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Zierhut M, Boege K, Bergmann N, Hahne I, Braun A, Kraft J, Ta T, Ripke S, Bajbouj M, Hahn E. The relationship between the recognition of specific basic emotions and negative symptom domains in patients with schizophrenia spectrum disorders. Eur Psychiatry 2022. [PMCID: PMC9567337 DOI: 10.1192/j.eurpsy.2022.305] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Current research suggests emotion recognition to be significantly impaired in individuals with schizophrenia spectrum disorders (SSD), whereby negative symptoms are theorised to play a crucial role. Emotion recognition deficits are assumed to be predictors of transition from clinical high risk to schizophrenia. So far, little attention has been given hereby to the subdomains of negative symptoms and recognizing the individual basic emotions. Objectives Our study aimed to explore the relationship between the recognition of the basic emotions and each negative symptom domain. Methods 66 patients with a SSD diagnosis were recruited at the Charité – Universitätsmedizin Berlin. Correlational and regression analyses to control for the covariates (age, education, sex) were conducted between the recognition of the six basic emotions (anger, disgust, fear, happiness, sadness, surprise) using the Emotion Recognition Task of the Cambridge Neuropsychological Test Automated Battery (CANTAB) and the seven different subdomains of negative symptoms of the Positive and Negative Syndrome Scale (PANSS). Results
revealed significantly negative correlations of blunted affect with the recognition of happiness, fear, and disgust. Difficulties in abstract thinking, also correlated positively with the recognition of fear. Additionally, we found a significant positive correlation between stereotyped thinking and difficulties in abstract thinking with the response latency in emotion recognition. Conclusions Individuals with SSD and domains of negative symptoms showed specific impairments in recognizing the representation of basic emotions. A longitudinal design to make causality statements would be useful for future research. Moreover, emotion recognition should be considered for early detection and individualized treatment. Disclosure No significant relationships.
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Zierhut M, Von Eisenhart-Rothe V, Graesser S, Hartter N, Wohlthan J, Hahne I, Bergmann N, Ta T, Bajbouj M, Hahn E, Boege K. The effect of intranasal oxytocin application and mindfulness-based group therapy for patients with schizophrenia spectrum disorders – A study protocol. Eur Psychiatry 2022. [PMCID: PMC9567096 DOI: 10.1192/j.eurpsy.2022.1969] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction
Research indicates improvements in negative symptoms and empathy for schizophrenia spectrum disorders (SSD) after mindfulness-based interventions (MBI). Current treatment approaches for SSD remain limited regarding their effectiveness on negative symptoms and sociocognitive deficits. After oxytocin (OXT) administration, especially in a positive social context, an increase in empathy could be shown. The effect of mindfulness in combination with OXT has not yet been examined.
Objectives
This study investigates the additional effect of OXT administration combined with MBI on empathy and negative symptoms in patients with SSD.
Methods
An experimental, randomised, triple-blinded, placebo-controlled study is proposed. Based on power calculations, 140 participants with SSD will be recruited at Charité – Universitätsmedizin Berlin. A dose of intranasal oxytocin with 24 I.U. or placebo will be administered 45 minutes before each session. Following each administration, a total of four MBI interventions will take place for two weeks. Empathy as primary outcome will be measured using validated psychometric questionnaires. Outcomes, including negative symptoms and OXT plasma levels, will be measured at baseline and post-intervention. A 2x2 mixed-model ANCOVA design with time as within- and group as between-subject factor will be calculated to assess empathy and negative symptom changes.
Results
The study hypothesises that applying intranasal oxytocin in combination with MBI will increase empathy and reduce negative symptoms in patients with SSD.
Conclusions
Findings could provide insight into enhancing therapies like MBI by utilising OXT as a possible supplementary treatment option. Findings could therefore pave the way for a personalised psychiatric medicine treatment for individuals with SSD.
Disclosure
No significant relationships.
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Nguyen VT, Braun A, Kraft J, Ta TMT, Panagiotaropoulou GM, Nguyen VP, Nguyen TH, Trubetskoy V, Le CT, Le TTH, Pham XT, Heuser-Collier I, Lam NH, Böge K, Hahne IM, Bajbouj M, Zierhut MM, Hahn E, Ripke S. Increasing sample diversity in psychiatric genetics - Introducing a new cohort of patients with schizophrenia and controls from Vietnam - Results from a pilot study. World J Biol Psychiatry 2022; 23:219-227. [PMID: 34449294 DOI: 10.1080/15622975.2021.1951474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Genome-Wide Association Studies (GWAS) of Schizophrenia (SCZ) have provided new biological insights; however, most cohorts are of European ancestry. As a result, derived polygenic risk scores (PRS) show decreased predictive power when applied to populations of different ancestries. We aimed to assess the feasibility of a large-scale data collection in Hanoi, Vietnam, contribute to international efforts to diversify ancestry in SCZ genetic research and examine the transferability of SCZ-PRS to individuals of Vietnamese Kinh ancestry. METHODS In a pilot study, 368 individuals (including 190 SCZ cases) were recruited at the Hanoi Medical University's associated psychiatric hospitals and outpatient facilities. Data collection included sociodemographic data, baseline clinical data, clinical interviews assessing symptom severity and genome-wide SNP genotyping. SCZ-PRS were generated using different training data sets: (i) European, (ii) East-Asian and (iii) trans-ancestry GWAS summary statistics from the latest SCZ GWAS meta-analysis. RESULTS SCZ-PRS significantly predicted case status in Vietnamese individuals using mixed-ancestry (R2 liability = 4.9%, p = 6.83 × 10-8), East-Asian (R2 liability = 4.5%, p = 2.73 × 10-7) and European (R2 liability = 3.8%, p = 1.79 × 10-6) discovery samples. DISCUSSION Our results corroborate previous findings of reduced PRS predictive power across populations, highlighting the importance of ancestral diversity in GWA studies.
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Affiliation(s)
- V T Nguyen
- Department of Psychiatry, Hanoi Medical University, Hà Nội, Việt Nam.,National Institute of Mental Health, Bach Mai Hospital, Hà Nội, Việt Nam
| | - A Braun
- Charité - Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Berlin, Germany
| | - J Kraft
- Charité - Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Berlin, Germany
| | - T M T Ta
- Berlin Institute of Health, Charité - Universitätsmedizin Berlin, BIH Academy, Clinician Scientist Program, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Berlin, Germany
| | - G M Panagiotaropoulou
- Charité - Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Berlin, Germany
| | - V P Nguyen
- Department of Psychiatry, Hanoi Medical University, Hà Nội, Việt Nam
| | - T H Nguyen
- Department of Psychiatry, Hanoi Medical University, Hà Nội, Việt Nam.,Charité - Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Berlin, Germany
| | - V Trubetskoy
- Charité - Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Berlin, Germany
| | - C T Le
- Department of Psychiatry, Hanoi Medical University, Hà Nội, Việt Nam.,National Institute of Mental Health, Bach Mai Hospital, Hà Nội, Việt Nam
| | - T T H Le
- Department of Psychiatry, Hanoi Medical University, Hà Nội, Việt Nam.,National Institute of Mental Health, Bach Mai Hospital, Hà Nội, Việt Nam
| | - X T Pham
- Department of Psychiatry, Hanoi Medical University, Hà Nội, Việt Nam
| | - I Heuser-Collier
- Charité - Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Berlin, Germany
| | - N H Lam
- Hanoi Mental Hospital, Hà Nội, Việt Nam
| | - K Böge
- Charité - Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Berlin, Germany
| | - I M Hahne
- Charité - Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Berlin, Germany
| | - M Bajbouj
- Charité - Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Berlin, Germany
| | - M M Zierhut
- Berlin Institute of Health, Charité - Universitätsmedizin Berlin, BIH Academy, Clinician Scientist Program, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Berlin, Germany
| | - E Hahn
- Charité - Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Berlin, Germany
| | - S Ripke
- Charité - Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Berlin, Germany.,Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
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Höhne E, Banaschewski T, Bajbouj M, Böge K, Sukale T, Kamp-Becker I. Prevalences of mental distress and its associated factors in unaccompanied refugee minors in Germany. Eur Child Adolesc Psychiatry 2021:10.1007/s00787-021-01926-z. [PMID: 34919189 DOI: 10.1007/s00787-021-01926-z] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 12/05/2021] [Indexed: 11/28/2022]
Abstract
Prevalences for mental disorders within minor refugees are comparatively high and heterogeneous. To reduce heterogeneity and identify high-risk subgroups, we compared unaccompanied refugee minors (URM) to accompanied refugee minors (ARM) regarding depressive symptoms and mental distress. Furthermore, we examined associative factors of mental distress in URM on a broad scale. We conducted a survey with a cross-sectional design in four German University hospitals. The sample consisted of n = 172 URM and n = 52 ARM aged 14-21. Depressive symptoms were assessed via the Patient Health Questionnaire (PHQ-9). Mental distress was assessed by the Refugee Health Screener (RHS-15). Mann-Whitney test was used to examine differences between URM and ARM. Associated factors of mental distress were evaluated via a stepwise multiple regression analysis. URM showed significantly higher mean scores for PHQ-9 (p < .001) and RHS-15 (p < .001) compared to ARM indicating medium effect sizes. Furthermore, URM were significantly more likely to surpass the cut-off for depression (61.6% vs. 30.8%) and overall mental distress (81.4% vs. 53.8%) compared to ARM. The factors Number of stressful life events (SLE), Female gender, and Fear of deportation were found to be associated with an increased mental distress in URM, whereas Weekly contact to a family member, School attendance, and German language skills were accompanied with lower distress scores. All six factors accounted for 32% of the variance of mental distress in URM (p < .001). Within minor refugees, URM are a highly vulnerable subgroup, which should receive particular attention and more targeted measures by health authorities. Our results indicate that these measures should comprise a rapid promotion of family contact, school attendance, language acquisition, and the fast processing of asylum applications. However, the cross-sectional design limits the interpretability of the results.
