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Schopf K, Schneider S, Meyer AH, Lennertz J, Humbel N, Bürgy NM, Wyssen A, Biedert E, Isenschmid B, Milos G, Claussen M, Trier S, Whinyates K, Adolph D, Teismann T, Margraf J, Assion HJ, Überberg B, Juckel G, Müller J, Klauke B, Munsch S. Eating disorder treatment in routine clinical care: A descriptive study examining treatment characteristics and short-term treatment outcomes among patients with anorexia nervosa and bulimia nervosa in Germany and Switzerland. PLoS One 2023; 18:e0280402. [PMID: 37390075 PMCID: PMC10313003 DOI: 10.1371/journal.pone.0280402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 12/27/2022] [Indexed: 07/02/2023] Open
Abstract
This descriptive study examined patient characteristics, treatment characteristics, and short-term outcomes among patients with Anorexia Nervosa (AN) and Bulimia Nervosa (BN) in routine clinical care. Results for patients receiving full-time treatment were contrasted with results for patients receiving ambulatory treatment. Data of a clinical trial including 116 female patients (18-35 years) diagnosed with AN or BN were subjected to secondary analyses. Patients were voluntarily admitted to one of nine treatment facilities in Germany and Switzerland. Patients received cognitive-behavioral interventions in accordance with the national clinical practice guidelines for the treatment of EDs under routine clinical care conditions, either as full-time treatment or ambulatory treatment. Assessments were conducted after admission and three months later. Assessments included a clinician-administered diagnostic interview (DIPS), body-mass-index (BMI), ED pathology (EDE-Q), depressive symptoms (BDI-II), symptoms of anxiety (BAI), and somatic symptoms (SOMS). Findings showed that treatment intensity differed largely by setting and site, partly due to national health insurance policies. Patients with AN in full-time treatment received on average 65 psychotherapeutic sessions and patients with BN in full-time treatment received on average 38 sessions within three months. In comparison, patients with AN or BN in ambulatory treatment received 8-9 sessions within the same time. Full-time treatment was associated with substantial improvements on all measured variables for both women with AN (d = .48-.83) and BN (d = .48-.81). Despite the relatively small amount of psychotherapeutic sessions, ambulatory treatment was associated with small increases in BMI (d = .37) among women with AN and small improvements on all measured variables among women with BN (d = .27-.43). For women with AN, reduction in ED pathology were positively related to the number of psychotherapeutic sessions received. Regardless of diagnosis and treatment setting, full recovery of symptoms was rarely achieved within three months (recovery rates ranged between 0 and 4.4%). The present study shows that a considerable amount of patients with EDs improved after CBT-based ED treatment in routine clinical care within three months after admission. Intensive full-time treatment may be particularly effective in quickly improving ED-related pathology, although full remission of symptoms is typically not achieved. A small amount of ambulatory sessions may already produce considerable improvements in BN pathology and weight gain among women with AN. As patient characteristics and treatment intensity differed largely between settings, results should not be interpreted as superiority of one treatment setting over another. Furthermore, this study shows that treatment intensity is quite heterogeneous, indicating the possibility for increasing effectiveness in the treatment of EDs in routine clinical care.
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Affiliation(s)
- Kathrin Schopf
- Mental Health Research and Treatment Center, Ruhr University Bochum, Bochum, Germany
| | - Silvia Schneider
- Mental Health Research and Treatment Center, Ruhr University Bochum, Bochum, Germany
| | - Andrea Hans Meyer
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Fribourg, Fribourg, Switzerland
| | | | - Nadine Humbel
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Fribourg, Fribourg, Switzerland
| | - Nadine-Messerli Bürgy
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Fribourg, Fribourg, Switzerland
- Institute of Psychology, Clinical Child and Adolescent Psychology, University of Lausanne, Lausanne, Switzerland
| | - Andrea Wyssen
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Esther Biedert
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Fribourg, Fribourg, Switzerland
| | - Bettina Isenschmid
- Center for Eating Disorders and Obesity, Clinic Zofingen, Zofingen, Switzerland
| | - Gabriella Milos
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital, Zurich, Switzerland
| | - Malte Claussen
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | | | - Dirk Adolph
- Mental Health Research and Treatment Center, Ruhr University Bochum, Bochum, Germany
| | - Tobias Teismann
- Mental Health Research and Treatment Center, Ruhr University Bochum, Bochum, Germany
| | - Jürgen Margraf
- Mental Health Research and Treatment Center, Ruhr University Bochum, Bochum, Germany
| | - Hans-Jörg Assion
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, LWL-Klinik Dortmund, Dortmund, Germany
| | - Bianca Überberg
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, LWL-Klinik Dortmund, Dortmund, Germany
| | - Georg Juckel
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital Bochum, Ruhr University Bochum, Bochum, Germany
| | - Judith Müller
- Christoph-Dornier-Klinik for Psychotherapy, Münster, Germany
| | - Benedikt Klauke
- Christoph-Dornier-Klinik for Psychotherapy, Münster, Germany
| | - Simone Munsch
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Fribourg, Fribourg, Switzerland
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Ueberberg B, Ackermann K, Illner SC, Assion HJ. [Physician and hospital rating portals-Handling and opinions from various perspectives]. Nervenarzt 2023:10.1007/s00115-023-01496-2. [PMID: 37310455 DOI: 10.1007/s00115-023-01496-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Accepted: 04/08/2023] [Indexed: 06/14/2023]
Affiliation(s)
- B Ueberberg
- LWL-Klinik Dortmund, Marsbruchstr. 179, 44287, Dortmund, Deutschland
| | - K Ackermann
- LWL-Klinik Dortmund, Marsbruchstr. 179, 44287, Dortmund, Deutschland
| | - S C Illner
- LWL-Klinik Dortmund, Marsbruchstr. 179, 44287, Dortmund, Deutschland
| | - H J Assion
- LWL-Klinik Dortmund, Marsbruchstr. 179, 44287, Dortmund, Deutschland.
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Ackermann K, Ueberberg B, Assion HJ. Zufriedenheit mit (teil-)stationärer psychiatrischer Behandlung: Effekte auf die physische und psychische Gesundheit. Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen 2023:S1865-9217(23)00009-0. [PMID: 37019754 DOI: 10.1016/j.zefq.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 01/13/2023] [Accepted: 01/23/2023] [Indexed: 04/05/2023]
Abstract
INTRODUCTION Quality assessment from the patient's point of view makes it possible to identify negative quality developments at an early stage. The focus is not on the medical result, but on what the patient wants. Correlations between patient satisfaction and physical and psychological treatment outcome were already shown in the 1990s. However, studies using rather unspecific satisfaction measures are scarce. The aim of this study was to investigate the influence of patient satisfaction with the treatment and the therapies offered on the extent of recovery. METHODS In this prospective study, a questionnaire developed for the differentiated recording of patient satisfaction with the therapy offerings of the LWL-Klinik Dortmund was used in a day-care/hospital setting. The structure of the questionnaire was tested by means of explorative factor analysis. The factors generated in this way served as the basis for the hierarchical regression analyses in the further course. In addition to important treatment aspects from the patient's point of view, the subjective health status was recorded by means of SF-36. RESULTS 105 patients participated in the study (64% female, 84% diagnosed with depression). Significant predictors for physical health were well-being after exercise therapy and satisfaction with the weekly structure of services. Significant predictors for mental health were age at onset of illness, age, perceived benefits from exercise therapy as well as occupational therapy, treatment duration and setting. DISCUSSION The demonstrated impact of patient satisfaction on mental health highlights the relevance of treatment quality improvement to recovery.
