 men complained of lack of desire and 9 of orgasm disorders. For the vast majority (19/25), the arousal disorder preceded the other sexual dysfunctions. Eleven patients suffered from a psychopathological disorder according to DSM-III or DSM-III-R (Axis I and II), with general anxiety, major depression and obsessive-compulsive personality being the most common disorders. Only 6 patients were free of any organic disorder or pathological lab…

Roxindole, a dopamine autoreceptor agonist, in the treatment of major depression

Roxindole is a potent autoreceptor-“selective” dopamine agonist originally developed for the treatment of schizophrenic syndromes. The drug also inhibits 5-HT uptake and has 5-HT1A agonistic actions. In this open clinical trial 12 in-patients suffering from a major depressive episode (DSM-III-R) were treated with roxindole for 28 days in a fixed dosage of 15 mg per day. A reduction of at least 50% in HAMD-17 total scores was observed in 8 out of 12 patients after 4 weeks (mean HAMD-17 reduction of 56% in all patients), while 4 patients did not respond to roxindole treatment. Half of the patients showed a complete psychopathological remission (HAMD-17 <8). Roxindole's onset of antidepressant…

Examination and treatment of sleep-related painful erections--a case report.

The case of a patient with sleep-related painful erections is described. Insomnia and a slight depressive syndrome occurred along with a long history of this disorder. No physical abnormality was found. At a baseline recording of sleep electroencephalography (EEG) and nocturnal penile tumescence (NPT), a disturbed sleep pattern and impaired NPT were recorded. Attempts to treat the disorder with diazepam, amitriptyline, trimipramine, and biperidene did not prompt a stable improvement of the disorder, but a dosage of 25 mg clozapine was sufficient to achieve normalized sleep architecture, remission of the depressive symptomatology, and normalization of NPT. It is likely that marked sedation i…

Patients' satisfaction with medication during psychiatric inpatient treatment

Schizoaffective disorder and affective disorders with mood-incongruent psychotic features: keep separate or combine? Evidence from a family study.

Objective This study investigated whether the distinction between schizoaffective disorder and affective disorders with mood-incongruent psychotic features as described in DSM-III-R is reflected by aggregation of schizophrenia in the families of probands with the former disorder and aggregation of affective disorders mainly among the relatives of probands with the latter type of disorders. Method The probands were 118 inpatients with definite lifetime diagnoses of DSM-III-R schizoaffective disorder or a major mood disorder with incongruent psychotic features according to structured clinical interviews. Diagnostic information on 475 of the probands' first-degree relatives was gathered throug…

Psychopharmaka im Alter und bei internistischen Erkrankungen

Dieses Kapitel enthalt Ubersichten zu den Risiken der einzelnen Psychopharmaka zu den Themen Alter, Herz-, Leber-, Nierenerkrankungen und Diabetes.

Subtyping panic disorder by major depression and avoidance behaviour and the response to active treatment

In order to establish the clinical validity of currently used ways of subtyping panic disorder the predictive power of associated current avoidance behaviour and (secondary) major depression for the response to active treatment (alprazolam, imipramine) was tested. The analysis was based on the data from the Cross-National-Collaborative-Panic-Study. Limited support for validity evidenced by predicting drug response was found for grading panic disorder by the severity of avoidance behaviour; patients with panic attacks and agoraphobia are more responsive to imipramine (compared with alprazolam) when using the reduction of the total number of panic attacks (or of spontaneous panic attacks) as …

Seroquel (ICI 204 636), a putative "atypical" antipsychotic, in schizophrenia with positive symptomatology: results of an open clinical trial and changes of neuroendocrinological and EEG parameters.

Preclinical data indicated that seroquel (ICI 204 636), a dibenzothiazepine with 5-HT2 and D2-like receptor antagonistic properties, might be an effective antipsychotic agent, causing fewer extrapyramidal side effects than typical neuroleptics. In the present study, 12 patients suffering from schizophrenia or schizophreniform disorder with predominantly positive symptomatology were treated in an open clinical trial for 4 weeks with seroquel at a maximum dosage of 750 mg/day. The drug was generally well tolerated, and virtually no adverse extrapyramidal side effects such as acute dystonia, parkinsonism or akathisia were observed. Total scores for BPRS (item score 0–6; baseline: 42.0±2.3; mea…

Medikamente zur Behandlung extrapyramidalmotorischer Störungen

Antiparkinsonmittel werden in diesem „Grundris“ aus 2 Grunden berucksichtigt: Sie haben einmal psychische Eigenwirkungen und werden zum anderen in Form von m-Cholinozeptorantagonisten in der psychiatrischen Pharmakotherapie als Adjuvanzien benotigt, wenn unter einer neuroleptischen Therapie extrapyramidalmotorische Nebenwirkungen (s. S. 192) auftreten.

Effects of subchronic paroxetine administration on night-time endocrinological profiles in healthy male volunteers

Abstract To evaluate the subchronic effects of paroxetine, a selective serotonin reuptake inhibitor, on nocturnal endocrinological profiles, eight healthy male volunteers with no personal or family history of a psychiatric or neurological disease were administered paroxetine (30 mg/day) or placebo in a double-blind cross-over design. Drugs were given as a single dose at 10:00 h for a period of 4 weeks each. Between days 21 and 28 of each treatment period, sleep EEG was registered for four consecutive nights from 23:00 to 07:00 h. During the last night, hormonal profiles for prolactin, growth hormone (GH), cortisol, corticotropin (ACTH), luteinizing hormone (LH), testosterone and melatonin w…

Fluvoxamine or placebo in the treatment of panic disorder and relationship to blood concentrations of fluvoxamine.

A six-week double-blind placebo-controlled trial of fluvoxamine was undertaken in 46 patients suffering from panic disorder with or without agoraphobia diagnosed by DSM-III-R guidelines. Average daily dosage of fluvoxamine was 160 mg, with a highest permitted dose of 300 mg/day. Weekly evaluation included a diary in which the number, severity, and duration of full-blown and limited panic attacks and the duration and severity of anticipating fear, CAS, GAS, CGI, HAM-D, adverse effects and the number of capsules not taken were noted. Fluvoxamine was not significantly superior to placebo with regard to the main outcome criterion, i.e., the reduction in the number of panic attacks, but it was s…

Treatment of chronic depression with sulpiride: evidence of efficacy in placebo-controlled single case studies

Systematic variation of treatment (alternating active drug and placebo in four treatment periods) in individual patients is proposed to collect preliminary evidence for a therapeutic effect of sulpiride in chronic depression; the ARIMA model is applied to evaluate the intervention effects of the tentatively effective treatment in single subjects. Ten single cases of chronic depression with a diagnosis of major depression or dysthymia were selected and seven of these provided evidence for beneficial effects of sulpiride with regard to treating the symptoms of depression and anxiety. However, the drug effects were intraindividually not always replicable. The results obtained with these single…

Fragestellung, Forschungsstand und methodische Probleme

In der empirischen Sozialforschung werden Kenntnisse, Meinungen, Einstellungen und Verhaltensweisen unterschieden. Unter Kenntnissen werden Sachinformationen verstanden, die richtig oder falsch sein konnen. Unter Meinungen versteht man wertende Stellungnahmen zu Meinungsobjekten (Konzepten), die nicht wahrheitsfahig sind. Unter Einstellungen versteht man dauerhafte Dispositionen genereller Art, die Meinungen und Verhaltensweisen im konkreten Fall beeinflussen konnen (Ajzen u. Fishbein 1980; Sample u. Warland 1973). Als Verhaltensweisen bezeichnet man beobachtbare Aktivitaten. Einstellungen sind im Unterschied zu Kenntnissen, Meinungen und Verhaltensweisen keine vorgegebenen Grosen. Es hande…

Dose-Related Effects of Amisulpride on Five Dimensions of Psychopathology in Patients With Acute Exacerbation of Schizophrenia

The present analysis investigated symptom-specific dose-response relationships of the atypical antipsychotic amisulpride (AMI) in schizophrenic patients. The effects of different AMI doses on five different symptom dimensions of the Brief Psychiatric Rating Scale (BPRS) were analyzed. Results on global efficacy and safety parameters have been previously published. Four AMI doses (100 mg/day [AMI100], 400 mg/day [AMI400], 800 mg/day [AMI800], 1200 mg/day) were compared with 16 mg haloperidol (HAL16) in a multicenter, double-blind, randomized, parallel-group, 4-week trial. A total of 319 patients with acute exacerbation of schizophrenia (DSM-III-R) were included. AMI100 was compared with the …

An overview of the clinical efficacy of mirtazapine

Mirtazapine is at least as effective as the tricyclic antidepressants and trazodone in a wide range of patient subgroups including in- and out-patients with moderate to severe depression. It also appears to be at least as effective as the serotonin and noradrenaline reuptake inhibitor venlafaxine in the treatment of severely depressed melancholic patients. When compared with the selective serotonin reuptake inhibitors (SSRIs), mirtazapine shows a significantly earlier onset of action. Further analysis of a study comparing mirtazapine with the SSRI paroxetine indicated that early improvement was a highly sensitive predictor of later stable response for both drugs. The positive predictive val…

Psychopharmaka in Schwangerschaft und Stillzeit

Es wird eine praxisrelevante Ubersicht zu den Risiken von Psychopharmaka in Schwangerschaft und Stillzeit gegeben. Sehr ausfuhrlich wird das Risiko von Antidepressiva besprochen.