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Affiliation(s)
- E Höhne
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Human Medicine, University Hospital of Marburg and Philipps-University Marburg, Marburg, Germany.
| | - T Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - M Bajbouj
- Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - K Böge
- Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - T Sukale
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany
| | - I Kamp-Becker
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Human Medicine, University Hospital of Marburg and Philipps-University Marburg, Marburg, Germany
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Kumpf U, Stadler M, Plewnia C, Bajbouj M, Langguth B, Zwanzger P, Normann C, Keeser D, Schellhorn K, Egert-Schwender S, Berkes S, Palm U, Hasan A, Padberg F. Transcranial Direct Current Stimulation (tDCS) for major depression - Interim analysis of cloud supervised technical data from the DepressionDC trial. Brain Stimul 2021; 14:1234-1237. [PMID: 34391956 DOI: 10.1016/j.brs.2021.08.005] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/02/2021] [Accepted: 08/05/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Transcranial direct current stimulation (tDCS) of prefrontal cortex regions has been reported to exert antidepressant effects, though large scale multicenter trials in major depressive disorder (MDD) supporting this notion are still lacking. Application of tDCS in multicenter settings, however, requires measurement, storage and evaluation of technical parameters of tDCS sessions not only for safety reasons but also for quality control. To address this issue, we conducted an interim analysis of supervised technical data across study centers in order to monitor technical quality of tDCS in an ongoing multicenter RCT in MDD (DepressionDC trial). METHODS Technical data of 818 active tDCS sessions were recorded, stored in a data cloud, and analysed without violating study blinding. Impedance, voltage and current were monitored continuously with one data point recorded every second of stimulation. RESULTS Variability of impedance was considerable (1,42 kΩ, to 8,23 kΩ), inter-individually and even more intra-individually, but did not significantly differ between the study centre in Munich and all other sites. CONCLUSION Measurement, centralized data storage via data cloud and remote supervision of technical parameters of tDCS are feasible and proposed for future RCTs on therapeutic tDCS in multiple settings.
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Affiliation(s)
- U Kumpf
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University Munich, Nussbaumstr. 7, 80336, Munich, Germany.
| | - M Stadler
- Faculty of Psychology and Educational Sciences, Ludwig Maximilian University Munich, Germany
| | - C Plewnia
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - M Bajbouj
- Department of Psychiatry and Psychotherapy, Charité-Campus Benjamin Franklin, Berlin, Germany
| | - B Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - P Zwanzger
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University Munich, Nussbaumstr. 7, 80336, Munich, Germany; kbo-Inn-Salzach-Hospital, Wasserburg am Inn, Germany
| | - C Normann
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine & Center for Basics in Neuomodulation NeuroModulBasics, University of Freiburg, Germany
| | - D Keeser
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University Munich, Germany; Department of Radiology, Ludwig Maximilian University Munich, Germany; Munich Center for Neurosciences (MCN) - Brain & Mind, Planegg-Martinsried, Germany
| | | | | | - S Berkes
- NeuroCare Group GmbH, Munich, Germany
| | - U Palm
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University Munich, Nussbaumstr. 7, 80336, Munich, Germany; Medicalpark Chiemseeblick, Bernau-Felden, Germany
| | - A Hasan
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, University of Augsburg, BKH Augsburg, Augsburg, Germany
| | - F Padberg
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University Munich, Germany
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Bergmann N, Hahn E, Hahne I, Zierhut M, Ta T, Bajbouj M, Pijnenborg M, Böge K. The relationship between mindfulness, depression, anxiety, and quality of life in individuals with schizophrenia spectrum disorders. Eur Psychiatry 2021. [PMCID: PMC9480094 DOI: 10.1192/j.eurpsy.2021.2079] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Mindfulness-based interventions have received growing attention over the last years for the treatment of various mental disorders, including schizophrenia spectrum disorders (SSD), demonstrating their transdiagnostic validity. However, no study has examined the relationship of probable mechanisms underlying the therapeutic effects of mindfulness in SSD. Objectives The current study examines the relationship between mindfulness, depression, anxiety, and quality of life in individuals with SSD through quantitative measures. Methods A total of 83 participants with SSD were recruited at the in- and outpatient facility of the Charité – Universitätsmedizin Berlin in Germany. Participants completed the Southampton Mindfulness Questionnaire, Comprehensive Inventory for Mindful Experiences, and Freiburger Mindfulness Inventory, the Depression, Anxiety, Stress Scale, and the World Health Organization Quality of Life Questionnaire. PROCESS analysis examined the relationship between mindfulness and quality of life and the mediating role of depression and anxiety. Results
Indicated a significant positive association between mindfulness and physical health, psychological and environmental quality of life. Depression and anxiety were found to mediate this relationship, with higher depression and anxiety scores being related to lower mindfulness and quality of life. In this relationship, however, depression was found to be the stronger predictor. Conclusions The findings of this study provide insight into the mechanisms of mindfulness. Initial evidence for the transdiagnostic and process-based clinical relevance of MBIs for SSD has been found and future studies can further explore the role of mindfulness for central therapeutic processes of change by employing longitudinal designs. Disclosure No significant relationships.
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7
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Böge K, Hahne I, Bergmann N, Zierhut M, Ta T, Wingenfeld K, Bajbouj M, Hahn E. Mindfulness-based group therapy for inpatients with schizophrenia spectrum disorders – feasibility, acceptability, and preliminary outcomes of a rater-blinded randomized controlled trial. Eur Psychiatry 2021. [PMCID: PMC9480089 DOI: 10.1192/j.eurpsy.2021.2130] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Introduction The therapeutic effectiveness of mindfulness-based interventions (MBIs) has been shown for various mental disorders. However, for schizophrenia spectrum disorders (SSD), only a few trials have been conducted, mostly in outpatient settings. Objectives This study aimed to investigate feasibility, acceptability, and preliminary effectiveness of a four-week mindfulness-based group therapy (MBGT) for in-patients with SSD. Methods A pre-registered randomized controlled trial (RCT) was conducted at the in-patient ward for SSD. All measures were employed at baseline, post-intervention (4-weeks), and follow-up (12-weeks). The primary outcome was ‘mindfulness’. Secondary outcomes were rater-blinded positive- and negative symptoms, depression, social functioning, as well as self-rated mindfulness, depression, anxiety, psychological flexibility, quality of life, and medication regime. Results N=40 participants were randomized into either four-week treatment-as-usual (TAU; n=19) or MBGT+TAU (n = 21). Protocol adherence was 95.2%, and the retention rate to treatments was 95%. ANCOVA analysis revealed significant improvements in the MBGT+TAU compared to TAU for the primary outcome and negative symptoms. Exploratory analyses showed medium-to-large intervention effects on secondary outcomes mindfulness, positive, negative, and depressive symptoms, psychological flexibility, quality of life, and social functioning for MBGT+TAU and small-to-moderate changes on positive symptoms and social functioning for TAU. No serious adverse effects were reported. Conclusions This study supports the feasibility and acceptability of MBGT for in-patients with SSD, including high protocol adherence and retention rates. A proof of concept of the MBIs and corresponding improvements on various clinical and process parameters warrant a fully powered RCT to determine effectiveness, cost-efficiency, and longitudinal outcomes of MBGT for SSD. Disclosure No significant relationships.
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Stippl A, Scheidegger M, Aust S, Herrera A, Bajbouj M, Gärtner M, Grimm S. Ketamine specifically reduces cognitive symptoms in depressed patients: An investigation of associated neural activation patterns. J Psychiatr Res 2021; 136:402-408. [PMID: 33647855 DOI: 10.1016/j.jpsychires.2021.02.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 02/05/2021] [Accepted: 02/12/2021] [Indexed: 12/28/2022]
Abstract
Major depressive disorder (MDD) is characterized by heterogeneous cognitive, affective and somatic symptoms. Hence, the investigation of differential treatment effects on these symptoms as well as the identification of symptom specific biomarkers might crucially contribute to the development of individualized treatment strategies. We here aimed to examine symptom specific responses to treatment with ketamine, which repeatedly demonstrated rapid antidepressant effects in severe MDD. Additionally, we investigated working memory (WM) related brain activity associated with changes in distinct symptoms in order to identify specific response predictors. In a sample of 47 MDD patients receiving a single sub-anesthetic dose of ketamine, we applied a three-factor solution of the Beck Depression Inventory (BDI) to detect symptom specific changes 24 h post-infusion. A subsample of 16 patients underwent additional fMRI scanning during an emotional working memory task prior to ketamine treatment. Since functional aberrations in the default mode network (DMN) as well as in the dorsolateral prefrontal cortex (DLPFC) have been associated with impaired cognitive and emotional processing in MDD, we investigated neural activity in these regions. Our results showed that ketamine differentially affects MDD symptoms, with the largest symptom reduction in the cognitive domain. WM related neuroimaging results indicated that a more pronounced effect of ketamine on cognitive symptoms is predicted by lower DMN deactivation and higher DLPFC activation. Findings thereby not only indicate that ketamine's antidepressant efficacy is driven by a pro-cognitive mechanism, but also suggest that this might be mediated by increased potential for adaptive adjustment in the circumscribed brain regions.
