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Saft C, Burgunder JM, Dose M, Jung HH, Katzenschlager R, Priller J, Nguyen HP, Reetz K, Reilmann R, Seppi K, Landwehrmeyer GB. Differential diagnosis of chorea (guidelines of the German Neurological Society). Neurol Res Pract 2023; 5:63. [PMID: 37993913 PMCID: PMC10666412 DOI: 10.1186/s42466-023-00292-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 10/18/2023] [Indexed: 11/24/2023] Open
Abstract
INTRODUCTION Choreiform movement disorders are characterized by involuntary, rapid, irregular, and unpredictable movements of the limbs, face, neck, and trunk. These movements often initially go unnoticed by the affected individuals and may blend together with seemingly intended, random motions. Choreiform movements can occur both at rest and during voluntary movements. They typically increase in intensity with stress and physical activity and essentially cease during deep sleep stages. In particularly in advanced stages of Huntington disease (HD), choreiform hyperkinesia occurs alongside with dystonic postures of the limbs or trunk before they typically decrease in intensity. The differential diagnosis of HD can be complex. Here, the authors aim to provide guidance for the diagnostic process. This guidance was prepared for the German Neurological Society (DGN) for German-speaking countries. RECOMMENDATIONS Hereditary (inherited) and non-hereditary (non-inherited) forms of chorea can be distinguished. Therefore, the family history is crucial. However, even in conditions with autosomal-dominant transmission such as HD, unremarkable family histories do not necessarily rule out a hereditary form (e.g., in cases of early deceased or unknown parents, uncertainties in familial relationships, as well as in offspring of parents with CAG repeats in the expandable range (27-35 CAG repeats) which may display expansions into the pathogenic range). CONCLUSIONS The differential diagnosis of chorea can be challenging. This guidance prepared for the German Neurological Society (DGN) reflects the state of the art as of 2023.
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Affiliation(s)
- Carsten Saft
- Department of Neurology, St. Josef-Hospital, Huntington-Zentrum NRW, Ruhr-Universität Bochum, Bochum, Germany.
| | - Jean-Marc Burgunder
- Department of Neurology, Schweizerisches Huntington-Zentrum, Bern University, Bern, Switzerland
| | - Matthias Dose
- Kbo-Isar-Amper-Klinikum Taufkirchen/München-Ost, Munich, Germany
| | - Hans Heinrich Jung
- Department of Neurology, University Hospital Zürich, Zurich, Switzerland
| | - Regina Katzenschlager
- Department of Neurology, Karl Landsteiner Institute for Neuroimmunological and Neurodegenerative Disorders, Klinik Donaustadt, Vienna, Austria
| | - Josef Priller
- Department of Psychiatry and Psychotherapy, Klinikum Rechts der Isar, School of Medicine and Health, Technical University of Munich, Munich, Germany
- Neuropsychiatry, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Huu Phuc Nguyen
- Department of Human Genetics, Huntington-Zentrum NRW, Ruhr-Universität Bochum, Bochum, Germany
| | - Kathrin Reetz
- Department of Neurology, Euregional Huntington Centre Aachen, RWTH Aachen University Hospital, Aachen, Germany
| | - Ralf Reilmann
- George-Huntington-Institute, Muenster, Germany
- Department of Radiology, Universitaetsklinikum Muenster (UKM), Westfaelische Wilhelms-University, Muenster, Germany
- Department of Neurodegenerative Diseases and Hertie-Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
| | - Klaus Seppi
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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Saft C, Burgunder JM, Dose M, Jung HH, Katzenschlager R, Priller J, Nguyen HP, Reetz K, Reilmann R, Seppi K, Landwehrmeyer GB. Symptomatic treatment options for Huntington's disease (guidelines of the German Neurological Society). Neurol Res Pract 2023; 5:61. [PMID: 37968732 PMCID: PMC10652593 DOI: 10.1186/s42466-023-00285-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 11/17/2023] Open
Abstract
INTRODUCTION Ameliorating symptoms and signs of Huntington's disease (HD) is essential to care but can be challenging and hard to achieve. The pharmacological treatment of motor signs (e.g. chorea) may favorably or unfavorably impact other facets of the disease phenotype (such as mood and cognition). Similarly, pharmacotherapy for behavioral issues may modify the motor phenotype. Sometimes synergistic effects can be achieved. In patients undergoing pragmatic polypharmacological therapy, emerging complaints may stem from the employed medications' side effects, a possibility that needs to be considered. It is recommended to clearly and precisely delineate the targeted signs and symptoms (e.g., chorea, myoclonus, bradykinesia, Parkinsonism, or dystonia). Evidence from randomized controlled trials (RCTs) is limited. Therefore, the guidelines prepared for the German Neurological Society (DGN) for German-speaking countries intentionally extend beyond evidence from RCTs and aim to synthesize evidence from RCTs and recommendations of experienced clinicians. RECOMMENDATIONS First-line treatment for chorea is critically discussed, and a preference in prescription practice for using tiapride instead of tetrabenazine is noted. In severe chorea, combining two antidopaminergic drugs with a postsynaptic (e.g., tiapride) and presynaptic mode of action (e.g., tetrabenazine) is discussed as a potentially helpful strategy. Sedative side effects of both classes of compounds can be used to improve sleep if the highest dosage of the day is given at night. Risperidone, in some cases, may ameliorate irritability but also chorea and sleep disorders. Olanzapine can be helpful in the treatment of weight loss and chorea, and quetiapine as a mood stabilizer with an antidepressant effect. CONCLUSIONS Since most HD patients simultaneously suffer from distinct motor signs and distinct psychiatric/behavioral symptoms, treatment should be individually adapted.
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Affiliation(s)
- Carsten Saft
- Department of Neurology, Huntington-Zentrum NRW, St. Josef-Hospital, Ruhr-Universität Bochum, Bochum, Germany.
| | - Jean-Marc Burgunder
- Department of Neurology, Schweizerisches Huntington-Zentrum, Bern University, Bern, Switzerland
| | - Matthias Dose
- Kbo-Isar-Amper-Klinikum, Taufkirchen/München-Ost, Germany
| | | | - Regina Katzenschlager
- Department of Neurology and Karl Landsteiner Institute for Neuroimmunological and Neurodegenerative Disorders, Klinik Donaustadt, Vienna, Austria
| | - Josef Priller
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
- Neuropsychiatry, Charité-Universitätsmedizin, Berlin, Germany
| | - Huu Phuc Nguyen
- Huntington-Zentrum NRW, Department of Human Genetics, Ruhr-Universität Bochum, Bochum, Germany
| | - Kathrin Reetz
- Department of Neurology, Euregional Huntington Centre Aachen, RWTH Aachen University Hospital, Aachen, Germany
| | - Ralf Reilmann
- George-Huntington-Institute, Muenster, Germany
- Department of Radiology, Universitaetsklinikum Muenster (UKM), Westfaelische Wilhelms-University, Muenster, Germany
- Department of Neurodegenerative Diseases and Hertie-Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
| | - Klaus Seppi
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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Witzmann M, Dose M, Noterdaeme M. [Recommendations for the Strategic Development of Health Care for People with Autism Spectrum Disorder (ASD) in Bavaria]. Gesundheitswesen 2023; 85:1060-1065. [PMID: 36690016 DOI: 10.1055/a-1973-7192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
As mental illnesses Autism spectrum disorders (ASD) in DSM-V and ICD - 11 are classified under the category of neuronal and mental disorders. ASD manifests itself them selves in early childhood. A valid, early diagnosis is a basic prerequisite for the provision of appropriate treatment and support services as well as any care planning in all relevant areas such as therapy and early intervention. On the basis of a participatory, scientific developmental process for the formulation of recommendations for the first Bavarian ASD strategy from 2018 to 2021, principles, goals, fields of action and measures for optimizing the care for people with ASD and their relatives were defined. It became clear that there is a need, in particular, to raise awareness of ASD, further generation and provision of knowledge about ASD, expansion of specialized services for early detection, counseling and diagnostics, as well as comprehensive access to early support and therapy.