Savoxepine: invalidation of an "atypical" neuroleptic response pattern predicted by animal models in an open clinical trial with schizophrenic patients.

The new tetracyclic compound savoxepine exhibits potent antidopaminergic effects with preferential activity in the hippocampus as compared to striatum in rat brain. As a result of behavioural animal models and regional differences in dopamine receptor binding characteristics, it has been suggested to possess an "atypical" neuroleptic response pattern. In an open clinical trial, savoxepine was administered to 12 in-patients suffering from paranoid schizophrenia and schizophreniform disorder (DSM-III). Eight patients were treated with a stable dose of 0.5 mg per day throughout the study, while in the remaining patients higher doses up to 20 mg/day were administered. Mean total BPRS scores and…

Dose escalation vs. continued doses of paroxetine and maprotiline: a prospective study in depressed out-patients with inadequate treatment response

In view of the fact that controlled prospective studies on the benefits of dose escalation of the selective serotonin re-uptake inhibitor (SSRI) paroxetine are lacking, we conducted a double-blind, randomized, parallel-group multicentre study designed to compare the possible benefits of dose escalation of paroxetine and maprotiline in patients suffering from major or minor depression according to modified Research Diagnostic Criteria (RDC) with inadequate treatment response. The study sample consisted of 544 out-patients with different degrees of severity of depression. Patients received either 20 mg paroxetine (n = 271) or 100 mg maprotiline (n = 273) for the first 3 weeks in a double-blin…

A randomized, double-blind comparison of a rapidly escalating dose of venlafaxine and imipramine in inpatients with major depression and melancholia.

A double-blind, randomized, parallel study in 167 hospitalized patients with major depression and melancholia was conducted to determine if rapidly escalated doses of venlafaxine produced an earlier response, compared with rapidly escalated doses of imipramine. The daily dose of venlafaxine was rapidly increased to 375 mg/day over a five-day period, was maintained at this level for 10 days, and then was reduced to 150 mg/day for the remainder of the study. The imipramine dose was rapidly increased to 200 mg/day over five days and was maintained at this level to the end of the study. The primary efficacy variables were time to response and time to sustained response on the HAM-D and MADRS. N…

Serial position effects in dementia of the Alzheimer type.

&lt;b&gt;Background: &lt;/b&gt;The aim of the present study was to analyse serial position effects for immediate and delayed free recall in patients with dementia of the Alzheimer type and controls. &lt;b&gt;Experiment 1:&lt;/b&gt; 44 patients with dementia of the Alzheimer-type and 24 non-demented controls were asked for immediate and delayed free recall of 12 schematic drawings of common objects presented at the rate of 10 s/picture. Steep primacy effects were obtained at all delays in controls. By contrast, primacy effects were significantly impaired in patients with dementia at all delays of recall. Small immediate and delayed recall recency effects were found in both, patients and cont…

Functional properties of the brain during sleep under subchronic zopiclone administration in man.

Zopiclone, a non-benzodiazepine, has been shown to be efficient in the treatment of transient, short-term or chronic sleep disorders. Apart from its hypnotic effects zopiclone has anxiolytic, anticonvulsant and myorelaxant properties and is therefore hardly distinguishable from benzodiazepines. Dependence liability and discontinuation effects have been reported to be less pronounced. Therefore zopiclone seems to be a hypnotic drug which may cause fewer side effects than conventional benzodiazepines. From the electrophysiological point of view one requires from a hypnotic drug the induction of a physiological sleep pattern as well as no alterations of information processing by the brain. The…

Patterns of response to serotonergic antidepressants

Roxindole, a dopamine autoreceptor agonist, in the treatment of positive and negative schizophrenic symptoms

Twenty schizophrenic inpatients with either predominantly positive or predominantly negative symptoms were treated with the dopamine autoreceptor agonist roxindole in prospective open clinical trials. There was no antipsychotic effect in the subgroup with positive symptoms, whereas the subgroup with negative symptoms, especially those with the residual type of schizophrenia, showed a moderate but significant 20% reduction in total scores on the Scale for the Assessment of Negative Symptoms.

Chronology of panic and avoidance, age of onset in panic disorder, and prediction of treatment response. A report from the Cross-National Collaborative Panic Study.

The relevance of the chronology between panic disorder and avoidance behavior and of an early, medium or late onset of panic disorder was tested. Groups from the sample of the cross-national collaborative panic study (CNCPS) were compared for differences in basic characteristics and for the ability to predict treatment response. Patients who developed avoidance behavior before the full syndrome of panic disorder had less often a full agoraphobia but were not different in their response to treatment. Patients with an early onset of panic disorder suffered more often from agoraphobia. The treatment response was similar in the groups with early, medium or late onset of panic disorder. Neither …

Differential effects of high-dose amisulpride versus flupentixol on latent dimensions of depressive and negative symptomatology in acute schizophrenia: an evaluation using confirmatory factor analysis.

While many acutely ill schizophrenic patients suffer from depressive symptoms, most studies on the efficacy of antipsychotic drugs focus on positive and negative symptoms. Dimensional models of schizophrenic symptoms, based on confirmatory factor analysis (CFA) using structural equation modelling, offer a methodological alternative to compare antipsychotics on empirically justified latent factors. The present report is a refined analysis of a published double-blind study on the D 2 /D 3 -selective antagonist amisulpride (ASP) versus the mixed D 1-5 /5-HT 2 antagonist flupentixol (FPX). CFA was applied to Brief Psychiatric Rating Scale, Scale for the Assessment of Negative Symptoms, Bech-Raf…

Comparison of Paroxetine and Maprotiline in Minor Depression

Whilst the efficacy of paroxetine has been demonstrated in MDD, its clinical utility in minor depression has not been established. This study assesses the antidepressant efficacy of paroxetine in patients meeting RDC criteria for minor depression. All patients scored 13 points on the 17-item Hamilton Depression Rating Scale (HAMD) at baseline. After a 3 day washout period, patients were randomised to receive paroxetine 20–40mg/day or maprotiline 100-150mg/day, dose being titrated according to clinical response after 3 weeks treatment at the lower doses. Assessments conducted at baseline (day 0) and at weekly intervals for 6 weeks included the 17-item HAMD, the Montgomery-Asberg Depression R…

Evaluation eines standardisierten Trainings für die "Positive and Negative Syndrome Scale" (PANSS)

Die vorliegende Arbeit umfasst 3 Untersuchungen zur Interrater-Reliabilitat der deutschen Version der “Positive and Negative Syndrome Scale for Schizophrenia” (PANSS). Zur Interrater-Reliabilitat und Trainierbarkeit der PANSS liegen im deutschen Sprachraum trotz der weiten Verbreitung der Skala bisher keine empirischen Daten vor. Bei 3 Stichproben mit insgesamt 47 Teilnehmern unterschiedlicher klinischer Erfahrung wurde ein standardisiertes PANSS-Rater-Training durchgefuhrt und evaluiert. Als Qualitatsmase fur das Training wurden die Ubereinstimmung mit einem Expertenstandard (K) und gewichtete Kappa-Koeffizienten (κw) berechnet. Als ein Hauptergebnis lasst sich feststellen, dass zur Erreic…

Early improvement under mirtazapine and paroxetine predicts later stable response with high sensitivity in patients with major depression

Antipsychotic effects and tolerability of the sigma ligand EMD 57445 (panamesine) and its metabolites in acute schizophrenia: an open clinical trial.