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Affiliation(s)
- A Stippl
- Department of Psychiatry, Campus Benjamin Franklin, Charité, Berlin, Germany.
| | - M Scheidegger
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry, University of Zurich, Switzerland
| | - S Aust
- Department of Psychiatry, Campus Benjamin Franklin, Charité, Berlin, Germany
| | - A Herrera
- Department of Psychiatry, Campus Benjamin Franklin, Charité, Berlin, Germany
| | - M Bajbouj
- Department of Psychiatry, Campus Benjamin Franklin, Charité, Berlin, Germany
| | - M Gärtner
- Department of Psychiatry, Campus Benjamin Franklin, Charité, Berlin, Germany; MSB Medical School Berlin, Germany
| | - S Grimm
- Department of Psychiatry, Campus Benjamin Franklin, Charité, Berlin, Germany; Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry, University of Zurich, Switzerland; MSB Medical School Berlin, Germany
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Luborzewski A, Danker-Hopfe H, Bajbouj M, Brakemeier EL. Optimierung der repetitiven transkraniellen Magnetstimulation als Behandlung von Depressionen. ACTA ACUST UNITED AC 2018. [DOI: 10.1055/s-0038-1626759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
ZusammenfassungDie rTMS gilt derzeit als mögliche Therapieoption für depressive Patienten, welche auf andere antidepressive Behandlungsverfahren nicht oder nur unzulänglich ansprechen. Die Datenlage zur Effektivität spricht insgesamt für eine moderate antidepressive Wirksamkeit der rTMS, allerdings ist die klinische Bedeutung der beobachteten Effekte eher gering, sodass Studien zur Optimierung der Effektivität von Nöten sind. In der Berliner Prädiktor Studie wurden mit der rTMS des linken DLPFC über einen Zeitraum von zwei Wochen 70 depressive Patienten behandelt, von denen 21% respondierten. Da insbesondere Einsicht in Veränderungen der individuellen klinischen Symptomcluster gewonnen werden sollte, wurden fünf Cluster im Verlauf analysiert. Durch regressionsanalytische Methoden konnte gezeigt werden, dass neben generellen Prädiktoren wie eine kurze Episodendauer und ein geringes Maß an Therapieresistenz, besonders motorische Retardierung und Schlafstörungen klinische Prädiktoren für ein Ansprechen auf rTMS sind.
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10
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Neu B, Nennstiel S, von Delius S, Abdelhafez M, Bajbouj M, Schmid RM, Berger H, Feussner H, Meining A. Endoscopic rendez-vous reconstruction of complete biliary obstruction. Dig Liver Dis 2017; 49:769-772. [PMID: 28314602 DOI: 10.1016/j.dld.2017.01.170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 09/15/2016] [Revised: 01/15/2017] [Accepted: 01/19/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND STUDY AIMS Complete biliary strictures normally require surgical intervention. We describe an alternative, minimally invasive endoscopic/percutaneous rendez-vous technique for the reconstruction of complete benign biliary strictures. PATIENTS AND METHODS Complete biliary strictures were reconstructed in four patients using a rendez-vous percutaneous-endoscopic or percutaneous-percutaneous route guided by fluoroscopic and visual (transillumination) control. RESULTS All four patients were treated successfully and safely with the rendez-vous technique. Complications were caused by the preliminary creation, dilatation and maturation of the percutaneous tract. CONCLUSION This technique may offer a good alternative to surgical bilio-enteric anastomosis in experienced hands. The long term course of the patients treated remains to be seen.
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Affiliation(s)
- B Neu
- Academic Teaching Hospital Landshut-Achdorf, Medizinische Klinik II, Landshut, Technische Universität München, Germany.
| | - S Nennstiel
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - S von Delius
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - M Abdelhafez
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - M Bajbouj
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - R M Schmid
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - H Berger
- Institut für diagnostische und interventionelle Radiologie, Klinikums rechts der Isar, Technische Universität München, München, Germany
| | - H Feussner
- Chirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - A Meining
- Klinik für Innere Medizin I, Universitätsklinikum Ulm, Ulm, Germany
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Kumpf U, Palm U, Nolden J, Pfeiffer A, Egert S, Görlitz T, Bajbouj M, Plewnia C, Langguth B, Zwanzger P, Kirsch B, Worsching J, Mansmann U, Falkai P, Keeser D, Hasan A, Padberg F. P278 Transcranial direct current stimulation (tDCS) as treatment for major depression (DepressionDC) – Objectives and design of a prospective multicenter double blind randomized placebo controlled trial. Clin Neurophysiol 2017. [DOI: 10.1016/j.clinph.2016.10.386] [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: 10/20/2022]
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Feußner H, Hüser N, Wilhelm D, Fingerle A, Jell A, Friess H, Bajbouj M. [Surgical treatment of esophageal diverticula : Endoscopic or open approach?]. Chirurg 2017; 88:196-203. [PMID: 28054111 DOI: 10.1007/s00104-016-0344-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Esophageal diverticula are comparatively rare. The majority are Zenker's diverticula but parabronchial and epiphrenic diverticula can also occur. Parabronchial diverticula are of low clinical relevance, whereas Zenker's and epiphrenic diverticula both belong to the group of pulsion diverticula and can become clinically apparent by dysphagia and regurgitation. Approximately 100 years after the first surgical treatment, peroral approaches (e.g. stapler dissection and flexible endoscopic diverticulotomy) have now achieved a certain level of importance. Both approaches are less invasive than the open approach but are evidently more prone to recurrences. Accordingly, traditional open diverticulectomy with cervical myotomy should be recommended to patients with a reasonable life expectancy and an acceptable operative risk. This holds particularly true for Brombart stages I-III of the disease, as complete myotomy cannot be achieved via the peroral access. The classical surgical treatment of epiphrenic diverticula is open or laparoscopic/thoracoscopic diverticulectomy with distal myotomy, mostly combined with an anterior partial fundoplication; however, the leakage rate is high and several alternative options are currently being evaluated.
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Affiliation(s)
- H Feußner
- Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, 81675, München, Deutschland.
| | - N Hüser
- Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - D Wilhelm
- Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - A Fingerle
- Institut für Diagnostische und Interventionelle Radiologie, Klinikum rechts der Isar der Technischen Universität München, München, Deutschland
| | - A Jell
- Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - H Friess
- Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - M Bajbouj
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar der Technischen Universität München, München, Deutschland
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Becker V, Ostler D, Feussner H, Nennstiel S, Haller B, Schmid RM, Bajbouj M, Schneider A. Esophageal bougination: a novel ex vivo endoscopic training model correlated with clinical data. Surg Endosc 2016; 31:2566-2572. [PMID: 27670649 DOI: 10.1007/s00464-016-5262-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 09/19/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Esophageal bougination is a worldwide standard endoscopic procedure. Clinical methods and recommendations are based on clinical experiences only. Mechanical properties have never been described. Aim of the study was to establish a realistic ex vivo training model. Therefore, detailed assessment of relevant mechanical features of esophageal bougination should be evaluated ex vivo and in patient setting and correlated against. PATIENTS AND METHODS A three-step concept was used to evaluate mechanical properties at stenosis level. First, insertion forces were evaluated in an ex vivo linear single stenosis model during steady mechanical insertion. Second, adding friction and properties of the pharynx and upper esophagus, the model was integrated in an artificial endoscopic training model (ELITE training model). Third, in vivo measurements were taken to correlate ex vivo data with parameters of a realistic patient setting. RESULTS With the presented setup, we were able to assess insertion force and pressure levels in an artificial stricture using different sizes of commercially available standard bougies. In all models, there was a relevant increase in insertion force with higher stricture pressure levels. Insertion force levels in the ELITE model show higher levels compared to the linear stenosis model. Having regard to the maximum forces in patients, there is also a constant increase in mean insertion force according to higher bougie sizes, but lower forces were measured as in the ELITE model. DISCUSSION The applied models are suitable to appraise mechanical properties of esophageal bougination in an ex vivo model and patient setting. Forces could be constituted reliable, significant increase was documented according to stenosis level and results were comparable to patient data. This was comparable to patient data. Further clinical evaluation in different kinds of stenosis is necessary.
