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Edlinger M, Brettbacher S, Schurr T, Yalcin-Siedentopf N, Hofer A. No gender differences in the pharmacological emergency treatment of schizophrenia: results of a 21-year observation. Int Clin Psychopharmacol 2024; 39:36-41. [PMID: 37555960 DOI: 10.1097/yic.0000000000000495] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
Patients suffering from schizophrenia are at high risk for admission and treatment in locked units. This study investigated gender differences in the pharmacological emergency treatment of schizophrenia patients over a 21-year observation period. The current retrospective study was conducted at the Division of Psychiatry I of the Medical University Innsbruck. All adult patients (n = 845; 425 female) suffering from schizophrenia who were admitted involuntarily to one of the acute psychiatric units in the years 1997, 2002, 2007, 2012 and 2017 were included in the study. In the years mentioned above, 590 schizophrenia patients (297 men, 293 women) admitted to a locked unit received pharmacological emergency treatment. With the exception of clozapine which was more frequently administered to men no significant differences between men and women were found in terms of the choice, dosage, and type of application of medication (antipsychotics and benzodiazepines). Since most treatment guidelines for schizophrenia do not consider gender differences at all, it is not surprising that acute treatment is almost the same for men and women. However, in times when individualized therapies gain more and more importance, the consideration of sex differences should be part of new treatment concepts.
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Affiliation(s)
- Monika Edlinger
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, University Hospital for Psychiatry I, Innsbruck, Austria
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2
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Schöttl SE, Niedermeier M, Kopp-Wilfling P, Frühauf A, Bichler CS, Edlinger M, Holzner B, Kopp M. Add-on exercise interventions for smoking cessation in people with mental illness: a systematic review and meta-analysis. BMC Sports Sci Med Rehabil 2022; 14:115. [PMID: 35729669 PMCID: PMC9210718 DOI: 10.1186/s13102-022-00498-y] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 06/07/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Smoking is the most common substance use disorder among people with mental illness. In contrast to people without mental illness, among whom the proportion of smokers has declined in recent decades, the proportion of smokers among people with mental illness remains high. There is a growing body of literature suggesting the use of exercise interventions in combination with smoking cessation in people without mental illness, but to our knowledge the available studies on this treatment option in people with mental illness have not been systematically reviewed. Therefore, this systematic review and meta-analysis aims to assess the effectiveness of exercise interventions as an adjunctive treatment for smoking cessation in people with mental illness. METHODS Electronic databases (PubMed, Web of Science, PsycInfo, Sport Discus and Base) were searched for randomised controlled trials and prospective single-group studies that investigated exercise interventions in combination with smoking cessation programmes alone or in comparison with a control group in people with mental illness. A meta-analysis using the Mantel-Haenszel fixed-effect model was conducted to estimate the overall effect of treatment on smoking cessation (abstinence rate at the end of the intervention and at 6-month follow-up). RESULTS Six studies, five randomised controlled trials and one study with a prospective single-group design, were included in the systematic review and four randomised controlled trials were included in the meta-analysis. The meta-analysis found a significantly higher abstinence rate after additional exercise at the end of the intervention [risk ratio (RR) 1.48, 95% confidence interval (CI) 1.13-1.94], but not at the 6-month follow-up (RR 1.34, 95% CI 0.89-2.04). CONCLUSIONS Exercise appears to be an effective adjunctive therapy to temporarily increase abstinence rates in individuals with mental illness at the end of the intervention. However, due to the small number of included studies and some risk of bias in the included studies, the results should be treated with caution. Therefore, future studies with larger samples are needed to provide a more accurate estimate of the effect in people with mental illness. Registration The systematic review and meta-analysis were registered in the International Prospective Register of Systematic Reviews (PROSPERO) (registration number: CRD42020178630).
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Affiliation(s)
- Stefanie E Schöttl
- Department of Sport Science, University of Innsbruck, Fürstenweg 185, 6020, Innsbruck, Austria.
| | - Martin Niedermeier
- Department of Sport Science, University of Innsbruck, Fürstenweg 185, 6020, Innsbruck, Austria
| | - Prisca Kopp-Wilfling
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatry I, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Anika Frühauf
- Department of Sport Science, University of Innsbruck, Fürstenweg 185, 6020, Innsbruck, Austria
| | - Carina S Bichler
- Department of Sport Science, University of Innsbruck, Fürstenweg 185, 6020, Innsbruck, Austria
| | - Monika Edlinger
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatry I, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Bernhard Holzner
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatry I, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Martin Kopp
- Department of Sport Science, University of Innsbruck, Fürstenweg 185, 6020, Innsbruck, Austria
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Doerler J, Edlinger M, Alber H, Berger R, Frick M, Hammerer M, Hasun M, Huber K, Lamm G, Lassnig E, Von Lewinski D, Roithinger F, Siostrzonek P, Steinwender C, Weidinger F. Prasugrel compared to ticagrelor in primary PCI. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Prasugrel and ticagrelor have similar recommendations in the setting of primary PCI by current guidelines. Data comparing both in daily clinical practice of primary PCI for ST-elevation myocardial infarction is limited.
Purpose
To compare the effect of prasugrel and ticagrelor on in-hospital outcomes after primary PCI.
Methods and results
We prospectively enrolled 5365 patients treated with prasugrel (n=2785, 51.9%) or ticagrelor (n=2580; 48.1%) in the setting of primary PCI from January 2011 to December 2018 in a nationwide registry. In-hospital outcomes were compared and multiple logistic regression analysis was performed. Prasugrel treated patients were younger, less often in cardiogenic shock, with lower rates of previous stroke and had shorter ischemic time. Both groups showed similar rates of previous MI, diabetes and current resuscitation. In the univariate analysis mortality was lower in patients with prasugrel (2.5% vs. 4.4% p<0.01). Similarly, MACE (3.3% vs. 5.3%, p<0.01) and NACE (4.0% vs. 5.7% p<0.01) were lower in prasugrel treated patients, whereas major bleeding events did not differ (0.4% vs. 0.6% p=0.24).
After adjustment in multivariable analysis mortality (0.99 95% CI 0.57 to 1.72), MACE (OR 0.99 95% CI 0.65 to 1.52) as well as NACE (0.86 95% CI 0.61 to 1.22) did not differ in patients treated with prasugrel compared to ticagrelor.
Conclusion
Patients treated with prasugrel showed improved outcomes compared to ticagrelor in a large cohort of primary PCI. However, after adjustment for confounders the Advantage of prasugrel in primary PCI did not persist.
Funding Acknowledgement
Type of funding source: Other. Main funding source(s): Austrian Society of Cardiology
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Affiliation(s)
- J Doerler
- Innsbruck Medical University, Department of Internal Medicine III, Cardiology, Innsbruck, Austria
| | - M Edlinger
- Innsbruck Medical University, Department of Internal Medicine III, Cardiology, Innsbruck, Austria
| | - H Alber
- Hospital Klagenfurt, Department of Internal Medicine and Cardiology, Klagenfurt, Austria
| | - R Berger
- Hospital Brothers of Mercy, Department of Internal Medicine I, Eisenstadt, Austria
| | - M Frick
- Academic Teaching Hospital, Department of Internal Medicine I, Feldkirch, Austria
| | - M Hammerer
- Paracelsus Medical University, Department of Internal Medicine II, Salzburg, Austria
| | - M Hasun
- Rudolfstiftung Hospital, 2nd Medical Department with Cardiology and intensive Care Medicine, Vienna, Austria
| | - K Huber
- Wilhelminen Hospital, 3rd Department of Medicine, Cardiology and Intensive Care Medicine, Vienna, Austria
| | - G Lamm
- University Hospital St. Polten, Department of Internal Medicine III, St. Polten, Austria
| | - E Lassnig
- Klinikum Wels-Grieskirchen, Department of Internal Medicine II, Wels, Austria
| | - D Von Lewinski
- Medical University of Graz, Department of Cardiology, Graz, Austria
| | - F.X Roithinger
- Landesklinikum Wiener Neustadt, Department of Internal Medicine, Cardiology and Nephrology, Wiener Neustadt, Austria
| | - P Siostrzonek
- Ordensklinikum Barmherzige Schwestern, Department of Internal Medicine II, Linz, Austria
| | - C Steinwender
- Kepler University Hospital Linz, Department of Internal Medicine I, Linz, Austria
| | - F Weidinger
- Rudolfstiftung Hospital, 2nd Medical Department with Cardiology and intensive Care Medicine, Vienna, Austria
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Hofer A, Baumgartner S, Edlinger M, Hummer M, Kemmler G, Rettenbacher MA, Schweigkofler H, Schwitzer J, Fleischhacker WW. Patient outcomes in schizophrenia I: correlates with sociodemographic variables, psychopathology, and side effects. Eur Psychiatry 2020; 20:386-94. [PMID: 16171653 DOI: 10.1016/j.eurpsy.2005.02.005] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [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] [Received: 08/30/2004] [Accepted: 02/02/2005] [Indexed: 10/25/2022] Open
Abstract
AbstractObjectiveThe present cross-sectional study examined the relationships of psychopathology, side effects, and sociodemographic factors with treatment outcomes in terms of patients' quality of life (QOL), functioning, and needs for care.MethodSixty outpatients with chronic schizophrenia who had been treated with either clozapine or olanzapine for at least 6 months were investigated.ResultsMost psychopathological symptoms as well as psychic side effects, weight gain, and female sex were associated with lower QOL, while cognitive symptoms correlated with better QOL. Female sex, cognitive symptoms, and parkinsonism negatively influenced occupational functioning, and negative symptoms determined a lesser likelihood of living independently. Age, education, depression/anxiety, negative symptoms, and psychic side effects were predictors of patients' needs for care.ConclusionOur results highlight the complex nature of patient outcomes in schizophrenia. They reemphasize the need of targeting effectiveness, i.e. both symptomatic improvement as well as drug safety, in such patients.