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Schmidt-Kraepelin C, Feyerabend S, Engelke C, Riesbeck M, Meisenzahl-Lechner E, Verde PE, Correll CU, Kluge M, Makiol C, Neff A, Lange C, Englisch S, Zink M, Langguth B, Poeppl TB, Reske D, Gouzoulis-Mayfrank E, Gründer G, Hasan A, Brockhaus-Dumke A, Jäger M, Baumgärtner J, Leucht S, Cordes J, Cordes J, Feyerabend S, Engelke C, Riesbeck M, Meisenzahl-Lechner E, Gaebel W, Deiß M, Sofie N, Galuba V, Wiechmann F, Janssen B, Kluge M, Makiol C, Kertzscher L, Neff A, Lange C, Englisch S, Zink M, Becker A, Muszinski S, Gründer G, Langguth B, Poeppl T, Frank E, Kreuzer P, Reske D, Gouzoulis-Mayfrank E, Veselinovic T, Hasan A, Falkai P, Wagner E, Brockhaus-Dumke A, Klos B, Jäger M, Lang F, Kling-Lourenço P, Baumgärtner J, Hasan A, Dreimüller N, Hiemke C, Leucht S, Heres S, Leucht C, Assion HJ, Kis B, Zilles-Wegner D, Kahl K, Correll C, Verde PE, Kolbe H, Rottmann A. Amisulpride and olanzapine combination treatment versus each monotherapy in acutely ill patients with schizophrenia in Germany (COMBINE): a double-blind randomised controlled trial. Lancet Psychiatry 2022; 9:291-306. [PMID: 35276079 DOI: 10.1016/s2215-0366(22)00032-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 01/03/2022] [Accepted: 01/19/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Combining antipsychotics is common in schizophrenia treatment, despite evidence-based guidelines generally not recommending such practice. Otherwise, evidence remains inconclusive, especially regarding specific combinations. The trial aimed to test whether a combination of amisulpride plus olanzapine is more effective than either intervention as a monotherapy. METHODS A multicentre, 16-week, randomised, double-blind, controlled trial was done at 16 psychiatric in-patient centres throughout Germany. Inclusion criteria were adults aged 18-65 years with non-first episode schizophrenia or schizoaffective disorder and with a Positive and Negative Syndrome Scale (PANSS) total score of at least 70 and at least two items of the positive symptoms subscale rated at least 4. Patients were randomly assigned to receive 16 weeks of treatment with either amisulpride plus olanzapine, amisulpride plus placebo, or olanzapine plus placebo (1:1:1), and block randomisation was stratified by study site. To keep patients and investigators masked throughout the duration of the trial, amisulpride, olanzapine, and placebo were administered as identical capsules. Flexibly dosed monotherapy of oral amisulpride (amisulpride plus placebo, 200-800 mg per day) or olanzapine (olanzapine plus placebo, 5-20 mg per day) was compared with a combination of amisulpride plus olanzapine. The primary outcome was symptom reduction measured by the PANSS total score after 8 weeks, in the modified intention-to-treat population (all patients randomly assigned to an intervention and receiving at least one study drug dose). As determined a priori, group differences were examined by t tests (Bonferroni-Holm-adjustment) followed by pre-planned Bayesian analyses as well as imputation methods based on mixed models to account for missing values and post-hoc ANCOVA adjusting for PANSS baseline scores. The study was registered on ClinicalTrials.gov, NCT01609153; the German Clinical Trials Register, DRKS00003603; and the European Union Drug Regulating Authorities Clinical Trials Database, EudraCT-No. 2011-002463-20. FINDINGS Between June 15, 2012, and Dec 15, 2018, 13 692 patients were assessed for eligibility. 13 364 patients were excluded (including for not meeting inclusion criteria, declining to participate, or inappropriate reasons for changing pharmacological treatment), and 328 were then randomly assigned to an intervention group. 112 patients were randomly assigned to receive amisulpride plus olanzapine, 109 were randomly assigned to receive amisulpride plus placebo, and 107 were randomly assigned to receive olanzapine plus placebo. 321 patients were analysed for the primary outcome in the modified intention-to-treat population after exclusion of screening failures and patients who did not receive the intervention (110 for amisulpride plus olanzapine, 109 for amisulpride plus placebo, and 102 for olanzapine plus placebo). Among the 321 patients who were randomly assigned to intervention groups and analysed for the primary outcome, 229 (71%) were male, 92 (29%) were female; the mean age was 40·2 years (SD 11·7); and 296 (92%) were White and 25 (8%) were classified as other ethnicity. PANSS total score improved significantly more at 8 weeks in the amisulpride plus olanzapine group (-29·6 [SD 14·5]) than in the olanzapine plus placebo group (-24·1 [13·4], p=0·049, Cohen's d=0·396). A significant difference was not observed in reduction of PANSS total score between the amisulpride and olanzapine group compared with the amisulpride and placebo group (-25·2 [SD 15·9], p=0·095, Cohen's d=0·29). After 8 weeks and 16 weeks, sexual dysfunction, weight, and waist circumference increase were significantly higher for patients receiving amisulpride plus olanzapine than for those receiving amisulpride plus placebo, with no differences in serious adverse events. Two patients died during study participation; one randomly assigned to the amisulpride plus olanzapine group, and one assigned to the olanzapine plus placebo group (both assessed with no relation to treatment). INTERPRETATION The advantages of amisulpride plus olanzapine have to be weighed against a higher propensity for side-effects. The use of this specific combination therapy could be an alternative to monotherapy in certain clinical situations, but side-effects should be considered. FUNDING German Federal Ministry of Education and Research.
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Affiliation(s)
- Christian Schmidt-Kraepelin
- LVR-Clinic Düsseldorf, Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Kaiserswerther Diakonie, Florence Nightingale Hospital, Department of Psychiatry and Psychotherapy, Düsseldorf, Germany.
| | - Sandra Feyerabend
- LVR-Clinic Düsseldorf, Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Kaiserswerther Diakonie, Florence Nightingale Hospital, Department of Psychiatry and Psychotherapy, Düsseldorf, Germany
| | - Christina Engelke
- LVR-Clinic Düsseldorf, Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Mathias Riesbeck
- LVR-Clinic Düsseldorf, Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Eva Meisenzahl-Lechner
- LVR-Clinic Düsseldorf, Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Pablo-Emilio Verde
- Coordination Centre for Clinical Trials, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Christoph U Correll
- Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA; The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, NY, USA; Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Berlin, Germany
| | - Michael Kluge
- Department of Psychiatry and Psychotherapy, University Hospital Leipzig, Leipzig, Germany
| | - Christian Makiol
- Department of Psychiatry and Psychotherapy, University Hospital Leipzig, Leipzig, Germany
| | - Andrea Neff
- LVR-Klinikum Langenfeld, Langenfeld, Germany
| | | | - Susanne Englisch
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; Department of Psychiatry and Psychotherapy, University Medical Centre Mainz, Mainz, Germany
| | - Mathias Zink
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; District Hospital Mittelfranken, Ansbach, Germany
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Timm B Poeppl
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany; Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany
| | | | | | - Gerhard Gründer
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany
| | - Alkomiet Hasan
- Department of Psychiatry and Psychotherapy, Klinikum der Universität München, Ludwig-Maximilians-University, Munich, Germany; Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, University of Augsburg, BKH Augsburg, Augsburg, Germany
| | - Anke Brockhaus-Dumke
- Department of Psychiatry and Psychotherapy 1 and 2, Rheinhessen-Fachklinik Alzey, Academic Hospital of the University of Mainz; Alzey, Germany
| | - Markus Jäger
- Department of Psychiatry II, Ulm University, Bezirkskrankenhaus Günzburg, Günzburg, Germany
| | - Jessica Baumgärtner
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, University of Augsburg, BKH Augsburg, Augsburg, Germany
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, Technical University of Munich, School of Medicine, Munich, Germany
| | - Joachim Cordes
- LVR-Clinic Düsseldorf, Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Kaiserswerther Diakonie, Florence Nightingale Hospital, Department of Psychiatry and Psychotherapy, Düsseldorf, Germany
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Abstract
BACKGROUND Old age bipolar disorder has been an orphan of psychiatric research for a long time despite the fact that bipolar disorder (BD)-I and II together may affect 0.5-1.0% of the elderly. It is also unclear whether aetiology, course of illness and treatment should differ in patients with a first manifestation in older age and patients suffering from a recurrence of a BD known for decades. This narrative review will summarize the current state of knowledge about the epidemiology, clinical features, and treatment of BD in the elderly. METHODS We conducted a Medline literature search from 1970 to 2021 using MeSH terms "Bipolar Disorder" × "Aged" or "Geriatric" or "Elderly". Search results were complemented by additional literature retrieved from examining cross references and by hand search in text books. Varying cut-off ages have been applied to differentiate old age from adult age BD. Within old age BD, there is a reasonable agreement of distinct entities, early and late-onset BD. They differ to some extent in clinical symptoms, course of illness, and some co-morbidities. Point prevalence of BD in older adults appears slightly lower than in working-age adults, with polarity of episodes shifting towards depression. Psychopharmacological treatment needs to take into account the special aspects of somatic gerontology and the age-related change of pharmacokinetic and pharmacodynamic characteristics. The evidence for commonly used treatments such as lithium, mood-stabilizing antiepileptics, antipsychotics, and antidepressants remains sparse. Preliminary results support a role of ECT as well as psychotherapy and psychosocial interventions in old age BD. CONCLUSIONS There is an obvious need of further research for all treatment modalities of BD in old age. The focus should be pharmacological and psychosocial approaches, as well as their combination, and the role of physical treatment modalities such as ECT.
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Affiliation(s)
- Nemanja Ljubic
- Bereich Forschung & Wissenschaft, LWL-Klinik, Marsbruchstr. 179, 44287, Dortmund, Germany
| | - Bianca Ueberberg
- Bereich Forschung & Wissenschaft, LWL-Klinik, Marsbruchstr. 179, 44287, Dortmund, Germany
| | - Heinz Grunze
- Psychiatrie Schwäbisch Hall, Ringstraße. 1, 74523, Schwäbisch Hall, Germany.
- Paracelsus Medical University, Ernst-Nathan Straße 1, 90419, Nuremberg, Germany.