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Affiliation(s)
- Markus Witzmann
- Fak. 11, Hochschule für angewandte Wissenschaften München, München, Germany
| | - Matthias Dose
- kbo-Fachberater für Autismus-Spektrum-Störungen und Huntington-Krankheit, Kliniken des Bezirks Oberbayern Kommunalunternehmen, München, Germany
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Bird TD, Lange H, Cruickshank T, Dose M, Eddy C, Oosterloo M, Paulsen JS, Reilmann R, Rickards H, Roos RAC, Weindl A. Reader Response: Timing and Impact of Psychiatric, Cognitive, and Motor Abnormalities in Huntington Disease. Neurology 2022; 98:514-515. [PMID: 35314515 DOI: 10.1212/wnl.0000000000200161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Vllasaliu L, Jensen K, Dose M, Hagenah U, Hollmann H, Kamp-Becker I, Lechmann C, Poustka L, Sinzig J, Spitzcok von Brisinski I, van Elst LT, Will D, Vogeley K, Freitag CM. Diagnostik von Autismus- Spektrum-Störungen im Kindes-, Jugend- und Erwachsenenalter: Überblick zu den wesentlichen Fragestellungen und Ergebnissen des ersten Teils der S3-Leitlinie. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie 2019; 47:359-370. [DOI: 10.1024/1422-4917/a000621] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Zusammenfassung. Hintergrund: Autismus-Spektrum-Störungen (ASS) umfassen die ICD-10-Diagnosen (International Statistical Classification of Diseases and Related Health Problems) frühkindlicher Autismus, Asperger-Syndrom und atypischer Autismus und zeigen eine Lebenszeitprävalenz von bis zu 1 %. Die S3-Leitlinie der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V. hat zum Ziel, evidenzbasierte Diagnostik und Therapie für professionelle Akteure im Gesundheits- und Sozialsystem systematisch zusammenzufassen und klinische Empfehlungen zu konsentieren. Der vorliegende Artikel fasst die wesentlichen Ergebnisse zum Teil Diagnostik zusammen. Methodik: Die Leitliniengruppe besteht aus 14 klinischen und wissenschaftlichen Fachgesellschaften sowie Patienten-/Angehörigen-Vertretern. Die Empfehlungen basieren dabei auf den Ergebnissen systematischer Literatursuche, Datenextraktion, Studienqualitäts-Bewertung sowie metaanalytischer Datenaggregation in Kombination mit der klinischen Expertise der jeweiligen Vertreter. Die Empfehlungen wurden anhand eines nominalen Gruppenprozesses abgestimmt. Ergebnisse: Der aktuelle Forschungsstand zur Diagnostik wird zusammengefasst. Dabei liegt ein besonderer Schwerpunkt auf der Frage der Notwendigkeit und Entbehrlichkeit verschiedener Bestandteile des diagnostischen Prozesses. Nach einer allgemeinen Einführung zum Krankheitsbild werden insbesondere die wesentlichen Aspekte der Anamnese, die sinnvolle Verwendung von Screening- und Diagnostikinstrumenten, die internistisch-neurologische Untersuchung, apparative Diagnostik, testpsychologische Untersuchung, Aufklärung und Beratung sowie sinnvolle Verlaufsdiagnostik detailliert dargestellt. Schlussfolgerung: Die ASS-Leitlinie gibt evidenzbasierte, klinisch konsentierte Empfehlungen zum Prozess der Diagnostik von ASS im Kindes-, Jugend- und Erwachsenenalter. Sie bietet Anwendern zudem die Möglichkeit, sich in kurzer Zeit über die Hintergründe der Störung sowie verschiedene diagnostische Instrumente zu informieren.
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Affiliation(s)
- Leonora Vllasaliu
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Autismus-Therapie- und Forschungszentrum, Universitätsklinikum Frankfurt, Goethe Universität
| | - Katrin Jensen
- Institut für Medizinische Biometrie und Informatik, Universitätsklinikum Heidelberg
| | - Matthias Dose
- kbo-Isar-Amper-Klinikum gemeinnützige GmbH; München-Ost; Sitz Haar, Landkreis München
| | - Ulrich Hagenah
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Uniklinik RWTH Aachen
| | | | - Inge Kamp-Becker
- Klinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, Universitätsklinikum Marburg und Philipps-Universität Marburg
| | | | - Luise Poustka
- Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Universitätsmedizin Göttingen
| | - Judith Sinzig
- Abteilung für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, LVR-Klinik Bonn, Akademisches Lehrkrankenhaus der Universität Bonn
| | | | | | - Diana Will
- Kinder- und Jugendlichenpsychotherapeutin, Leiterin der Ambulanz und Beratungsstelle Kiel und der Autismus-Therapiezentren (ATZ) Neumünster und Lübeck von Hilfe für das autistische Kind e. V. Landesverband Schleswig-Holstein, Timmendorfer Strand
| | - Kai Vogeley
- Zentrum für Neurologie und Psychiatrie, Universitätsklinikum Köln
| | - Christine M. Freitag
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Autismus-Therapie- und Forschungszentrum, Universitätsklinikum Frankfurt, Goethe Universität
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Saft C, Bonelli R, Burgunder JM, Dose M, Epplen J, Jung H, Priller J, Reilmann R, Rudnik S, Seppi K, Landwehrmeyer GB. Leitlinien „Chorea/Morbus Huntington“ für die deutschsprachigen Länder neu überarbeitet. Akt Neurol 2018. [DOI: 10.1055/a-0676-8477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
ZusammenfassungDie neu überarbeiteten Leitlinien Chorea/Morbus Huntington geben auf S2k Niveau einen Überblick über den Stand der Forschung zum Erkrankungsverlauf sowie zu neuen Ansätzen der symptomatischen und verlaufsmodifizierenden Therapie bei der Huntington-Krankheit. Im Gegensatz zu vielen anderen Leitlinien bevorzugen die Autoren aus den deutschsprachigen Ländern als Erstlinienbehandlung der Chorea Tiaprid. Aufgrund von Nebenwirkungen, welche unter Tetrabenazin auftreten können – wie etwa Depression oder Akathisie, ist es gängige Praxis, Tetrabenazin erst in zweiter Linie einzusetzen. Die Leitlinien nehmen Stellung zu rechtlichen Fragen der Präimplantationsdiagnostik (PID) und der pränatalen Diagnostik (PD) in Deutschland, Österreich und der Schweiz sowie zu den Unterschieden zwischen dem prädiktiven und dem differenzialdiagnostischen Einsatz der molekulargenetischen Diagnostik. In den Leitlinien wird darüber hinaus sehr ausführlich zu den möglichen Differenzialdiagnosen bei einer Chorea ungeklärter Ätiologie Stellung genommen.
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Affiliation(s)
- Carsten Saft
- Huntington-Zentrum NRW, Neurologische Klinik der Ruhr-Universität Bochum, St. Josef-Hospital, Bochum
| | - Raphael Bonelli
- Forschungsgruppe Neuropsychiatrie, Sigmund-Freud-Universität, Wien
| | - Jean-Marc Burgunder
- Schweizerisches Huntington Zentrum und Neurologische Klinik, Universität Bern (Vertreter SNG)
| | - Matthias Dose
- kbo-Fachberater für Huntington-Krankheit und Autismus-Spektrum-Störungen; kbo-Isar-Amper-Klinikum Taufkirchen/München-Ost (Vertreter DGPPN und für den wissenschaftlichen Beirat der Deutschen Huntington-Hilfe e.V.)