Antipsychotic efficacy and side effects of the selective sigma ligand EMD 57445 (panamesine) were investigated in 12 patients (6 males, 6 females) who met DSM-III-R criteria for schizophrenia. A 4-week open clinical study revealed only modest effects of EMD 57445 and its metabolites on positive and negative symptoms of schizophrenia. Extrapyramidal and other side effects were moderate, although a significant increase in mild dyskinetic movements was found. Five patients, four of whom were females, completed the trial. Dropouts were mainly due to treatment failure. Antipsychotic effects were significantly greater in female than male patients.

Allgemeine Grundlagen der psychiatrischen Pharmakotherapie

Psychopharmaka werden heute von Arzten aller Fachdisziplinen verordnet. Ihrer sachkundigen Anwendung ist es zu verdanken, das viele psychische Storungen bereits im ersten Schritt von Allgemeinarzten behandelt werden konnen. Durch den gezielten, langfristigen Einsatz bestimmter Psychopharmaka ist auch ein wichtiger Beitrag zur Prophylaxe psychiatrischer Erkrankungen geleistet worden.

Effects of moclobemide on sexual performance and nocturnal erections in psychogenic erectile dysfunction

Rationale and objectives: We tested the hypothesis that the selective reversible MAO-A inhibitor moclobemide has a specific therapeutic effect on erectile dysfunction independent of its antidepressive properties. Methods: In a double-blind placebo controlled study, 12 male outpatients suffering from psychogenic erectile dysfunction without any other psychiatric disorder were investigated. Based on comprehensive diagnosis before the beginning of the study, organic factors relevant for sexual function were excluded. The treatment period was 8 weeks. Half the patients received 450 mg moclobemide during the first week, and 600 mg afterwards; the others received placebo. Apart from assessment of…

Quality of partnership in patients with erectile dysfunction after sildenafil treatment.

OBJECTIVE A comprehensive investigation on the quality of partnership of male patients with erectile dysfunction (ED) after treatment with sildenafil vs. untreated patients, as perceived by both the patients and their female partners. METHODS This report describes an observational, cross-sectional exploratory study comparing ED patients responsive to sildenafil with ED patients prior to therapy. Assessments included the 'International Index of Erectile Function' (IIEF) and the 'Partnerschaftsfragebogen' (PFB), a partnership questionnaire used in German-speaking countries. The comparability of the two study groups was examined using a stepwise logit model. Significant intergroup differences …

Randomised placebo-controlled trial of moclobemide, cognitive–behavioural therapy and their combination in panic disorder with agoraphobia

BackgroundIn the treatment of panic disorder with agoraphobia, the efficacy of pharmacological, psychological and combined treatments has been established. Unanswered questions concern the relative efficacy of such treatments.AimsTo demonstrate that moclobemide and cognitive–behavioural therapy (CBT) are effective singly and more effective in combination.MethodFifty-five patients were randomly assigned to an eight-week treatment of: moclobemide plus CBT; moclobemide plus clinical management (‘psychological placebo’); placebo plus CBT; or placebo plus clinical management.ResultsComparisons between treatments revealed strong effects for CBT. Moclobemide with clinical management was not superi…

Three dimensions of depression in patients with acute psychotic disorders: A replication study

Depressive symptoms in psychotic disorders are of high relevance but seem to be heterogeneous when assessed with a standard rating scale. The present analysis is a replication study on the dimensionality of the Bech-Rafaelsen Melancholia Scale (BRMES) in acutely psychotic patients with substantial depression defined according to a functional approach across the nosological borders of schizophrenia with major affective symptoms, schizoaffective disorder, depressed subtype, and major depression with psychotic features. The baseline data of 123 patients participating in a multicenter pharmacological trial were evaluated with structural equation models. A previously reported three-dimensional m…

Medikamente zur Behandlung von Entzugssyndromen und Abhängigkeit

In diesem Kapitel werden die Suchtmittel mit ihren Substanzcharakteristika, Entzugssyndromen, Entwohnungsmasnahmen und ihrer Intoxikationssymptomatik bzw. -therapie im Hinblick auf die verschiedenen spezifischen klinischen Syndrome der Suchtkrankheiten abgehandelt (Tabelle 7.1). Generelle Einschrankungen wie z.B. die veranderte Einschatzung des eigenen Leistungsvermogens oder die verminderte Selbstkontrolle beim Autofahren werden nicht mehr bei jedem Suchtmittel erwahnt.

The neuroendocrinological profile of roxindole, a dopamine autoreceptor agonist, in schizophrenic patients

Roxindole is a potent autoreceptor-selective dopamine agonist with additional properties as a serotonin reuptake inhibitor and 5-HT1A agonist. In order to get more insight into its mode of action in various psychiatric populations, we evaluated the effects of subchronic roxindole treatment on pituitary and adrenal hormone secretion, i.e. release of prolactin, thyroid stimulating hormone (TSH), growth hormone (GH), luteinizing hormone (LH), and cortisol. Fifteen schizophrenic patients with positive and negative symptomatology, respectively, were treated with roxindole for 28 days. Both basal and thyrotropin releasing hormone (TRH) -induced prolactin secretion diminished significantly to 26.4…

Medikamente zur Behandlung von Hypersomnien

Hypersomniesyndrome konnen seit einigen Jahren aufgrund neuer diagnostischer Moglichkeiten und neuer pharmakotherapeutischer Therapieansatze als eigenes Krankheitsbild aus der Gruppe der Schlafstorungen ausgegrenzt werden. Leitsymptome sind vermehrte Tagesmudigkeit und/oder Schlafattacken, die nicht durch einen gestorten Nachtschlaf erklart werden konnen. Atiologisch liegen den Hypersomniesyndromen uberwiegend organische Ursachen zugrunde. Die diagnostische Abklarung sollte neben der psychiatrischen und korperlichen Untersuchung auch eine Untersuchung im Schlaflabor umfassen. Es konnen folgende Hypersomniesyndrome unterschieden werden: Narkolepsie Schlafapnoesyndrom nachtliche Myoklonien pr…

Acute, subchronic and discontinuation effects of zopiclone on sleep EEG and nocturnal melatonin secretion

Zopiclone is a new short half-life cyclopyrrolone hypnotic agent acting at the GABA-benzodiazepine receptor complex. In order to characterize its pharmacological profile, the effects of 7.5 mg zopiclone on nocturnal melatonin secretion were investigated under polysomnographic control in 11 healthy subjects following acute and subchronic administration as well as after abrupt discontinuation of the drug. No effect of zopiclone on the melatonin plasma levels could be observed. Regarding both total melatonin production and the temporal pattern of melatonin secretion during the night, there was no difference between placebo baseline condition, acute and subchronic administration, and discontinu…

IMPROVEMENT OF PICTURE RECALL BY REPETITION IN PATIENTS WITH DEMENTIA OF ALZHEIMER TYPE

The evidence for positive effects of repetition on recall performance in patients with dementia of Alzheimer type is equivocal. This may be due to the difference repetition conditions used. The aim of this study was therefore to evaluate the effects of different repetition modes on the improvement of recall performance in demented subjects. Twenty-four patients with Alzheimer type dementia and 24 control subjects with remitted depression were included in the study. Pictures were presented repeatedly using different presentation modes at a constant total presentation time. Free recall was tested repeatedly after different periods of delay (0-8 hours). Immediate and delayed list repetition si…

Syndrome profiles in alcoholism and panic disorder with or without agoraphobia

It is proposed that alcoholism and panic disorder/agoraphobia demonstrate in part common genetic and environmental origins. Shared subthreshold symptom patterns in the parents' generation could confirm the proposed genetic role in alcoholism and panic disorder/agoraphobia, even if the parents do not fulfil the diagnostic criteria for a primary psychiatric diagnosis. This is the first family study of exploratively analyzing subthreshold symptoms in both disorders. The authors investigated families with panic disorder/agoraphobia and/or alcoholism with the Munich-Composite International Diagnostic Interview (M-CIDI). We documented the diagnoses according to Diagnostic and Statistical Manual o…