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Affiliation(s)
- V Becker
- II. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, Munich, Germany.
| | - D Ostler
- MITI, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - H Feussner
- MITI, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - S Nennstiel
- II. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, Munich, Germany
| | - B Haller
- Institut für Medizinische Statistik und Epidemiologie, Technische Universität München, Munich, Germany
| | - R M Schmid
- II. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, Munich, Germany
| | - M Bajbouj
- II. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, Munich, Germany
| | - A Schneider
- MITI, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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Bajbouj M, Schlag C. [Obstructed food bolus impaction in emergency endoscopy--follow up is crucial]. Z Gastroenterol 2016; 54:366-7. [PMID: 27056463 DOI: 10.1055/s-0042-100550] [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: 10/21/2022]
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Nennstiel S, Bajbouj M, Becker V, Slotta-Huspenina J, Wagenpfeil S, Schmid RM, Schlag C. High-resolution manometry in patients with eosinophilic esophagitis under topical steroid therapy-a prospective observational study (HIMEOS-study). Neurogastroenterol Motil 2016; 28:599-607. [PMID: 26891170 DOI: 10.1111/nmo.12753] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [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: 09/09/2015] [Accepted: 11/16/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND In eosinophilic esophagitis (EoE), dysphagia, which might reflect esophageal dysmotility, is the most common symptom. High-resolution manometry (HRM) has become widely accepted for evaluating esophageal motility disorders, but to date has been sparsely examined in EoE patients, particularly under therapy. The aim of this study was to evaluate HRM in symptomatic EoE-patients under topical steroid treatment. METHODS In this prospective observational study, symptomatic EoE patients received HRM-examinations before and after 8 weeks of topical steroid treatment with budesonide. All HRM-abnormalities were assessed and interpreted according to the Chicago classification. The primary endpoint was the influence of topical steroid treatment on the intrabolus pressure (IBP). Clinical symptoms, endoscopic findings and histological esophageal eosinophilic load were also reported. KEY RESULTS Twenty symptomatic EoE patients were included. Overall success of budesonide therapy was 85% regarding complete histologic remission and 80% regarding complete clinical remission. High-resolution manometry showed abnormal esophageal motility in 35% of patients at baseline, which was resolved after therapy in 86% of these patients. Most frequent HRM-findings were early pan-esophageal pressurizations and weak persitalsis. There was no significant reduction of the IBP under therapy (before: 12.5 ± 4.9 mmHg, after: 10.9 ± 2.9 mmHg; p = 0.119). CONCLUSIONS & INFERENCES Although dysphagia is the leading symptom of EoE, HRM is able to identify esophageal motility disorders in only some EoE patients. Observed motility disorders resolve after successful treatment in almost all of these patients. Intrabolus pressure does not seem an optimal parameter for the monitoring of successful treatment response in EoE patients.
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Affiliation(s)
- S Nennstiel
- II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - M Bajbouj
- II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - V Becker
- II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - J Slotta-Huspenina
- Institut für Allgemeine Pathologie und Pathologische Anatomie der Technischen Universität München, München, Germany
| | - S Wagenpfeil
- Medizinische Fakultät der Universität des Saarlandes, Institut für Medizinische Biometrie, Epidemiologie und Medizinische Informatik (IMBEI), Homburg, Germany
| | - R M Schmid
- II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - C Schlag
- II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, München, Germany
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Abstract
Major depressive disorders are one of the most prevalent psychiatric disorders worldwide but approximately 20-30 % of patients do not respond to standard guideline conform treatment. Recent neuroimaging studies in depressive patients revealed altered activation patterns in prefrontal brain areas and that successful cognitive behavioral therapy and psychopharmacological interventions are associated with a reversal of these neural alterations. Therefore, a direct modulation of prefrontal brain activation by non-invasive brain stimulation techniques, such as transcranial direct current stimulation (tDCS) seems to be a promising and innovative approach for the treatment of depressive disorders. In addition, recent neuropsychological findings indicated an augmentation of positive tDCS effects by simultaneous external activation of the stimulated brain area, for example by cognitive training tasks. Based on these findings, the possibility to augment cognitive-emotional learning processes during cognitive behavioral therapy by simultaneous tDCS to increase antidepressive therapeutic effects is discussed in this article.
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Affiliation(s)
- S Aust
- Center for Affective Sciences, Klinik für Psychiatrie und Psychotherapie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Deutschland.
| | - U Palm
- Sektion für Psychosomatische Medizin und Psychotherapie und Munich Center for Brain Stimulation, Klinik für Psychiatrie und Psychotherapie, LMU Klinikum der Universität München, München, Deutschland
| | - F Padberg
- Sektion für Psychosomatische Medizin und Psychotherapie und Munich Center for Brain Stimulation, Klinik für Psychiatrie und Psychotherapie, LMU Klinikum der Universität München, München, Deutschland
| | - M Bajbouj
- Center for Affective Sciences, Klinik für Psychiatrie und Psychotherapie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Deutschland
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17
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Schlag C, Miehlke S, Heiseke A, Brockow K, Krug A, von Arnim U, Straumann A, Vieth M, Bussmann C, Mueller R, Greinwald R, Bajbouj M. Peripheral blood eosinophils and other non-invasive biomarkers can monitor treatment response in eosinophilic oesophagitis. Aliment Pharmacol Ther 2015; 42:1122-30. [PMID: 26314389 DOI: 10.1111/apt.13386] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [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: 06/03/2015] [Revised: 06/17/2015] [Accepted: 08/09/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Monitoring of the treatment response in eosinophilic oesophagitis (EoE) requires structured endoscopical and histological examination of the oesophagus. Less invasive methods would be highly desirable. AIM To evaluate the utility of several EoE-associated blood and serum markers in order to non-invasively monitor the response to treatment with swallowed topical corticosteroids in adult EoE patients. METHODS In a randomised, controlled double-blind trial blood samples of EoE patients (n = 69) were collected at baseline and after 14 days of treatment with budesonide (n = 51) or placebo (n = 18) respectively. Absolute blood eosinophil count (AEC) as well as serum levels of CCL-17, CCL-18, CCL-26, eosinophil-cationic-protein (ECP) and mast cell tryptase (MCT) were determined and correlated with oesophageal eosinophil density and with symptom and endoscopy scores. RESULTS Histological remission, defined as mean number of <16 eos/mm(2) hpf at end-of-treatment, was achieved in 98% of the budesonide and 0% of the placebo recipients. AEC [380.2 vs. 214.7/mm(3) (P = 0.0001)], serum-CCL-17 [294.3 vs. 257.9 pg/mL (P = 0.0019)], -CCL-26 [26.7 vs. 16.2 pg/mL (P = 0.0058)], -ECP [45.5 ± 44.7 vs. 27.5 ± 25.0 μg/L (P = 0.0016)] and -MCT [5.3 ± 2.9 vs. 4.5 ± 2.6 μg/L (P = 0.0019)] significantly decreased under budesonide but not under placebo. AEC significantly correlated with oesophageal eosinophil density before (r = 0.28, P = 0.0236) and after (r = 0.42, P = 0.0004) budesonide treatment. In ROC-AUC analyses post-treatment values of AEC were significantly associated with histological remission (ROC-AUC 0.754; 95% CI: 0.617-0.891; P = 0.0003). CONCLUSIONS The budesonide-induced treatment response in EoE is mirrored by several blood and serum markers, and the absolute blood eosinophil count is the most valuable as it shows correlation with the oesophageal eosinophil density.
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Affiliation(s)
- C Schlag
- 2nd Medical Department, Technische Universität München, Munich, Germany
| | - S Miehlke
- Center for Digestive Diseases Eppendorf, Hamburg, Germany
| | - A Heiseke
- Institute for Immunology, Ludwig-Maximillian-Universität München, Munich, Germany
| | - K Brockow
- Department of Dermatology and Allergy Biederstein, Technische Universität München, Munich, Germany
| | - A Krug
- Institute for Immunology, Ludwig-Maximillian-Universität München, Munich, Germany
| | - U von Arnim
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke-Universität Magdeburg, Magdeburg, Germany
| | - A Straumann
- Swiss EoE Research Network, Olten, Switzerland
| | - M Vieth
- Institute for Pathology, Klinikum Bayreuth, Bayreuth, Germany
| | - C Bussmann
- Institute for Pathology, Kantonsspital Luzern, Luzern, Switzerland
| | - R Mueller
- Dr Falk Pharma GmbH, Freiburg, Germany
| | | | - M Bajbouj
- 2nd Medical Department, Technische Universität München, Munich, Germany
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18
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Neumann WJ, Huebl J, Brücke C, Gabriëls L, Bajbouj M, Merkl A, Schneider GH, Nuttin B, Brown P, Kühn AA. Different patterns of local field potentials from limbic DBS targets in patients with major depressive and obsessive compulsive disorder. Mol Psychiatry 2014; 19:1186-92. [PMID: 24514569 PMCID: PMC4813757 DOI: 10.1038/mp.2014.2] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [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: 07/02/2013] [Revised: 12/15/2013] [Accepted: 01/06/2014] [Indexed: 12/11/2022]
Abstract
The role of distinct limbic areas in emotion regulation has been largely inferred from neuroimaging studies. Recently, the opportunity for intracranial recordings from limbic areas has arisen in patients undergoing deep brain stimulation (DBS) for neuropsychiatric disorders including major depressive disorder (MDD) and obsessive compulsive disorder (OCD). Here we test the hypothesis that distinct temporal patterns of local field potential (LFP) activity in the human limbic system reflect disease state and symptom severity in MDD and OCD patients. To this end, we recorded LFPs via implanted DBS electrodes from the bed nucleus of stria terminalis (BNST area) in 12 patients (5 OCD, 7 MDD) and from the subgenual cingulate cortex in 7 MDD patients (CG25 area). We found a distinct pattern of oscillatory activity with significantly higher α-power in MDD compared with OCD in the BNST area (broad α-band 8-14 Hz; P<0.01) and a similar level of α-activity in the CG25 area as in the BNST area in MDD patients. The mean α-power correlated with severity of depressive symptoms as assessed by the Beck depression inventory in MDD (n=14, r=0.55, P=0.042) but not with severity of obsessive compulsive symptoms in OCD. Here we show larger α-band activity in MDD patients compared with OCD recorded from intracranial DBS targets. Our results suggest that α-activity in the limbic system may be a signature of symptom severity in MDD and may serve as a potential state biomarker for closed loop DBS in MDD.