| | - Hans-Jörg Assion
- Bereich Forschung & Wissenschaft, LWL-Klinik, Marsbruchstr. 179, 44287, Dortmund, Germany
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Munsch S, Messerli-Bürgy N, Meyer AH, Humbel N, Schopf K, Wyssen A, Forrer F, Biedert E, Lennertz J, Trier S, Isenschmid B, Milos G, Claussen M, Whinyates K, Adolph D, Margraf J, Assion HJ, Teismann T, Ueberberg B, Juckel G, Müller J, Klauke B, Schneider S. Consequences of exposure to the thin ideal in mass media depend on moderators in young women: An experimental study. J Abnorm Psychol 2021; 130:498-511. [PMID: 34472886 DOI: 10.1037/abn0000676] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study examined the consequences of media exposure to thin ideals compared to pictures of landscapes in healthy young women and women with eating and mixed mental disorders and investigated whether appearance-related cognitive factors and cognitive distortions moderate the effects. Two hundred seventy-five women in a multisite laboratory trial (174 in- or outpatients and 101 healthy women; Mage 22.87 years, SD = 3.94) were exposed to either thin ideals or to landscape pictures and guided through a vivid imagery of these pictures thereafter. Changes in body image dissatisfaction, mood, eating behavior, and physiological markers were assessed. After thin ideal exposure and even more after guided imagery, women's body image dissatisfaction increased and mood declined. The effect on mood was most pronounced in women with eating disorders, less in women with mixed disorders, and smallest in healthy controls. No effects were found on physiological measures. Higher values of appearance-related cognitive factors moderated the effect of thin ideal exposure and guided imagery on all psychological outcomes. Cognitive distortions moderated the effect of thin ideal exposure and guided imagery on mood. Findings indicate an overall susceptibility to viewing thin ideal pictures in magazines in young and especially in women with eating disorders. Though exposure in the laboratory resulted in psychological effects, it did not lead to a physiological stress response. The impact of thin ideal exposure on mood is in line with affect-regulation models in eating disorders, with appearance-related cognitive factors and cognitive distortions potentially accelerating such effects. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Malte Claussen
- Department of Psychiatry, Psychotherapy and Psychosomatics
| | | | | | | | - Hans-Jörg Assion
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine
| | | | - Bianca Ueberberg
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine
| | - Georg Juckel
- Department of Psychiatry, Psychotherapy and Preventive Medicine
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Koch E, Assion HJ. BDK-AK Migration (Bericht aus dem Arbeitskreis Juni 2021). Psychiatr Prax 2021. [DOI: 10.1055/a-1494-5184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Illner SC, Ueberberg B, Assion HJ. [Effectiveness of short-term therapy: the concept of the crisis day clinic]. Nervenarzt 2020; 91:1054-1057. [PMID: 32488416 DOI: 10.1007/s00115-020-00933-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- S C Illner
- LWL-Klinik Dortmund, Marsbruchstr. 179, 44287, Dortmund, Deutschland
| | - B Ueberberg
- LWL-Klinik Dortmund, Marsbruchstr. 179, 44287, Dortmund, Deutschland
| | - H J Assion
- LWL-Klinik Dortmund, Marsbruchstr. 179, 44287, Dortmund, Deutschland.
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Forkmann T, Glaesmer H, Paashaus L, Rath D, Schönfelder A, Stengler K, Juckel G, Assion HJ, Teismann T. Interpersonal theory of suicide: prospective examination. BJPsych Open 2020; 6:e113. [PMID: 32958092 PMCID: PMC7576651 DOI: 10.1192/bjo.2020.93] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 08/13/2020] [Accepted: 08/18/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The interpersonal theory of suicide (IPTS) is one of the most intensively researched contemporary theories on the development of suicidal ideation and behaviour. However, there is a lack of carefully conducted prospective studies. AIMS To evaluate the main predictions of the IPTS regarding the importance of perceived burdensomeness, thwarted belongingness and capability for suicide in predicting future suicide attempts in a prospective design. METHOD Psychiatric in-patients (n = 308; 53.6% (n = 165) female; mean age 36.82 years, s.d. = 14.30, range 18-81) admitted for severe suicidal ideation (n = 145, 47.1%) or a suicide attempt completed self-report measures of thwarted belongingness, perceived burdensomeness, capability for suicide, hopelessness, depression and suicidal ideation as well as interviews on suicide intent and suicide attempts and were followed up for 12 months. Logistic regression and receiver operating characteristics (ROC) analysis were conducted. RESULTS The interaction of perceived burdensomeness, thwarted belongingness and capability for suicide was not predictive of future suicide attempts, but perceived burdensomeness showed a significant main effect (z = 3.49, P < 0.01; OR = 2.34, 95% CI 1.59-3.58) and moderate performance in screening for future suicide attempts (area under the curve AUC = 0.729, P < 0.01). CONCLUSIONS The results challenge the theoretical validity of the IPTS and its clinical utility - at least within the methodological limitations of the current study. Yet, findings underscore the importance of perceived burdensomeness in understanding suicidal ideation and behaviour.
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Affiliation(s)
- Thomas Forkmann
- Department of Clinical Psychology, University of Duisburg-Essen, Germany
| | - Heide Glaesmer
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Germany
| | - Laura Paashaus
- Department of Clinical Psychology, University of Duisburg-Essen, Germany
| | - Dajana Rath
- Department of Clinical Psychology, University of Duisburg-Essen, Germany
| | - Antje Schönfelder
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Germany
| | - Katharina Stengler
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Helios Park Hospital Leipzig, Germany
| | - Georg Juckel
- Department of Psychiatry, LWL-University Hospital, Ruhr-Universität Bochum, Germany
| | | | - Tobias Teismann
- Mental Health Research and Treatment Center, Department of Psychology, Ruhr-Universität Bochum, Germany
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Ueberberg B, Frommberger U, Messer T, Zwanzger P, Kuhn J, Anghelescu I, Ackermann K, Assion HJ. Drug-Induced Liver Injury (DILI) in Patients with Depression Treated with Antidepressants: A Retrospective Multicenter Study. Pharmacopsychiatry 2020; 53:60-64. [PMID: 31958850 DOI: 10.1055/a-1071-8028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Drug-induced liver injury (DILI) is the 4th most common cause of liver damage in Western countries and can be caused by antidepressants. METHODS Against the background of increasing antidepressant prescriptions and increasing use of polypharmacy, we analyzed administered antidepressants and other pharmacological substances, liver toxicity, comorbid somatic secondary diseases together with the occurrence of DILI in a patient population of 6 centers throughout Germany. RESULTS The majority of the enrolled 329 patients received polypharmacological treatment in an inpatient setting. During antidepressant treatment 5.1% of the patients had elevated serum transaminase levels, whereby exactly and not more than 1 criterion proposed to be indicative for DILI, was fulfilled by 3 patients (0.9%). DISCUSSION During patient characterization it becomes clear that a sensitization for relevant risk constellations causing liver injury in MDD patients is relevant to prevent further serious adverse events.
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Affiliation(s)
- Bianca Ueberberg
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, LWL-Klinik Dortmund, Dortmund, Germany
| | - Ulrich Frommberger
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Klinik an der Lindenhöhe, Offenburg, Germany.,Department of Psychiatry and Psychotherapy, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Peter Zwanzger
- kbo Inn-Salzach-Klinikum, Psychiatry, Wasserburg/Inn, Germany
| | - Jens Kuhn
- Johanniter Krankenhaus Oberhausen, Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Oberhausen, Germany
| | - Ion Anghelescu
- Dr. Fontheim GmbH und Co KG, Mentale Gesundheit, Liebenburg, Germany.,Blomenburg Mental Health Care, Psychiatrie, Psychotherapie und Psychosomatik, Selent, Germany
| | - Katharina Ackermann
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, LWL-Klinik Dortmund, Dortmund, Germany
| | - Hans-Jörg Assion
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, LWL-Klinik Dortmund, Dortmund, Germany
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Efkemann SA, Bernard J, Kalagi J, Otte I, Ueberberg B, Assion HJ, Zeiß S, Nyhuis PW, Vollmann J, Juckel G, Gather J. Ward Atmosphere and Patient Satisfaction in Psychiatric Hospitals With Different Ward Settings and Door Policies. Results From a Mixed Methods Study. Front Psychiatry 2019; 10:576. [PMID: 31543830 PMCID: PMC6728825 DOI: 10.3389/fpsyt.2019.00576] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 07/22/2019] [Indexed: 11/22/2022] Open
Abstract
Background: Open-door policies in psychiatry are discussed as a means to improve the treatment of involuntarily committed patients in various aspects. Current research on open-door policies focuses mainly on objective effects, such as the number of coercive interventions or serious incidents. The aim of the present study was to investigate more subjective perceptions of different psychiatric inpatient settings with different door policies by analyzing ward atmosphere and patient satisfaction. Methods: Quantitative data on the ward atmosphere using the Essen Climate Evaluation Scale (EssenCES) and on patient satisfaction (ZUF-8) were obtained from involuntarily committed patients (n = 81) in three psychiatric hospitals with different ward settings and door policies (open, facultative locked, locked). Furthermore, qualitative interviews with each of 15 patients, nurses, and psychiatrists were conducted in one psychiatric hospital with a facultative locked ward comparing treatment in an open vs. a locked setting. Results: Involuntarily committed patients rated the EssenCES' subscale "Experienced Safety" higher in an open setting compared with a facultative locked and a locked setting. The subscale "Therapeutic Hold" was rated higher in an open setting than a locked setting. Regarding the safety experienced from a mental health professionals' perspective, the qualitative interviews further revealed advantages and disadvantages of door locking in specific situations, such as short-term de-escalation vs. increased tension. Patient satisfaction did not differ between the hospitals but correlated weakly with the EssenCES' subscale "Therapeutic Hold." Conclusion: Important aspects of the ward atmosphere seem to be improved in an open vs. a locked setting, whereas patient satisfaction does not seem to be influenced by the door status in the specific population of patients under involuntary commitment. The ward atmosphere turned out to be more sensitive to differences between psychiatric inpatient settings with different door policies. It can contribute to a broader assessment by including subjective perceptions by those who are affected directly by involuntary commitments. Regarding patient satisfaction under involuntary commitment, further research is needed to clarify both the relevance of the concept and its appropriate measurement.