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Affiliation(s)
- Alex Hofer
- Department of Biological Psychiatry, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria.
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5
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Hofer A, Benecke C, Edlinger M, Huber R, Kemmler G, Rettenbacher MA, Schleich G, Wolfgang Fleischhacker W. Facial emotion recognition and its relationship to symptomatic, subjective, and functional outcomes in outpatients with chronic schizophrenia. Eur Psychiatry 2020; 24:27-32. [DOI: 10.1016/j.eurpsy.2008.06.008] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2008] [Revised: 06/01/2008] [Accepted: 06/21/2008] [Indexed: 10/21/2022] Open
Abstract
AbstractOutcome in schizophrenia is multidimensional and consists of clinical and psychosocial domains. Difficulties in affect recognition are a hallmark of schizophrenia, but there is little research investigating the consequences of this deficit on patients’ psychosocial status. This cross-sectional study examined the relationship of facial affect recognition and treatment outcomes in terms of psychopathology, quality of life (QOL), and psychosocial functioning.We investigated 40 regular attendees of a specialized schizophrenia outpatient clinic who had been stable both from a symptomatic and a medication perspective for a minimum of 6 months and 40 healthy volunteers who were chosen to match patients in age, sex, and education. Affect recognition was positively associated with patients’ level of education and negatively with increasing age. Deficits in this area corresponded to the severity of negative and affective symptoms as well as to poor work and global functioning. These findings suggest that affect recognition is an important aspect of psychosocial functioning in stable outpatients with schizophrenia.
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Kaufmann A, Post F, Yalcin-Siedentopf N, Baumgartner S, Biedermann F, Edlinger M, Kemmler G, Rettenbacher MA, Widschwendter CG, Zernig G, Fleischhacker WW, Hofer A. Corrigendum to "Changes in psychopathology in schizophrenia patients starting treatment with new-generation antipsychotics: therapeutic drug monitoring in a naturalistic treatment setting" [Eur. Neuropsychopharmacol. 26 (2016) 717-728]. Eur Neuropsychopharmacol 2020; 31:162-163. [PMID: 31924492 DOI: 10.1016/j.euroneuro.2019.12.108] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 12/08/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Alexandra Kaufmann
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Innsbruck, Austria.
| | - Fabienne Post
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Innsbruck, Austria
| | - Nursen Yalcin-Siedentopf
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Innsbruck, Austria
| | - Susanne Baumgartner
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Innsbruck, Austria; Center for Psychosocial Health, Sonnenpark Lans, Lans, Austria
| | - Falko Biedermann
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Innsbruck, Austria
| | - Monika Edlinger
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Innsbruck, Austria
| | - Georg Kemmler
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Innsbruck, Austria
| | - Maria A Rettenbacher
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Innsbruck, Austria
| | - Christian G Widschwendter
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Innsbruck, Austria
| | - Gerald Zernig
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Innsbruck, Austria
| | - W Wolfgang Fleischhacker
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Innsbruck, Austria
| | - Alex Hofer
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Innsbruck, Austria
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Andexlinger S, Fritz J, Edlinger M, Concin H, Nagel G, Brozek W, Ruttmann E, Foeger B, Ulmer H. P3402Validation of the SCORE O.P. for prediction of cardiovascular disease mortality in a large population of elderly individuals. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Estimation of absolute cardiovascular risk in apparently healthy individuals, using SCORE (Systematic COronary Risk Evaluation) is recommended by the ESC guidelines on cardiovascular disease (CVD) prevention in clinical practice. Recently, the SCORE system has been extended by the SCORE O.P. aiming to improve estimates of cardiovascular risk specifically in older persons (65 years and older).
Purpose
The aim of this study was to validate the SCORE O.P. in an Austrian population of 34,909 healthy individuals aged between 65 and 80 years which were prospectively followed for a minimum of 10 years.
Methods
Predicted fatal CVD and coronary heart disease (CHD) event rates within 10 years were calculated using the “SCORE O.P. risk function for low risk regions” and compared to the actually observed rates, thereby assessing calibration. In addition, predicted probabilities were plotted against observed mortality by deciles of predicted risk. Regarding discrimination, receiver operating characteristics (ROC) analysis and corresponding c-statistics were used.
Results
In 14,586 males, 1,509 deaths from CVD (10.4%) and 847 deaths from CHD (5.8%) occurred within 10 years of follow-up. SCORE O.P. predicted 1,699 fatal CVD (11.7%) and 872 CHD (6.0%) events. In male high risk individuals (10th decile), SCORE O.P. overestimated mortality from CVD and CHD. C-statistics were 0.68 (95% CI 0.67–0.70) for CVD and 0.67 (0.65–0.69) for CHD.
In 20,323 females, 1,340 deaths from CVD (6.6%) and 672 deaths from CHD (3.3%) were observed. SCORE O.P. predicted 1,232 fatal CVD (6.1%) and 539 CHD events (2.7%). In female high risk individuals (8–10th deciles), SCORE O.P. underestimated mortality from CVD and CHD. C-statistics were 0.77 (0.75–0.78) for CVD and 0.77 (0.75–0.79) for CHD.
Conclusion
With regard to overall accuracy, the SCORE O.P. performed considerably well in this elderly Austrian population. However, in high-risk individuals, cardiovascular risk was overestimated for males and underestimated for females. SCORE O.P. was able to discriminate high-risk from low-risk individuals, better in women than in men.
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Affiliation(s)
- S Andexlinger
- Innsbruck Medical University, Medical Statistics, Informatics and Health Economics, Innsbruck, Austria
| | - J Fritz
- Innsbruck Medical University, Medical Statistics, Informatics and Health Economics, Innsbruck, Austria
| | - M Edlinger
- Innsbruck Medical University, Medical Statistics, Informatics and Health Economics, Innsbruck, Austria
| | - H Concin
- Agency for Preventive and Social Medicine, Bregenz, Austria
| | - G Nagel
- University of Ulm, Institute of Epidemiology and Medical Biometry, Ulm, Germany
| | - W Brozek
- Agency for Preventive and Social Medicine, Bregenz, Austria
| | - E Ruttmann
- Innsbruck Medical University, Department of Cardiac Surgery, Innsbruck, Austria
| | - B Foeger
- Agency for Preventive and Social Medicine, Bregenz, Austria
| | - H Ulmer
- Innsbruck Medical University, Medical Statistics, Informatics and Health Economics, Innsbruck, Austria
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8
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Decristoforo P, Kaltseis J, Fritz A, Edlinger M, Posch W, Wilflingseder D, Lass-Flörl C, Orth-Höller D. High-quality endoscope reprocessing decreases endoscope contamination. Clin Microbiol Infect 2018; 24:1101.e1-1101.e6. [DOI: 10.1016/j.cmi.2018.01.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 01/13/2018] [Accepted: 01/18/2018] [Indexed: 01/10/2023]
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Edlinger M, Welte AS, Yalcin-Siedentopf N, Kemmler G, Neymeyer F, Fleischhacker WW, Hofer A. Trends in pharmacological emergency treatment of patients suffering from schizophrenia over a 16-year observation period. Int Clin Psychopharmacol 2018; 33:197-203. [PMID: 29664808 DOI: 10.1097/yic.0000000000000220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Indexed: 11/25/2022]
Abstract
Patients suffering from schizophrenia are often treated in locked psychiatric units because of psychomotor agitation, hostility and aggressive behavior, or suicidality. Because of legal conditions, investigations on these acutely ill patients are difficult, and many studies do not represent 'real-life psychiatry'. This retrospective survey was conducted at the Department of Psychiatry, Psychotherapy and Psychosomatics of the Medical University, Innsbruck, Austria. Data were collected from the records of all adult inpatients suffering from a schizophrenia spectrum disorder according to the International Classification of Diseases, 10th ed. (ICD-10) (F2x) who had been admitted to a locked unit in 1997, 2002, 2007, and 2012. In addition to demographic data, diagnoses at the time of admission, length of stay at the locked unit, and psychopharmacological treatment (3 h before and following admission) were recorded. The mean length of stay at a locked unit decreased significantly from 11.8±4.43 days (mean±SD) in 1997 to 8.5±12.96 days (mean±SD) in 2012. The use of antipsychotics decreased nonsignificantly from 1997 to 2012. Despite an increasing use of second compared with first-generation antipsychotic drugs over the course of time, haloperidol was the most frequently used single compound in all investigated years except 2012. The majority of medications were administered orally. The use of benzodiazepines did not change substantially over the course of time. All in all, pharmacological emergency treatment of patients suffering from schizophrenia spectrum disorders in locked units was in line with current treatment guidelines, which recommend the use of second-generation antipsychotic drugs, monotherapy, oral application, and cautious dosing.
