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Fulda S, Beitinger PA, Wehrle R, Himmerich H, Pollmächer T, Wetter TC. Increased prevalence of restless legs syndrome in narcoleptic patients. PHARMACOPSYCHIATRY 2007. [DOI: 10.1055/s-2007-991837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Lattova Z, Maurovich-Horvat E, Nia S, Pollmächer T. Prevalence of Restless Leg Syndrom in Psychiatric Population. PHARMACOPSYCHIATRY 2007. [DOI: 10.1055/s-2007-991840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Beitinger PA, Wehrle R, Fulda S, Himmerich H, Pollmächer T, Wetter TC. Metabolic alterations in patients with narcolepsy. Exp Clin Endocrinol Diabetes 2007. [DOI: 10.1055/s-2007-972383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Pollmächer T. PS05.1 Sleep and the immune system. Sleep Med 2007. [DOI: 10.1016/s1389-9457(07)70022-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Ehrenreich H, Hinze-Selch D, Stawicki S, Aust C, Knolle-Veentjer S, Wilms S, Heinz G, Erdag S, Jahn H, Degner D, Ritzen M, Mohr A, Wagner M, Schneider U, Bohn M, Huber M, Czernik A, Pollmächer T, Maier W, Sirén AL, Klosterkötter J, Falkai P, Rüther E, Aldenhoff JB, Krampe H. Improvement of cognitive functions in chronic schizophrenic patients by recombinant human erythropoietin. Mol Psychiatry 2007; 12:206-20. [PMID: 17033631 DOI: 10.1038/sj.mp.4001907] [Citation(s) in RCA: 186] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Schizophrenia is increasingly recognized as a neurodevelopmental disease with an additional degenerative component, comprising cognitive decline and loss of cortical gray matter. We hypothesized that a neuroprotective/neurotrophic add-on strategy, recombinant human erythropoietin (rhEPO) in addition to stable antipsychotic medication, may be able to improve cognitive function even in chronic schizophrenic patients. Therefore, we designed a double-blind, placebo-controlled, randomized, multicenter, proof-of-principle (phase II) study. This study had a total duration of 2 years and an individual duration of 12 weeks with an additional safety visit at 16 weeks. Chronic schizophrenic men (N=39) with defined cognitive deficit (>or=1 s.d. below normal in the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS)), stable medication and disease state, were treated for 3 months with a weekly short (15 min) intravenous infusion of 40,000 IU rhEPO (N=20) or placebo (N=19). Main outcome measure was schizophrenia-relevant cognitive function at week 12. The neuropsychological test set (RBANS subtests delayed memory, language-semantic fluency, attention and Wisconsin Card Sorting Test (WCST-64) - perseverative errors) was applied over 2 days at baseline, 2 weeks, 4 weeks and 12 weeks of study participation. Both placebo and rhEPO patients improved in all evaluated categories. Patients receiving rhEPO showed a significant improvement over placebo patients in schizophrenia-related cognitive performance (RBANS subtests, WCST-64), but no effects on psychopathology or social functioning. Also, a significant decline in serum levels of S100B, a glial damage marker, occurred upon rhEPO. The fact that rhEPO is the first compound to exert a selective and lasting beneficial effect on cognition should encourage new treatment strategies for schizophrenia.