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Affiliation(s)
- W-J Neumann
- Department of Neurology, Charité–University Medicine Berlin, Berlin, Germany
| | - J Huebl
- Department of Neurology, Charité–University Medicine Berlin, Berlin, Germany
| | - C Brücke
- Department of Neurology, Charité–University Medicine Berlin, Berlin, Germany
| | - L Gabriëls
- Department of Psychiatry, University Hospital Leuven, Leuven, Belgium
| | - M Bajbouj
- Department of Psychiatry and Psychotherapy, Charité–University Medicine Berlin, Berlin, Germany
| | - A Merkl
- Department of Neurology, Charité–University Medicine Berlin, Berlin, Germany
,Department of Psychiatry and Psychotherapy, Charité–University Medicine Berlin, Berlin, Germany
| | - G-H Schneider
- Department of Neurosurgery, Charité–University Medicine Berlin, Berlin, Germany
| | - B Nuttin
- Department of Neurosurgery, University Hospital Leuven, Leuven, Belgium
| | - P Brown
- Nuffield Department of Clinical Neurosciences, University of Oxford, and National Institute of Health Related Research Oxford Biomedical Research Centre, Oxford, UK
| | - AA Kühn
- Department of Neurology, Charité–University Medicine Berlin, Berlin, Germany
,Berlin School of Mind and Brain, Charité–University Medicine Berlin, Berlin, Germany
,NeuroCure, Charité–University Medicine Berlin, Berlin, Germany
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Klare P, Meining A, von Delius S, Wolf P, Konukiewitz B, Schmid RM, Bajbouj M. Argon plasma coagulation of gastric inlet patches for the treatment of globus sensation: it is an effective therapy in the long term. Digestion 2014; 88:165-71. [PMID: 24157960 DOI: 10.1159/000355274] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [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: 05/16/2013] [Accepted: 08/26/2013] [Indexed: 02/04/2023]
Abstract
AIM To determine the long-term effect of argon plasma coagulation (APC) of gastric inlet patches in the cervical esophagus for patients suffering from globus sensation. METHODS We intended to follow up all patients between 2004 and 2011 (n = 49) who received argon plasma ablation of gastric inlet patches for globus sensation at our clinic. Symptoms were assessed by a visual analogue scale (VAS) in 31 of 49 patients. Follow-up endoscopy of the upper gastrointestinal tract was performed to confirm residual or relapsed cervical inlet patches. RESULTS After a median period of 27 months, APC was assessed as a successful therapy in 23 of 31 patients (74%). VAS scores decreased significantly from 7.6 to 4.0 in the long term. Twenty-two of 31 patients were willing to undergo follow-up endoscopy. Endoscopy revealed recurrent/residual gastric inlet patches after APC in 11 of 22 cases. These patients suffered from a significant relapse of symptoms in the postinterventional period (p < 0.001). CONCLUSION This retrospective study indicates that APC of gastric inlet patches for the treatment of globus sensation might be a sufficient therapy option. Recurrences or residual heterotopic gastric mucosa are possible and seem to be associated with a relapse of symptoms. Therefore, endoscopic follow-up and retreatment might be necessary if globus sensation is not sufficiently eliminated.
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Affiliation(s)
- P Klare
- Department of Medicine II, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
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Bajbouj M, Feussner H. [Diagnosis of atypical reflux: new probe - more problems]. Z Gastroenterol 2014; 52:603-5. [PMID: 24905113 DOI: 10.1055/s-0034-1366190] [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: 10/25/2022]
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21
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Ott R, Bajbouj M, Feussner H, Graf S, Holzapfel K, Niestroy B, Tzavella K, Wagner-Sonntag E, München A. [Dysphagia--what is important for primary diagnosis in private practice?]. MMW Fortschr Med 2014; 156:54-7. [PMID: 24956660 DOI: 10.1007/s15006-014-2922-0] [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: 10/25/2022]
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Abstract
Gastroesophageal reflux disease (GERD) is a frequent chronic disorder occurring in two forms: on the one hand, typical symptoms such as heartburn and acid regurgitation are seen, while on the other hand atypical (extraesophageal) symptoms such as chronic cough, hoarseness, recurrent sinusitis, globus sensations in the throat, a burning feeling on the tongue, dental erosions and the constant need to clear the throat can be associated with gastroesophageal reflux. The standard therapeutic medical procedure comprises the administration of acid-suppressive agents, proton pump inhibitors (PPI). However, this therapy has proved to be ineffective in a number of patients, especially in atypical GERD. Only after reliable identification of the GERD patient by using valid diagnostic tools medical or interventional therapeutic options can be applied individually. In the absence of atypical GERD symptoms, the diagnosis of GERD becomes very unlikely and other causes of the symptoms need to be taken into consideration.
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Affiliation(s)
- M Bajbouj
- II. Medizinische Klinik, Klinikum rechts der Isar, TU München, Ismaningerstr. 22, 81575, München, Deutschland.
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Brücke C, Hübl J, Merkl A, Schneider GH, Bajbouj M, Kühn AA. Emotional processing in the Cg25 area: Preliminary LFP data from 3 patients with major depressive disorder. KLIN NEUROPHYSIOL 2012. [DOI: 10.1055/s-0032-1301668] [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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von Delius S, Salletmaier H, Meining A, Wagenpfeil S, Saur D, Bajbouj M, Schneider G, Schmid RM, Huber W. Bispectral index monitoring of midazolam and propofol sedation during endoscopic retrograde cholangiopancreatography: a randomized clinical trial (the EndoBIS study). Endoscopy 2012; 44:258-64. [PMID: 22261747 DOI: 10.1055/s-0031-1291485] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [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] [Indexed: 12/10/2022]
Abstract
INTRODUCTION Bispectral index (BIS) monitoring provides a non-invasive measure of the level of sedation. The purpose of this randomized, single-blind clinical trial was to evaluate whether BIS monitoring of sedation would lead to improved oxygenation and a reduced rate of cardiopulmonary complications during endoscopy. PATIENTS AND METHODS Patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) under procedural sedation with a combination of low dose midazolam and propofol were randomly assigned to either standard monitoring of sedation only (BIS-blinded arm) or an open arm in which additional BIS monitoring was available (BIS-open arm). In the BIS-open arm, propofol administration was to be withheld if BIS values were <55. The primary study end point was the mean oxygen saturation per patient. Secondary end points were the rates of cardiopulmonary complications, propofol dose, quality of sedation (patient cooperation as rated by the endoscopist and patient satisfaction), and recovery. RESULTS A total of 144 patients were enrolled and included in the intention-to-treat analysis. Mean oxygen saturation per patient was 97.7% in the BIS-open arm and 97.6% in the BIS-blinded arm (P=0.71). Total rates of cardiopulmonary complications, single numbers of hypoxemic, bradycardic, and hypotensive events, mean propofol doses, and quality of sedation also showed no statistically significant differences between the groups. However, BIS monitoring did result in faster recovery of patients as reflected by shorter times to eye opening (P=0.001), first verbal response (P=0.02), and leaving the procedure room (P<0.001). CONCLUSIONS The use of additional BIS monitoring did not lead to improved oxygenation or a reduced rate of cardiopulmonary complications. Recovery times after the procedure were shorter than with standard monitoring alone, but the clinical benefit for daily practice may be limited.
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Affiliation(s)
- S von Delius
- II. Medizinische Klinik, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Strasse 22, Munich, Germany.