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Affiliation(s)
- Monika Edlinger
- Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Medical University Innsbruck, Innsbruck, Austria
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10
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Hofer A, Radner V, Edlinger M, Kemmler G, Rettenbacher MA, Fleischhacker WW. Why do indiviuals with schizophrenia drop out of observational clinical trials? Psychiatry Res 2017; 256:1-5. [PMID: 28609646 DOI: 10.1016/j.psychres.2017.06.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 05/10/2017] [Accepted: 06/04/2017] [Indexed: 11/26/2022]
Abstract
Randomized controlled trials (RCTs) and observational studies frequently differ with regard to study dropouts. The present naturalistic follow-up investigation aimed to shed a light on this issue by evaluating the time to and the reasons for study dropout in patients suffering from schizophrenia who started monotherapy with an oral new-generation antipsychotic. To this end, psychopathological symptoms and safety data were assessed in 194 patients who were followed up to a maximum observation period of twelve months. 9.3% of study participants completed the study. The mean time to study dropout was 2.6 ± 2.7 months with almost two thirds of patients dropping out within three months. 44.3% discontinued medication at the date of study dropout, the remainders dropped out due to withdrawal of written consent, logistic reasons, or nonappearance to the study visit ("loss to follow-up"), which were not necessarily to be equated with cessation of the antipsychotic. These findings indicate that in contrast to RCTs, dropout of observational studies is not necessarily associated with drug discontinuation. Accordingly, systematic differences between trial designs need to be considered when interpreting the results of clinical trials.
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Affiliation(s)
- Alex Hofer
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Innsbruck, Austria.
| | - Verena Radner
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Innsbruck, Austria
| | - Monika Edlinger
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Innsbruck, Austria
| | - Georg Kemmler
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Innsbruck, Austria
| | - Maria A Rettenbacher
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Innsbruck, Austria
| | - W Wolfgang Fleischhacker
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Innsbruck, Austria
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11
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Risslegger B, Zoran T, Lackner M, Aigner M, Sánchez-Reus F, Rezusta A, Chowdhary A, Taj-Aldeen SJ, Arendrup MC, Oliveri S, Kontoyiannis DP, Alastruey-Izquierdo A, Lagrou K, Lo Cascio G, Meis JF, Buzina W, Farina C, Drogari-Apiranthitou M, Grancini A, Tortorano AM, Willinger B, Hamprecht A, Johnson E, Klingspor L, Arsic-Arsenijevic V, Cornely OA, Meletiadis J, Prammer W, Tullio V, Vehreschild JJ, Trovato L, Lewis RE, Segal E, Rath PM, Hamal P, Rodriguez-Iglesias M, Roilides E, Arikan-Akdagli S, Chakrabarti A, Colombo AL, Fernández MS, Martin-Gomez MT, Badali H, Petrikkos G, Klimko N, Heimann SM, Houbraken J, Uzun O, Edlinger M, Fuente SDL, Lass-Flörl C. A prospective international Aspergillus terreus survey: an EFISG, ISHAM and ECMM joint study. Clin Microbiol Infect 2017; 23:776.e1-776.e5. [PMID: 28412383 DOI: 10.1016/j.cmi.2017.04.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [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: 02/24/2017] [Revised: 04/07/2017] [Accepted: 04/09/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES A prospective international multicentre surveillance study was conducted to investigate the prevalence and amphotericin B susceptibility of Aspergillus terreus species complex infections. METHODS A total of 370 cases from 21 countries were evaluated. RESULTS The overall prevalence of A. terreus species complex among the investigated patients with mould-positive cultures was 5.2% (370/7116). Amphotericin B MICs ranged from 0.125 to 32 mg/L, (median 8 mg/L). CONCLUSIONS Aspergillus terreus species complex infections cause a wide spectrum of aspergillosis and the majority of cryptic species display high amphotericin B MICs.
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Affiliation(s)
- B Risslegger
- Division of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Austria
| | - T Zoran
- Division of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Austria
| | - M Lackner
- Division of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Austria
| | - M Aigner
- Division of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Austria
| | - F Sánchez-Reus
- Servei de Microbiologia, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - A Rezusta
- Microbiologia, Hospital Universitario Miguel Servet, IIS Aragon, Universidad de Zaragoza, Zaragoza, Spain
| | - A Chowdhary
- Department of Medical Mycology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - S J Taj-Aldeen
- Microbiology Division, Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha, Qatar
| | - M C Arendrup
- Statens Serum Institute, Unit of Mycology, & Department of Clinical Microbiology, Copenhagen University, Rigshospitalet, Copenhagen, Denmark
| | - S Oliveri
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - D P Kontoyiannis
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - K Lagrou
- Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - G Lo Cascio
- Unità Operativa Complessa di Microbiologia e virologia, Dipartimento di Patologia e diagnostica, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - J F Meis
- Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - W Buzina
- Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Graz, Austria
| | - C Farina
- Microbiology Institute, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - M Drogari-Apiranthitou
- Infectious Diseases Research Laboratory, 4(th) Department of Internal Medicine, ATTIKON University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - A Grancini
- Laboratorio Centrale di Analisi Chimico Cliniche e Microbiologia, IRCCS Foundation, Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - A M Tortorano
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - B Willinger
- Department of Laboratory Medicine, Division of Clinical Microbiology, Medical University of Vienna, Vienna, Austria
| | - A Hamprecht
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Cologne, Germany
| | - E Johnson
- Mycology Reference Laboratory, Public Health England, Bristol, UK
| | - L Klingspor
- Karolinska Institutet, Department of Laboratory Medicine, F 68, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - V Arsic-Arsenijevic
- National Reference Medical Mycology Laboratory, Institute of Microbiology and Immunology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - O A Cornely
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Department I of Internal Medicine, Clinical Trials Centre Cologne (ZKS Köln), Centre for Integrated Oncology (CIO Köln-Bonn), German Centre for Infection Research (DZIF), University of Cologne, Cologne, Germany
| | - J Meletiadis
- Clinical Microbiology Laboratory, National Kapodistrian University of Athens, ATTIKON University Hospital Athens, Athens, Greece
| | - W Prammer
- Department of Hygiene and Medical Microbiology, Klinikum Wels-Grieskirchen, Wels, Austria
| | - V Tullio
- Department of Public Health and Pediatrics, Microbiology Division, Turin, Italy
| | - J-J Vehreschild
- Department I for Internal Medicine, University Hospital of Cologne, Cologne and German Centre for Infection Research, Partner Site Bonn-Cologne, Germany
| | - L Trovato
- A.O.U. Policlinico Vittorio Emanuele Catania, Biometec - University of Catania, Italy
| | - R E Lewis
- Infectious Diseases Unit, S. Orsola-Malpighi, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - E Segal
- Department of Clinical Microbiology and Immunology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - P-M Rath
- Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - P Hamal
- Department of of Microbiology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic
| | - M Rodriguez-Iglesias
- Clinical Microbiology, Puerta del Mar University Hospital, University of Cádiz, Cádiz, Spain
| | - E Roilides
- Infectious Diseases Unit, 3(rd) Department of Paediatrics, Faculty of Medicine, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki, Greece
| | - S Arikan-Akdagli
- Department of Medical Microbiology, Hacettepe University Medical School, Ankara, Turkey
| | - A Chakrabarti
- Division of Mycology, Department of Medial Microbiology, Chandigarh, India
| | - A L Colombo
- Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil
| | - M S Fernández
- Departmento de Micología, Instituto de Medicina Regional, Universidad Nacional del Nordeste, CONICET, Resistencia, Argentina
| | - M T Martin-Gomez
- Division of Clinical Mycology, Department of Microbiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - H Badali
- Department of Medical Mycology and Parasitology/Invasive Fungi Research Centre, Mazandaran University of Medical Sciences, Sari, Iran
| | - G Petrikkos
- School of Medicine, European University Cyprus, Nicosia, Cyprus
| | - N Klimko
- Department of Clinical Mycology, Allergy and Immunology, North Western State Medical University, Saint Petersburg, Russia
| | - S M Heimann
- Department I for Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - J Houbraken
- CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands
| | - O Uzun
- Hacettepe University Medical School, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - M Edlinger
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria
| | - S de la Fuente
- Department of Dermatology, Hospital Ernest Lluch Martin, Calatayud, Zaragoza, Spain
| | - C Lass-Flörl
- Division of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Austria.