Dopamine Autoreceptor Agonists in the Treatment of Schizophrenia and Major Depression*

Dopamine autoreceptor agonists reduce the firing rate, synthesis, and release of dopamine in dopaminergic neurons by means of a negative feedback mechanism via stimulation of autoreceptors. Moreover, dopamine autoreceptor agonists are able to stimulate supersensitive but not normosensitive postsynaptic receptors. For dopamine autoreceptor agonists, therapeutic effects by readjustment of excessive or deficient dopaminergic function have been postulated for positive and negative schizophrenic symptomatology as well as for subtypes of depressive disorders. Investigations on the therapeutic effects of autoreceptor-nonselective dopamine agonists in schizophrenia or depression have yielded incons…

Long-Term Effects of the Substituted Benzamide Derivative Amisulpride on Baseline and Stimulated Prolactin Levels

In the present study, we investigated the long-term effects of treatment with amisulpride, a substituted benzamide derivative, as compared with the effects of treatment with flupenthixol, a thioxanthene, on the prolactin levels in schizophrenic patients. After completing 6 weeks of medication with either amisulpride or flupenthixol, the patients entered a long-term maintenance treatment with amisulpride 200–600 mg/day or flupenthixol 5–15 mg/day for a maximum of 12 months with a subsequent drug-free follow-up until month 15. Eighteen initially included patients were still participating in the study at month 6. In the flupenthixol group, only 1 patient treated reached month 12, and none of t…

Effects of yohimbine on sexual experiences and nocturnal penile tumescence and rigidity in erectile dysfunction.

The therapeutic effect of the alpha 2-antagonist yohimbine in erectile dysfunction was studied in a double-blind placebo-controlled design. Thirty-one male patients underwent extensive clinical, urological, and psychiatric diagnosis and were dichotomically classified into an organic and a nonorganic subgroup. Following a 1-week placebo run-in period, patients were randomly assigned to a placebo or a verum group (yohimbine 15 mg daily) for a treatment period of 7 weeks. The Clinical Global Impression (CGI) scale was used as the primary efficacy parameter. Additionally, nocturnal penile tumescence and rigidity (NPTR) were measured. Global assessment of erectile function applying the CGI scale…

Drug combination treatment in acute and subacute states of schizophrenia and schizoaffective disorder

Subchronic Effects of Olanzapine on Sleep EEG in Schizophrenic Patients with Predominantly Negative Symptoms

Background It is well known that sleep disturbance is an integral symptom of schizophrenia. In recent studies, a deficit of delta sleep has been observed in schizophrenic patients. Antipsychotic drugs with serotonin (5-HT2) receptor-antagonistic properties are considered to have delta sleep promoting effects. We have investigated the effects of subchronic olanzapine treatment on sleep EEG in schizophrenic patients. Methods The effects of administration of olanzapine (15 to 20 mg) on sleep were studied for four weeks in 10 male, drug-free patients suffering from schizophrenia with predominantly negative symptoms. Conventional sleep EEG parameters were investigated at baseline and after treat…

Medikamente zur Phasenprophylaxe affektiver Psychosen

Die Lithiumprophylaxe ist der entscheidende Fortschritt in der Behandlung affektiver Psychosen seit Entdeckung der Antidepressiva. Lithiumsalze vermogen bei langfristiger Anwendung nicht nur depressive und manische Phasen, sondern auch die phasenhaften Manifestationen schizoaffektiver Psychosen zu kupieren oder zumindest in der Intensitat abzuschwachen. Die Intervalle zwischen den einzelnen Phasen werden unter Lithiummedikation anfangs langer, bis der Rezidivschutz um so deutlicher hervortritt, je langer Lithium zuverlassig eingenommen wird [121]. Lithiumsalze haben auch eine antimanische Wirkung. Die Behandlung der Manie mit Lithiumsalzen wird ebenfalls in diesem Kapitel besprochen, wenngl…

Dopamine autoreceptor agonists in the treatment of schizophrenic disorders

Abstract 1. Synthesis and release of dopamine as well as firing rates of dopaminergic neurons are controlled by stimulation of autoreceptors via a negative feedback regulation, investigations on therapeutic effects of autoreceptor-nonselective dopamine agonists in schizophrenia have yielded inconsistent results. 2. With respect to the dopamine hypothesis of schizophrenia, dopamine autoreceptor agonists have been tested in positive schizophrenic symptomatology in order to reduce the postulated excess of central dopaminergic activity. However, administration of selective dopamine autoreceptor agonists like talipexole or roxindole did not result in a significant improvement of psychopathologic…

CORTICOTROPIN-RELEASING-FACTOR INDUCED PITUITARY-ADRENAL RESPONSE IN DEPRESSION

Extrapyramidal Symptoms and their Relationship to Clinical Efficacy under Perphenazine Treatment*

In order to verify the hypothesis of a strict relationship between clinical improvement and extrapyramidal side-effects, especially micrographia, twenty-two acutely ill schizophrenics were treated with perphenazine in a controlled prospective 28-day trial. During the study period, psychopathometric data, prolactin plasma levels, and handwriting samples were collected. According to the remission criteria fixed before the study began (both BPRS ≤ 25 and GAS ≥ 80 points), 45.5% (10/22) of the total patient sample were classified as treatment responders. Handwriting tests were quantified in 21 patients. "Positive" handwriting results, i. e., a reduction of at least 13% in the overall area of 50…

Mirtazapine compared with paroxetine in major depression.

Background: The aim was to compare the efficacy and tolerability of mirtazapine with those of paroxetine. Method: 275 outpatients with a diagnosis of major depressive episode (DSM-IV) and a score ≥ 18 on the 17-item Hamilton Rating Scale for Depression (HAM-D-17) were randomly assigned to 6 weeks of treatment with mirtazapine (15-45 mg/day) or paroxetine (20-40 mg/day). Efficacy was assessed by the HAM-D-17, Hamilton Rating Scale for Anxiety (HAM-A), and Clinical Global Impressions scales (Severity and Improvement), and analyses were performed on the intent-to-treat sample (127 mirtazapine-treated patients and 123 paroxetine-treated patients). Results: Mean daily doses were 32.7 mg of mirta…

Is There an Advantage to Venlafaxine in Comparison with Other Antidepressants?

The purpose of this article is to compare and contrast the benefits and limitations of antidepressant drugs. Several different classes of antidepressants are available for treatment of major depressive disorder, each with its own benefits and limitations as a result of its pharmacological profile. Tricyclic antidepressants (TCAs) and monoamine oxidase (MAO) inhibitors are effective in a large proportion of depressed patients, but their use is often limited by short- and long-term safety/tolerability problems. Selective serotonin reuptake inhibitors (SSRIs) exhibit comparable efficacy to TCAs in most patients, but may be less effective in certain patients. Additionally, SSRI use may by impac…

Zusammenfassung der empirischen Ergebnisse

Gegenstand der Untersuchung war die Akzeptanz von Psychopharmaka durch die Bevolkerung. Dabei mussen zwei Fragestellungen unterschieden werden. Die erste Frage lautete, weshalb Laien die Anwendung von Psychopharmaka billigen oder misbilligen. Sie stand am Beginn der Untersuchung. Die zweite Frage lautete, weshalb zahlreiche Personen die Anwendung von Psychopharmaka im konkreten Fall ablehnen, obwohl sie sich abstrakt fur ihre Anwendung aussprechen. Ihre besondere Relevanz hat sich im Laufe der Untersuchung ergeben.