| | - Jörg Epplen
- HZ NRW, Humangenetik, Ruhr-Universität Bochum (Vertreter GfH)
| | - Hans Jung
- Klinik für Neurologie, Universitätsspital Zürich
| | - Josef Priller
- Abteilung für Neuropsychiatrie, Charité – Universitätsmedizin Berlin und DZNE, Berlin (Vertreter DGPPN)
| | - Ralf Reilmann
- George-Huntington-Institut GmbH und Klinik für Radiologie, Universität Münster, sowie Sektion für Neurodegeneration und Hertie-Institut für klinische Hirnforschung, Universität Tübingen
| | - Sabine Rudnik
- Sektion Humangenetik, Medizinische Universität Innsbruck (Vertreterin ÖGH)
| | - Klaus Seppi
- Universitätsklinik für Neurologie, Medizinische Universität Innsbruck (Vertreter der ÖGN)
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Kästner A, Begemann M, Michel TM, Everts S, Stepniak B, Bach C, Poustka L, Becker J, Banaschewski T, Dose M, Ehrenreich H. Autism beyond diagnostic categories: characterization of autistic phenotypes in schizophrenia. BMC Psychiatry 2015; 15:115. [PMID: 25968177 PMCID: PMC4436160 DOI: 10.1186/s12888-015-0494-x] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 04/29/2015] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Behavioral phenotypical continua from health to disease suggest common underlying mechanisms with quantitative rather than qualitative differences. Until recently, autism spectrum disorders and schizophrenia were considered distinct nosologic entities. However, emerging evidence contributes to the blurring of symptomatic and genetic boundaries between these conditions. The present study aimed at quantifying behavioral phenotypes shared by autism spectrum disorders and schizophrenia to prepare the ground for biological pathway analyses. METHODS Specific items of the Positive and Negative Syndrome Scale were employed and summed up to form a dimensional autism severity score (PAUSS). The score was created in a schizophrenia sample (N = 1156) and validated in adult high-functioning autism spectrum disorder (ASD) patients (N = 165). To this end, the Autism Diagnostic Observation Schedule (ADOS), the Autism (AQ) and Empathy Quotient (EQ) self-rating questionnaires were applied back to back with the newly developed PAUSS. RESULTS PAUSS differentiated between ASD, schizophrenia and a disease-control sample and substantially correlated with the Autism Diagnostic Observation Schedule. Patients with ADOS scores ≥12 obtained highest, those with scores <7 lowest PAUSS values. AQ and EQ were not found to vary dependent on ADOS diagnosis. ROC curves for ADOS and PAUSS resulted in AuC values of 0.9 and 0.8, whereas AQ and EQ performed at chance level in the prediction of ASD. CONCLUSIONS This work underscores the convergence of schizophrenia negative symptoms and autistic phenotypes. PAUSS evolved as a measure capturing the continuous nature of autistic behaviors. The definition of extreme-groups based on the dimensional PAUSS may permit future investigations of genetic constellations modulating autistic phenotypes.
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Affiliation(s)
- Anne Kästner
- Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Hermann-Rein-Str.3, 37075, Göttingen, Germany.
| | - Martin Begemann
- Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Hermann-Rein-Str.3, 37075, Göttingen, Germany. .,DFG Research Center for Nanoscale Microscopy and Molecular Physiology of the Brain (CNMPB), Göttingen, Germany.
| | - Tanja Maria Michel
- Department of Psychiatry, Institute for Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Sarah Everts
- Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Hermann-Rein-Str.3, 37075, Göttingen, Germany.
| | - Beata Stepniak
- Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Hermann-Rein-Str.3, 37075, Göttingen, Germany.
| | - Christiane Bach
- Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany.
| | - Luise Poustka
- Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany.
| | - Joachim Becker
- Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Hermann-Rein-Str.3, 37075, Göttingen, Germany.
| | - Tobias Banaschewski
- Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany.
| | - Matthias Dose
- kbo-Isar-Amper-Klinikum Taufkirchen, Taufkirchen (Vils), Germany.
| | - Hannelore Ehrenreich
- Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Hermann-Rein-Str.3, 37075, Göttingen, Germany. .,DFG Research Center for Nanoscale Microscopy and Molecular Physiology of the Brain (CNMPB), Göttingen, Germany.
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Lambeck J, Niesen WD, Reinhard M, Weiller C, Dose M, Zucker B. Erratum to: Substantia nigra hyperechogenicity in hypokinetic Huntington’s disease patients. J Neurol 2015; 262:718. [DOI: 10.1007/s00415-015-7656-0] [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: 11/24/2022]
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Dose M. [Legislation for compulsory outpatient psychiatric treatment--pro]. Psychiatr Prax 2014; 41:239-240. [PMID: 24983450 DOI: 10.1055/s-0034-1370085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Ribbe K, Friedrichs H, Begemann M, Grube S, Papiol S, Kästner A, Gerchen MF, Ackermann V, Tarami A, Treitz A, Flögel M, Adler L, Aldenhoff JB, Becker-Emner M, Becker T, Czernik A, Dose M, Folkerts H, Freese R, Günther R, Herpertz S, Hesse D, Kruse G, Kunze H, Franz M, Löhrer F, Maier W, Mielke A, Müller-Isberner R, Oestereich C, Pajonk FG, Pollmächer T, Schneider U, Schwarz HJ, Kröner-Herwig B, Havemann-Reinecke U, Frahm J, Stühmer W, Falkai P, Brose N, Nave KA, Ehrenreich H. The cross-sectional GRAS sample: a comprehensive phenotypical data collection of schizophrenic patients. BMC Psychiatry 2010; 10:91. [PMID: 21067598 PMCID: PMC3002316 DOI: 10.1186/1471-244x-10-91] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Accepted: 11/10/2010] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Schizophrenia is the collective term for an exclusively clinically diagnosed, heterogeneous group of mental disorders with still obscure biological roots. Based on the assumption that valuable information about relevant genetic and environmental disease mechanisms can be obtained by association studies on patient cohorts of ≥ 1000 patients, if performed on detailed clinical datasets and quantifiable biological readouts, we generated a new schizophrenia data base, the GRAS (Göttingen Research Association for Schizophrenia) data collection. GRAS is the necessary ground to study genetic causes of the schizophrenic phenotype in a 'phenotype-based genetic association study' (PGAS). This approach is different from and complementary to the genome-wide association studies (GWAS) on schizophrenia. METHODS For this purpose, 1085 patients were recruited between 2005 and 2010 by an invariable team of traveling investigators in a cross-sectional field study that comprised 23 German psychiatric hospitals. Additionally, chart records and discharge letters of all patients were collected. RESULTS The corresponding dataset extracted and presented in form of an overview here, comprises biographic information, disease history, medication including side effects, and results of comprehensive cross-sectional psychopathological, neuropsychological, and neurological examinations. With >3000 data points per schizophrenic subject, this data base of living patients, who are also accessible for follow-up studies, provides a wide-ranging and standardized phenotype characterization of as yet unprecedented detail. CONCLUSIONS The GRAS data base will serve as prerequisite for PGAS, a novel approach to better understanding 'the schizophrenias' through exploring the contribution of genetic variation to the schizophrenic phenotypes.