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Kaufmann A, Wartelsteiner F, Yalcin-Siedentopf N, Baumgartner S, Biedermann F, Edlinger M, Kemmler G, Rettenbacher MA, Rissanen TT, Widschwendter CG, Zernig G, Fleischhacker WW, Hofer A. Changes in psychopathology in schizophrenia patients starting treatment with new-generation antipsychotics: therapeutic drug monitoring in a naturalistic treatment setting. Eur Neuropsychopharmacol 2016; 26:717-28. [PMID: 26879690 DOI: 10.1016/j.euroneuro.2016.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 09/23/2015] [Revised: 12/03/2015] [Accepted: 02/01/2016] [Indexed: 11/24/2022]
Abstract
Previous studies on the relationship between plasma levels of new-generation antipsychotics (NGAs) and clinical response did not account for inter- and intra-individual variability in drug levels. Therefore, the present study calculated the ratio of observed versus expected NGA plasma levels and investigated its relationship with changes in the Positive and Negative Syndrome Scale (PANSS). Data of patients starting monotherapy with a NGA were collected 2, 4, 8, and 12 weeks after initiation of treatment. Next to the assessment of changes in psychopathology (PANSS) the ratio of observed versus expected plasma level was calculated. A total number of 221 ratios were eligible for analysis. About half of them ranged from 0.5-2 and were considered "normal", whereas the others were considered either "too low" or "too high". Psychopathological symptoms improved over the course of treatment, but changes in PANSS from baseline did not correlate significantly with the ratios of observed versus expected plasma levels at any assessment. The lack of linear correlation can be explained by the fact that 92% of the observed NGA plasma levels were at ≥ 50% of the lower limit of the therapeutic reference range, i.e., within the asymptote of the logistic plasma level-effect relationship. Accordingly, our findings indicate that the great majority of patients were treated with NGA doses that led to optimal plasma levels, based on the clinical impression of the treating psychiatrist only. Thus, calculating the ratio of observed versus expected plasma level may not be necessary in a routine clinical setting.
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Affiliation(s)
- Alexandra Kaufmann
- Medical University Innsbruck, Department of Psychiatry and Psychotherapy, Biological Psychiatry Division, Austria
| | - Fabienne Wartelsteiner
- Medical University Innsbruck, Department of Psychiatry and Psychotherapy, Biological Psychiatry Division, Austria
| | - Nursen Yalcin-Siedentopf
- Medical University Innsbruck, Department of Psychiatry and Psychotherapy, Biological Psychiatry Division, Austria
| | - Susanne Baumgartner
- Medical University Innsbruck, Department of Psychiatry and Psychotherapy, Biological Psychiatry Division, Austria
| | - Falko Biedermann
- Medical University Innsbruck, Department of Psychiatry and Psychotherapy, Biological Psychiatry Division, Austria
| | - Monika Edlinger
- Medical University Innsbruck, Department of Psychiatry and Psychotherapy, Biological Psychiatry Division, Austria
| | - Georg Kemmler
- Medical University Innsbruck, Department of Psychiatry and Psychotherapy, General and Social Psychiatry Division, Austria
| | - Maria A Rettenbacher
- Medical University Innsbruck, Department of Psychiatry and Psychotherapy, Biological Psychiatry Division, Austria
| | - Tanja T Rissanen
- Medical University Innsbruck, Department of Psychiatry and Psychotherapy, Biological Psychiatry Division, Austria
| | - Christian G Widschwendter
- Medical University Innsbruck, Department of Psychiatry and Psychotherapy, Biological Psychiatry Division, Austria
| | - Gerald Zernig
- Medical University Innsbruck, Department of Psychiatry and Psychotherapy, General and Social Psychiatry Division, Austria
| | - W Wolfgang Fleischhacker
- Medical University Innsbruck, Department of Psychiatry and Psychotherapy, Biological Psychiatry Division, Austria
| | - Alex Hofer
- Medical University Innsbruck, Department of Psychiatry and Psychotherapy, Biological Psychiatry Division, Austria.
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Widschwendter CG, Rettenbacher MA, Kemmler G, Edlinger M, Baumgartner S, Fleischhacker WW, Hofer A. Bilirubin concentration correlates with positive symptoms in patients with schizophrenia. J Clin Psychiatry 2016; 77:512-6. [PMID: 27035280 DOI: 10.4088/jcp.14m09642] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Accepted: 03/26/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Besides its toxic effects, bilirubin has been demonstrated to have antioxidant properties to counteract oxidative stress, which has been suggested to play a role in the pathophysiology of schizophrenia. METHODS This study investigated the potential association between changes in psychopathology measured by the Lindenmayer model of the Positive and Negative Syndrome Scale (PANSS) and changes in total plasma bilirubin concentrations. Data of patients with schizophrenia (ICD-10) starting monotherapy with a new-generation antipsychotic were analyzed at baseline (N = 52) and 2 (n = 40), 4 (n = 46), and 12 weeks (n = 30) after the initiation of treatment. Data were collected between December 1997 and October 2007 and analyzed retrospectively. RESULTS The PANSS total score decreased significantly from baseline to weeks 2, 4, and 12 of treatment (all P values ≤ .001). Total plasma bilirubin concentration also dropped significantly from baseline to week 2 (P = .015) and decreased further until week 4 (P = .013); no significant decrease was observed between baseline and week 12. Spearman rank correlation revealed a significant association of bilirubin concentration with the PANSS positive (r = 0.371, P = .007) and excitement (r = 0.322, P = .020) components at baseline. No further correlations were found. From baseline to weeks 2, 4, and 12, changes in the PANSS positive component correlated significantly with changes in plasma bilirubin concentration (all P values < .05), whereas correlations between changes in the remaining PANSS components and bilirubin were less consistent. CONCLUSIONS Assuming that positive symptoms are associated with the subjective experience of psychological distress, our findings indirectly expand the evidence on potential antioxidant properties of bilirubin in patients with schizophrenia.