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Affiliation(s)
- Simone Agnes Efkemann
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Johannes Bernard
- Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Bochum, Germany
| | - Janice Kalagi
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Ina Otte
- Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Bochum, Germany
| | - Bianca Ueberberg
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr University Bochum, Bochum, Germany.,LWL-Klinik Dortmund, Psychiatrie, Psychotherapie, Psychosomatische Medizin, Rehabilitation, Dortmund, Germany
| | - Hans-Jörg Assion
- LWL-Klinik Dortmund, Psychiatrie, Psychotherapie, Psychosomatische Medizin, Rehabilitation, Dortmund, Germany
| | - Swantje Zeiß
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, St. Marien Hospital Eickel, Herne, Germany
| | - Peter W Nyhuis
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, St. Marien Hospital Eickel, Herne, Germany
| | - Jochen Vollmann
- Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Bochum, Germany
| | - Georg Juckel
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Jakov Gather
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr University Bochum, Bochum, Germany.,Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Bochum, Germany
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Brailovskaia J, Schillack H, Assion HJ, Horn H, Margraf J. Risk-taking propensity and (un)healthy behavior in Germany. Drug Alcohol Depend 2018; 192:324-328. [PMID: 30316034 DOI: 10.1016/j.drugalcdep.2018.08.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 08/02/2018] [Accepted: 08/14/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Earlier research in South Africa (Szrek et al., 2012) confirmed the one-item Dohmen measure (Dohmen et al., 2011) to be a significant predictor of risky health behavior. METHODS The present study investigated the relationship of the Dohmen measure with other measures of risk-taking propensity (e.g., Domain-Specific Risk-Taking scale), and its predictive power for smoking, problematic drinking, problematic car driving, and problematic sexual behavior, in a sample of 63 patients of psychiatric clinics and 102 healthy participants in Germany. RESULTS The Dohmen measure was significantly positively related to other involved instruments. It served as predictor of two of the four investigated risky health activities (i.e., smoking, problematic drinking). CONCLUSIONS The Dohmen measure seems to be a valid and time efficient instrument to assess general risk-taking propensity, as well as specific propensity for smoking and problematic drinking in Germany.
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Affiliation(s)
- Julia Brailovskaia
- Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Massenbergstr. 9-13, 44787 Bochum, Germany.
| | - Holger Schillack
- Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Massenbergstr. 9-13, 44787 Bochum, Germany
| | - Hans-Jörg Assion
- Landschaftsverband Westfalen-Lippe (LWL)-Clinic Dortmund, Marsbruchstr. 179, 44287 Dortmund, Germany.
| | - Helmut Horn
- Knappschaftskrankenhaus Clinic for Psychiatry and Psychotherapy Dortmund, Volksgartenstr. 40, 44388 Dortmund, Germany.
| | - Jürgen Margraf
- Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Massenbergstr. 9-13, 44787 Bochum, Germany
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Humbel N, Messerli-Bürgy N, Schuck K, Wyssen A, Garcia-Burgos D, Biedert E, Lennertz J, Meyer AH, Whinyates K, Isenschmid B, Milos G, Trier S, Adolph D, Cwik J, Margraf J, Assion HJ, Teismann T, Ueberberg B, Juckel G, Müller J, Klauke B, Schneider S, Munsch S. Self-reported emotion regulation difficulties are associated with mood but not with the biological stress response to thin ideal exposure. PLoS One 2018; 13:e0199769. [PMID: 29949642 PMCID: PMC6021103 DOI: 10.1371/journal.pone.0199769] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 06/13/2018] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Difficulties in emotion regulation have been related to psychological and physiological stress responses such as lower mood and lower parasympathetic activation (HF-HRV) under resting condition, but evidence on the potential link to the hypothalamic-pituitary-adrenal (HPA) axis functioning and to physiological stress responses during a stress task is still scarce. The aim of the study was to investigate stress responses in young women when confronted to a daily stressor such as exposure to thin ideals and to understand the role of correlates of self-reported trait-like emotion regulation difficulties (ERD). METHODS Heart rate variability (HRV) and salivary cortisol data were collected in a sample of 273 young women aged 18-35 with and without mental disorders during a vivid imagination of thin ideals (experimental condition) or landscapes (control condition). Changes in mood states were measured on a visual analogue scale (0-100). Correlates of trait-like ERD were self-reported using the Difficulties in Emotion Regulation Scale (DERS). RESULTS Participants with higher ERD showed a stronger decline in self-reported mood after vivid imagination of thin ideals compared to participants with lower ERD in the experimental condition but also a stronger increase of positive mood with increasing ERD in the control condition. ERD were not related to baseline HF-HRV or baseline salivary cortisol levels nor to any physiological response during and after the imagination of thin ideals. DISCUSSION AND CONCLUSION The results corroborate the role of ERD regarding the immediate psychological impact of daily stressors. Exposition to daily stressors in the laboratory results in discrepant psychological and physiological reactivity. Future studies should investigate under what conditions the complex interrelations between immediate and long-term ERD and biological activation are amenable to assessment in a laboratory setting. The additive effects of multiple exposition to stressors, such as thin ideals in daily life, also need to be addressed.
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Affiliation(s)
- Nadine Humbel
- Clinical Psychology and Psychotherapy, Department of Clinical Psychology, University of Fribourg, Fribourg, Switzerland
| | - Nadine Messerli-Bürgy
- Clinical Psychology and Psychotherapy, Department of Clinical Psychology, University of Fribourg, Fribourg, Switzerland
| | - Kathrin Schuck
- Faculty of Psychology, Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
| | - Andrea Wyssen
- Clinical Psychology and Psychotherapy, Department of Clinical Psychology, University of Fribourg, Fribourg, Switzerland
| | - David Garcia-Burgos
- Clinical Psychology and Psychotherapy, Department of Clinical Psychology, University of Fribourg, Fribourg, Switzerland
| | - Esther Biedert
- Clinical Psychology and Psychotherapy, Department of Clinical Psychology, University of Fribourg, Fribourg, Switzerland
| | - Julia Lennertz
- Faculty of Psychology, Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
| | - Andrea H. Meyer
- Clinical Psychology and Psychotherapy, Department of Clinical Psychology, University of Fribourg, Fribourg, Switzerland
- Department of Psychology, Division of Clinical Psychology and Epidemiology, University of Basel, Basel, Switzerland
| | | | - Bettina Isenschmid
- Kompetenzzentrum für Essstörungen und Adipositas (KEA), Spital Zofingen, Zofingen, Switzerland
| | - Gabriella Milos
- Klinik für Psychiatrie und Psychotherapie, Universitätsspital Zürich, Zürich, Switzerland
| | | | - Dirk Adolph
- Faculty of Psychology, Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
| | - Jan Cwik
- Faculty of Psychology, Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
| | - Jürgen Margraf
- Faculty of Psychology, Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
| | - Hans-Jörg Assion
- LWL-Klinik Dortmund, Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Dortmund, Germany
| | - Tobias Teismann
- Faculty of Psychology, Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
| | - Bianca Ueberberg
- LWL-Klinik Dortmund, Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Dortmund, Germany
| | - Georg Juckel
- Department of Psychiatry, Psychotherapy and Preventive Medicine, Ruhr University Bochum, LWL University Hospital, Bochum, Germany
| | - Judith Müller
- Christoph-Dornier-Clinic for Psychotherapy, Münster, Germany
| | - Benedikt Klauke
- Christoph-Dornier-Clinic for Psychotherapy, Münster, Germany
| | - Silvia Schneider
- Faculty of Psychology, Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
| | - Simone Munsch
- Clinical Psychology and Psychotherapy, Department of Clinical Psychology, University of Fribourg, Fribourg, Switzerland
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14
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Machulska A, Zlomuzica A, Rinck M, Assion HJ, Margraf J. Approach bias modification in inpatient psychiatric smokers. J Psychiatr Res 2016; 76:44-51. [PMID: 26874269 DOI: 10.1016/j.jpsychires.2015.11.015] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 11/25/2015] [Accepted: 11/30/2015] [Indexed: 10/22/2022]
Abstract
Drug-related automatic approach tendencies contribute to the development and maintenance of addictive behavior. The present study investigated whether a nicotine-related approach bias can be modified in smokers undergoing inpatient psychiatric treatment by using a novel training variant of the nicotine Approach-Avoidance-Task (AAT). Additionally, we assessed whether the AAT-training would affect smoking behavior. Inpatient smokers were randomly assigned to either an AAT-training or a sham-training condition. In the AAT-training condition, smokers were indirectly instructed to make avoidance movements in response to nicotine-related pictures and to make approach movements in response to tooth-cleaning pictures. In the sham-training condition, no contingency between picture content und arm movements existed. Trainings were administered in four sessions, accompanied by a brief smoking-cessation intervention. Smoking-related self-report measures and automatic approach biases toward smoking cues were measured before and after training. Three months after training, daily nicotine consumption was obtained. A total of 205 participants were recruited, and data from 139 participants were considered in the final analysis. Prior to the trainings, smokers in both conditions exhibited a stronger approach bias for nicotine-related pictures than for tooth-cleaning pictures. After both trainings, this difference was no longer evident. Although reduced smoking behavior at posttest was observed after both trainings, only the AAT-training led to a larger reduction of nicotine consumption at a three-month follow-up. Our preliminary data partially support the conclusion that the AAT might be a feasible tool to reduce smoking in the long-term in psychiatric patients, albeit its effect on other smoking-related measures remains to be explored.
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Affiliation(s)
| | | | - Mike Rinck
- Ruhr-Universität Bochum, Germany; Behavioral Science Institute, Radboud University Nijmegen, The Netherlands
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15
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Edel MA, Edel S, Krüger M, Assion HJ, Juckel G, Brüne M. Attachment, recalled parental rearing, and ADHD symptoms predict emotion processing and alexithymia in adults with ADHD. Ann Gen Psychiatry 2015; 14:43. [PMID: 26633990 PMCID: PMC4667529 DOI: 10.1186/s12991-015-0082-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 11/23/2015] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The aim of the aricle is to study the relationship between attachment, parental rearing behavior, and (infant and current) ADHD symptoms with emotion processing and alexithymia in adults with ADHD. METHODS Attachment, parental behavior, and ADHD variables were tested for predictive value regarding emotion processing and alexithymia in the total sample, the pooled ADHD groups (with inattentive type and combined type, each with n = 26) and a control group (n = 26). Comparisons were performed between the pooled ADHD groups and the control group, and between the ADHD subtype groups regarding all emotion processing and alexithymia, and attachment-related measures. RESULTS Emotion processing/alexithymia parameters were mainly predicted by early or current attachment-related features, and, to a lesser extent, by childhood or current ADHD symptoms, primarily in the ADHD groups. CONCLUSIONS The findings suggest partly specific and possibly causal relationships between attachment-related features and current emotion processing/alexithymia in adults with ADHD. The results confirm the necessity for further study of the multiple interactions between infant and parental ADHD symptoms, aversive parenting, and attachment with respect to emotional functioning in adult ADHD.