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Affiliation(s)
- Katja Ribbe
- Division of Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Göttingen, Germany
| | - Heidi Friedrichs
- Division of Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Göttingen, Germany
| | - Martin Begemann
- Division of Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Göttingen, Germany
| | - Sabrina Grube
- Division of Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Göttingen, Germany
| | - Sergi Papiol
- Division of Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Göttingen, Germany,DFG Research Center for Molecular Physiology of the Brain (CMPB), Germany
| | - Anne Kästner
- Division of Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Göttingen, Germany
| | - Martin F Gerchen
- Division of Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Göttingen, Germany
| | - Verena Ackermann
- Division of Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Göttingen, Germany
| | - Asieh Tarami
- Division of Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Göttingen, Germany
| | - Annika Treitz
- Division of Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Göttingen, Germany
| | - Marlene Flögel
- Division of Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Göttingen, Germany
| | - Lothar Adler
- Department of Psychiatry and Psychotherapy, Ecumenical Hospital Hainich, Germany
| | - Josef B Aldenhoff
- Hospital of Psychiatry and Psychotherapy, Center for Integrative Psychiatry, Kiel, Germany
| | - Marianne Becker-Emner
- Karl-Jaspers-Hospital, Psychiatric Federation Oldenburger Land, Bad Zwischenahn, Germany
| | - Thomas Becker
- Department of Psychiatry II, Ulm University, District Hospital Günzburg, Germany
| | - Adelheid Czernik
- Department of Psychiatry and Psychotherapy, Hospital Fulda, Germany
| | - Matthias Dose
- Department of Psychiatry and Psychotherapy, Isar-Amper-Hospital, Taufkirchen (Vils), Germany
| | - Here Folkerts
- Department of Psychiatry and Psychotherapy, Reinhard-Nieter Hospital, Wilhelmshaven, Germany
| | - Roland Freese
- Vitos Hospital of Forensic Psychiatry Eltville, Eltville, Germany
| | - Rolf Günther
- Vitos Hospital of Psychiatry and Psychotherapy Merxhausen, Kassel, Germany
| | - Sabine Herpertz
- Department of Psychiatry and Psychotherapy, University of Rostock, Germany
| | - Dirk Hesse
- Hospital of Forensic Psychiatry, Moringen, Germany
| | - Gunther Kruse
- Hospital of Psychiatry and Psychotherapy Langenhagen, Regional Hospitals Hannover, Germany
| | - Heinrich Kunze
- Vitos Hospital of Psychiatry and Psychotherapy, Bad Emstal-Merxhausen, Germany
| | - Michael Franz
- Vitos Hospital of Psychiatry and Psychotherapy, Bad Emstal-Merxhausen, Germany
| | - Frank Löhrer
- Addiction Hospital "Am Waldsee", Rieden, Germany
| | - Wolfgang Maier
- Department of Psychiatry and Psychotherapy, University Medical Center of Bonn, Germany
| | - Andreas Mielke
- Vitos Hospital of Psychiatry and Psychotherapy Merxhausen, Hofgeismar, Germany
| | | | - Cornelia Oestereich
- Department of Psychiatry and Psychotherapy, Regional Hospitals Hannover, Wunstorf, Germany
| | | | - Thomas Pollmächer
- Department of Psychiatry and Psychotherapy, Hospital Ingolstadt, Germany
| | - Udo Schneider
- Department of Psychiatry and Psychotherapy, Hospital Lübbecke, Germany
| | | | | | - Ursula Havemann-Reinecke
- Department of Psychiatry and Psychotherapy, University Medical Center of Göttingen, Germany,DFG Research Center for Molecular Physiology of the Brain (CMPB), Germany
| | - Jens Frahm
- Biomedical NMR Research GmbH, Max Planck Institute of Biophysical Chemistry, Göttingen, Germany,DFG Research Center for Molecular Physiology of the Brain (CMPB), Germany,Founders of the GRAS Initiative
| | - Walter Stühmer
- Department of Molecular Biology of Neuronal Signals, Max Planck Institute of Experimental Medicine, Göttingen, Germany,DFG Research Center for Molecular Physiology of the Brain (CMPB), Germany,Founders of the GRAS Initiative
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University Medical Center of Göttingen, Germany,DFG Research Center for Molecular Physiology of the Brain (CMPB), Germany,Founders of the GRAS Initiative
| | - Nils Brose
- Department of Molecular Neurobiology, Max Planck Institute of Experimental Medicine, Göttingen, Germany,DFG Research Center for Molecular Physiology of the Brain (CMPB), Germany,Founders of the GRAS Initiative
| | - Klaus-Armin Nave
- Department of Neurogenetics, Max Planck Institute of Experimental Medicine, Göttingen, Germany,DFG Research Center for Molecular Physiology of the Brain (CMPB), Germany,Founders of the GRAS Initiative
| | - Hannelore Ehrenreich
- Division of Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Göttingen, Germany,DFG Research Center for Molecular Physiology of the Brain (CMPB), Germany,Founders of the GRAS Initiative
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11
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Gabriel P, Obertová Z, Ratnayake M, Arent T, Cattaneo C, Dose M, Tutkuviene J, Ritz-Timme S. Schätzung des Lebensalters kindlicher Opfer auf Bilddokumenten. Rechtsmedizin (Berl) 2010. [DOI: 10.1007/s00194-010-0702-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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12
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Affiliation(s)
- M Dose
- Fachkrankenhaus für Psychiatrie, Psychotherapie und psychosomatische Medizin, Isar-Amper-Klinikum, Klinik Taufkirchen (Vils), Taufkirchen, Germany.
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13
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Reilmann R, Roos R, Rosser A, Grimbergen Y, Kraus P, Craufurd D, Dose M, Weindl A, Howard E, Ecker D, Bohlen S, Burgunder JM, Lange HW, Landwehrmeyer GB. A teaching film, video library and online certification for the Unified Huntington's Disease Rating Scale Total Motor Score. Akt Neurol 2009. [DOI: 10.1055/s-0029-1238568] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [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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14
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Dose M. Wirkungen und Nebenwirkungen typischer und atypischer Neuroleptika. Gesundheitswesen 2009. [DOI: 10.1055/s-0029-1215473] [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: 10/21/2022]
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15
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Fischer-Barnicol D, Lanquillon S, Haen E, Zofel P, Koch HJ, Dose M, Klein HE. Typical and atypical antipsychotics--the misleading dichotomy. Results from the Working Group 'Drugs in Psychiatry' (AGATE). Neuropsychobiology 2008; 57:80-7. [PMID: 18515977 DOI: 10.1159/000135641] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [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: 09/19/2007] [Accepted: 02/15/2008] [Indexed: 11/19/2022]
Abstract
OBJECTIVES (1) To investigate the risk of extrapyramidal motor side effects (EPS) associated with the prescription of different antipsychotics under naturalistic treatment conditions; (2) to test the rationale of the terms 'typical' and 'atypical' based on EPS rates. DESIGN Cross-sectional study in the federal state of Bavaria. SETTING 20 psychiatric hospitals in Bavaria. PARTICIPANTS 6,061 inpatients, aged 18-65 years, with psychotic disorders. MAIN OUTCOME MEASURES Co-medication with the anticholinergic biperiden was used as an index of EPS. Odds ratios for EPS and numbers needed to harm [number of patients who would need to be treated to obtain one more case with an adverse outcome (i.e. EPS) as compared with the control treatment (clozapine)] were calculated to obtain risk estimates for 15 different antipsychotics. RESULTS Groups of 'typical' and 'atypical' antipsychotics were not homogeneous in their EPS rates, and showed wide variation within each group. Nor did the frequency of EPS allow a clear distinction between the groups. There were 2 reasons for this: first, EPS rates rose continuously over the whole spectrum of drugs under study, and therefore precluded the definition of a cut-off score; second, there was considerable overlap between the 2 groups as EPS rates of various 'atypicals' (e.g. amisulpride, risperidone and zotepine) did not differ from some 'typical' substances (e.g. fluphenazine), while one 'typical' antipsychotic (perazine) even had a lower EPS risk than most 'atypicals'. CONCLUSIONS The odds of inducing EPS are not distinguishable between 'typical' and 'atypical' antipsychotics as EPS rates rise on a continuous scale throughout both classes. We propose dropping the categorization of antipsychotics as 'typical' and 'atypical' and instead using risk estimates like number needed to harm for EPS to help in benefit/risk considerations for antipsychotic treatment.
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16
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Berger M, Krieg J, Rummler R, Raptis C, Morinigo A, Dose M, Benker B. The Treatment of Mania with the Cholinomimetic Drug RS 86. Pharmacopsychiatry 2008. [DOI: 10.1055/s-2007-1017257] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [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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17
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Finke K, Schneider WX, Redel P, Dose M, Kerkhoff G, Müller HJ, Bublak P. The capacity of attention and simultaneous perception of objects: A group study of Huntington's disease patients. Neuropsychologia 2007; 45:3272-84. [PMID: 17681560 DOI: 10.1016/j.neuropsychologia.2007.06.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [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: 02/06/2007] [Revised: 06/07/2007] [Accepted: 06/17/2007] [Indexed: 11/23/2022]
Abstract
Using a whole report-paradigm based on [Bundesen, C. (1990). A theory of visual attention. Psychological Review, 97, 523-547; Bundesen, C. (1998). A computational theory of visual attention. Philosophical Transactions of the Royal Society of London B, Biological Sciences, 353, 1271-1281] theory of visual attention (TVA), [Finke, K., Bublak, P., Dose, M., Müller, H. J., & Schneider, W. X. (2006). Parameter-based assessment of spatial and non-spatial attentional deficits in Huntington's disease. Brain, 129, 1137-1151] demonstrated profound reductions in perceptual processing speed and visual working memory (WM) storage capacity in Huntington's disease (HD) patients. A comparably severe impairment of visual processing capacity has previously been reported for two simultanagnosia patients [Duncan, J., Bundesen, C., Olson, A., Humphreys, G., Ward, R., Kyllingsbaek, S., van Raamsdonk, M., Rorden, C., & Chavda, S. (2003). Attentional functions in dorsal and ventral simultanagnosia. Cognitive Neuropsychology, 20, 675-702]. To investigate whether such a deficit does also prevail in HD, the simultaneous perception of visual objects was tested in 10 HD patients under free viewing conditions and without time constraints. Objects were presented under four different conditions: (i) single, (ii) multiple adjacent, (iii) multiple embedded, and (iv) multiple overlapping. The dependent measure was the percentage of identification failures. Performance was compared to that of 15 healthy subjects matched for age, education, gender and general mental ability. For HD patients, the percentage of errors in the various testing conditions was examined for correlations with the TVA parameters of visuo-perceptual processing speed and WM storage capacity. These parameters were estimated using verbal whole report of briefly presented letters. TVA permits the two parameters to be estimated mathematically independently and relatively unaffected by any motor deficits present in HD. The identification error rate was substantially increased in HD patients, compared to control subjects, in the overlapping-figures subtest. This deficit was significantly and negatively correlated with processing speed, whereas there was no correlation with WM storage capacity. These results demonstrate the presence of deficits in simultaneous perception in HD, related to a severe reduction in perceptual processing speed. The results are discussed with respect to a dopamine mediated decline of cortical cholinergic activation, diminishing the number of visual objects that can be simultaneously represented within the visual processing system.