Adverse effects associated with the short-term treatment of panic disorder with imipramine, alprazolam or placebo

Summary Side effects play a significant role in the selection of drugs to be used in panic disorder/agoraphobia whose polyphobic symptomatology often includes a suspiciousness about taking drugs and a fear of undesired side effects which may lead to the refusal of treatment. The safety, side effects and patients' acceptance of alprazolam and imipramine versus placebo were evaluated in 1168 subjects with panic disorder/agoraphobia who had been enrolled in the second phase of the Upjohn World Wide Panic Study. Side effects that worsened over baseline to a greater extent with alprazolam than with imipramine and placebo were sedation, fatigue/weakness, memory problems, ataxia and slurred speech…

Amisulpride versus flupentixol in schizophrenia with predominantly positive symptomatology - a double-blind controlled study comparing a selective D 2 -like antagonist to a mixed D 1 -/D 2 -like antagonist

The benzamide amisulpride (ASP) is a selective D2-like dopamine antagonist, while flupentixol (FPX), a thioxanthene, blocks D2-like, D1-like and 5-HT2 receptors. To evaluate efficacy and safety of ASP and to investigate the importance of an additional D1-like antagonism for antipsychotic effects and extrapyramidal tolerability, a randomized double-blind multi-center study versus FPX as reference drug was performed for 6 weeks in 132 patients suffering from acute schizophrenia (DSM-III-R) with predominant positive symptomatology. Doses were initially fixed (ASP: 1000 mg/day; FPX: 25 mg/day) but could be reduced by 40% in case of side effects (mean daily doses: ASP: 956 mg; FPX: 22.6 mg). Int…

Dopamine agonists in schizophrenia: a review.

Although it is unlikely that the different types of course and severity of schizophrenia are caused by one neurochemical abnormality alone, indirect pharmacological evidence still suggests a relative excess of dopaminergic activity being implicated in the pathogenesis of most of the schizophrenic symptoms, e.g. positive symptomatology. Synthesis and release of dopamine as well as firing rates of dopaminergic neurons are controlled by stimulation of autoreceptors via a negative feedback regulation. Investigations on therapeutic effects of autoreceptor-nonselective dopamine agonists in schizophrenia have yielded inconsistent results. Dopamine autoreceptor agonists like pramipexole, roxindole,…

Welche Eigenschaften machen ein Neuroleptikum "atypisch"?

Die Gruppe der “atypischen” Neuroleptika ist keine einheitliche Substanzklasse, sondern sowohl nach pharmakologischen als auch nach klinischen Kriterien sehr heterogen. Die Ubergange von dem prototypischen “atypischen” Neuroleptikum Clozapin zu den “konventionellen” Neuroleptika erscheinen fliesend. Anhand der praklinischen Besonderheiten dieser Substanzen und ihrer Charakteristika in SPECT- und PET-Studien werden die wesentlichen Konzepte diskutiert, die man heute fur die “Atypie” eines Neuroleptikums verantwortlich macht. Dazu zahlen insbesondere der kombinierte Antagonismus von D2-artigen Dopamin- und 5-HT2-Serotoninrezeptoren und die praferentielle Beeinflussung mesolimbischer dopaminer…

Medikamente zur Behandlung von sexuellen Störungen

Folgende Storungen sind im Rahmen der psychiatrischen Pharmakotherapie — weitgehend oder auch nur ansatzweise — zu beeinflussen: Erektionsstorungen bzw. Storungen der sexuellen Erregung bei der Frau, vermindertes sexuelles Verlangen, Ejaculatio praecox, gesteigertes sexuelles Verlangen und substanzinduzierte sexuelle Funktionsstorungen. Fur andere Diagnosen im Bereich sexueller Storungen sind keine pharmakotherapeutischen Studien bekannt.

Neuroendocrine response to antipsychotics: effects of drug type and gender

Abstract Background: To study the influences of drug type and gender on the neuroendocrine response to neuroleptic treatment, we compared the endocrine actions of two neuroleptics with different receptor affinity profiles—a substituted benzamide, amisulpride, a selective D 2 -like dopamine antagonist; and a thioxanthene, flupenthixol, a mixed D 1 /D 2 -like antagonist also blocking serotonin, H 1 , and D 1 receptors—on anterior pituitary hormone secretion in schizophrenic patients (DSM-III-R). Methods: Blood was withdrawn at 15-min intervals to assess basal secretion of prolactin, growth hormone (GH), and thyroid-stimulating hormone (TSH). Four hundred micrograms of thyrotropin-releasing ho…

Risperidone in the Treatment of Disorders with a combined Psychotic and Depressive Syndrome - A Functional Approach

In vitro receptor-binding profiles and in vivo pharmacological studies have shown risperidone to be a potent mixed serotonin-S2 dopamine-D2-like receptor antagonist. While anti-D2 activity may relate to the antipsychotic potency of neuroleptic drugs, an antidepressive efficacy of substances with anti-S2 activity has been suggested. In an open pilot-study, ten patients with schizodepressive disorders or a DSM-III-R diagnosis of psychotic major depressive episodes were treated with risperidone (2-10 mg/d) for six weeks. Weekly psychopathological evaluation was performed, including BPRS, SANS, SAPS, VAS scales, and AIMS and UKU for the assessment of side-effects. Generally, the psychotic syndr…

Conventional and spectral power analysis of all-night sleep EEG after subchronic treatment with paroxetine in healthy male volunteers.

Paroxetine is a selective and potent serotonin reuptake inhibitor with reported antidepressant properties. Since changes in the regular sleeping pattern were described as side effects under treatment with paroxetine, the impact of the drug on the sleep architecture is of major interest. The present study addressed the question of subchronic effects of paroxetine medication (30 mg/day) in eight healthy male volunteers in a double blind, placebo-controlled crossover-design. Conventional sleep EEG parameters and additionally computed spectral power analysis based on FFT of 20-s time epochs in the delta, theta, alpha, beta and gamma frequency range for different sleep stages after 4 weeks of tr…

Effects of brofaremine (CGP 11 305A), a short-acting, reversible, and selective inhibitor of MAO-A on sleep, nocturnal penile tumescence and nocturnal hormonal secretion in three healthy volunteers.

The effects of brofaremine (CGP 11 305A), a short-acting, reversible and selective inhibitor of MAO-A, on sleep, nocturnal penile tumescence (NPT) and hormonal secretion during the night were studied during a long-term trial. Three healthy males underwent sleep-EEG and NPT recordings during consecutive nights (1) under placebo, (2) under stepwise increasing dosages of brofaremine and (3) under placebo after withdrawal. Hormone profiles were sampled during selected nights to analyze the plasma concentration of cortisol, HGH, prolactin, testosterone, LH and FSH. REM sleep was suppressed markedly under 150 mg brofaremine, while stages 1 and 2 increased. In comparison to the effect of irreversi…

Medikamente zur Behandlung von Persönlichkeitsstörungen

Die Therapie von Personlichkeitsstorungen war lange Zeit ausschlieslich eine Domane psychotherapeutischer Interventionen. Mittlerweile existieren einige kontrollierte Studien auch zum Einsatz von Psychopharmaka bei Personlichkeitsstorungen Die Ergebnisse sind aber fur allgemeine Empfehlungen noch zu wenig abgesichert. Die Diagnose von Personlichkeitsstorungen (z. B. Achse-Il-Storungen nach DSM-IV) ist fehleranfallig. Die diagnostischen Kategorien sind uneinheitlich und derzeit noch im Flus; selbst strukturierte Interviews erfahrener Untersucher zeigen nur begrenzte Verlaslichkeit. Wichtig ist die Erfassung und — wenn moglich — Abgrenzung von gleichzeitig vorhandenen Achse-I-Storungen nach D…

The Primary Care Evaluation of Mental Disorders (PRIME-MD), German version: a comparison with the CIDI

There is a need for the development and evaluation of diagnostic instruments suitable for daily use in primary care offices that can improve recognition rates of psychopathology. The objective of this study is the comparison of the German version of the Primary Care Evaluation of Mental Disorders (PRIME-MD), a short structured diagnostic instrument, with the Composite International Diagnostic Interview (CIDI) and to gather some information on the usefulness of the PRIME-MD. Seven hundred and four patients were assessed three times, once using the physician's clinical judgement, subsequently, administering the PRIME-MD, DSM-IV version and finally, with the CIDI. The CIDI was administered on …

Decreased benzodiazepine receptor binding in panic disorder measured by IOMAZENIL-SPECT. A preliminary report.

Single photon emission tomography (SPECT) imaging of the central benzodiazepine receptor (BZr) became possible with the newly developed ligand 123I-IOMAZENIL. The BZr binding was investigated in ten patients with panic disorder (PP) compared to ten epileptic patients (EP). Panic patients had lower IOMAZENIL uptake rates in the frontal, occipital and temporal cortex than EP indicating the involvement of the BZr complex in panic disorder.