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Affiliation(s)
- Marc-Andreas Edel
- Department of Psychiatry, LWL University Hospital, Ruhr University Bochum, Alexandrinenstraße 1-3, 44791 Bochum, Germany
| | - Susanne Edel
- Psychiatry Clinic, St. Marien Hospital Eickel, Marienstr. 2, 44651 Herne, Germany
| | - Marie Krüger
- Department of Psychiatry, LWL University Hospital, Ruhr University Bochum, Alexandrinenstraße 1-3, 44791 Bochum, Germany
| | - Hans-Jörg Assion
- Psychiatry Clinic, LWL Hospital Dortmund, Marsbruchstr. 179, 44287 Dortmund, Germany
| | - Georg Juckel
- Department of Psychiatry, LWL University Hospital, Ruhr University Bochum, Alexandrinenstraße 1-3, 44791 Bochum, Germany
| | - Martin Brüne
- Department of Psychiatry, LWL University Hospital, Ruhr University Bochum, Alexandrinenstraße 1-3, 44791 Bochum, Germany
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Norra C, Reventlow HGV, Kieslich K, Assion HJ, Juckel G. Quetiapine in the treatment of psychotic depression: A pilot study. Pharmacopsychiatry 2013. [DOI: 10.1055/s-0033-1353268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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17
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Krogias C, Hoffmann K, Norra C, Eyding J, Scheele D, Gold R, Juckel G, Assion HJ. Transkranielle Sonographie des Hirnparenchyms bei bipolarer Störung. Vergleich zu Gesunden sowie innerhalb von Subgruppen der Erkrankung. KLIN NEUROPHYSIOL 2012. [DOI: 10.1055/s-0032-1301663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Krogias C, Hoffmann K, Eyding J, Scheele D, Norra C, Gold R, Juckel G, Assion HJ. Evaluation of basal ganglia, brainstem raphe and ventricles in bipolar disorder by transcranial sonography. Psychiatry Res 2011; 194:190-7. [PMID: 21958513 DOI: 10.1016/j.pscychresns.2011.04.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Revised: 04/04/2011] [Accepted: 04/08/2011] [Indexed: 10/17/2022]
Abstract
Transcranial brain sonography (TCS) has become a reliable and sensitive diagnostic tool in the evaluation of extrapyramidal movement disorders. Alterations of brainstem raphe (BR) have been depicted by TCS in major depression but not in bipolar disorder. The aim of our study was to evaluate BR echogenicity depending on the different conditions of bipolar patients. Echogenicities of dopaminergic basal ganglia structures were assessed for the first time in bipolar disorder. Thirty-six patients with bipolar I disorder (14 depressed, 8 manic, 14 euthymic) were compared to 35 healthy controls. Echogenicities were investigated according to the examination protocol for extrapyramidal disorders using a Siemens Sonoline® Elegra system. The sonography examiner was blinded for clinical rating scores. Six patients (16.7%) showed hyperechogenicity of the substantia nigra. The raphe was hypoechogenic in 13 (36.1%) of the patients. No significant differences were seen between the subgroups. Compared to the control group, frequency of altered echogenicities did not reach statistical significance. The width of third ventricle was significantly larger in the patient group (3.8±-2.1 mm vs. 2.7±1.2 mm). Depressed bipolar patients with reduced BR echogenicity showed significantly higher scores on the Hamilton Depression Rating Scale as well as the Montgomery-Åsberg Depression Rating Scale. In contrast to unipolar depression, sonographic findings of bipolar patients may generally indicate structural integrity of mesencephalic raphe structures. If bipolar disorder coexists with hypoechogenic raphe structure, depressive symptoms are more severe.
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Affiliation(s)
- Christos Krogias
- Dept. of Neurology, Ruhr University Bochum, St. Josef-Hospital, Gudrunstr. 56, Bochum, Germany.
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Uhl I, Krumova EK, Regeniter S, Bär KJ, Norra C, Richter H, Assion HJ, Westermann A, Juckel G, Maier C. Association between wind-up ratio and central serotonergic function in healthy subjects and depressed patients. Neurosci Lett 2011; 504:176-180. [PMID: 21964385 DOI: 10.1016/j.neulet.2011.09.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2011] [Revised: 08/17/2011] [Accepted: 09/14/2011] [Indexed: 10/17/2022]
Abstract
Temporal summation of C-fiber evoked responses generates an increase in action potential discharge in second-order neurons and in perceived pain intensity (wind-up). This may be related to the central serotonergic system which modulates and partly inhibits sensory input. Aim of the study was to investigate the relationship between wind-up and serotonergic activity using loudness dependence of auditory evoked potentials (LDAEP). 18 healthy subjects were compared to 18 patients with major depression, a disease with a putative serotonin deficit. They were examined with quantitative sensory testing (QST) using the protocol of the German Research Network on Neuropathic Pain (DFNS), including the wind-up ratio (WUR), LDAEP, and psychometric measurements. We found a slight positive correlation between WUR and LDAEP both in healthy controls and depressed patients combined (r=0.340, p=0.043), indicating that WUR may be modulated by serotonergic activity. It can be concluded that inhibitory control to noxious stimuli is partly associated with the central serotonergic function as indicated by LDAEP.
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Affiliation(s)
- Idun Uhl
- Department of Psychiatry, Ruhr University Bochum, LWL University Hospital Bochum, Alexandrinenstrasse 1, 44791 Bochum, Germany.
| | - Elena K Krumova
- Department of Pain Management, Berufsgenossenschaftliche Universitätsklinik Bergmannsheil GmbH, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
| | - Sabrina Regeniter
- Department of Psychiatry, Ruhr University Bochum, LWL University Hospital Bochum, Alexandrinenstrasse 1, 44791 Bochum, Germany
| | - Karl-Jürgen Bär
- Department of Psychiatry, Ruhr University Bochum, LWL University Hospital Bochum, Alexandrinenstrasse 1, 44791 Bochum, Germany
| | - Christine Norra
- Department of Psychiatry, Ruhr University Bochum, LWL University Hospital Bochum, Alexandrinenstrasse 1, 44791 Bochum, Germany
| | - Helmut Richter
- Department of Pain Management, Berufsgenossenschaftliche Universitätsklinik Bergmannsheil GmbH, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
| | - Hans-Jörg Assion
- Department of Psychiatry, Ruhr University Bochum, LWL University Hospital Bochum, Alexandrinenstrasse 1, 44791 Bochum, Germany
| | - Andrea Westermann
- Department of Pain Management, Berufsgenossenschaftliche Universitätsklinik Bergmannsheil GmbH, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
| | - Georg Juckel
- Department of Psychiatry, Ruhr University Bochum, LWL University Hospital Bochum, Alexandrinenstrasse 1, 44791 Bochum, Germany
| | - Christoph Maier
- Department of Pain Management, Berufsgenossenschaftliche Universitätsklinik Bergmannsheil GmbH, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
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Abstract
Objective Given sparse research on the issue, this study sought to shed light upon the interactions of alexithymia, emotion processing, and social anxiety in adults with attention-deficit hyperactivity disorder (ADHD). Subjects and methods 73 German adults with ADHD according to DSM-IV diagnostic criteria participated. We used the Toronto Alexithymia Scale (TAS-20) to assess alexithymia, the Social Phobia Scale (SPS) and the Social Interaction Anxiety Scale (SIAS) to assess different features of social anxiety, and we applied the German 'Experience of Emotions Scale' (SEE) to measure emotion processing. Results 40% of the sample were found to meet the DSM-IV criteria of social anxiety disorder, and about 22% were highly alexithymic according to a TAS-20 total score ≥ 61; however, the mean TAS-20 total score of 50.94 ± 9.3 was not much higher than in community samples. Alexithymic traits emerged to be closely linked to emotion processing problems, particularly 'difficulty accepting own emotions', and to social anxiety features. Discussion/conclusion Our findings suggest interactions of alexithymia, emotion processing dysfunction, and social anxiety in adults with ADHD, which may entail the therapeutic implication to thoroughly instruct these patients to identify, accept, communicate, and regulate their emotions to aid reducing interaction anxiety.
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Affiliation(s)
- M-A Edel
- Depart. of Psychiatry, Rurh University, LWL, Hospital Bouchum, Germany
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Beucke JC, Uhl I, Plotkin M, Winter C, Assion HJ, Endrass T, Amthauer H, Kupsch A, Juckel G. Serotonergic neurotransmission in early Parkinson's disease: a pilot study to assess implications for depression in this disorder. World J Biol Psychiatry 2010; 11:781-7. [PMID: 20586535 DOI: 10.3109/15622975.2010.491127] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Depression, a disease usually accompanied by a serotonergic deficit, has been observed in about 40% of patients suffering from Parkinson's disease (PD). Thus, a serotonergic dysfunction in PD can be assumed. We aimed to investigate the interaction between serotonergic (5-HT) and dopaminergic activity in early PD. We hypothesized a serotonergic as well as a dopaminergic deficit in PD patients. We also assumed a correlation between these neurotransmitters indicating a relationship between dopaminergic and serotonergic function in PD. METHODS Nine unmedicated PD patients before and 12 weeks after L-dopa treatment and nine healthy subjects were examined using the loudness dependence of auditory evoked potentials (LDAEP), a promising indicator of central serotonergic function. Dopaminergic transporters (DAT) were collected using (123)I-FP-CIT and single photon emission computer tomography (SPECT). LDAEP values were correlated with (123)I-FP-CIT SPECT data. RESULTS A significant difference between LDAEP of controls and patients (P= 0.05) suggested lower serotonergic activity in PD. Twelve weeks after initiation of L-dopa treatment this difference was lost between patients and controls (P= 0.20). There was a trend towards a correlation between LDAEP and DAT (r= 0.65; P = 0.057) of the unmedicated patients, suggesting a low serotonergic activity may be related to a dopamine deficit in PD. CONCLUSIONS Our results support the hypothesis that serotonergic neurotransmission is decreased in untreated PD and suggest that a low serotonergic activity may be related to the dopamine pathology in PD. This could be related to the high prevalence of depression in PD.