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Affiliation(s)
- Kathrin Finke
- Department of Psychology, General and Experimental Psychology/ Neuro-Cognitive Psychology, Ludwig-Maximilian-University, Munich, Germany.
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18
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Dose M. [Priority for atypical antipsychotic drugs? Current studies clarify the issues]. Psychiatr Prax 2007; 34:46-9. [PMID: 17265252 DOI: 10.1055/s-2006-959065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
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19
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Metzger S, Bauer P, Tomiuk J, Laccone F, Didonato S, Gellera C, Mariotti C, Lange HW, Weirich-Schwaiger H, Wenning GK, Seppi K, Melegh B, Havasi V, Balikó L, Wieczorek S, Zaremba J, Hoffman-Zacharska D, Sulek A, Basak AN, Soydan E, Zidovska J, Kebrdlova V, Pandolfo M, Ribaï P, Kadasi L, Kvasnicova M, Weber BHF, Kreuz F, Dose M, Stuhrmann M, Riess O. Genetic analysis of candidate genes modifying the age-at-onset in Huntington's disease. Hum Genet 2006; 120:285-92. [PMID: 16847693 DOI: 10.1007/s00439-006-0221-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [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: 05/04/2006] [Accepted: 06/08/2006] [Indexed: 01/19/2023]
Abstract
The expansion of a polymorphic CAG repeat in the HD gene encoding huntingtin has been identified as the major cause of Huntington's disease (HD) and determines 42-73% of the variance in the age-at-onset of the disease. Polymorphisms in huntingtin interacting or associated genes are thought to modify the course of the disease. To identify genetic modifiers influencing the age at disease onset, we searched for polymorphic markers in the GRIK2, TBP, BDNF, HIP1 and ZDHHC17 genes and analysed seven of them by association studies in 980 independent European HD patients. Screening for unknown sequence variations we found besides several silent variations three polymorphisms in the ZDHHC17 gene. These and polymorphisms in the GRIK2, TBP and BDNF genes were analysed with respect to their association with the HD age-at-onset. Although some of the factors have been defined as genetic modifier factors in previous studies, none of the genes encoding GRIK2, TBP, BDNF and ZDHHC17 could be identified as a genetic modifier for HD.
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Affiliation(s)
- Silke Metzger
- Department of Medical Genetics, University of Tübingen, Calwerstrasse 7, 72076, Tübingen, Germany
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20
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Finke K, Bublak P, Dose M, Müller HJ, Schneider WX. Parameter-based assessment of spatial and non-spatial attentional deficits in Huntington's disease. ACTA ACUST UNITED AC 2006; 129:1137-51. [PMID: 16504973 DOI: 10.1093/brain/awl040] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A major challenge for neuropsychological research on Huntington's disease is the identification of biomarkers for the disease at the level of cognitive functions. Given that cortical-striatal-thalamic circuits are particularly vulnerable, possible markers loading functionally on these brain regions should be particularly significant. We investigated whether parametric values derived from a 'theory of visual attention' (TVA) can serve that purpose. They are derived as mathematically independent, quantitative measures of attentional components, and the tasks require only non-speeded vocal responses. As such, the methodology seems well suited for testing patients with motor problems and general cognitive decline. Accumulating neuroanatomical evidence suggests that striatal atrophy in Huntington's disease is asymmetrical with a more pronounced left-sided degeneration. We applied a partial-report paradigm to analyse whether this results in a pathological (leftward) bias of the spatial distribution of attention. In partial report, red target letters are presented either alone or accompanied by either a second target or a green distractor letter presented in the same or in the opposite hemi-field. Since basal ganglia lesions have also been shown to cause spatially non-lateralized impairments, that is, reduced perceptual processing speed and visual working memory (WM) storage capacity within both hemi-fields, we tested possible reductions in these parameters with a whole-report paradigm. Here, columns of five red or green letters are briefly presented and the subject has to report as many as possible. Eighteen patients and 18 matched control subjects performed a partial- and a whole-report task with briefly presented letter displays. In partial report, Huntington's disease patients demonstrated a pathological bias, indicating increased attentional weighting to the left hemi-field. The extent of lateralization was strongly related to age at onset and to the number of cytosine-adenine-guanine (CAG) triplet repeats on gene IT15. In contrast, the extent of lateralization was not related to disease progression as reflected by the duration of the disease since onset of the first symptoms. In whole report, the non-lateralized attentional parameters processing speed and visual WM storage capacity were reduced bilaterally in both hemi-fields. The extent of the reduction was related to the disease duration since onset, whereas no significant correlation with CAG repeats or age at onset was found. Laterality of attentional weighting may, therefore, represent a possible trait marker reflecting the intensity of the pathogenic mechanisms, while the reduction of visual processing speed and storage capacity may be state markers for the stage of disease progression.
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Affiliation(s)
- Kathrin Finke
- Department of Psychology, General and Experimental Psychology, Ludwig-Maximilians-University Munich, Leopold Street 13, 80802 Munich, Germany.
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21
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Dose M. Buchbesprechung. Zeitschrift für Klinische Psychologie und Psychotherapie 2006. [DOI: 10.1026/1616-3443.35.1.66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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22
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Metzger S, Bauer P, Tomiuk J, Laccone F, Didonato S, Gellera C, Soliveri P, Lange HW, Weirich-Schwaiger H, Wenning GK, Melegh B, Havasi V, Balikó L, Wieczorek S, Arning L, Zaremba J, Sulek A, Hoffman-Zacharska D, Basak AN, Ersoy N, Zidovska J, Kebrdlova V, Pandolfo M, Ribaï P, Kadasi L, Kvasnicova M, Weber BHF, Kreuz F, Dose M, Stuhrmann M, Riess O. The S18Y polymorphism in the UCHL1 gene is a genetic modifier in Huntington's disease. Neurogenetics 2005; 7:27-30. [PMID: 16369839 DOI: 10.1007/s10048-005-0023-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [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: 07/25/2005] [Accepted: 11/07/2005] [Indexed: 10/25/2022]
Abstract
An expanded polyglutamine stretch in the huntingtin protein has been identified as the pathogenetic cause of Huntington's disease (HD). Although the length of the expanded polyglutamine repeat is inversely correlated with the age-at-onset, additional genetic factors are thought to modify the variance in the disease onset. As linkage analysis suggested a modifier locus on chromosome 4p, we investigated the functional relevance of S18Y polymorphism of the ubiquitin carboxy-terminal hydrolase L1 in 946 Caucasian HD patients. In this group, the allelic variation on locus S18Y is responsible for 1.1% of the variance in the HD age-at-onset, and the rare Y allele is associated with younger-aged cases.