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Pollmächer T. S08.C Experimental endotoxinemia: a powerful tool to study sleep-immune system interactions in humans. Sleep Med 2007. [DOI: 10.1016/s1389-9457(07)70042-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Ehrenreich H, Hinze-Selch D, Stawicki S, Aust C, Knolle-Veentjer S, Wilms S, Heinz G, Erdag S, Jahn H, Degner D, Ritzen M, Mohr A, Wagner M, Schneider U, Bohn M, Huber M, Czernik A, Pollmächer T, Maier W, Sirén AL, Klosterkötter J, Falkai P, Rüther E, Aldenhoff J, Krampe H. Hemoglobin-Independent Organ Protection by EPO in Humans: Amelioration of Cognitive Loss in Chronic Schizophrenia. J Am Soc Nephrol 2007. [DOI: 10.1681/asn.2006111278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Billiard M, Bassetti C, Dauvilliers Y, Dolenc-Groselj L, Lammers GJ, Mayer G, Pollmächer T, Reading P, Sonka K. EFNS guidelines on management of narcolepsy. Eur J Neurol 2006; 13:1035-48. [PMID: 16987156 DOI: 10.1111/j.1468-1331.2006.01473.x] [Citation(s) in RCA: 138] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Management of narcolepsy with or without cataplexy relies on several classes of drugs, namely stimulants for excessive daytime sleepiness and irresistible episodes of sleep, antidepressants for cataplexy and hypnosedative drugs for disturbed nocturnal sleep. In addition, behavioral measures can be of notable value. Guidelines on the management of narcolepsy have already been published. However contemporary guidelines are necessary given the growing use of modafinil to treat excessive daytime sleepiness in Europe within the last 5-10 years, and the decreasing need for amphetamines and amphetamine-like stimulants; the extensive use of new antidepressants in the treatment of cataplexy, apart from consistent randomized placebo-controlled clinical trials; and the present re-emergence of gamma-hydroxybutyrate under the name sodium oxybate, as a treatment of all major symptoms of narcolepsy. A task force composed of the leading specialists of narcolepsy in Europe has been appointed. This task force conducted an extensive review of pharmacological and behavioral trials available in the literature. All trials were analyzed according to their class evidence. Recommendations concerning the treatment of each single symptom of narcolepsy as well as general recommendations were made. Modafinil is the first-line pharmacological treatment of excessive daytime sleepiness and irresistible episodes of sleep in association with behavioral measures. However, based on several large randomized controlled trials showing the activity of sodium oxybate, not only on cataplexy but also on excessive daytime sleepiness and irresistible episodes of sleep, there is a growing practice in the USA to use it for the later indications. Given the availability of modafinil and methylphenidate, and the forseen registration of sodium oxybate for narcolepsy (including excessive daytime sleepiness, cataplexy, disturbed nocturnal sleep) in Europe, the place of other compounds will become fairly limited. Since its recent registration cataplexy sodium oxybate has now become the first-line treatment of cataplexy. Second-line treatments are antidepressants, either tricyclics or newer antidepressants, the later being increasingly used these past years despite few or no randomized placebo-controlled clinical trials. As for disturbed nocturnal sleep the best option is still hypnotics until sodium oxybate is registered for narcolepsy. The treatments used for narcolepsy, either pharmacological or behavioral, are diverse. However the quality of the published clinical evidences supporting them varies widely and studies comparing the efficacy of different substances are lacking. Several treatments are used on an empirical basis, specially antidepressants for cataplexy, due to the fact that these medications are already used widely in depressed patients, leaving little motivation from the manufacturers to investigate efficacy in relatively rare indications. Others, in particular the more recently developed substances, such as modafinil or sodium oxybate, are evaluated in large randomized placebo-controlled trials. Our objective was to reinforce the use of those drugs evaluated in randomized placebo-controlled trials and to reach a consensus, as much as possible, on the use of other available medications.
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Schuld A, Birkmann S, Beitinger P, Haack M, Kraus T, Dalal MA, Holsboer F, Pollmächer T. Low doses of dexamethasone affect immune parameters in the absence of immunological stimulation. Exp Clin Endocrinol Diabetes 2006; 114:322-8. [PMID: 16868892 DOI: 10.1055/s-2006-924255] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Recent findings suggest an important role of subtle changes in the plasma levels of inflammatory cytokines within the brain-immune interplay. It is unclear how such changes are regulated in the absence of acute inflammatory or infectious stimuli. Endocrine systems are a good candidate, because innate immunity and the hypothalamo-pituitary-adrenal (HPA)-system are closely related: glucocorticoids have immunosuppressive properties and modulate cytokine release from stimulated mononuclear blood cells in vitro and the immune response in vivo, but it still remains unclear, whether they also modulate circulating cytokine levels in the absence of immunological stimuli. We measured the influence of 1.5 or 3.0 mg dexamethasone (DEX) per os at 09:00 or 21:00 hours on body temperature, cortisol plasma levels, differential white blood cell counts, and cytokine plasma levels in 40 healthy male volunteers using a double-blind, placebo-controlled study design. In addition to significant morning-evening differences in tympanic temperature and several immune parameters, we found that DEX-intake significantly increased tympanic temperature, decreased cortisol plasma levels, altered differential white blood cell counts and induced changes in unstimulated plasma cytokine levels. Whereas the levels of TNF-alpha and sTNF-R p75 were reduced, the levels of sTNF-R p55 increased after a transient decrease.