Negative symptomatology: psychopharmacological strategies and methodological aspects for drug evaluation

Analysis of sleep EEG microstructure in subchronic paroxetine treatment of healthy subjects

Paroxetine is a selective and potent serotonin reuptake inhibitor and its efficacy for the treatment of depression has been proven. Under acute and subchronical treatment regimens, disturbances of the regular sleep pattern are a reported side effect of the drug. The present study was therefore performed to investigate the impact of subchronic treatment with the selective serotonin reuptake inhibitor paroxetine on the microstructure of the sleep EEG. The study especially addressed the question of subchronic effects of paroxetine medication (30 mg/day) in eight healthy male volunteers in a double blind, placebo-controlled crossover design. Conventional sleep EEG parameters and a spectral powe…

The Calgary Depression Rating Scale for Schizophrenia: development and interrater reliability of a German version (CDSS-G)

A German version of the Calgary Depression Rating Scale for Schizophrenia (CDSS-G) approved by the author of the original scale is presented comprising a semi-structured interview for 9 items to sensitively and specifically assess depression in schizophrenia and related disorders. The process of translation is outlined and the finally derived CDSS-G was investigated with respect to interrater reliability in three studies. To keep comparability with the CDSS source version a standard procedure was used. Two trained raters jointly assessed ten schizophrenic patients (study I). In a second study, videotapes with the CDSS-G were presented to clinically inexperienced raters (study II, N = 14/15)…

Medikamente zur Phasenprophylaxe affektiver Psychosen und zur Behandlung manischer Syndrome

Folgende Substanzgruppen sind in der Therapie manischer Syndrome und/oder in der Phasenprophylaxe affektiver Storungen etabliert (Im folgenden werden die Begriffe affektive bzw. schizoaffektive „Storung“ bzw. „Psychose“ weitgehend synonym verwendet.)

Results of an Open Clinical Trial of Brofaromine (CGP 11 305 A), a Competitive, Selective, and Short-Acting Inhibitor of MAO-A in Major Endogenous Depression

In an open clinical trial the authors treated 18 hospitalized patients suffering from endogenous depression with brofaromine (CGP 11305A), a competitive, selective, and short-acting inhibitor of type A monoamine oxidase (MAO). Four patients were defined as good responders, as they had a final HAMD score of between 0 and 7 points. Four patients were judged as improved, with final HAMD scores of between 8 and 15 points, while the remaining eight patients failed to respond (final HAMD score greater than or equal to 16 points). The major observations were a beneficial influence on drive in most patients, while paranoid symptoms worsened markedly, rendering the substance contraindicated in psych…

Moderate and severe depression

Background: Despite its importance, no distinction between moderate and severe depression using the Montgomery–Asberg Depression Rating Scale (MADRS) based on a direct comparison with the Hamilton Depression Rating Scale (HAMD-17) is available. Methods: HAMD-17 and MADRS ratings from N=40 at least moderately depressed inpatients with major depression (DSM-III-R) were analyzed. Linear and non-parametric correlations were computed and a MADRS cut-off score for severe depression using an HAMD-17 score of at least 28 points as reference was estimated. Results: HAMD-17 and MADRS mean scores were 24.6±4.3 and 32.6±5.0 points, respectively. Linear correlation of both scores was r=0.70 (P<0.0005). …

Standardisierte Verlaufsdokumentation als Grundlage zur Verbesserung der Prozessqualit�t der station�ren psychiatrischen Behandlung

Es wird eine standardisierte Verlaufsdokumentation zur detaillierten Beschreibung und Analyse des Behandlungsprozesses fur stationare psychiatrische Patienten vorgestellt. Im Rahmen eines an der Psychiatrischen Klinik der Universitat Mainz durchgefuhrten Pilotprojekts, zunachst beschrankt auf Patienten mit einem depressiven Syndrom, wurde der mit Hilfe wochentlich durchgefuhrter psychopathologischer Ratings erfasste klinische Zustand zusammen mit den therapeutischen Masnahmen fur die einzelnen Patienten im Zeitverlauf abgebildet. Es hat sich gezeigt, dass die Visualisierung des Behandlungsprozesses die klinische Arbeit unterstutzen und die Anwendung von Therapiestandards bei klinischen Ents…

Recurrent brief depression in general practice. Clinical features, comorbidity with other disorders, and need for treatment.

This study tested the clinical validity of the new diagnostic entity "recurrent brief depression" (RBD) in 300 general practice patients who participated in the WHO study on "Psychological Problems in Primary Care." Patients with current RBD reported of episodes major depression more often than did a comparison group of nondepressed general practice patients: however, the majority of RBD patients had not received a diagnostic of any well-established affective disorder during the last 12 months. RBD patients (without MDE) did not suffer more frequently from dysthymia, from nonaffective psychiatric disorders, or from somatic disorders. However, RBD was associated with a higher percentage of p…

Response to treatment in minor and major depression: results of a double-blind comparative study with paroxetine and maprotiline.

Several concepts of minor depression in the sense of acute but less severe symptomatology than major depression have been proposed in the literature, but currently none of them is generally accepted. For the treatment of these conditions, only few recommendations based on empirical data are available. We conducted a randomized double-blind multicentre study in depressed outpatients comparing paroxetine and maprotiline in both patients with minor (n = 245) and major depression (n = 298). For the diagnosis, Research Diagnostic Criteria were used in a modified version. Two response criteria were applied: a reduction of 50% or more in total HAMD-17 scores from baseline (criterion 1), and a redu…

Effects of corticotropin-releasing hormone on respiratory parameters during sleep in normal men.

Corticotropin-releasing hormone (CRH) is well-known to be a centrally acting respiratory stimulant after systemic application both in healthy subjects and in patients suffering from respiratory failure. In order to study the effects of CRH on sleep EEG and respiratory parameters during sleep, 14 healthy male volunteers were investigated in a single-blind placebo controlled design. After an adaptation night, polysomnography was performed during two successive nights between 23.00 hrs. and 7.00 hrs. During one night placebo was applied, on the other 50 μg ovine CRH was administered intravenously as a bolus every hour from 0.00 hrs. to 6.00 hrs. For the assessment of respiration, blood oxygen …

Ergebnisse der Mainzer Studie

Die Ergebnisse werden in mehreren Schritten vorgelegt. Im ersten Schritt werden — gestutzt auf die Bevolkerungsumfrage — die Ansichten der Bevolkerung zur Behandlung von Krankheiten sowie zur Anwendung von Psychopharmaka dargestellt (4.2). Dies fuhrt zur Identifikation von funf Personentypen und zur Entwicklung von zwei Fragestellungen: Was sind die Ursachen des Widerstandes gegen Psychopharmaka, und was sind die Ursachen widerspruchlicher Ansichten? Im Anschlus daran wird gezeigt, auf welche Informationsquellen sich die Bevolkerung stutzt (4.3). Dabei werden eigene Erfahrungen, Kontakte zu Kranken, Gesprache uber Kranke und Medienberichte unterschieden.

Occupancy of striatal D 2 -like dopamine receptors after treatment with the sigma ligand EMD 57445, a putative atypical antipsychotic

Rationale: EMD 57445 (panamesine) is a high affinity sigma ligand with the profile of an atypical antipsychotic in animal studies. It has been reported recently to have antipsychotic activity in schizophrenia. However, its metabolite, EMD 59983, binds also to D2 and D3 dopamine (DA) receptors. Objectives: The aim of this study was to test, using single photon emission computed tomography (SPECT) and [123I]iodobenzamide (IBZM) as the radiotracer, whether EMD 59983 would pass the blood-brain barrier and to what extent it would contribute to the effects of EMD 57445 in schizophrenia. Methods: Two IBZM SPECT-scans were performed in five neuroleptic-free schizophrenic patients (DSM IV), one befo…

Avoidance behaviour: A predictor of the efficacy of pharmacotherapy in panic disorder?