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Grimm S, Scheidegger M, Henning A, Walter M, Weigand A, Böker H, Bajbouj M, Seifritz E. Emotionalcognitive processing and brain metabolism after pharmacological challenge with ketamine. Pharmacopsychiatry 2011. [DOI: 10.1055/s-0031-1292482] [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: 10/17/2022]
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Lim LG, Bajbouj M, von Delius S, Meining A. Fluorescein-enhanced autofluorescence imaging for accurate differentiation of neoplastic from non-neoplastic colorectal polyps: a feasibility study. Endoscopy 2011; 43:419-24. [PMID: 21360422 DOI: 10.1055/s-0030-1256215] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND Autofluorescence imaging (AFI) is sensitive but not specific for differentiating neoplastic from non-neoplastic colorectal polyps. We aimed to determine the sensitivity and specificity of fluorescein-enhanced AFI (FAFI) in differentiating neoplastic from non-neoplastic colorectal polyps. METHODS All patients with colorectal polyps detected during AFI colonoscopy received intravenous fluorescein followed by AFI (FAFI). The video sequences were recorded and divided into a learning group and a test group. AFI and FAFI criteria for neoplastic and non-neoplastic lesions were determined after viewing videos in the learning group unblinded to histology. Videos in the test group were viewed blinded to histology, and diagnoses of neoplastic versus non-neoplastic were made for AFI and FAFI using the predetermined criteria. Still frames were objectively measured for red:green ratio (AFI) and green contrast (FAFI). RESULTS Eight videos (four neoplastic, four non-neoplastic) were used for the learning group. Criteria for neoplasia when using FAFI were determined as the presence of a patchy or granular pattern which appeared more fluorescent green compared with the background. For AFI, purple or pink represented neoplasia; green represented non-neoplasia. In the test group (13 neoplastic, 12 non-neoplastic), for differentiating between neoplasia and non-neoplasia, subjective analysis of video sequences yielded a sensitivity of 100 % for AFI and 100 % for FAFI ( P = 1.000), and a specificity of 16.7 % for AFI and 91.7 % for FAFI ( P = 0.004). Using objective color analysis, the area under the receiver operating characteristics curve was 0.647 for AFI using the red:green ratio to distinguish between neoplasia and non-neoplasia, and 0.994 for FAFI using green contrast. CONCLUSIONS FAFI accurately differentiated between neoplastic and non-neoplastic colorectal polyps.
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Affiliation(s)
- L G Lim
- Department of Medicine II, Klinikum rechts der Isar, Technical University of Munich, Ismaningerstrasse 22, Munich, Germany
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Becker V, Bajbouj M, Schmid RM, Meining A. Multimodal endoscopic therapy for multifocal intraepithelial neoplasia and superficial esophageal squamous cell carcinoma - a case series. Endoscopy 2011; 43:360-4. [PMID: 21455875 DOI: 10.1055/s-0030-1256310] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [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: 12/10/2022]
Abstract
Local endoscopic procedures are increasingly used and accepted treatments for unifocal superficial esophageal squamous cell carcinoma (SESCC). In multifocal SESCC, esophagectomy with or without chemoradiotherapy is often regarded as standard therapy. However, a combination of local endoscopic resection and new techniques such as radiofrequency ablation may play an increasing role in the treatment of selected patients with multifocal SESCC. The aim of this series was to evaluate the feasibility of a multimodal endoscopic approach. We report a case series of six consecutive patients from a European tertiary center who underwent endoscopic treatment for multifocal SESCC. The treatment comprised endoscopic mucosal resection using the cap technique or endoscopic submucosal dissection, in combination with radiofrequency ablation. The main outcome measure was complete tumor eradication after therapy and during the follow-up period. Using such an approach, complete eradication of cancer was achieved in all patients during follow-up. No major adverse events occurred. In conclusion, in selected patients with multifocal or residual SESCC, local resection techniques in combination with radiofrequency ablation may be safe and potentially curative alternative treatments.
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Affiliation(s)
- V Becker
- 2nd Medicinal Department, Klinikum rechts der Isar, Munich, Germany.
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Bajbouj M, Vieth M, Rösch T, Miehlke S, Becker V, Anders M, Pohl H, Madisch A, Schuster T, Schmid RM, Meining A. Probe-based confocal laser endomicroscopy compared with standard four-quadrant biopsy for evaluation of neoplasia in Barrett's esophagus. Endoscopy 2010; 42:435-40. [PMID: 20506064 DOI: 10.1055/s-0029-1244194] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.1] [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: 01/29/2023]
Abstract
BACKGROUND AND STUDY AIMS Surveillance of Barrett's esophagus includes endoscopic inspection with biopsy of suspicious lesions followed by four-quadrant biopsy of the remaining mucosa. We assessed the ability of probe-based confocal laser endomicroscopy (pCLE) to replace biopsy in the endoscopic evaluation of patients with Barrett's esophagus in a prospective and controlled setting. PATIENTS AND METHODS A total of 68 patients who were referred for endoscopic assessment of Barrett's esophagus were included across three centers. pCLE recordings were interpreted live during the examination as well as in a blinded manner at least 3 months after endoscopy. pCLE diagnosis of neoplasia based on pre-defined criteria was compared with histopathology from suspicious as well as four-quadrant biopsies. RESULTS A total of 670 pairs of biopsies and pCLE video sequences were available for analysis, with neoplasia (high-grade dysplasia or cancer) being histologically diagnosed in 8.3 %. Specificity and negative predictive value of pCLE in excluding neoplasia was 0.97 (90 %CI 0.95 - 0.98) and 0.93 (0.91 - 0.95) for the blinded evaluation, and 0.95 (0.90 - 0.98) and 0.92 (0.90 - 0.94) for the on-site assessment. Positive predictive values (PPVs) and sensitivity were rather poor for both settings (46 %/28 % [blinded] and 18 %/12 % [on-site], respectively). CONCLUSIONS pCLE can be regarded as non-inferior to endoscopic biopsy in excluding neoplasia of Barrett's esophagus mucosa. However, due to its low PPV and sensitivity, pCLE may currently not replace standard biopsy techniques for the diagnosis of Barrett's esophagus and associated neoplasia. Further technical development of pCLE and a better understanding of its role in relation to other imaging technologies are necessary.
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Affiliation(s)
- M Bajbouj
- II Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Germany
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Meining A, Kähler G, von Delius S, Buess G, Schneider A, Hochberger J, Wilhelm D, Kübler H, Kranzfelder M, Bajbouj M, Fuchs KH, Gillen S, Feussner H. [Natural orifices transluminal endoscopic surgery (NOTES) in Germany: summary of the working group reports of the "D-NOTES meeting 2009"]. Z Gastroenterol 2009; 47:1160-7. [PMID: 19885782 DOI: 10.1055/s-0028-1109775] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The D-NOTES-group met in June 2009 for an evaluation of ongoing preclinical and clinical activities in natural orifice endoscopic surgery and the further coordination of research in Germany. Different working groups with various topics were formed. Consensus statements among various participants with different scientific and medical background were initiated. In summary, important topics were handled such as the correct handling of bacterial contamination and related complications, the question of the ideal entry point and a secure closure, interdisciplinary cooperation, and matters related to training and education. Furthermore, participants agreed on terminological basics. A to-do-list for medical engineering was formulated.
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Affiliation(s)
- A Meining
- Die Institutsangaben sind am Ende des Beitrags gelistet.
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Huber W, Grosser M, Frimberger E, Bajbouj M, Prinz C, Ludwig L, Ebert M, Meining M, Saur D, Neu B, Schmid RM. Einfluss der Kolsokopievorbereitung mit Macrogol-4000 (Oralav) auf Serum-Elektrolyte, Osmolarität und renale Retentionsparameter. Z Gastroenterol 2009. [DOI: 10.1055/s-0029-1242224] [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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Merkl A, Schneider GH, Kühn A, Bührsch NC, Anghelescu I, Heuser I, Bajbouj M. Deep brain stimulation of the anterior subgenual cingulate (Cg 25) in treatment-resistant depression. Pharmacopsychiatry 2009. [DOI: 10.1055/s-0029-1240173] [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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Luborzewski A, Schubert F, Merkl A, Quante A, Bajbouj M. Metabolite levels in the dorsolateral prefrontal cortex and anterior cingulum of patients with major depression. Comparism with healthy controls and follow-up after a 4-week naturalistic treatment period. Pharmacopsychiatry 2009. [DOI: 10.1055/s-0029-1240168] [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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van Hall F, Zahn C, Schommer N, Anghelescu I, Heuser I, Bajbouj M. rTMS as add-on to escitalopram: a way to enhance antidepressant response? A randomized, placebo controlled trial. Pharmacopsychiatry 2009. [DOI: 10.1055/s-0029-1240239] [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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Bührsch NC, Swoboda U, Quante A, Zeugmann S, Bajbouj M, Anghelescu I, Heuser I. Cortisol awakening reaction in depressed patients with and without early life stress. Pharmacopsychiatry 2009. [DOI: 10.1055/s-0029-1240094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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Becker V, Huber W, Meining A, Prinz C, Umgelter A, Ludwig L, Bajbouj M, Gaa J, Schmid RM. Infected necrosis in severe pancreatitis--combined nonsurgical multi-drainage with directed transabdominal high-volume lavage in critically ill patients. Pancreatology 2009; 9:280-6. [PMID: 19407483 DOI: 10.1159/000212093] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [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: 04/30/2008] [Accepted: 08/17/2008] [Indexed: 12/11/2022]
Abstract
BACKGROUND Infection of pancreatic necrosis is a life-threatening complication during the course of acute pancreatitis. In critically ill patients, surgical or extended endoscopic interventions are associated with high morbidity and mortality. Minimally invasive procedures on the other hand are often insufficient in patients suffering from large necrotic areas containing solid or purulent material. We present a strategy combining percutaneous and transgastric drainage with continuous high-volume lavage for treatment of extended necroses and liquid collections in a series of patients with severe acute pancreatitis. PATIENTS AND METHODS Seven consecutive patients with severe acute pancreatitis and large confluent infected pancreatic necrosis were enrolled. In all cases, the first therapeutic procedure was placement of a CT-guided drainage catheter into the fluid collection surrounding peripancreatic necrosis. Thereafter, a second endosonographically guided drainage was inserted via the gastric or the duodenal wall. After communication between the separate drains had been proven, an external to internal directed high-volume lavage with a daily volume of 500 ml up to 2,000 ml was started. RESULTS In all patients, pancreatic necrosis/liquid collections could be resolved completely by the presented regime. No patient died in the course of our study. After initiation of the directed high-volume lavage, there was a significant clinical improvement in all patients. Double drainage was performed for a median of 101 days, high-volume lavage for a median of 41 days. Several endoscopic interventions for stent replacement were required (median 8). Complications such as bleeding or perforation could be managed endoscopically, and no subsequent surgical therapy was necessary. All patients could be dismissed from the hospital after a median duration of 78 days. CONCLUSION This approach of combined percutaneous/endoscopic drainage with high-volume lavage shows promising results in critically ill patients with extended infected pancreatic necrosis and high risk of surgical intervention. Neither surgical nor endoscopic necrosectomy was necessary in any of our patients.