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Affiliation(s)
- Jan C Beucke
- Department of Clinical Psychology, Humboldt University, Berlin, Germany
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22
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Abstract
OBJECTIVES Studies into social cognition in psychiatric disorders have recently been expanded to address the question of whether or not theory of mind (ToM), i.e., the ability to represent ones own and others mental states, is impaired in bipolar affective disorder (BPD). Results have been mixed so far, mainly due to possible confounding effects of neurocognition, as well as clinical factors such as acuity and current mood. Here, we explored ToM and its associations with neurocognitive functioning in BPD. METHODS A total of 33 patients with bipolar I disorder (of whom 12 were currently depressed, 10 manic, and 11 remitted) and 29 healthy controls were assessed using a test battery that was identical to the one that was used in previous studies in schizophrenia, comprising diverse neurocognitive tasks, including measures of intelligence, executive functioning, and ToM tasks. RESULTS The bipolar disorder patient group as a whole and all three clinical subgroups were impaired on all measures of ToM relative to controls, but did not differ from each other in most ToM scores. Patients poorer performance on executive tasks did not fully explain ToM differences between patients and controls, suggesting a partially selective ToM deficit in BPD. CONCLUSIONS Patients with BPD are impaired in ToM, partially independent of other cognitive dysfunctions and current mood.
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Affiliation(s)
- Frederike Wolf
- Research Department of Cognitive Neuropsychiatryand Psychiatric Preventive Medicine, University of Bochum, LWL-University Hospital, Germany
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Juckel G, Schumacher C, Giegling I, Assion HJ, Mavrogiorgou P, Pogarell O, Mulert C, Hegerl U, Norra C, Rujescu D. Serotonergic functioning as measured by the loudness dependence of auditory evoked potentials is related to a haplotype in the brain-derived neurotrophic factor (BDNF) gene. J Psychiatr Res 2010; 44:541-6. [PMID: 20004415 DOI: 10.1016/j.jpsychires.2009.11.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2009] [Revised: 10/28/2009] [Accepted: 11/05/2009] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The serotonergic system plays an important pathophysiological role in various psychiatric disorders. Brain-derived neurotrophic factor (BDNF) is involved in the differentiation and survival of serotonergic neurons. A previous study showed that low serum BDNF levels were associated with strong loudness dependence of auditory evoked potentials (LDAEP) as a reflection of low central serotonergic activity. To evaluate the genetic basis of this relationship, we studied whether the LDAEP is correlated with genetic variants within the BDNF gene. METHODS Ninety five healthy subjects (41 males, 54 females) received electrophysiological recording of LDAEP and blood drawing for BDNF genotyping. Three BDNF markers (including the single nucleotide polymorphism rs6265(Val66Met)) were analyzed. RESULTS Haplotype analysis revealed stronger LDAEP values in carriers of the G(Val)-C-T [rs6265(Val66Met)-rs2030324-rs1491850] haplotype within the BDNF gene in comparison to other haplotype carriers. These findings were demonstrated for the LDAEP of both left and right primary auditory cortices as well as for the vertex electrode (Cz). CONCLUSION Subjects with the BDNF haplotype G(Val)-C-T seem to be characterized by low serotonergic activity as well as possibly by low serum BDNF levels. These findings need replication in independent samples.
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Affiliation(s)
- Georg Juckel
- Department of Psychiatry, Ruhr University, 44791 Bochum, Germany.
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24
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Studentkowski G, Scheele D, Calabrese P, Balkau F, Höffler J, Aubel T, Edel MA, Juckel G, Assion HJ. Cognitive impairment in patients with a schizoaffective disorder: a comparison with bipolar patients in euthymia. Eur J Med Res 2010; 15:70-8. [PMID: 20452887 PMCID: PMC3352048 DOI: 10.1186/2047-783x-15-2-70] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Objectives Several studies have shown persistent neurocognitive impairment in patients with a bipolar affective disorder (BD) even in euthymia as well as in patients with a schizoaffective disorder (SAD). The aim of our study was to compare the neuropsychological performance between these two groups. Confounding variables were controlled to enhance our understanding of cognitive dysfunction in both BD and SAD. Methods Several domains of neurocognitive function, executive function, memory, attention, concentration and perceptuomotor function were examined in 28 euthymic SAD patients and 32 BD patients by using a neuropsychological test battery. The Hamilton Depression Rating Scale (HAMD), Montgomery-Asberg Depression Rating Scale (MADRS) and Young Mania Rating Scale (YMRS) were used to evaluate the patients' clinical status. Data analysis was performed by using a multivariate analysis of covariance (ANCOVA/MANCOVA). Results Euthymic SAD patients showed greater cognitive impairment than euthymic BD patients in the tested domains including declarative memory and attention. Putative significant group differences concerning cognitive flexibility vanished when controlled for demographic and clinical variables. Age and medication were robust predictors to cognitive performance of both SAD and BD patients. Conclusions Our results point out the worse cognitive outcome of SAD compared to BD patients in remission. Remarkably, the variance is higher for some of the test results between the groups than within each group, this being discussed in light of the contradictive concept of SAD.
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Affiliation(s)
- G Studentkowski
- Dept. of Psychiatry and Psychotherapy, LWL Hospital, Ruhr-University Bochum, Germany
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25
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Abstract
Previous research has demonstrated that patients with Delusional Disorder are impaired in executive functioning that affects performance on social cognitive tasks. In patients with Parkinson's disease, poor executive control induces an increase in “Machiavellianism,” a term that refers to opportunistic behaviors that aim at exploiting and manipulating others. Accordingly, the association between Machiavellianism in Delusional Disorder and executive functioning deficits was examined. Machiavellianism and executive functioning were measured in 22 patients with Delusional Disorder and compared with a group of 22 healthy controls matched for sex, (premorbid) intelligence, and education. Patients and controls did not differ regarding Machiavellianism scores, education level, or intelligence. However, patients with Delusional Disorder performed more poorly on an executive functioning task. Impaired executive functioning was associated with greater Machiavellianism, particularly cynical views on human nature, but not with intelligence or illness duration. Similar to findings in patients with Parkinson's disease, Machiavellianism in Delusional Disorder was associated with poorer executive functioning. This finding indicates that frontal lobe dysfunction may influence interpersonal attitudes and personality in Delusional Disorder.
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Affiliation(s)
- Martin Brüne
- Department of Psychiatry, LWL University Hospital, Ruhr-University of Bochum
| | - Miriam Basilowski
- Department of Psychiatry, LWL University Hospital, Ruhr-University of Bochum
| | - Isabel Bömmer
- Department of Psychiatry, LWL University Hospital, Ruhr-University of Bochum
| | - Georg Juckel
- Department of Psychiatry, LWL University Hospital, Ruhr-University of Bochum
| | - Hans-Jörg Assion
- Department of Psychiatry, LWL University Hospital, Ruhr-University of Bochum
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26
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Abstract
Recently, increasing attention has been drawn to the potential diabetogenic effect of novel antipsychotics. Until now, large prospective studies examining the relationship between atypical antipsychotics and impaired glucose metabolism have been lacking. However, the case reports and retrospective studies that we review here suggest an increased risk of developing diabetes mellitus (DM) in patients treated with atypical antipsychotics compared to schizophrenic patients treated with conventional antipsychotics or those without treatment. Although most atypical antipsychotic agents might have a diabetogenic potential, the risk of developing DM might be higher in patients treated with either clozapine or olanzapine than with risperidone, whereas data on quetiapine and ziprasidone is presently limited and needs further attention. Possible mechanisms include the induction of peripheral insulin resistance and the direct influence on pancreatic beta-cell function by 5-HT1A/2A/2C receptor antagonism, by inhibitory effects via alpha 2-adrenergic receptors or by toxic effects. On the other hand, atypical antipsychotics might not be an independent risk factor for the development of DM, but hasten the onset of DM in patients bearing other risk factors. It is suggested that schizophrenic patients should be monitored for the occurrence of glucose metabolism abnormalities before starting atypical antipsychotics, and at a 3-month interval at least during therapy.