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Himmerich H, Pollmächer T, Schaaf L. [Affective disorders and diabetes]. MMW Fortschr Med 2006; 148:37-40. [PMID: 16875377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Affective disorders increase the risk for the occurrence of type 2 diabetes, and the presence of type 1 or type 2 diabetes may contribute to the development of an affective disorder. Certain antidepressants and behavioral therapy seem to improve blood sugar levels in patients suffering from depression and type 2 diabetes, although these antidepressants may lead to weight gain. However, some antipsychotics unfavorably affect weight development and carbohydrate metabolism. In diabetic patients, the physician should be particularly alert to affective symptoms, and in mentally ill patients, he should look out for metabolic changes that may be caused by diabetogenic psychopharmacological medication.
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Pollmächer T. European sleep medicine is airborne. J Sleep Res 2006; 15:230. [PMID: 16704579 DOI: 10.1111/j.1365-2869.2006.00526.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Künzel HE, Schuld A, Pollmächer T. [Chronic pain and depression]. VERSICHERUNGSMEDIZIN 2006; 58:67-72. [PMID: 16800143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Pain and depression are a severe burden on the patient and on the health system. The diseases have many common pathophysiological aspects and a high level of comorbidity. In this article the different diagnostic tools and options for the treatment of pain and depression are described. Prognostic factors for the course of the diseases are given. Documentation of the disease is important for treatment, for questions in the field of healthcare and in order to furnish a medical opinion. Important diagnostic assessments and differential diagnoses are described.
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Kaufmann C, Wehrle R, Wetter TC, Holsboer F, Auer DP, Pollmächer T, Czisch M. Brain activation and hypothalamic functional connectivity during human non-rapid eye movement sleep: an EEG/fMRI study. ACTA ACUST UNITED AC 2005; 129:655-67. [PMID: 16339798 DOI: 10.1093/brain/awh686] [Citation(s) in RCA: 188] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Regional differences in sleep EEG dynamics indicate that sleep-related brain activity involves local brain processes with sleep stage specific activity patterns of neuronal populations. Macroscopically, it is not fully understood which cerebral brain regions are involved in the successive discontinuation of wakefulness. We simultaneously used EEG and functional MRI on 9 subjects (6 female: mean = 24.1 years, 3 male: mean = 26.0 years) and analyzed local blood oxygenation level dependent signal changes linked to the transition from wakefulness to different non-rapid eye movement (NREM) sleep stages (according to Rechtschaffen and Kales) of the first sleep cycles after 36 h of total sleep deprivation. Several brain regions throughout the cortex, the limbic lobe, the thalamus, the caudate nucleus, as well as midbrain structures, such as the mammillary body/hypothalamus, showed reduced activity during NREM sleep across all sleep stages. Additionally, we found deactivation patterns specific to NREM sleep stages compared with wakefulness suggesting that a synchronized sleeping state can be established only if these regions interact in a well-balanced way. Sleep stage 2, which is usually linked to the loss of self-conscious awareness, is associated with signal decreases comprising thalamic and hypothalamic regions, the cingulate cortex, the right insula and adjacent regions of the temporal lobe, the inferior parietal lobule and the inferior/middle frontal gyri. The hypothalamic region known to be of particular importance in the regulation of the sleep-wake cycle shows specific temporally correlated network activity with the cortex while the system is in the sleeping state, but not during wakefulness. We describe a specific pattern of decreased brain activity during sleep and suggest that this pattern must be synchronized for establishing and maintaining sleep.