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Affiliation(s)
- V Becker
- Second Medical Department, Klinikum rechts der Isar, University of Munich, Munich, Germany.
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Becker V, Vieth M, Bajbouj M, Schmid RM, Meining A. Confocal laser scanning fluorescence microscopy for in vivo determination of microvessel density in Barrett's esophagus. Endoscopy 2008; 40:888-91. [PMID: 19009480 DOI: 10.1055/s-2008-1077718] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [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: 12/10/2022]
Abstract
BACKGROUND AND STUDY AIMS Angiogenesis has been reported to be an essential step in the progression of cancers arising from Barrett's esophagus. Confocal laser scanning microscopy (CLM) has the potential to perform in vivo microscopy to detect angiogenesis and determine microvessel density (MVD). We aimed therefore to use this new promising imaging tool for the evaluation of MVD in Barrett's esophagus and associated neoplasia. PATIENTS AND METHODS We enrolled 20 patients with Barrett's esophagus. CLM sequences were recorded from pre-marked areas using argon beamer coagulation spots after intravenous application of fluorescein. Sequences had to be recorded within the first 8 minutes of injection. Biopsies were taken from the same areas for standard histopathology. All CLM sequences were put into a random order and analyzed by a single investigator who was blinded to any clinical or histopathological data. Five still images per sequence were analyzed for MVD using a specially designed software algorithm. The primary endpoint was determination of vessel diameter and MVD in relation to neoplastic or non-neoplastic Barrett's esophagus. RESULTS We evaluated 750 still CLM images from 150 sequences/biopsy sites. Histopathology revealed 69 biopsies as non-neoplastic Barrett's esophagus (46.0 %), 11 as neoplastic Barrett's esophagus (7.3 %), 64 as cardiac mucosa (42.7 %), and six as squamous mucosa (4.0 %). Mean vessel diameter as determined by CLM was similar in all four groups (P = 0.2). However, MVD was significantly higher in CLM sequences of neoplastic Barrett's esophagus compared with benign conditions (neoplastic Barrett's esophagus 23.6 %; Barrett's esophagus 14.2 %; cardiac mucosa 15.8 %; squamous epithelium 20.6 %; neoplastic Barrett's esophagus vs. Barrett's esophagus P < 0.001, T-test). CONCLUSION Fibered fluorescein-guided CLM helps to detect angiogenesis in malignant and non-malignant Barrett's esophagus in vivo. These data might help to improve the diagnostic yield of detecting Barrett's neoplasia but also to facilitate monitoring of antiangiogenetic therapy.
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Affiliation(s)
- V Becker
- Department of Medicine II, Technical University of Munich, Munich, Germany
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Bajbouj M, Becker V, Eckel F, Miehlke S, Pech O, Schmid RM, Meining A. Argon-Plasma-Koagulation heterotoper zervikaler Magenschleimhaut im Ösophagus bei Patienten mit Globussensationen – eine randomisierte, Schein-kontrollierte Studie. Z Gastroenterol 2008. [DOI: 10.1055/s-0028-1096422] [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: 10/19/2022]
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Bajbouj M, Becker V, Phillip V, Schmid RM, Meining A. Hochdosis-Esomeprazol in Kombination mit Baclofen zur Therapie eines pathologischen Gastroösophagealen Reflux– Prospektive Therapieevaluation kontrolliert durch pH-Metrie-/Impedanzmessung. Z Gastroenterol 2008. [DOI: 10.1055/s-0028-1096458] [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: 10/19/2022]
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Affiliation(s)
- M Bajbouj
- II. Medizinische Klinik, Klinikum Rechts der Isar, Technische Universität München, Germany.
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Lang UE, Hellweg R, Bajbouj M, Gaus V, Sander T, Gallinat J. Gender-dependent association of a functional NGF polymorphism with anxiety-related personality traits. Pharmacopsychiatry 2008; 41:196-9. [PMID: 18763222 DOI: 10.1055/s-0028-1082070] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Nerve growth factor (NGF) has been shown to be involved in anxiety behaviour and the expression of conditioned fear in mice. METHODS We have tested a total of 337 (age: 39.2 +/- 14.6 years) unrelated subjects of German descent (166 males; 171 females) who were carefully screened for psychiatric health. The self-ratable State-Trait Anxiety Inventory, which enables anxiety to be quantified as a comparatively stable personality trait was applied and a recently described non-synonymous NGF SNP (rs6330,c.104C > T,p.Ala35Val) was examined. RESULTS In the trait-related anxiety score, a significant gender-dependent effect of the genotype was observed (F=4.580, df=2, p=0.011) with higher levels of trait anxiety in females with C/C genotype when compared to females with T/T and C/T genotypes and an opposite effect in males. DISCUSSION Our findings support the hypothesis that anxiety relates to a genetic variation of NGF and that genes modulate behaviour in a gender-dependent manner. Since anxiety and attention deficit hyperactivity disorder are related to NGF, the present results may represent a common biological link for the gender-specific occurrence and comorbidity of the diseases.
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Affiliation(s)
- U E Lang
- Clinic for Psychiatry and Psychotherapy, Charité Medicine Berlin, Campus Charité Mitte, Berlin, Germany.
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Abstract
BACKGROUND/AIM True adenomas of the cardia appear to be extremely rare lesions. There are no data on the natural history and histopathological background of these lesions. We report 3 patients with true adenomas of the cardia. METHODS AND RESULTS Three patients with polypoid masses at the cardia below the Z-line were submitted to a tertiary referral center for further diagnosis and therapy. In 2 of the 3 cases Barrett's esophagus with low-grade intraepithelial neoplasia was assumed on the basis of histopathological examination of biopsy specimens taken from the surface of the lesions. Polypectomy was performed in all 3 cases. In 2 of the 3 cases the final histopathological diagnosis of low-grade adenoma of the cardia could only be established after complete removal of the polypoid masses. CONCLUSIONS Adenomas of the cardia can be mistaken for dysplasia arising from Barrett's esophagus, if the diagnosis is based on endoscopic biopsies only. It is, therefore, reasonable to completely remove any suspicious lesions by endoscopy not only for therapeutic but also for diagnostic reasons.
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Affiliation(s)
- M Bajbouj
- 2nd Medical Department, Klinikum rechts der Isar, Technische Universitat Munchen, Munich, Germany
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Schlaepfer TE, Frick C, Zobel A, Maier W, Heuser I, Bajbouj M, O'Keane V, Corcoran C, Adolfsson R, Trimble M, Rau H, Hoff HJ, Padberg F, Müller-Siecheneder F, Audenaert K, Van den Abbeele D, Stanga Z, Hasdemir M. Vagus nerve stimulation for depression: efficacy and safety in a European study. Psychol Med 2008; 38:651-661. [PMID: 18177525 DOI: 10.1017/s0033291707001924] [Citation(s) in RCA: 137] [Impact Index Per Article: 8.6] [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: 12/20/2022]
Abstract
BACKGROUND Vagus nerve stimulation (VNS) therapy is associated with a decrease in seizure frequency in partial-onset seizure patients. Initial trials suggest that it may be an effective treatment, with few side-effects, for intractable depression. METHOD An open, uncontrolled European multi-centre study (D03) of VNS therapy was conducted, in addition to stable pharmacotherapy, in 74 patients with treatment-resistant depression (TRD). Treatment remained unchanged for the first 3 months; in the subsequent 9 months, medications and VNS dosing parameters were altered as indicated clinically. RESULTS The baseline 28-item Hamilton Depression Rating Scale (HAMD-28) score averaged 34. After 3 months of VNS, response rates (> or = 50% reduction in baseline scores) reached 37% and remission rates (HAMD-28 score <10) 17%. Response rates increased to 53% after 1 year of VNS, and remission rates reached 33%. Response was defined as sustained if no relapse occurred during the first year of VNS after response onset; 44% of patients met these criteria. Median time to response was 9 months. Most frequent side-effects were voice alteration (63% at 3 months of stimulation) and coughing (23%). CONCLUSIONS VNS therapy was effective in reducing severity of depression; efficacy increased over time. Efficacy ratings were in the same range as those previously reported from a USA study using a similar protocol; at 12 months, reduction of symptom severity was significantly higher in the European sample. This might be explained by a small but significant difference in the baseline HAMD-28 score and the lower number of treatments in the current episode in the European study.