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Affiliation(s)
- Peter Schwenkreis
- Department of Psychiatry and Psychotherapty, Ruhr-University of Bochum, Germany
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27
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Ozgürdal S, van Haren E, Hauser M, Ströhle A, Bauer M, Assion HJ, Juckel G. Early mood swings as symptoms of the bipolar prodrome: preliminary results of a retrospective analysis. Psychopathology 2009; 42:337-42. [PMID: 19672137 DOI: 10.1159/000232977] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2008] [Accepted: 02/06/2009] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Temperament and mood swings are promising indicators for the characterization of mood spectrum vulnerability. The aim of this study was to investigate the relationship between affective temperament and mood swings in bipolar disorder. We explored these clinical features retrospectively. METHODS Patients who met the criteria for bipolar I disorder were enrolled in the study. Exclusion criteria were partial remittance and a full affective or psychotic episode. Data concerning illness and family history, mood swings (semistructured interview for mood swings) and depression (Beck, Depression Inventory) were obtained. We examined premorbid temperament with the validated German version Temps-M of the original version Temps-A. Patients with and without mood swings were compared with respect to the dominant temperament. RESULTS Out of 20 bipolar patients, 6 subjects reported mood swings prior to the onset of affective disorder. Subjects with mood swings prior to the onset of bipolar disorder significantly correlated with a positive family history of affective disorders. Concerning cyclothymic and irritable temperament, bipolar affective patients with mood swings had higher scores. No differences were found between males and females. CONCLUSION Our findings go in line with previous results that mood swings, as represented by the cyclothymic temperament, are present prior to the first onset of bipolar disorder in a subset of patients. These traits may represent vulnerability markers and could presumably be used to identify individuals at high risk for developing bipolar disorder in order to prevent this illness. Further studies are indicated to clarify the correlation with genetic risk factors.
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Affiliation(s)
- Seza Ozgürdal
- Department of Psychiatry, Ruhr University Bochum, LWL University Hospital Bochum, Bochum, Germany
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28
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Klauenberg S, Maier C, Assion HJ, Hoffmann A, Krumova EK, Magerl W, Scherens A, Treede RD, Juckel G. Depression and changed pain perception: hints for a central disinhibition mechanism. Pain 2008; 140:332-343. [PMID: 18926637 DOI: 10.1016/j.pain.2008.09.003] [Citation(s) in RCA: 127] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2008] [Revised: 08/10/2008] [Accepted: 09/03/2008] [Indexed: 01/28/2023]
Abstract
Although patients with a depressive disorder report often of pain, their sensitivity to experimental pain is controversial, probably due to differences in sensory testing methods and to the lack of normal values. Therefore, we used a standardized and validated comprehensive sensory testing paradigm to assess the peripheral and central nervous system performance in depressive patients compared to healthy controls and chronic pain patients with fibromyalgia syndrome (FMS), in which depression is a common comorbidity. Twenty-five depressive psychiatric inpatients (pain-free: n=20), 35 FMS outpatients and 25 healthy controls underwent quantitative sensory testing (QST), including thermal and mechanical detection and pain thresholds, pain sensitivity and responsiveness to repetitive noxious mechanical stimuli (wind-up). In depressive disorder (to a lesser extent also in FMS), significantly decreased cold pain thresholds and an increased wind-up were found, although the mechanical pain thresholds and pain sensitivity were comparable to those of the healthy controls. All the detection thresholds were within the normal range in all the groups. In depressive disorder, there were no significant side differences in the detection and pain thresholds. The results contradict the former assumption of a general insensitivity to experimental pain in depressive disorder. In the mostly pain-free patients signs of an enhanced central hyperexcitability are even more pronounced than usually found in chronic pain patients (e.g. FMS), indicating common mechanisms in depressive disorder and chronic pain in accordance with the assumption of non-pain associated mechanisms in depressive disorder for central hyperexcitability, e.g. by inhibited serotonergic function. Furthermore, this trial demonstrates the feasibility of QST in depressive patients.
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Affiliation(s)
- Sabrina Klauenberg
- Department of Pain Management, Berufsgenossenschaftliche Universitätsklinik Bergmannsheil GmbH, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany Department of Psychiatry, Ruhr University Bochum, LWL University Hospital, Alexandrinenstrasse 1, 44791 Bochum, Germany Private Practice of Rheumatology, Richard-Wagner-Strasse 13-17, 50674 Cologne, Germany Division of Neurophysiology, CBTM, Medical Faculty Mannheim, Ruprecht Karls University Heidelberg, Ludolf-Krehl-Strasse 13-17, 68167 Mannheim, Germany
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29
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Assion HJ. [Patients of Turkish origin in an institutional psychiatric outpatient service]. MMW Fortschr Med 2007; 149:40. [PMID: 17987719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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30
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Machleidt W, Assion HJ. [Immigrants in the general medical practice. Good patient-doctor-patient relationship protects against somatization]. MMW Fortschr Med 2007; 149:30-31. [PMID: 17987715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- W Machleidt
- Sozialpsychiatrie & Psychotherapie, Medizinische Hochschule Hannover
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31
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Balkau F, Juckel G, Assion HJ. Migration als Belastungsfaktor einer schizoaffektiven Störung. Psychiat Prax 2007; 34:354-6. [DOI: 10.1055/s-2007-971006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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32
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Kornischka J, Assion HJ, Ziegenbein M, Agelink MW. [Psychosocial problems and mental disorders among immigrants of German origin]. Psychiatr Prax 2007; 35:60-6. [PMID: 17902058 DOI: 10.1055/s-2007-971023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The number of ethnic German immigrants from former East bloc countries (Aussiedler) has considerably increased during the past 20 years. However, studies on the frequency of psychiatric disorders or on psychosocial risk factors for psychiatric morbidity in this partially inhomogenous population group are remarkably rare. METHOD We undertook a comprehensive research of the current literature to gain the first systematic review on this issue. RESULTS The most frequent mental disorders among these special group of migrants were depressive disorders, adjustment disorders with brief depressive reactions as well as somatoform disorders, alcoholism and drug dependency. CONCLUSIONS Ethnic German immigrants are a risk group for mental disorders.
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Affiliation(s)
- Jürgen Kornischka
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik am Klinikum Herford, Akademisches Lehrkrankenhaus der Medizinischen Hochschule Hannover.
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33
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Assion HJ, Zarouchas I, Multamäki S, Zolotova J, Schröder SG. Patients' use of alternative methods parallel to psychiatric therapy: does the migrational background matter? Acta Psychiatr Scand 2007; 116:220-5. [PMID: 17655564 DOI: 10.1111/j.1600-0447.2007.01010.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Unconventional medicine is widespread in nearly every culture and often used parallel to professional help. This survey evaluates the use of unconventional methods of psychiatric in-patients with vs. without a background of migration. METHOD A total of 167 psychiatric in-patients underwent a structured interview. One hundred patients were migrants (group 1) and were compared with 67 German in-patients (group 2). RESULTS Nearly 50% of all patients reported of at least one unconventional therapy. Both migrants and natives used healing methods parallel to professional help. The migrant group rathered to use folk medical concepts and the native group rathered alternative medicine. Around half of the patients with experience of complementary therapy believed it to be efficacious. CONCLUSION The results suggest that nearly half of the psychiatric patients use alternative medicine and a quarter believe in its efficacy. People with a more traditional background tend to use folk medical practices.
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Affiliation(s)
- H J Assion
- Unit for Mental Health of Migrants, Westphalian Center, Department of Psychiatry and Psychotherapy, Ruhr-University Bochum, Bochum, Germany.
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34
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Assion HJ, Bingöl H, Ozguerdal S, Basilowski M. [Patients of Turkish origin in an institutional psychiatric outpatient service]. MMW Fortschr Med 2007; 149:57-8. [PMID: 17619601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Germany has changed to a multicultural society within the last decades, similar to other industrial countries in Europe. The health system has not yet adapted to this situation and there is a need for better treatment of migrants with specialized programs. It is important to create consciousness about the situation of migrants and their requirements. The Westphalian Center Bochum as part of the Ruhr-University Bochum offers a specialized care project for people derived from Turkey and has a culture competent outpatient service. The results of this care project are presented along an evaluation of 115 Turks, who were treated within the year 2006.
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Affiliation(s)
- Hans-Jörg Assion
- Westfalisches Zentrum Bochum, Psychiatrie und Psychotherapie, Ruhr-Universität Bochum.
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35
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Abstract
INTRODUCTION This study examines the prevalence of off-label prescriptions in a large German psychiatric hospital. The influence of a 2002 decision by the Federal Social Court regarding reimbursement issues is investigated. METHODS Two random samples ( N(1)=125; N(2)=126) of all patients treated in the years 2001-2002 and 2003-2004, respectively, were examined. All prescriptions of psychotropic drugs were evaluated and categorized as CLEARLY OFF-LABEL, PROBABLY OFF-LABEL, or ON-LABEL. Label status for each product was judged according to the information stated in the officially authorized Summary of Product Characteristics. RESULTS In 2001-2002 20% of all prescriptions of psychotropic drugs were clearly off-label, and 19% were probably off-label. In 2003-2004 the numbers were 21% and 26%, respectively. There was a significant increase in probable and combined probable and clear off-label use. There was no significant influence of sex and patients' age on off-label prescribing, but treatment duration showed a significant positive correlation with off-label use. Drugs prescribed on discharge were significantly more often prescribed off-label than drugs prescribed during the whole duration of treatment. DISCUSSION Prevalence of psychiatric off-label use in Germany is high. These results are in accordance with international surveys. The restrictive interpretation of the legal reimbursement provisions applied by the German Federal Social Court has not caused a decrease in off-label use. Although measures have been taken to solve the legal problems arising from off-label-use, further solutions are needed to ensure both patient and prescriber safety.
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Affiliation(s)
- H J Assion
- Westphalian Center Bochum, Dep. of Psychiatry and Psychotherapy, Ruhr-University Bochum.
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36
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Abstract
Erotomania is a rare delusional disorder usually associated with other psychic disorders, especially paranoid schizophrenia. The primary form without comorbidity is very rare. A case report is presented with characteristic features of the pure form of erotomania in a female patient that was nevertheless an affective disorder. A historical review is presented and the division of Clérambault's syndrome into primary and secondary categories critically discussed.