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Affiliation(s)
- Christian G Widschwendter
- Department of Psychiatry and Psychotherapy, Biological Psychiatry Division, Medical University of Innsbruck, Anichstr. 35, A-6020 Innsbruck, Austria
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14
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Gruber L, Edlinger M, Gruber H, Loizides A. Is Strain Elastography Really a Good Adjunct for Prediction of Malignancy in Soft Tissue Tumours? Ultraschall Med 2015; 36:637. [PMID: 26669870 DOI: 10.1055/s-0041-107983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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15
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Yalcin-Siedentopf N, Wartelsteiner F, Kaufmann A, Biedermann F, Edlinger M, Kemmler G, Rettenbacher MA, Widschwendter CG, Zernig G, Fleischhacker WW, Hofer A. Measuring adherence to medication in schizophrenia: the relationship between attitudes toward drug therapy and plasma levels of new-generation antipsychotics. Int J Neuropsychopharmacol 2015; 18:pyu091. [PMID: 25522423 PMCID: PMC4376546 DOI: 10.1093/ijnp/pyu091] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Nonadherence to medication is still a major problem in the treatment of schizophrenia. The current longitudinal study investigated whether the patients' attitudes toward treatment correlated with the ratio of observed vs expected plasma levels of antipsychotic drugs as an objective measurement of adherence. METHODS Data of patients starting monotherapy with a new-generation antipsychotic were collected 2, 4, and 12 weeks after the initiation of treatment. Next to the assessment of patients' attitudes toward medication by means of the Drug Attitude Inventory, the ratio of the observed vs expected plasma level was calculated. Antipsychotic-induced side effects were evaluated by means of the Udvalg for Kliniske Undersogelser Side Effect Rating Scale. RESULTS A total of 93 patients were eligible for statistical analysis. About one-half of the ratios of observed vs expected plasma levels ranged from 0.5 to 2 and were considered normal, whereas the other ratios were considered either too low (<0.5) or too high (>2). No consistent correlation between patients' attitude toward drug therapy and the individual ratios of observed vs expected plasma levels of medication was detected. This finding was not affected by side effects. CONCLUSIONS Our results highlight the importance of recognizing the complex nature of adherence to medication in schizophrenia patients. Importantly, we found no consistent correlation between subjective and objective measures of medication adherence. Therefore, monitoring adherence to medication remains a challenge in clinical practice.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Alex Hofer
- Biological Psychiatry Division (Drs Yalcin-Siedentopf, Wartelsteiner, Kaufmann, Biedermann, Edlinger, Rettenbacher, Widschwendter, Fleischhacker, and Hofer), and General and Social Psychiatry Division (Drs Kemmler and Zernig), Medical University Innsbruck, Department of Psychiatry and Psychotherapy, Innsbruck, Austria
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Binder E, Lange O, Edlinger M, Meraner D, Abt D, Moser C, Steichen E, Hofer S. Frequency of Dermatological Side Effects of Continuous Subcutaneous Insulin Infusion in Children and Adolescents with Type 1 Diabetes. Exp Clin Endocrinol Diabetes 2015; 123:260-4. [DOI: 10.1055/s-0034-1394381] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- E. Binder
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck
| | - O. Lange
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck
| | - M. Edlinger
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Innsbruck
| | - D. Meraner
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck
| | - D. Abt
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck
| | - C. Moser
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck
| | - E. Steichen
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck
| | - S. Hofer
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck
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Puchner R, Mur E, Edlinger M, Eberl G, Machold K. FRI0219 Optimisation of Interface Management between General Practitioners and Rheumatologists - Results of A Survey. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.4704] [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: 11/03/2022]
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Wachter T, Edlinger M, Foerg C, Djedovic G, Mayerl C, Kinzl J, Bauer T, Wolfram D. Differences between patients and medical professionals in the evaluation of aesthetic outcome following breast reconstruction with implants. J Plast Reconstr Aesthet Surg 2014; 67:1111-7. [PMID: 24857595 DOI: 10.1016/j.bjps.2014.04.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 02/11/2014] [Accepted: 04/16/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND AIM Most studies on breast reconstruction evaluate different surgical techniques, types of implant or time of reconstruction. Moreover, evaluations are usually performed either by surgeons or by patients, but are rarely compared. We conducted a study on aesthetic outcome following breast reconstruction with implants comparing the evaluation by patients versus medical professionals. METHODS Forty-seven patients, who had a breast reconstruction with implants between 2001 and 2010 (median follow-up 71 months), underwent a clinical examination, standardized photo documentation and filled out a questionnaire to evaluate their aesthetic result (rate 1 very good to 5 very poor). Photo documentation was independently evaluated by 18 medical professionals using the same evaluation instrument and the results were compared. Gender and patient aspects were taken into account. RESULTS We found statistically significant differences between patients and medical professional ratings. The patient evaluation was better through all categories as compared to the evaluation by medical personnel. The degree of medical education or gender aspects did not significantly affect the professional ratings. Age at reconstruction, length of follow-up or primary versus secondary reconstruction did not seem to make a difference in the evaluations of the patients versus the medical professionals.. CONCLUSION The differences between patient and expert opinion in rating of aesthetic results indicate that patient satisfaction is influenced by multiple factors and not only by good aesthetic outcome. Patient evaluation should therefore be carefully considered in treatment and outcome studies of breast reconstruction..
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Affiliation(s)
- T Wachter
- Department of Plastic, Reconstructive and Aesthetic Surgery, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria
| | - M Edlinger
- Department of Medical Statistics, Informatics and Health Economics, Innsbruck Medical University, Schoepfstrasse 41/1, 6020 Innsbruck, Austria
| | - C Foerg
- Department of Plastic, Reconstructive and Aesthetic Surgery, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria
| | - G Djedovic
- Department of Plastic, Reconstructive and Aesthetic Surgery, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria
| | - C Mayerl
- Division of Biological Chemistry, Biocenter, Innsbruck Medical University, Innrain 80-82, 6020 Innsbruck, Austria
| | - J Kinzl
- Department of Psychiatry and Psychotherapy, University Hospital for Psychosomatic Medicine, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria
| | - T Bauer
- Department of Plastic, Reconstructive and Aesthetic Surgery, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria
| | - D Wolfram
- Department of Plastic, Reconstructive and Aesthetic Surgery, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria.
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Nagel G, Bjørge T, Stocks T, Manjer J, Hallmans G, Edlinger M, Häggström C, Engeland A, Johansen D, Kleiner A, Selmer R, Ulmer H, Tretli S, Jonsson H, Concin H, Stattin P, Lukanova A. Metabolic risk factors and skin cancer in the Metabolic Syndrome and Cancer Project (Me-Can). Br J Dermatol 2012; 167:59-67. [PMID: 22530854 DOI: 10.1111/j.1365-2133.2012.10974.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Little is known about the associations of metabolic aberrations with malignant melanoma (MM) and nonmelanoma skin cancer (NMSC). OBJECTIVES To assess the associations between metabolic factors (both individually and combined) and the risk of skin cancer in the large prospective Metabolic Syndrome and Cancer Project (Me-Can). METHODS During a mean follow-up of 12 years of the Me-Can cohort, 1728 (41% women) incident MM, 230 (23% women) fatal MM and 1145 (33% women) NMSC were identified. Most NMSC cases (76%) were squamous cell carcinoma (SCC) (873, 33% women). Hazard ratios (HRs) were estimated by Cox proportional hazards regression for quintiles and standardized z-scores (with a mean of 0 and SD of 1) of body mass index (BMI), blood pressure, glucose, cholesterol, triglycerides and for a combined metabolic syndrome score. Risk estimates were corrected for random error in the measurements. RESULTS Blood pressure per unit increase of z-score was associated with an increased risk of incident MM cases in men and women [HR 1·17, 95% confidence interval (CI) 1·04-1·31 and HR 1·18, 95% CI 1·03-1·36, respectively] and fatal MM cases among women (HR 2·39, 95% CI 1·58-3·64). In men, all quintiles for BMI above the reference were associated with a higher risk of incident MM. In women, SCC NMSC risk increased across quintiles for glucose levels (P-trend 0·02) and there was a trend with triglyceride concentration (P-trend 0·09). CONCLUSION These findings suggest that mechanisms linked to blood pressure may be involved in the pathogenesis of MM. SCC NMSC in women could be related to glucose and lipid metabolism.
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Affiliation(s)
- G Nagel
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081 Ulm, Germany.
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20
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Semsroth S, Dumfarth J, Edlinger M, Müller L, Grimm M. The influence of prosthesis-patient mismatch (PPM) on survival among impaired LV-function patients after aortic valve replacement (AVR). Thorac Cardiovasc Surg 2012. [DOI: 10.1055/s-0031-1297661] [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: 10/14/2022]
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Ulmer H, Strohmaier S, Borena W, Edlinger M, Concin H, Diem G, Kelleher C, Nagel G. P2-310 Gamma-glutamyltransferase as a biomarker for oxidative stress, metabolic syndrome, and alcohol consumption and its association with cancer incidence. Br J Soc Med 2011. [DOI: 10.1136/jech.2011.142976k.43] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Edlinger M, Bjorge T, Manjer J, Stattin P, Ulmer H. P2-69 Metabolic syndrome and risk of brain tumour in a large population-based cohort study. Br J Soc Med 2011. [DOI: 10.1136/jech.2011.142976i.4] [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: 11/03/2022]
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23
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Schäfer I, Burns T, Fleischhacker WW, Galderisi S, Rybakowski JK, Libiger J, Rössler W, Molodynski A, Edlinger M, Piegari G, Hrnčiarova J, Gorna K, Jaeger M, Fett AK, Hissbach J, Naber D. Attitudes of patients with schizophrenia and depression to psychiatric research: a study in seven European countries. Soc Psychiatry Psychiatr Epidemiol 2011; 46:159-65. [PMID: 20119828 DOI: 10.1007/s00127-010-0181-7] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2009] [Accepted: 01/11/2010] [Indexed: 11/27/2022]
Abstract
BACKGROUND Relatively few studies have examined how patients with schizophrenia and depression view psychiatric research and what influences their readiness to participate. METHODS A total of 763 patients (48% schizophrenia, 52% depression) from 7 European countries were examined using a specifically designed self-report questionnaire ["Hamburg Attitudes to Psychiatric Research Questionnaire" (HAPRQ)]. RESULTS Most patients (98%) approved of psychiatric research, in general, at least "a little". There was a tendency to approve psychosocial rather than biological research topics (e.g. research on the role of the family by 91% of patients compared to 79% in genetics). Reasons to participate were mainly altruistic. Only a minority (28%) considered monetary incentives important. Patients wanted extensive background information and a feedback of the results; both were significantly more expressed by schizophrenia as compared to depressive patients, although these findings need to be interpreted with care because of age and gender differences between the diagnostic groups. CONCLUSION While patients expressed discerning views of psychiatric research, only few differences were apparent between the two diagnostic groups. Patients' research priorities are not the same as those of many professionals and funding bodies. Their demonstrated critical appraisal should inform future research ensuring an increased patient role in the research process.