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Affiliation(s)
- Silke Metzger
- Department of Medical Genetics, University of Tübingen, Calwerstrasse 7, 72076 Tübingen, Germany
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23
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Metzger S, Bauer P, Tomiuk J, Laccone F, DiDonato S, Gellera C, Lange H, Weirich-Schwaiger H, Melegh B, Havasi V, Baliko L, Epplen J, Zaremba J, Sulek A, Basak A, Soydan E, Zidovska J, Kebrdlova V, Pandolfo M, Ribai P, Kadasi L, Kvasnicova M, Weber B, Kreuz F, Dose M, Stuhrmann M, Riess O. Genetic analysis of candidate genes modifying the age-at-onset in Huntington's Disease: results of a large European association study. Akt Neurol 2005. [DOI: 10.1055/s-2005-919317] [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: 10/26/2022]
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Reilmann R, Kirsten F, Saemann P, Bohlen S, Sommer J, Klopstock T, Bender A, Dose M, Weindl A, Auer D, Ringelstein E. Huntington'sche Krankheit: Variabilität isometrischer Greifkräfte als Surrogate Marker für klinischen Studien. Akt Neurol 2005. [DOI: 10.1055/s-2005-919187] [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: 10/26/2022]
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25
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Kirsten F, Bohlen S, Sommer J, Merl T, Saemann P, Klopstock T, Bender A, Dose M, Weindl A, Auer D, Ringelstein E, Reilmann R. Altered isometric force control during object release in patients with Huntington's Disease. Akt Neurol 2005. [DOI: 10.1055/s-2005-919363] [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: 10/26/2022]
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26
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Weinmüller B, Dose M, Glaser T. Tolerability and efficacy of neuroleptic medication in schizophrenia – a comparison of „typical“ and „atypical“ antipsychotics. Pharmacopsychiatry 2005. [DOI: 10.1055/s-2005-918869] [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: 10/18/2022]
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27
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Naber D, Dose M. [Pro and contra: basic precedence of atypical neuroleptics]. Psychiatr Prax 2005; 32:163-6. [PMID: 15852207 DOI: 10.1055/s-2004-834708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Affiliation(s)
- Dieter Naber
- Universitätsklinikum Hamburg-Eppendorf, Klinik für Psychiatrie und Psychotherapie.
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Bender A, Auer DP, Merl T, Reilmann R, Saemann P, Yassouridis A, Bender J, Weindl A, Dose M, Gasser T, Klopstock T. Creatine supplementation lowers brain glutamate levels in Huntington?s disease. J Neurol 2005; 252:36-41. [PMID: 15672208 DOI: 10.1007/s00415-005-0595-4] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.2] [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: 01/05/2004] [Revised: 06/10/2004] [Accepted: 06/23/2004] [Indexed: 12/12/2022]
Abstract
There is evidence from in vitro and animal experiments that oral creatine (Cr) supplementation might prevent or slow down neurodegeneration in Huntington's disease (HD). However, this neuroprotective effect could not be replicated in clinical trials, possibly owing to treatment periods being too short to impact on clinical endpoints. We used proton magnetic resonance spectroscopy ((1)H-MRS) as a surrogate marker to evaluate the effect of Cr supplementation on brain metabolite levels in HD.Twenty patients (age 46+/-7.3 years, mean duration of symptoms 4.0+/-2.1 years, number of CAG repeats 44.5+/-2.7) were included. The primary endpoint was metabolic alteration as measured by (1)H-MRS in the parieto-occipital cortex before (t1) and after 8-10 weeks (t2) of Cr administration. Secondary measures comprised the motor section of the Unified Huntington's Disease Rating Scale and the Mini Mental State Examination. (1)H-MRS showed a 15.6% decrease of unresolved glutamate (Glu)+glutamine (Gln; Glu+Gln=Glx; p<0.001) and a 7.8% decrease of Glu (p<0.027) after Cr treatment. N-acetylaspartate trended to fall (p=0.073) whereas total Cr, choline-containing compounds, glucose, and lactate remained unchanged. There was no effect on clinical rating scales. This cortical Glx and Glu decrease may be explained by Cr enhancing the energy-dependent conversion of Glu to Gln via the Glu-Gln cycle, a pathway known to be impaired in HD. Since Glu-mediated excitotoxicity is presumably pivotal in HD pathogenesis, these results indicate a therapeutic potential of Cr in HD. Thus, longterm clinical trials are warranted.
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Affiliation(s)
- Andreas Bender
- Department of Neurology, Klinikum Grosshadern, University of Munich, Marchioninistrasse 15, 81377 Munich, Germany
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Wolfersdorf M, Klein HE, Dose M. [Psychotherapy units in Bavarian state mental hospitals]. Psychiatr Prax 2004; 31 Suppl 1:S76-8. [PMID: 15570510 DOI: 10.1055/s-2004-828424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE AND METHOD In this paper we report about the situation of psychotherapeutic inpatient treatment in Bavarian state mental hospitals, based on data coming from surveys in those hospitals. RESULTS AND CONCLUSION 22 State mental hospitals in Bavaria have 1217 beds for acute psychotherapy, proofed on the basis of quality criteria. More than 50 per cent of all psychotherapy beds are located in those hospitals.
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Beister A, Kraus P, Kuhn W, Dose M, Weindl A, Gerlach M. The N-methyl-D-aspartate antagonist memantine retards progression of Huntington’s disease. Focus on Extrapyramidal Dysfunction 2004:117-22. [PMID: 15354397 DOI: 10.1007/978-3-7091-0579-5_14] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
According to the excitotoxicity hypothesis, neurotoxicity due to glutamate is regarded as potential factor in the progredient neurodegeneration of Huntington's disease (HD). Memantine, as a glutamate receptor antagonist, should counteract this mechanism. Its effectiveness (up to 30 mg/day) with regard to retardation of progression was thus examined in 27 HD patients in a two year, open and multicentre trial. The results suggest that memantine treatment of HD may be useful in terms of retardation of the progression of the disorder.
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Affiliation(s)
- A Beister
- District Hospital, Taufkirchen/Vils, Germany
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31
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Philipp M, Lesch OM, Schmauss M, Dose M, Glaser T. [Comparative effectiveness of flupenthixol and risperidone on negative symptoms of schizophrenia]. Psychiatr Prax 2003; 30 Suppl 2:S94-6. [PMID: 14509050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
The efficacy of flupentixol and risperidone were compared in a randomized double-blind study in 153 chronic schizophrenic patients. Flupentixol showed to be not inferior to risperidone concerning schizophrenic negative symptoms at week 8, 16 and 24. Positive symptoms and general psychopathology improved comparably, too. There was a trend in favor of flupentixol concerning the improvement of depressive symptoms and a trend in favor of risperidone concerning the improvement of preexisting parkinsonian symptoms. The study data justify to regard flupentixol as a "partial atypical" antipsychotic.
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Affiliation(s)
- Michael Philipp
- Bezirkskrankenhaus Landshut, Prof.-Buchner-Strasse 22, 84034 Landshut
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Philipp M, Lesch OM, Schmauss M, Dose M, Glaser T. [Comparative Efficacy of Flupentixol and Risperidone on Schizophrenic Negative Symptoms]. Psychiatr Prax 2003; 30:94-96. [PMID: 13130348 DOI: 10.1055/s-2003-39746] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The efficacy of flupentixol and risperidone were compared in a randomized double-blind study in 153 chronic schizophrenic patients. Flupentixol showed to be not inferior to risperidone concerning schizophrenic negative symptoms at week 8, 16 and 24. Positive symptoms and general psychopathology improved comparably, too. There was a trend in favor of flupentixol concerning the improvement of depressive symptoms and a trend in favor of risperidone concerning the improvement of preexisting parkinsonian symptoms. The study data justify to regard flupentixol as a "partial atypical" antipsychotic.