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Affiliation(s)
- P Debbelt
- Zentrum für Psychiatrie, Ruhr-Universität Bochum, Alexandrinenstrasse 1, 44791 Bochum
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37
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Abstract
The treatment of Turkish patients is peculiar due to differences of socio-cultural background and speech. Magic conceptions of pathogenesis and nosogeny have a broad acceptance in a part of population. Magic faith healers, Hocas, are authorities to be consulted for treatment. In ritual acts they intend to stave off noxious influences and to strengthen the healing power with sacred formulas and through powerful objects. To investigate the importance, utilisation and attitude towards the Hocas of Turkish psychiatric patients living in Germany we conducted an interview with 55 psychiatric inpatients. Our findings were a reduced importance of Hocas due to influences of the Western culture and modern medicine. "Folk" medicine is still important for patients with psychic disorders and is used parallel to modern medical facilities.
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Affiliation(s)
- H J Assion
- Zentrum für Psychiatrie und Psychotherapie der Ruhr-Universität Bochum
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38
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Abstract
Neuroleptic malignant syndrome (NMS) is a rare complication of treatment with neuroleptics. The pathophysiology is not fully known. A dopaminergic transmission block in the basal ganglia and hypothalamus is thought to be the pathophysiological mechanism of NMS. Several cases of NMS have been reported, precipitated by medication without a direct effect on the dopaminergic system. This Medline analysis concerns 23 cases of antidepressant-induced NMS reported in the literature with the differing pathophysiological hypotheses on the precipitation of NMS. The results indicate no hard evidence of an antidepressant-evoked NMS. However, various hypotheses assuming an disturbed balance of the dopaminergic and non-dopaminergic system may be relevant in animal studies, but are without clinically relevant proof presently. An antidepressant-induced NMS is a very rare complication on the basis of pretreatment with neuroleptics causing chronic dopamine blockade and elevated plasma level of neuroleptics due to comedicated antidepressants.
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Affiliation(s)
- H J Assion
- Department of Psychiatry, University of Bochum, Germany
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39
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Abstract
Asperger syndrome is an autistic disorder and was first described by Hans Asperger in 1944 without further acceptance in the literature over almost four decades. Following several publications in the 1980s, for the disorder became more widely known and was first introduced into ICD-10 and DSM-IV as a new diagnosis in 1988 and 1994, respectively. The etiology is unknown. We present a female patient with typical features of Asperger syndrome, suffering also from epilepsy and internal medical disorders. The associated diseases, diagnostic criteria and possible therapeutic options are discussed.
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Affiliation(s)
- B Bonus
- Psychiatrische Universitätsklinik Bonn
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40
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Abstract
We report on a 22-year-old schizophrenic patient who attempted suicide and suffered an epidural hemorrhage. 16 days after the neurosurgical operation. After several weeks of treatment with promethazine, 1 day after intake of paroxetin he partially lost consciousness and developed extrapyramidal symptoms and vegetative disorders. Hyper-Ck-aemia up to 680 U/l was observed. Malignant neuroleptic syndrome (MNS) was diagnosed, which led to withdrawal of paroxetin and promethazine. He was put on dantamacrine and amantadine until the symptoms resolved. To date there have been few reports on MNS under tricyclic antidepressants and selective serotonin inhibitors. The influence of the central serotonergic system on the pathophysiology of MNS is discussed.
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Affiliation(s)
- F Heinemann
- Neurologische Abteilung, St.-Josef-Krankenhaus, Moers
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41
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Abstract
The neuroleptic malignant syndrome (NMS) is a rare complication in the treatment of neuroleptics. The pathophysiology is not fully known. A dopaminergic transmission block in the basal ganglia and the hypothalamus is thought to be the pathophysiological mechanism of NMS. There are some findings against the single role of dopamine receptor blockade: NMS is rare under neuroleptic treatment, although a strong dopamine receptor blockade is found even with a low dosis of neuroleptics. NMS can develop even after longterm treatment with neuroleptics and is not improved by dopamine agonists within the expected period. NMS may even develop when neuroleptics are reduced. Several cases have been reported of NMS precipitated by medication without a direct effect on dopaminergic system. Only rare case reports describe NMS under antidepressants. We report on all cases of NMS associated with antidepressants and present the different pathophysiological hypotheses on the precipitation of NMS.
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Affiliation(s)
- F Heinemann
- Neurologische Abteilung, St.-Josef-Krankenhaus Moers
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42
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Abstract
Asperger syndrome is an autistic disorder which was first described in 1944 without further acceptance in the literature over almost four decades. Following several publications in the "80's, the disorder became more widely known. Asperger syndrome was introduced into ICD-10 and DSM-IV as a new diagnosis in 1988 and 1994, respectively. Several authors developed own criteria. Until now, some of the diagnostic criteria of Asperger syndrome remain controversial. We present a survey and a comparison of the criteria in the classification of DSM-IV, ICD-10 and of other authors. Six criteria are widely accepted, but there are divergent opinions about the criteria "intelligence" and "speech development".
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Affiliation(s)
- B Bonus
- Psychiatrische Universitätsklinik Bonn
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43
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Assion HJ, Kolbinger HM, Rao ML, Laux G. Lymphocytopenia and thrombocytopenia during treatment with risperidone or clozapine. Pharmacopsychiatry 1996; 29:227-8. [PMID: 8956354 DOI: 10.1055/s-2007-979577] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The atypical antipsychotic clozapine is associated with several well-known abnormalities of blood cell count, whereas only rare reports are associated with the neuroleptic risperidone. This report describes lymphocytopenia and thrombocytopenia under treatment with risperidone which continued after changing to clozapine without other clinically significant abnormal hematological parameters. Within one week after discontinuation of both neuroleptics abnormalities of blood cell count reversed to the initial values. Abnormalities of lymphocytes or thrombocytes are rare side-effects under treatment with risperidone or clozapine.
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Affiliation(s)
- H J Assion
- Department of Psychiatry, University of Bonn, Germany
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Assion HJ, Heinemann F. [Psychiatric disorders after a single 3,4-methylenedioxyethamphetamine (MDE, "Eve") and tetrahydrocannabinol (cannabis) use]. Psychiatr Prax 1996; 23:298-9. [PMID: 9036403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We report on a single intake of 3,3-methylenedioxyethamphetamine (MDE, "Eve") and tetrahydrocannabinol (cannabis). Because of the increasing abuse of "designer-drugs" and the rare reports on MDE the psychopathology after intake of MDE and cannabis is presented.
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Affiliation(s)
- H J Assion
- Neurologische Abteilung, St.-Josef-Krankenhaus Moers, Oberhausen
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Abstract
We report on a patient with a history of alcoholism who developed hyperbilirubinemia induced by treatment with clomethiazole during two hospitalizations. After discontinuation of clomethiazole symptoms of cholestasis improved. Clomethiazole is a thiazole analogon and is chemically related to thiamine (vitamin B1). It can be administered as tablets, capsules, mixtures, and a 0.8% solution. Because of its sedative, hypnotic, and anti-convulsive effects it is used in the treatment of alcoholic delirium.
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Affiliation(s)
- F Heinemann
- Department of Neurology, St-Josef-Hospital, Moers, Germany
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Heinemann F, Assion HJ. [Panic attacks with cycloleptic course--differential diagnostic considerations in differentiating panic disorder from epileptic anxiety attacks]. Psychiatr Prax 1996; 23:192-3. [PMID: 8927649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This paper reports on a patient suffering from panic-attacks. A therapy with antidepressants and benzodiazepines was ineffective. The panic-attacks had a short duration and a cycloleptic course. Under the treatment with carbamazepine panic attacks improved. The differential diagnosis of panic disorder and epileptic panic attacks is discussed.
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Heinemann F, Assion HJ. [Language regression to the mother tongue in polyglot patients with acute psychosis]. Nervenarzt 1996; 67:599-601. [PMID: 8927199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Three bilingual patients with schizophrenia are presented, who spoke almost exclusively in their native language during acute episodes of psychosis. Normal use of the foreign language, German, was again possible after remission of the acute symptoms. This phenomenon of regression is similar to speech disorders in patients with aphasia and is discussed with reference to recent biological findings.
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Affiliation(s)
- F Heinemann
- Neurologische Abteilung, St.-Josef-Krankenhaus, Moers
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Heinemann F, Assion HJ. [Therapy of coinciding trigeminal neuralgia and schizophrenia]. Psychiatr Prax 1996; 23:197. [PMID: 8927651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Sobanski T, Assion HJ, Scholl HP, Höflich G, Laux G. Successful zidovudine (AZT) treatment in a case of human immunodeficiency virus (HIV)-1-associated dementia complex. Biol Psychiatry 1996; 39:1065-6. [PMID: 8780847 DOI: 10.1016/0006-3223(96)00014-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Sobanski T, Assion HJ, Höflich G, Scholl HP. [Dementia-paranoid syndrome as the initial manifestation of AIDS. Case report and diagnostic overview]. Nervenarzt 1996; 67:68-71. [PMID: 8676991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
A 33-year-old HIV-1-positive man developed dementia and a paranoid symptomatology with auditory hallucinations as the first manifestation of AIDS. The immunodeficiency syndrome is currently represented only by the immunohistochemical findings (CD4 216/microliters; CD4/CD8 ratio 0.12); no other manifestations of the disease are present. According to the literature about 15% of patients suffering from AIDS are likely to develop dementia during the course of the disease, usually after preceding opportunistic infections, severe systemic illness, or neoplasm. The manifestation of the disease solely by dementia is a rare phenomenon and represents, particularly if the incident of infection is cryptic, a diagnostic challenge.
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Affiliation(s)
- T Sobanski
- Psychiatrische Klinik und Poliklinik, Universität, Bonn
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