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Affiliation(s)
- Ingo Schäfer
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
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24
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Strohmaier S, Borena W, Strasak A, Goebel G, Edlinger M, Diem G, Concin H, Kelleher C, Ulmer H. 075 Gamma-glutamyltransferase as a predictor for alcohol- and non-alcohol-related cancer incidence. Br J Soc Med 2010. [DOI: 10.1136/jech.2010.120956.75] [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: 11/04/2022]
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25
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Edlinger M, Deisenhammer EA, Fiala M, Hofer A, Kemmler G, Strauss R, Widschwendter CG, Fleischhacker WW. Attitudes of patients with schizophrenia and depression towards psychiatric research. Psychiatry Res 2010; 177:172-6. [PMID: 20362343 DOI: 10.1016/j.psychres.2008.12.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [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: 02/10/2008] [Revised: 10/21/2008] [Accepted: 12/31/2008] [Indexed: 10/19/2022]
Abstract
The success of clinical research depends heavily on patients' willingness to participate in studies. In recent years much work has been dedicated to studying the problems of conducting research in psychiatry, mainly in schizophrenia patients. In an attempt to replicate previous findings and extend results beyond schizophrenia, we interviewed patients suffering from schizophrenia or depression in a large academic centre concerning their attitudes towards psychiatric research. Ninety-five patients with a diagnosis of schizophrenia (48) or depression (47) completed the "Hamburg General Attitudes to Psychiatric Research Questionnaire" self-report instrument. Furthermore, demographic and clinical data were collected. Illness severity was evaluated using Clinical Global Impression and Global Assessment of Functioning scores. In general, patients approved of psychiatric research, and attitudes towards specific areas of research and research methods were rather positive. There were no significant differences between the two diagnostic groups regarding reasons for participation or non-participation in a clinical trial. The theoretical willingness to participate in studies was highest for studies using a questionnaire. Receiving sufficient information about a study before taking part was stated to be highly important. Our findings confirm and extend those of other groups. This should encourage psychiatrists at least in academic settings where most of this research has been done to approach patients to take part in clinical research.
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Affiliation(s)
- Monika Edlinger
- Medical University Innsbruck, Department of Psychiatry and Psychotherapy, University Clinic of Biological Psychiatry, Anichstrasse 35, A-6020 Innsbruck, Austria.
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Edlinger M, Hofer A, Rettenbacher MA, Baumgartner S, Widschwendter CG, Kemmler G, Neco NA, Fleischhacker WW. Factors influencing the choice of new generation antipsychotic medication in the treatment of patients with schizophrenia. Schizophr Res 2009; 113:246-51. [PMID: 19595578 DOI: 10.1016/j.schres.2009.06.008] [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: 02/17/2009] [Revised: 06/09/2009] [Accepted: 06/14/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This prospective, naturalistic study investigated the factors influencing physicians' choice of antipsychotic drug therapy in the treatment of patients with schizophrenia. METHOD 108 in- and outpatients treated at the Department of Psychiatry of the Medical University Innsbruck who started treatment with a new generation antipsychotic (except clozapine) were included. The following factors were investigated: sociodemographic and illness-related variables, pretreatment, the reasons for change of treatment (lack of efficacy, side effects, non-compliance), side effects of pretreatment and body-mass-index (BMI). RESULTS Sociodemographic and most illness-related variables did not have an influence on the physicians' choice of medication. Risperidone was more frequently prescribed in patients with severe positive symptoms than amisulpride or quetiapine. Rigidity, orthostatic dizziness and gynecomastia during pretreatment were frequently associated with starting patients on ziprasidone. In patients with diminished sexual desire ziprasidone was preferred over olanzapine. Amisulpride was used more commonly than olanzapine if patients had experienced weight gain during pretreatment. Moreover, patients who were prescribed amisulpride had a significantly higher BMI in comparison to patients who were prescribed olanzapine. The reasons for current change of treatment, as well as the drug history (total number of antipsychotic drugs prescribed during the course of the illness) did not have an influence on the physicians' choice of antipsychotic. CONCLUSION In summary, the data suggest that side effects have a larger influence on the choice of antipsychotic than demographic or illness-related variables, except the severity of positive symptoms.
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Affiliation(s)
- Monika Edlinger
- University Clinic of Biological Psychiatry, Department of Psychiatry and Psychotherapy, Medical University Innsbruck, Innsbruck, Austria.
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Tschoner A, Engl J, Rettenbacher M, Edlinger M, Kaser S, Tatarczyk T, Effenberger M, Patsch J, Fleischhacker W, Ebenbichler C. Effects of Six Second Generation Antipsychotics on Body Weight and Metabolism – Risk Assessment and Results from a Prospective Study. Pharmacopsychiatry 2009; 42:29-34. [DOI: 10.1055/s-0028-1100425] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [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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Sinzig M, Edlinger M, Fasching G, Lesnik G, Illiasch H, Hausegger KA. Skisportverletzungen bei intensivtherapiepflichtigen Kindern und Jugendlichen. ROFO-FORTSCHR RONTG 2008. [DOI: 10.1055/s-2008-1073443] [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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Edlinger M, Pichler E, Gasser J, Kaulfersch W. Wernicke-Encephalopathie bei jugendlichen Patienten mit Colitis ulzerosa. Z Geburtshilfe Neonatol 2008. [DOI: 10.1055/s-2008-1078942] [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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Hofer A, Rettenbacher MA, Edlinger M, Kemmler G, Widschwendter CG, Fleischhacker WW. Subjective response and attitudes toward antipsychotic drug therapy during the initial treatment period: a prospective follow-up study in patients with schizophrenia. Acta Psychiatr Scand 2007; 116:354-61. [PMID: 17868428 DOI: 10.1111/j.1600-0447.2007.01087.x] [Citation(s) in RCA: 29] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE In this prospective study, patients with schizophrenia were followed up for 3 months to investigate the impact of sociodemographic factors, psychopathology, change in psychopathology and side effects on subjective response and attitudes toward antipsychotics during the initial treatment period. METHOD We investigated 42 patients starting treatment with a new-generation antipsychotic. Next to the registration of demographic data various rating scales were used: the Positive and Negative Syndrome Scale (PANSS), the Udvalg for Kliniske Undersogelser (UKU) Side Effect Rating Scale and the Drug Attitude Inventory (DAI). RESULTS Two patients experienced a first episode of the illness and were neuroleptic naïve, and 40 had suffered from at least one prior episode of schizophrenia. Longer duration of illness as well as the amelioration of psychopathological symptoms had a positive impact on subjective response to treatment. Correlations between antipsychotic-induced side effects and drug attitude tended to be weak. CONCLUSION Our results emphasize the necessity of improving psychopathological symptoms during the initial treatment period to improve attitudes toward and compliance with treatment.
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Affiliation(s)
- A Hofer
- Department of Biological Psychiatry, Medical University Innsbruck, Innsbruck, Austria.