The impact of the avoidance behaviour on the psychopharmacological treatment of panic disorder was explored in the Cross National Collaborative Panic Study (n = 1134 patients); in this double blind randomized trial alprazolam, imipramine and placebo were compared during an 8-week treatment period. Patients with extensive avoidance behaviour (agoraphobia) had the most profit from the active drugs. Counter expectancy these specific drug effects were most pronounced in avoidance behaviour. Active drugs (in particular imipramine) were especially more effective than placebo if the patients presented with associated avoidance behaviour. The results suggest that agoraphobia defines more a particul…

Sleep investigations in erectile dysfunction

Abstract Regarding the aetiology of erectile dysfunction, beside numerous organic causes in many cases psychological factors play an important role. The pathophysiological mechanisms underlying the so-called psychogenic erectile dysfunction are not yet understood. Based on a neurobiological approach to psychogenic erectile dysfunction, polysomnographic investigations were carried out with the aim of identifying possible alterations of the sleep EEG. 24 male patients with psychogenic erectile dysfunction without detectable organic factors or other mental disorders were studied in the sleep laboratory, as well as an age-matched control group without sexual dysfunctions. Beside a reduction of …

Minimum effective dose for antidepressants - an obligatory requirement for antidepressant drug evaluation?

Extensive clinical trials are required for registration and approval of new antidepressants in most countries including the requirement that a minimal effective dose should be determined. The rationale for this requirement is to avoid the use of unnecessarily high doses. The implication is that for every antidepressant, a dose exists that serves as a threshold, below which all doses are not effective or are clearly less effective in treating a major depressive episode. Dose titration and fixed dose studies are used to determine the minimal effective dose, but both strategies have limitations and often do not allow definite establishment of a clear-cut minimal effective dose. The effort of e…

Risperidone Versus Haloperidol and Amitriptyline in the Treatment of Patients With a Combined Psychotic and Depressive Syndrome

In a multicenter, double-blind, parallel group trial, the efficacy of risperidone (RIS) was compared with a combination of haloperidol and amitriptyline (HAL/AMI) over 6 weeks in patients with coexisting psychotic and depressive symptoms with either a schizoaffective disorder, depressive type, a major depression with psychotic features, or a nonresidual schizophrenia with major depressive symptoms according to DSM-III-R criteria. A total of 123 patients (62 RIS; 61 HAL/AMI) were included; the mean daily dosage at endpoint was 6.9 mg RIS versus 9 mg HAL combined with 180 mg AMI. Efficacy results for those 98 patients (47 RIS; 51 HAL/AMI) who completed at least 3 weeks of double-blind treatme…

Pharmakotherapie Psychiatrischer Akutsituationen

Die Einfuhrung der Psychopharmaka hat die Voraussetzungen dafur geschaffen, das heute nicht nur der Psychiater, sondern jeder Arzt in der Lage sein sollte, psychiatrische Akutsituationen zu beherrschen. Das ist v. a. deswegen vorteilhaft, weil es oft nicht die psychiatrischen Kliniken, sondern die Allgemeinkrankenhauser und die arztlichen Praxen sind, in denen schnelles therapeutisches Handeln in psychiatrischen Akutsituationen gefordert wird. Ist es in dieser Hinsicht durch die Anwendungsmoglichkeiten der Psychopharmaka zu einer beachtlichen Ausweitung akuter psychiatrischer Masnahmen gekommen, so darf nicht ubersehen werden, das die Anwendung von Psychopharmaka auch bisher unbekannte Ther…

Psychopharmaka und Fahrtüchtigkeit

Der Behandlungserfolg bei neuropsychiatrischen Erkrankungen wird zunehmend nicht nur an der Verbesserung der psychopathologischen Symptomatik, sondern auch an den Ergebnissen hinsichtlich Lebensqualitat, sozialem Funktionsniveau und kognitiven Fahigkeiten, bis hin zur berufl ichen Wiedereingliederung, gemessen. Diese sogenannten Patienten-relevanten Endpunkte finden bei der Bewertung der Effektivitat von pharmakologischen Behandlungsansatzen als wichtige Zielparameter zunehmend an Bedeutung.

The cardiac anxiety syndrome ? a subtype of panic attacks

Cardiac anxiety syndrome and the diagnosis of cardiac neurosis respectively are characterized by panic attacks. Panic attacks are the core syndrome of a validated anxiety disorder (panic disorder). The purpose of this study was to investigate if the cardiac anxiety syndrome represents a separate disorder or if it is only a subtype of panic attacks. In a sample of 122 patients with panic attacks, all patients with a cardiac anxiety syndrome were selected (n = 31). Furthermore, parallel to this group--matched in the variables age and sex--a second group of patients with no cardiac anxiety syndrome was selected. There were no significant differences in course; in clinical phenomenology, patien…

Visual memory in Alzheimer patients: effects of practice, retention interval and severity of cognitive decline.

The study was aimed at estimating the effect size of practice, retention interval and dementia severity on free recall performance in Alzheimer patients. Patients met DSM-III-R criteria for dementia of Alzheimer type. Different picture sets were presented on 4 days. The forgetting curves on different days were compared using ANOVA for repeated measurements. Practice had a minor, but significant negative effect on recall performance explaining 1% of the variance in recall performance. The retention interval varied between zero and 24 h explaining 23% of the total variance. Dementia severity explained 52% of the variance. For the development of memory improvement strategies in Alzheimer patie…

Subchronic Antidepressant Treatment with Venlafaxine or Imipramine and Effects on Blood Pressure and Heart Rate: Assessment by Automatic 24-Hour Monitoring

Venlafaxine is a new nontricyclic antidepressant inhibiting the reuptake of serotonin, noradrenaline, and, to a lesser extent, dopamine without antagonizing cholinergic, histaminergic, or noradrenergic receptors. Significantly, in a first placebo-controlled safety and efficacy study, high doses of venlafaxine increased blood pressure in some study subjects. In order to investigate further the effect of subchronic antidepressant drug treatment on blood pressure and heart rate, the effects of a conventional tricyclic (imipramine) and a structurally different phenethylamine antidepressant (venlafaxine) were compared. Sixteen inpatients with major depression (melancholic type) were treated for …

Pharmakokinetik und Arzneimittelinteraktionen

Hintergrunde zur Pharmakokinetik und zu Interaktionen werden dargestellt. Alle in der Psychopharmakotherapie relevanten Wechselwirkungen werden in Anhang INT und Anhang SUB ausfuhrlich so aufgefuhrt, dass der Leser die einzelnen Risiken selbst nachvollziehen kann. Der Bezug zu den Angaben bei den einzelnen Praparaten wird hergestellt.

Psychopharmacological Drugs as Represented in the Press: Results of Systematic Analysis of Newspapers and Popular Magazines

The representation of mental diseases and psychopharmacological drugs in the media, especially in the press, is thought to be of great impact on people's opinions on the subject. During the course of one year, all articles about psychopharmacological drugs and cardiac drugs published in nineteen German newspapers were collected. All statements, together with related aspects, reasons for prescription, individual details of the patient, effects and side-effects, were registered and classified according to a key. The results show that, in contrast to 13% of the articles about cardiac drugs, half of the reports about psychopharmacological drugs deal primarily with the problems of side-effects a…

A comparison study of moclobemide and doxepin in major depression with special reference to effects on sexual dysfunction

A double-blind parallel-group comparison study of moclobemide versus doxepin in 237 patients with major depression confirmed that moclobemide was equal in efficacy and better tolerated than doxepin. It was less sedating and caused fewer anticholinergic adverse events as measured by the UKU side-effect rating scale. Unexpectedly, moclobemide therapy more often than doxepin resulted in increased sexual desire. An exploratory analysis of UKU-measured symptoms of impaired sexual function prior to commencement of the study revealed that moclobemide more often than doxepin led to an improvement of reduced libido and impaired erection, ejaculation and orgasm. This finding is compatible with the as…

Continuity and discontinuity of affective disorders and schizophrenia. Results of a controlled family study.

Background: It is widely acknowledged that the genetic diatheses for schizophrenia and affective disorders are independent. However, there are increasing doubts about this classic view, and empirical evidence for a dichotomy of these two prototypes of functional psychoses is limited. A controlled family study of consecutive admissions was conducted to determine whether familial risks for schizophrenic (SCZ) and affective disorders were independent or overlapping. Methods: Index probands met Research Diagnostic Criteria for SCZ (n=146), schizoaffective (SA [n=115]), bipolar (BP [n=80]), or unipolar major depressive (UP [n=184])disorder. Comparison probands met Research Diagnostic Criteria fo…

Dimensional Classification as an Instrument for Biological Research in Endogenous Depression

Biological psychiatry needs highly reliable classifications capable of supplying research with homogeneous groups of patients. Operational diagnoses (OPD abbreviated) have been introduced to serve this aim. At present, research in endogenous depression can choose among more than ten different operational diagnoses, all purporting to be valid for diagnosing endogenous depression. Eight of these operational diagnoses are listed in Table 1.