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Dose M. [New "atypical" neuroleptics -- the emperor's new clothes?]. Psychiatr Prax 2003; 30:1-3. [PMID: 12524575 DOI: 10.1055/s-2003-36630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Wiedemann G, Hahlweg K, Müller U, Feinstein E, Hank G, Dose M. Effectiveness of targeted intervention and maintenance pharmacotherapy in conjunction with family intervention in schizophrenia. Eur Arch Psychiatry Clin Neurosci 2002; 251:72-84. [PMID: 11407442 DOI: 10.1007/s004060170056] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [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: 11/30/2022]
Abstract
A sample of 85 patients with schizophrenia, of whom 34 later dropped out, received randomised treatment. There were no significant differences between treatment-takers and drop-outs in the variables assessed. Patients received either standard-dose maintenance neuroleptic treatment or targeted maintenance pharmacotherapy and all patients received behavioural family therapy. Measures of psychopathology, social adjustment, side-effects, family burden, and expressed emotion were assessed at baseline and then periodically over an 18-month period. The study was designed to compare the two alternative pharmacological maintenance approaches, each of them supported by psychosocial intervention. Any evaluation of the impact of behavioural family treatment on relapse rates and other outcome criteria is exclusively descriptive. A significantly higher rate of relapse was observed at 18 months in patients randomised to targeted treatment compared to those randomised to standard-dose treatment (35% vs 4%). Although patients assigned to the targeted maintenance group received significantly lower mean doses of neuroleptics, there were no significant differences between the two groups with regard to side-effects, global measures of social function, and overall psychopathology. Family burden was higher in the targeted-treatment group at six months, but did not differ at the one-year and eighteen-month time points. However, both groups improved significantly from baseline to 12 or 18 months in almost all variables assessed. Thus, the behavioural family approach did not compensate for the problems associated with the targeted medication strategy.
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Affiliation(s)
- G Wiedemann
- University of Tuebingen, Department of Psychiatry and Psychotherapy, Germany.
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Grunze H, Walden J, Dittmann S, Berger M, Bergmann A, Bräunig P, Dose M, Emrich HM, Gastpar M, Greil W, Krüger S, Möller HJ, Uebelhack R. [Psychopharmacotherapy of bipolar affective diseases]. Nervenarzt 2002; 73:4-17; quiz 18-9. [PMID: 11975062 DOI: 10.1007/s115-002-8142-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The broadening of the classification systems for manic-depressive illness towards a spectrum of bipolar disorders implicates a more differentiated use of pharmacotherapies. However, many questions still remain open. This implies that all consensus guidelines and recommendations have to be considered as preliminary. On the other hand, research in the last decade has developed many new treatment alternatives, both for mood stabilizers and antidepressants as well as antipsychotics. These recommendations, which have been developed in the process of two consensus meetings, try to consider the broadening of the concept of bipolar disorder by differentiating between subgroups according to acute symptomatology and characteristics of the long-term course, e.g., rapid cycling. In particular, the emerging role and new indications of mood stabilizing antiepileptic drugs, atypical antipsychotics, and new antidepressants will be discussed.
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Affiliation(s)
- H Grunze
- Psychiatrische Klinik der Universität München
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Abstract
After nearly 50 years of therapeutic application of neuroleptics, diagnosis and classification of neuroleptic-induced extrapyramidal syndromes still concentrate on their "neurological" (motor) aspects. Psychiatric (mental) aspects are in general - if at all - regarded as "secondary" to motor symptoms. Psychiatric side effects of neuroleptics (including psychotic exacerbations during neuroleptic treatment) have, however, anecdotally been reported since 1954 but never developed into a systematic classification. Accordingly, psychiatric manifestations of extrapyramidal side effects frequently are overlooked, misdiagnosed as psychotic deteriorations and treated by increased dosing of neuroleptics instead anticholinergics, which in addition are falsely suspected of bearing a high addictive potential and the risk of development of tardive dyskinesia. It is suggested that neuroleptic-induced basal ganglia dysfunction results in motor as well as mental extrapyramidal side effects, whose recognition and management is essential to achieve better tolerability of and thereby compliance with neuroleptic treatment.
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Abstract
Anticholinergics are widely used to treat extrapyramidal motor symptoms caused by neuroleptics or other drugs with antidopaminergic (dopamine D2) effects. In the medical literature, occasional reports are concerned with the abuse of centrally acting anticholinergic compounds. These drugs may be abused because of their stimulant effects, mostly by patients on neuroleptic treatment. Their supposed "euphoric" effect when too quickly parenterally administered (only after previous treatment with neuroleptics) seems to consist in the abolition of neuroleptic-induced anhedonia. In a few patients, excessive use of anticholinergics persists in the face of detrimental effects and is, therefore, properly termed "abuse". More commonly, however, patients with schizophrenia take more than the recommended dose of anticholinergics in an attempt to treat the adverse effects of neuroleptics. The abuse of anticholinergics in addicts who are not using neuroleptics is low.
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Davidson M, Harvey PD, Vervarcke J, Gagiano CA, De Hooge JD, Bray G, Dose M, Barak Y, Haushofer M. A long-term, multicenter, open-label study of risperidone in elderly patients with psychosis. On behalf of the Risperidone Working Group. Int J Geriatr Psychiatry 2000; 15:506-14. [PMID: 10861916 DOI: 10.1002/1099-1166(200006)15:6<506::aid-gps146>3.0.co;2-v] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.4] [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: 11/06/2022]
Abstract
RATIONALE Studies have shown that risperidone is safe and efficacious in young and middle-aged adults with chronic schizophrenia, but considerably fewer data are available on the treatment of elderly patients with schizophrenia or other psychotic disorders, particularly long-term outcomes. OBJECTIVE A 12-month, open-label study was conducted to assess the effects of risperidone in elderly, chronically ill, psychotic patients. METHODS This study enrolled 180 elderly, chronically ill, psychotic patients (median age, 72 years [range 54-89]), 97 of whom completed the 12-month study. At endpoint, the mean dose of risperidone was 3.7 mg/day. RESULTS Clinical improvement (> or =20% reduction in Positive and Negative Syndrome Score [PANSS] total score) was achieved by 54% of patients at endpoint. There were significant reductions in PANSS total, subscale (positive, negative, and general psychopathology), and cognition cluster scores at endpoint (p<0.001). Clinical Global Impressions severity of illness scores showed continued improvement through month 12 (p<0.001). In contrast, PANSS data from a historical comparable control group of patients receiving conventional antipsychotic agents showed no symptom improvement over a 12-month treatment period. The severity of preexisting extrapyramidal symptoms (EPS) in patients treated with risperidone decreased significantly from baseline to endpoint (p<0.001), and the use of antiparkinsonian medication decreased from 41.1% of patients before the trial to 25.6% during the trial. There were no spontaneous reports of tardive dyskinesia (TD) and the incidence of assessed TD was 4.3% in contrast to the expected 26% reported in middle-aged and elderly patients receiving conventional antipsychotic agents for 1 year. CONCLUSIONS Long-term treatment with risperidone was associated with continued symptom improvement, a decrease in the severity of preexising EPS, and a low incidence of TD in elderly psychotic patients.
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Abstract
The benzamide derivative tiapride (Tiapridex, Synthelabo) has a highly selective antagonistic effect on striatal adenylate cyclase-independent dopamine-2 receptors. Its in vitro binding affinity is especially high for dopamine receptors which have been sensitized by pre-incubation with dopamine. The involvement of altered dopamine receptor sensitivity in several extrapyramidal dys- and hyperkinesia has been hypothesized. By its high affinity for these receptors, without any affinity for other neurotransmitter receptors of the brain, tiapride is especially well suited for the treatment of movement disorders related to functional dopamine hyperactivity. Even at higher doses, tiapride does not exceed a D2-receptor occupancy of 80%, which is in accordance with the finding that tiapride rarely causes acute extrapyramidal syndromes and has, up to now, never implicated in inducing tardive dyskinesias. On the contrary, clinical studies demonstrate its excellent efficacy in neuroleptic-induced tardive dyskinesia, L-Dopa-induced dyskinesias, psychomotor agitation in geriatric patients and choreatic movement disorders. Since tiapride is not available in the USA as yet, most of the studies concerning tiapride have been carried out in Europe. In a recent study, based on objective measurements, tiapride effectively controlled choreatic movements in patients suffering from Huntington's disease (HD). Tiapride is well tolerated in daily doses between 300 and 1200 mg. Adverse events are generally rare and mild.