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Widschwendter CG, Hofer A, Rettenbacher MA, Edlinger M, Kemmler G, Fleischhacker WW. Drug attitude during the initial treatment period: A prospective follow-up study in patients with schizophrenia. Pharmacopsychiatry 2007. [DOI: 10.1055/s-2007-991744] [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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Ihrenberger C, Hofer A, Benecke C, Edlinger M, Huber R, Kemmler G, Rettenbacher MA, Schleich G, Fleischhacker WW. Facial emotion recognition and its relationship to symptomatic, subjective, and functional outcomes in outpatients with chronic schizophrenia. Pharmacopsychiatry 2007. [DOI: 10.1055/s-2007-991761] [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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Rettenbacher MA, Biedermann F, Edlinger M, Hofer A, Kemmler GP, Fleischhacker WW. Neutropenia induced by second generation antipsychotics: a prospective investigation. Pharmacopsychiatry 2007. [DOI: 10.1055/s-2007-991783] [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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Rettenbacher MA, Hummer M, Hofer A, Baumgartner S, Ebenbichler C, Edlinger M, Kemmler G, Lechleitner M, Wolfgang Fleischhacker W. Alterations of glucose metabolism during treatment with clozapine or amisulpride: results from a prospective 16-week study. J Psychopharmacol 2007; 21:400-4. [PMID: 17050656 DOI: 10.1177/0269881106069467] [Citation(s) in RCA: 9] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Although second-generation antipsychotics have notable benefits as compared to typical antipsychotics, their use has been associated with metabolic disturbances, such as alterations of glucose homeostasis. It is still being debated whether this is a class effect of second-generation antipsychotics. We conducted a prospective, open study comparing body weight, parameters of insulin resistance in schizophrenia patients treated with either clozapine (n = 10) or amisuLpride ( n = 12). All parameters were assessed monthly over a period of 12 to 16 weeks. Body mass index (BMI), fasting serum insulin levels and the Homeostasis Model Assessment (HOMA) index for insulin resistance increased significantly in patients treated with clozapine. None of these parameters increased significantly in patients treated with amisulpride. This study indicates that treatment with clozapine appears to have a higher risk to lead to metabolic disturbances than amisupride.
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Affiliation(s)
- Maria A Rettenbacher
- Department of Biological Psychiatry, Medical University Innsbruck, Innsbruck, Austria.
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Hofer A, Rettenbacher MA, Edlinger M, Huber R, Bodner T, Kemmler G, Sachs G, Fleischhacker WW. Outcomes in Schizophrenia Outpatients Treated with Amisulpride or Olanzapine. Pharmacopsychiatry 2007; 40:1-8. [PMID: 17327953 DOI: 10.1055/s-2007-958520] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION We compared stable patients with schizophrenia who were treated with either amisulpride or olanzapine in terms of symptomatic outcome, neurocognitive functioning, functionality, and subjective outcome. METHODS Sixty outpatients with chronic schizophrenia who had been treated with either amisulpride or olanzapine for at least six months were investigated. RESULTS The scores of positive, negative, and cognitive symptoms did not differ between the two groups, but patients treated with olanzapine had significantly lower scores on the excitement and depression/anxiety components of the PANSS. With regard to cognitive variables, patients treated with amisulpride showed significantly lower values regarding verbal fluency and significantly better verbal memory than patients treated with olanzapine. Both treatment groups were comparable with respect to functional and subjective outcome variables. DISCUSSION These observations add to the evidence that continuous treatment with different second-generation antipsychotics with relatively few side effects leads to comparable outcomes in patients with schizophrenia.
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Affiliation(s)
- A Hofer
- Department of Biological Psychiatry, Innsbruck Medical University, Austria.
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Rettenbacher MA, Ebenbichler C, Hofer A, Kemmler G, Baumgartner S, Edlinger M, Hummer M, Lechleitner M, Fleischhacker WW. Early changes of plasma lipids during treatment with atypical antipsychotics. Int Clin Psychopharmacol 2006; 21:369-72. [PMID: 17012984 DOI: 10.1097/01.yic.0000224786.75664.3b] [Citation(s) in RCA: 25] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Metabolic side effects have been found earlier during treatment with second-generation antipsychotics. Among those disturbances serum lipids are less investigated. We conducted a prospective, open study in schizophrenia patients in order to compare body weight and serum lipids during treatment with amisulpride, ziprasidone, clozapine or olanzapine over a period of 4 weeks. Body mass index, total cholesterol and triglycerides increased in patients treated with clozapine and olanzapine whereas high-density lipoprotein cholesterol decreased in those patients. In patients treated with amisulpride or ziprasidone, we found a decrease in body mass index and total cholesterol whereas high-density lipoprotein cholesterol increased. Our results indicate that treatment with ziprasidone and amisulpride is more favourable than treatment with clozapine and olanzapine with respect to the risk to induce weight gain and hyperlipidaemia. These results are important with regard to the increased risk for cardiovascular complications in patients with schizophrenia.
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Affiliation(s)
- Maria A Rettenbacher
- Department of Biological Psychiatry, Medical University Innsbruck, Innsbruck, Austria.
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Rettenbacher MA, Baumgartner S, Eder-Ischia U, Edlinger M, Graziadei I, Hofer A, Huber R, Hummer M, Kemmler G, Weiss E, Fleischhacker WW. Association between antipsychotic-induced elevation of liver enzymes and weight gain: a prospective study. J Clin Psychopharmacol 2006; 26:500-3. [PMID: 16974192 DOI: 10.1097/01.jcp.0000236654.85791.ae] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [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: 01/22/2023]
Abstract
We conducted a prospective, open study in schizophrenia patients treated with second-generation antipsychotics in order to investigate the risk for elevation of liver enzymes and its correlation to antipsychotic-induced weight gain. Body mass index, serum transaminases, plasma serum levels of the antipsychotic used, and blood cell counts were measured weekly during the first 6 weeks of treatment and monthly thereafter. A considerable proportion of subjects showed an increase beyond normal levels of at least one of the measured transaminases. In all but one case, the elevation of liver enzymes was transient. We found a statistically significant correlation between weight gain and liver enzyme elevation. The group of patients that had gained at least 7% of the baseline body weight showed significantly higher increases of transaminases as compared with those who had gained less than 7% weight. We conclude that antipsychotic-induced elevation of liver enzymes is mostly transient and could be associated with weight gain.
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Affiliation(s)
- Maria A Rettenbacher
- Department of Biological Psychiatry, Medical University Innsbruck, Anichstrasse, Innsbruck, Austria.
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Edlinger M, Wolfgang Fleischhacker W. Review: no evidence to support gradual over abrupt switching of antipsychotics. Evid Based Ment Health 2006; 9:10. [PMID: 16436550 DOI: 10.1136/ebmh.9.1.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Monika Edlinger
- Medical University Innsbruck, Department of Biological Psychiatry, Innsbruck, Austria
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Hofer A, Baumgartner S, Bodner T, Edlinger M, Hummer M, Kemmler G, Rettenbacher MA, Fleischhacker WW. Patient outcomes in schizophrenia II: the impact of cognition. Eur Psychiatry 2006; 20:395-402. [PMID: 16171654 DOI: 10.1016/j.eurpsy.2005.02.006] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.6] [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] [Received: 08/30/2004] [Accepted: 02/02/2005] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Cognitive dysfunction is increasingly considered to be the strongest clinical predictor of poor long-term outcome in schizophrenia. Associations have been found between the severity of cognitive deficits and social dysfunction, impairments in independent living, occupational limitations, and disturbances in quality of life (QOL). METHODS In this cross-sectional study, the relationships of cognitive deficits and treatment outcomes in terms of QOL, needs, and psychosocial functioning were examined in 60 outpatients with schizophrenia who had a duration of illness over 2 years and had been treated with either clozapine or olanzapine for at least 6 months. RESULTS The present study suggests that cognitive functioning might be a predictor of work functioning/independent living outcome in stabilized patients with schizophrenia: deficits of visual memory and working memory were negatively associated with occupational functioning, and older patients lived independently and/or in a stable partnership more often. The patients' assessments of QOL and needs for care did not show any significant associations with cognitive functioning. DISCUSSION These findings suggest that cognitive functioning is a key determinant of work functioning/independent living for stable outpatients with schizophrenia.
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Affiliation(s)
- Alex Hofer
- Department of Biological Psychiatry, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria.