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Affiliation(s)
- T E Schlaepfer
- Departments of Psychiatry, University Hospital, Bern, Switzerland.
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de Castro AGC, Bajbouj M, Schlattmann P, Lemke H, Heuser I, Neu P. Cerebrovascular reactivity in depressed patients without vascular risk factors. J Psychiatr Res 2008; 42:78-82. [PMID: 17113598 DOI: 10.1016/j.jpsychires.2006.10.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [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] [Received: 07/27/2006] [Revised: 10/04/2006] [Accepted: 10/06/2006] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Cerebrovascular reactivity (CVR) seems to be gaining importance as a prognostic factor for stroke risk. CVR reflects the compensatory dilatory capacity of cerebral arterioles to a dilatory stimulus; this mechanism plays an important role in maintaining a constant cerebral blood flow. Evaluating factors that influence CVR will help prevention or early detection of cerebrovascular disease (CVD). In this study we aimed to measure the CVR in vascular-risk free depressed individuals so as to evaluate the effect depression has on CVR and hence its role as a stroke risk factor. METHODS Using acetazolamid (ACZ) stimulation, CVR was assessed with a transcranial Doppler ultrasound in 25 non-smoking depressed patients (average age: 48.48 +/- 14.40) and in 25 healthy non-smoking controls (average age: 46.76 +/- 13.69) by calculating the difference between the maximal mean blood flow velocity at baseline and the maximal mean blood flow velocity after ACZ stimulation. RESULTS Basal Cerebral Blood flow in Patients was 50.6 cm/s (SD: 11.6) versus controls 52.80 cm/s (SD: 12.70) whereas after stimulation maximal blood flow velocity was 72.64 cm/s (SD: 15.75) in patients versus 80.20 cm/s (SD: 18.43) in controls. In an analysis of covariance we found that cerebrovascular reactivity was significantly reduced in the vascular-risk free depressed sample. Age had a significant influence whereas gender did not. DISCUSSION Major Depression appears to decrease cerebrovascular reactivity supporting the idea of increased risk for stroke in depressed patients. The mechanisms leading to this phenomenon and its subtle subgroup differences should be further investigated.
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Becker V, Bajbouj M, Waller K, Schmid RM, Meining A. Clinical trial: persistent gastro-oesophageal reflux symptoms despite standard therapy with proton pump inhibitors - a follow-up study of intraluminal-impedance guided therapy. Aliment Pharmacol Ther 2007; 26:1355-60. [PMID: 17900268 DOI: 10.1111/j.1365-2036.2007.03529.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [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: 12/12/2022]
Abstract
BACKGROUND Persistent gastro-oesophageal reflux disease (GERD), despite proton pump inhibitor (PPI) therapy, is a common problem. Combined pH/impedance monitoring (pH/MII) enables detection of reflux episodes. Aim To identify patients with objective episodes of persistent reflux and second, to evaluate the effect of modified therapy based on the results of pH/MII. METHODS In all, 143 patients were examined with pH/MII because of GERD-symptoms resistant to PPI-therapy. Patients with pathological pH/MII (group 1) and with normal results (group 2) were identified. Therapy modifications were evaluated after a minimum follow-up of 3 months. RESULTS In 56 of 143 (39.1%) patients, pathological findings in pH/MII were identified. Therapy was escalated in 33/52 patients (group 1) and in 30/71 patients (group 2). Escalating therapy led to symptomatic relief in 90.9% of the patients in group 1 and 43.3% of the patients in group 2 (P < 0.001). CONCLUSIONS GERD symptoms refractory to PPI-therapy could be objectively identified with pH/MII in almost 40% of all patients. Furthermore, escalating anti-reflux therapy if pH/MII was pathological is associated with a significantly higher rate of successful treatment compared to the patients with normal findings. Therefore, pH/MII facilitates a more focussed therapeutical approach to patients with PPI-resistant GERD.
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Affiliation(s)
- V Becker
- II. Medical Department Internal Medicine, Klinikum Rechts der Isar, Technical University of Munich, Germany.
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Becker V, Bajbouj M, Waller C, Schmid RM, Meining A. Therapieanpassung anhand der kombinierten pH-Metrie/Impedanzmessung bei Patienten mit persistierenden Refluxbeschwerden trotz standarddosierter PPI-Therapie. Z Gastroenterol 2007. [DOI: 10.1055/s-2007-992732] [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: 10/21/2022]
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Knieper M, Noe S, Prinz C, Bajbouj M, Meining A, Born P, Schmid RM, Neu B. Eisenmangelanämie – ist die Kapselendoskopie zur Ursachensuche sinnvoll? Z Gastroenterol 2007. [DOI: 10.1055/s-2007-992738] [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: 10/21/2022]
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Neuhaus AH, Luborzewski A, Rentzsch J, Brakemeier EL, Opgen-Rhein C, Gallinat J, Bajbouj M. P300 is enhanced in responders to vagus nerve stimulation for treatment of major depressive disorder. J Affect Disord 2007; 100:123-8. [PMID: 17098290 DOI: 10.1016/j.jad.2006.10.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [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] [Received: 08/03/2006] [Revised: 09/28/2006] [Accepted: 10/02/2006] [Indexed: 11/22/2022]
Abstract
BACKGROUND Vagus nerve stimulation (VNS) is a new therapy option for treatment of otherwise therapy-refractory major depressive disorder. However, the mechanism of central nervous action is poorly understood. Electroencephalographic (EEG) studies may be of interest since chronic peripheral current application to the vagus nerve may exert lasting neurophysiologically detectable effects on central electrical activity. In an exploratory study, we investigated the effects of VNS on auditory event-related potentials (ERP). METHODS Thirteen depressive patients (mean Hamilton depression score (HAMD) at baseline=24.2) receiving VNS were investigated prior to implantation and 10 weeks after standard cycling VNS. Stimulation intensity was 0.94+/-0.46 mA, pulse width 0.250 mus, and frequency 20 Hz. 1 h prior to follow-up investigation, VNS was turned off. Auditory ERP were elicited using a standard auditory oddball paradigm and were recorded with 29-channel EEG. RESULTS Post VNS, grand averages of the auditory ERP did not show significant differences as compared to baseline recording. However, differential effects were found when separating ERP of responders (N=5, mean HAMD post VNS=8.8) and non-responders (N=8, mean HAMD post VNS=22.4). In VNS responders only, P300 at midline electrodes Fz and Cz was significantly increased and correlated with HAMD scores. CONCLUSION Auditory ERP seem to provide a useful tool for investigating VNS-induced changes concerning information processing in major depressive disorder. In our sample, enhancement of P300 distinguished VNS responders from non-responders 10 weeks after therapy onset. Our findings may be relevant for the understanding of both neurophysiological mechanism of action of VNS and pathophysiology of depression.
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Affiliation(s)
- A H Neuhaus
- Department of Psychiatry and Psychotherapy, Charité University Medicine, Berlin, Germany.
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Meining A, Semmler V, Kassem AM, Sander R, Frankenberger U, Burzin M, Reichenberger J, Bajbouj M, Prinz C, Schmid RM. The effect of sedation on the quality of upper gastrointestinal endoscopy: an investigator-blinded, randomized study comparing propofol with midazolam. Endoscopy 2007; 39:345-9. [PMID: 17285514 DOI: 10.1055/s-2006-945195] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [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: 02/08/2023]
Abstract
BACKGROUND AND STUDY AIMS Sedation with propofol is associated with a high acceptance rate in upper gastrointestinal endoscopy. So far, however, there are no valid data on whether the use of propofol can increase the general quality of the endoscopic examination. PATIENTS AND METHODS A total of 60 patients referred for upper gastrointestinal endoscopy were randomized to receive sedation with either midazolam (n = 30) or propofol (n = 30). The maximum dosages permitted were 5 mg of midazolam and 500 mg of propofol. The examinations were recorded on videotapes, and the quality of upper endoscopy was assessed by videotape analysis by three experienced endoscopists who were all blinded to patient data and the medications used for sedation. A score sheet was used with 18 assessment items that each represented a step of upper gastrointestinal endoscopy and a global score for the entire examination. A scale ranging from 1 (excellent) to 6 (very poor) was used. Data were analyzed on an intention-to-investigate basis: inability to perform the procedure because of a patient's intolerance of the procedure, for example, was scored as 6 (i. e. very poor). RESULTS Patients in the two groups were well matched with respect to demographic and clinical data. Four patients in the midazolam group could not be adequately examined. The median dosage used for sedation was 5 mg midazolam (range 2-5 mg) and 160 mg propofol (range 70-320 mg). When assessments by all three blinded examiners were added together, propofol sedation was found to result in significantly better scores for all parameters except for the assessments of "Z-line/cardia", "duodenal bulb", and "duodenal folds" (all P < 0.05, Mann-Whitney U test). CONCLUSION Sedation with propofol might increase the quality of upper endoscopy. This finding may have a significant impact on the selection of the type of sedation, not only in terms of increasing patients' acceptance of the procedure, but also for improving the diagnostic accuracy of upper gastrointestinal endoscopy.
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Affiliation(s)
- A Meining
- Medical Department II, Technical University of Munich, Munich, Germany.
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Affiliation(s)
- A Meining
- II. Department of Medicine, Klinikum rechts der Isar, Technical University of Munich, Germany.
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