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Affiliation(s)
- M Dose
- Psychiatric District Hospital, Taufkirchen, Germany
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Dose M, Hellweg R, Yassouridis A, Theison M, Emrich HM. Combined treatment of schizophrenic psychoses with haloperidol and valproate. Pharmacopsychiatry 1998; 31:122-5. [PMID: 9754845 DOI: 10.1055/s-2007-979312] [Citation(s) in RCA: 38] [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] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In accordance with a previous study of adjuvant effects of the anticonvulsant carbamazepine (CBZ) on the neuroleptic treatment of schizophrenic psychoses, the effects of valproate (VPA) were tested in a randomly assigned double-blind, placebo-controlled study. Apart from a (statistically nonsignificant) psychopathological deterioration following discontinuation of VPA while on continuous neuroleptic mediation after four weeks and a statistically significant effect on "hostile belligerence", no overall therapeutic effects of the combination of haloperidol (HPD) with VPA were observed under controlled conditions. Unlike the results with CBZ, concomitant use of VPA led to an even higher consumption of haloperidol and biperiden and to a higher rate of extrapyramidal symptoms compared with the corresponding placebo group, although these differences did not attain statistical significance. In regard to use of the sedative neuroleptic chlorprothixene, there was a trend toward lower doses in the VPA group than in the placebo group. From these results, adjuvant effects like those of carbamazepine in the neuroleptic treatment of schizophrenic psychoses could not be confirmed for valproate in the present study. However, the trend toward lower doses of sedative medication and observed effects on "hostile belligerence" may indicate sedative and/or antimanic properties of valproate which have recently been demonstrated in several controlled studies.
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Affiliation(s)
- M Dose
- Psychiatric District Hospital, Taufkirchen, Germany
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Dose M. [Huntington disease]. Psychiatr Prax 1996; 23:107-8. [PMID: 8710998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Dose M. [Informed consent requirement in treatment with clozapine according to section 1904 of the patient rights law?]. Nervenarzt 1994; 65:787-91. [PMID: 7816156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Clozapine-treatment of schizophrenic psychoses under observation of the producer's directions regarding indication, warnings, information of the patient and control-examinations is no measure which entails (according to section 1904 of German Civil Code-"Betreuungsrecht") the existing risk that the person concerned will die or suffer a serious or lasting health-injury. Therefore, in case of patient's inability to consent, the curator's approval after proper information is regarded to be sufficient in most cases of an intended treatment with clozapine. An approval by the Guardianship Court according to section 1904 should be applied for when--because of medical reasons after evaluating risks and benefits--clozapine-treatment is taken into consideration despite risks and contraindications according to the producer's informations.
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Wiedemann G, Hahlweg K, Hank G, Feinstein E, Müller U, Dose M. [Detection of early warning signs in schizophrenic patients. Possible applications in prevention of recurrence]. Nervenarzt 1994; 65:438-43. [PMID: 7800087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
In the treatment of schizophrenia, two new strategies have been developed with the aim of adequate relapse prevention accompanied by lowest possible risk of side-effects. One strategy is to have the patient continue to take medication at a highly reduced dosage (10-20% of the standard dose). The other is to gradually stop neuroleptic medication after remission and to reinstitute medication only in the case of prodromal symptoms (termed targeted or intermittent treatment). According to Herz and Melville [13] many schizophrenic patients show signs of relapse well before recurrence of overt psychotic features. Monitoring to detect prodromal symptoms is especially important in targeted treatment because, otherwise, neuroleptic medication often cannot be initiated in time. In the present study of 51 schizophrenic patients we were able to replicate the results of Herz & Melville in the German-speaking countries. Prior to acute exacerbation of psychosis, most patients experience alterations of feelings and behaviour. These alterations may also be recognized by family members. Such early warning signs of relapse mainly consist of non-specific, non-psychotic symptoms: tenseness and nervousness, eating less, trouble concentrating and sleeping, depressive mood and seeing friends less. Furthermore, the regular monitoring and use of early warning signs specific to each patient in the aftercare of schizophrenic patients seems to be practicable, especially in psychoeducative family therapy.
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Affiliation(s)
- G Wiedemann
- Max-Planck-Institut für Psychiatrie, München
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Loprinzi CL, Goldberg RM, O'Fallon JR, Quella SK, Miser AW, Mynderse LA, Brown LD, Tschetter LK, Wilwerding MB, Dose M. Transdermal clonidine for ameliorating post-orchiectomy hot flashes. J Urol 1994; 151:634-6. [PMID: 8308973 DOI: 10.1016/s0022-5347(17)35034-6] [Citation(s) in RCA: 75] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
To determine the efficacy of transdermal clonidine for alleviating post-orchiectomy hot flashes, a randomized, double-blind, crossover clinical trial was designed including 70 men with a history of prostate cancer who had undergone a medical or surgical orchiectomy and were suffering from hot flashes. The results of this study demonstrated that clonidine did not significantly decrease hot flash frequency or severity. Future research is necessary to find effective means of alleviating hot flashes in post-orchiectomy patients.
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Affiliation(s)
- C L Loprinzi
- Department of Urology, Mayo Clinic, Rochester, Minnesota
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Abstract
As part of an open clinical trial currently underway at the Max Planck Institute of Psychiatry in Munich, the feasibility of behavioral family management (Falloon et al. 1984) for schizophrenia in combination with two different neuroleptic medication strategies was investigated. The treatment approaches were psychoeducational family management with a standard dose or with targeted medication. In this article the following questions were addressed: (1) What proportion of the total schizophrenia population admitted as inpatients might be eligible for psychoeducational family treatment (assessment based on n = 411 over a 33-month period)? (2) How representative of this population are the patients who were randomized to the experimental groups? (3) How many patients dropped out of treatment after entering the trial? The results show that about 60 percent (247) of the patients were eligible for a psychoeducational treatment approach. Of these, 34 percent (85) participated in the trial and were randomized to the treatments. Only 4 percent of the relatives but 20 percent of the patients refused to take part in the study. The 85 trial patients did not differ from the total eligible on the numerous socioeconomic and symptom variables assessed. The treatment dropout rate was 11 percent. Those patients who accepted treatment did not differ from those patients who dropped out on socioeconomic or illness variables. The results indicate that early identification of dropouts is not possible at least with the methods used in this study.
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Affiliation(s)
- G Wiedemann
- Dept. of Psychiatry, University of Tuebingen, Germany
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Abstract
One of the main challenges in the psychopharmacology of affective disorders is to explain the partial similarity of the profiles of action of the different mood-stabilizers lithium, carbamazepine, and valproate, and possibly also calcium antagonists like verapamil and nimodipine. Elucidation of this problem requires understanding the basic neurobiological mechanisms underlying the pathogenesis of affective disorders and would also imply elucidating the modes of action of the different compounds. However, we are far from reaching such an understanding.
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Affiliation(s)
- H M Emrich
- Department of Clinical Psychiatry, Medizinische Hochschule Hannover, FRG
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Dose M. [Drug therapy of anxiety disorders]. Dtsch Krankenpflegez 1992; 45:234-40. [PMID: 1349275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
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Leeb B, Hahlweg K, Goldstein MJ, Feinstein E, Mueller U, Dose M, Magana-Amato A. Cross-national reliability, concurrent validity, and stability of a brief method for assessing expressed emotion. Psychiatry Res 1991; 39:25-31. [PMID: 1771207 DOI: 10.1016/0165-1781(91)90005-a] [Citation(s) in RCA: 61] [Impact Index Per Article: 1.8] [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: 12/28/2022]
Abstract
The Five-Minute Speech Sample (FMSS; Magana et al., 1986) is a brief method designed to assess the "expressed emotion" (EE) status of a respondent. The FMSS-EE rating is derived from statements made by a patient's key relative during a 5-minute monologue, with codes similar to those used in the original EE rating system (e.g., criticism and emotional overinvolvement). Rating is done from the audiotape and takes about 15-30 minutes. The article reports on the results of a cross-national study carried out in Germany using the FMSS with a sample of 60 relatives of schizophrenic patients. Results indicated that (1) German investigators could readily learn the system and could achieve a high degree of interrater reliability; (2) the association with the original index of EE, the Camberwell Family Interview, was comparable to that found by Magana et al.; and (3) the method yields very stable data over a 4-5 week retest period.
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Affiliation(s)
- B Leeb
- Max Planck Institute of Psychiatry, Munich, Germany
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