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Dzaja A, Schneider HJ, Wehrle R, Stalla GK, Pollmächer T. Plasma ghrelin levels during and after pregnancy. Exp Clin Endocrinol Diabetes 2005. [DOI: 10.1055/s-2005-920473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Himmerich H, Fulda S, Künzel HE, Pfennig A, Dzaja A, Cummings DE, Pollmächer T. Ghrelin plasma levels during psychopharmacological treatment. PHARMACOPSYCHIATRY 2005. [DOI: 10.1055/s-2005-918717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Rathgeb-Fuetsch M, Beer U, Urmann I, Pollmächer T, Schuld A. Cognitive-behavioral therapy of patients with pure and comorbid panic disorder in a hospital setting–a comparison of therapy response. PHARMACOPSYCHIATRY 2005. [DOI: 10.1055/s-2005-918808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Beitinger PA, Dalal MA, Wehrle R, Fulda S, Schuld A, Wetter TC, Pollmächer T. Impaired glucose tolerance in patients with narcolepsy. PHARMACOPSYCHIATRY 2005. [DOI: 10.1055/s-2005-918635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Himmerich H, Fulda S, Schaaf L, Beitinger PA, Schuld A, Pollmächer T. Does antidepressant therapy improve glucose metabolism? PHARMACOPSYCHIATRY 2005. [DOI: 10.1055/s-2005-918715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Reisinger B, Mueller E, Kropp-Hartmann B, Wölflick D, Zimmerer C, Schuld A, Pollmächer T. Metabolic abnormalities in patients with chronic psychiatric disorders receiving long-term psychopharmacological treatment. PHARMACOPSYCHIATRY 2005. [DOI: 10.1055/s-2005-918809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Himmerich H, Binder EB, Künzel HE, Schuld A, Lucae S, Uhr M, Pollmächer T, Holsboer F, Ising M. Successful antidepressant therapy restores the disturbed interplay between TNF-alpha system and HPA axis. PHARMACOPSYCHIATRY 2005. [DOI: 10.1055/s-2005-918716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Wehrle R, Kaufmann C, Wetter TC, Holsboer F, Auer DP, Pollmächer T, Czisch M. Functional neuroanatomical correlates of spectral EEG power during NREM sleep. PHARMACOPSYCHIATRY 2005. [DOI: 10.1055/s-2005-918867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Mueller E, Stöhr K, Weixler C, Kuenzel HE, Schuld A, Pollmächer T. Efficacy of electroconvulsive therapy for depressive disorders in a Bavarian district hospital. PHARMACOPSYCHIATRY 2005. [DOI: 10.1055/s-2005-918785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Nickel T, Sonntag A, Backmund M, Pollmächer T. Depression during therapy with interferon alpha--how long should an antidepressant treatment last? PHARMACOPSYCHIATRY 2005; 38:102-4. [PMID: 15744637 DOI: 10.1055/s-2005-837813] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Although depressive symptoms are well-known side effects of interferon alpha (IFNalpha), it is uncertain if these symptoms decline with the cessation of IFNalpha therapy. We report on a 47-year-old man who, apart from former drug abuse, never had suffered from a psychiatric disorder. However, he had a family history burdened with the suicide of his mother and his twin sister. After a depressive symptomatology during the IFNalpha therapy, which had been tolerably treated by mirtazapine, he committed a suicide attempt six months after the parallel termination of IFNalpha and antidepressant treatment. Two aspects of this case report should be emphasised. First, patients with an increased risk for psychiatric complications of interferon therapy must be followed closely for a depressive symptomatology and treated aggressively if symptoms arise. Second, this case report shows the relapse of depressive symptoms far beyond the end of the interferon treatment. If an antidepressant treatment is necessary during IFNalpha therapy this should not be stopped prematurely with the termination of the interferon medication.
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Künzel HE, Schuld A, Pollmächer T. Sleepwalking associated with reboxetine in a young female patient with major depression--a case report. PHARMACOPSYCHIATRY 2005; 37:307-8. [PMID: 15551201 DOI: 10.1055/s-2004-832692] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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50
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Himmerich H, Kraus T, Pollmächer T. Epidemiology and mechanisms of weight gain induced by psychotropic drugs. PHARMACOPSYCHIATRY 2004. [DOI: 10.1055/s-2003-825377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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