Differential effects of the enantiomers R(-) and S(+) oxaprotiline on major endogenous depression, the sleep EEG and neuroendocrine secretion: studies on depressed patients and normal controls.

The effects of the optically active enantiomers of oxaprotiline (OXP), R(-) OXP and S(+) OXP, on depressive symptomatology and the sleep EEG were investigated in two separate exploratory studies. In addition, the neuroendocrine profile of both compounds was characterized in normal controls. In the patients treated with a daily oral dose of 150 mg S(+) OXP we found a Hamilton depression score that decreased from 29.1 +/- 1.8 (SEM) on day 0 to 14.7 +/- 3.2 on day 28 (P0.01). Six patients were judged to be full responders (HAMD score 0-7 points), three were improved (HAMD score 8-15) and four were nonresponders (HAMD score16). The therapeutic effect achieved with 150 mg R(-) OXP daily was less…

Serotonin dysfunction syndromes: a functional common denominator for classification of depression, anxiety, and obsessive-compulsive disorder.

Demenzscreening im klinischen Alltag

Dementia-screening in clinical routine requires short, sensitive and specific tools. A number of standardized instruments are available for this purpose. The present study analysed the relationship between size of three exemplary dementia-screening tests and their diagnostic accuracy. The Mini-Mental-State-Examination (MMSE), the Structured Interview for the Diagnosis of Dementia of the Alzheimer-type, Multiinfarct Dementia and Dementias of other Aetiologies according to ICD-10 and DSM-III-R (SIDAM) and the Alzheimer's Disease Assessment Scale (ADAS) were applied to 71 patients with dementia of the Alzheimer-type and 73 non-demented controls. A ROC-analysis revealed that neither SIDAM nor A…

Early improvement under mirtazapine and paroxetine predicts later stable response and remission with high sensitivity in patients with major depression

OBJECTIVE Current clinical knowledge holds that antidepressants have a delayed onset of efficacy. However, the delayed onset hypothesis has been questioned recently by survival analytical approaches. We aimed to test whether early improvement under antidepressant treatment is a clinically useful predictor of later stable response and remission. METHOD We analyzed data from a randomized double-blind controlled trial with mirtazapine and paroxetine in patients with major depression (DSM-IV). Improvement was defined as a 17-item Hamilton Rating Scale for Depression (HAM-D-17) score reduction of > or = 20%. Stable response was defined as > or = 50% HAM-D-17 score reduction at week 4 and week 6,…

Public Opinion on Psychotropic Drugs: An Analysis of the Factors Influencing Acceptance or Rejection

Widespread negative attitudes and irrational beliefs about psychotropic drugs held by the public affect patients' treatment compliance. This study was an attempt to identify factors influencing people's acceptance or rejection of psychotropic drugs. An opinion poll was taken by a representative group of 2,176 adults in Germany. In addition to their attitudes toward psychotropic and cardiac drugs and their ratings of perceived risks and benefits, they were also asked about their drug knowledge, their fear of losing self-control, and their fundamental political values. Our results show that even for the treatment of severe mental disease, psychotropic drugs generally are not well accepted com…

Andere Pharmaka für psychiatrische Indikationen

Drei z. Z. noch nicht klassifizierte Pharmaka, die in der psychiatrischen Pharmakotherapie eine wichtige Bedeutung haben, sollen hier ausfuhrlich beschrieben werden: Clomethiazol (Distraneurin) Cyproteronazetat (Androcur) Disulfifram (Antabus)

Plasma levels of benperidol, prolactin, and homovanillic acid after intravenous versus two different kinds of oral application of the neuroleptic in schizophrenic patients

Plasma levels of prolactin (PRL) and the butyrophenone neuroleptic benperidol (BPD) were closely followed 0 to 48 h after acute application of 6 mg BPD as intravenous injection, orally as liquid, and orally as tablets in 12 schizophrenic patients using a partially randomized cross over design. Drug concentrations showed application specific pharmacokinetic behavior with complete elimination within 48 h. All three applications led to a biphasic PRL response with pronounced initial plasma PRL peaks returning to baseline levels within 48 h. The results suggest that after acute neuroleptic challenge BPD plasma levels as low as 2-3 ng/ml can be sufficient for complete depletion of pituitary PRL …

Theoretische Annahmen, Untersuchungsanlage und Hauptbefunde

Psychische Erkrankungen werden im Unterschied zu korperlichen Erkrankungen als Bedrohung bzw. Verlust der Personlichkeit betrachtet, weil sie den Patienten als ganzen und nicht nur seinen Korper betreffen. Dadurch vernichten oder gefahrden sie die Identitat der Betroffenen, ihr Selbstwertgefuhl und ihre Selbstkontrolle. Der Betroffene hat nicht nur eine Krankheit, er wird von ihr besessen. Die gleichen oder zumindest ahnliche Bedrohungen gehen auch von den Psychopharmaka aus: Auch sie stellen einen Eingriff in die Identitat der Anwender dar, die sich ihren Wirkungen ausliefern. Das dies auch auf andere Medikamente zutrifft, spielt dabei keine Rolle, weil diese tatsachlich oder scheinbar die…

Lower self-reported depression in patients with erectile dysfunction after treatment with sildenafil

Abstract Background: Depressive symptoms in men with erectile dysfunction (ED) may improve under successful ED treatment. Self-reported depressive symptoms were compared in men with ED after sildenafil treatment to a group of untreated patients. Methods: In an open study, self-reported depressive symptoms of 54 men after successful treatment with sildenafil (>4 weeks) and 51 men awaiting ED treatment were investigated with the Center of Epidemiologic Studies–Depression Scale (CES–D). CES–D items were subjected to an exploratory factor analysis and group differences in CES–D items and factors were analyzed. Results: Groups were comparable with respect to demographic characteristics and illne…

Differentiation between major and minor depression

Though the concept of Major Depression was generated by clinicians using depressed inpatients as models, a polydiagnostic study in 600 psychiatric inpatients with heterogenous psychological disturbances revealed that all six competing operational definitions of Major Depression (including DSM-III-R and ICD-10) were too restrictive to serve as a general concept of depression. Another polydiagnostic study in 500 primary care outpatients showed that more than two-thirds of all non-chronic depressed cases were below the severity threshold of Major Depression: these patients are classified as Depression Not Otherwise Specified (NOS) by DSM-III-R. Loosening of the over-restrictive time criteria w…

Medikamente zur Behandlung von Eßstörungen

Unter Esstorungen versteht man persistierende Storungen des Esverhaltens, die zu einem veranderten Konsum oder einer Malabsorption von Nahrung fuhren und damit die korperliche Gesundheit und die psychosoziale Funktionsfahigkeit beeintrachtigen. Ein Mas fur das Korpergewicht ist der sog. Body-mass-Index (BMI, Quotient aus: Korpergewicht in kg zu Quadrat der Korpergrose in m2). Es gibt 4 Esstorungen, die neben der internistischen Basistherapie auch im Rahmen der psychiatrischen Pharmakotherapie behandelt werden konnen: Anorexia nervosa Bulimia nervosa „Binge-eating-Storung“ Adipositas. Die Behandlung der Anorexia nervosa, Bulimia nervosa und der „Binge-eating-Storung“ besteht indikationsabhan…

Benzodiazepines for catatonic symptoms, stupor, and mutism.

A double-blind study comparing paroxetine and maprotiline in depressed outpatients.

A double-blind multicenter randomized parallel group study comparing paroxetine and maprotiline was carried out in a total of 544 outpatients. Included were patients with varying degrees of severity of depressive symptoms who fulfilled modified RDC criteria for either Minor or Major Depression and showed a HAMD-17 score of > or = 13. No concomitant benzodiazepine treatment was allowed. Duration of treatment was 6 weeks, after an initial wash-out period. Doses were fixed during the first 3 weeks of treatment, patients receiving either 20 mg paroxetine or 100 mg maprotiline daily. An option for dose escalation was provided for insufficient responders after 3 weeks. The weekly assessments comp…