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Edlinger M, Hausmann A, Kemmler G, Kurz M, Kurzthaler I, Walch T, Walpoth M, Fleischhacker WW. Trends in the pharmacological treatment of patients with schizophrenia over a 12 year observation period. Schizophr Res 2005; 77:25-34. [PMID: 16005382 DOI: 10.1016/j.schres.2005.01.015] [Citation(s) in RCA: 33] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2004] [Revised: 01/20/2005] [Accepted: 01/21/2005] [Indexed: 10/25/2022]
Abstract
In this study we evaluated whether our efforts to promote evidence-based guidelines for the psychopharmacological treatment of patients with schizophrenia have led to measurable changes of treatment practice in our hospital by investigating three primary hypotheses: 1) Polypharmacy has become less common in recent years, 2) Conventional neuroleptics have been replaced by second generation antipsychotics; and 3) Dosing regimes have changed towards lower doses. We have therefore collected data from the clinical records of all in-patients with ICD-9/ICD-10 diagnoses of schizophrenia hospitalized at the Department of Psychiatry of the Medical University Innsbruck in the years 1989, 1995, 1998 and 2001. Data from 1989 to 1998 showed a significant decrease in the use of two or more antipsychotics given simultaneously. Contrary to our hypothesis, there was a significant increase in polypharmacy between 1998 and 2001. The predominant use of second generation antipsychotics became standard in schizophrenia treatment. In this context the decrease of concomitant anticholinergic medication is notable. Doses of conventional antipsychotics like haloperidol as well as doses of risperidone decreased whereas doses of other second generation antipsychotics increased. All in all, the pharmacological management of schizophrenia patients is increasingly in tune with current treatment guidelines.
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Affiliation(s)
- Monika Edlinger
- Department of Biological Psychiatry, Medical University Innsbruck Anichstrasse 35 A-6020, Austria.
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Rettenbacher MA, Eder-Ischia U, Bader A, Edlinger M, Hofer A, Hummer M, Kemmler G, Weiss EM, Hochleitner M, Fleischhacker WW. QTc variability in schizophrenia patients treated with antipsychotics and healthy controls. J Clin Psychopharmacol 2005; 25:206-10. [PMID: 15876897 DOI: 10.1097/01.jcp.0000162799.64378.fc] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [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: 11/27/2022]
Abstract
QTc prolongation is associated with the administration of some antipsychotics but the QTc interval is also known to vary physiologically. There is little published evidence about changes in QTc variability during treatment with antipsychotics. In this prospective investigation, we analyzed ECGs in 61 patients suffering from a schizophrenic disorder who were treated with different antipsychotics and 31 sex- and age-matched healthy controls. We found no differences in QTc intervals nor in QTc variability between patients and controls. Our results raise the question of the clinical relevance of a single ECG for diagnostics of cardiac complications in schizophrenia patients and suggest the need to conduct ECG monitoring in patients at high risk for cardiac complications during antipsychotic treatment.
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Affiliation(s)
- Maria A Rettenbacher
- Department of Biological Psychiatry, Innsbruck University Hospital, A-6020 Innsbruck, Austria.
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Ebenbichler C, Laimer M, Kranebitter M, Lechleitner M, Patsch JR, Baumgartner S, Edlinger M, Hofer A, Hummer M, Rettenbacher MA, Fleischhacker WW. The soluble leptin receptor in olanzapine-induced weight gain: results from a prospective study. Schizophr Res 2005; 75:143-6. [PMID: 15820334 DOI: 10.1016/j.schres.2004.10.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2004] [Revised: 10/29/2004] [Accepted: 10/30/2004] [Indexed: 11/28/2022]
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Abstract
The introduction of second-generation antipsychotics represents an important advance in the treatment of schizophrenia. Although these drugs are generally very effective, not all patients respond in the same way. Partial response with persistent positive and negative symptoms and residual symptoms may force physicians to change antipsychotic medication. As more and more second-generation antipsychotics are introduced, the need for practical guidelines on switching these medications becomes increasingly important. In this article we provide a short summary of the second-generation antipsychotics, focusing on efficacy, adverse effect profile and safety. Indications for switching antipsychotic medication are outlined, as well as recommendations when switching is disadvantageous. Three basic switching strategies (abrupt, gradual and overlapping switching) and their potential risks and benefits are described. We review the available evidence concerning techniques, problems and consequences when switching from one second-generation antipsychotic agent to another and discuss potential difficulties.
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Affiliation(s)
- Monika Edlinger
- Department of Biological Psychiatry, Innsbruck Medical University, Innsbruck, A-6020, Austria
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Hofer A, Kemmler G, Eder U, Edlinger M, Hummer M, Fleischhacker WW. Quality of life in schizophrenia: the impact of psychopathology, attitude toward medication, and side effects. J Clin Psychiatry 2004; 65:932-9. [PMID: 15291682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
BACKGROUND Quality of life (QOL) is now seen as a key outcome variable in schizophrenia. Factors deemed relevant in this context include severity of symptoms, antipsychotic-induced side effects, sociodemographic variables, and patients' subjective response to medication. METHOD In the current cross-sectional study, 80 patients with a schizophrenic disorder according to ICD-10 criteria who had a duration of illness over 1 year and whose discharge from an inpatient unit had been at least 6 weeks earlier were investigated. Apart from the registration of demographic data, various rating scales were used: the Positive and Negative Syndrome Scale (PANSS), the St. Hans Rating Scale for Extrapy-ramidal Syndromes, the UKU Side Effect Rating Scale, the Drug Attitude Inventory, and the Lancashire Quality of Life Profile. RESULTS More than half of all patients (47/80) indicated that they were satisfied with their life in general. The specific areas of subjective dissatisfaction that were most commonly noted in the present sample concerned partnership and mental health. The depression/anxiety component of the PANSS, parkinsonism, and a negative attitude toward antipsychotic medication negatively influenced the patients' QOL, while cognitive symptoms and employment status correlated with higher QOL. CONCLUSION Our results highlight the importance of recognizing the complex nature of QOL in schizophrenia patients. They suggest that special attention should be paid to patients who experience anxiety and depressive symptoms or parkinsonism, to those who are unemployed, and to those with negative feelings and attitudes toward antipsychotics.
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Affiliation(s)
- Alex Hofer
- Department of Biological Psychiatry, Innsbruck University Clinics, Innsbruck, Austria.
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Oehl MA, Hummer M, Baumgartner S, Ebenbichler C, Edlinger M, Hofer A, Kemmler G, Lechleitner M, Fleischhacker WW. Alterations of glucose metabolism under treatment with atypical antipsychotics. Pharmacopsychiatry 2004. [DOI: 10.1055/s-2003-825455] [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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Abstract
BACKGROUND Prediction of complications is an essential part of risk management in surgery. Knowing which patients are at high risk of developing complications will contribute to the quality and cost reduction of surgery. METHODS All patients admitted to a general surgical ward during a 1-year interval were followed until 30 days after discharge. Complications and data on potential risk factors were recorded prospectively. Relative risks were calculated for each risk factor and predictive values for the development of a serious or minor complication were computed using logistic regression analysis. The predictive values of different combinations of variables were expressed as receiver operating characteristic curves. RESULTS Of 3075 patients, 375 suffered one or more serious complications and 319 experienced a minor complication. A model was developed for prediction of serious complications, consisting of 11 variables, with an area under the curve (AUC) of 0.79 (95 per cent confidence interval (c.i.) 0.76 to 0.81). The prognostic value of the model for minor complications (seven variables) was lower (AUC 0.68 (95 per cent c.i. 0.65 to 0.71)). CONCLUSION Serious complications in patients admitted to a surgical ward can be predicted using a model consisting of 11 variables. The risk score can be used in the decision-making process before surgery.
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Affiliation(s)
- S C Veltkamp
- Department of Surgery, University Medical Centre, Utrecht, The Netherlands.
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Abstract
Studies from Denmark and the USA have reported a strong correlation between the seasonal pattern for stillbirths and the seasonal birth pattern for people who develop schizophrenia. It has been suggested that the correlation could be caused by a common seasonal factor (e. g. intra-uterine infections during the third trimester of pregnancy), which produces death in some fetuses and nonfatal brain changes in others, changes that are manifested in later life as schizophrenia. The aims of our study were (i) to assess the seasonal patterns for stillbirths and for pre-schizophrenic births in The Netherlands and (ii) to examine their relationship. The Dutch psychiatric registry provided data on all Dutch-born subjects who had been hospitalized at least once with a diagnosis of schizophrenia in the period 1970-1994. We selected data on patients born in the period 1926-1970 (n=29891). The government provided monthly numbers of live births and stillbirths in the latter period. Seasonality of birth was examined using Poisson regression analysis. The risk of an admission for schizophrenia was highest for people born in the months of May and June and lowest for those born in August and September. When the risk for subjects born in June was compared with the risk for subjects born in September, the Relative Risk was 1.14 [95% confidence interval (CI): 1.07 to 1.22]. The seasonal pattern of stillbirths was different, in that it showed a peak in the month of January. The low, however, as in schizophrenia, occurred in the months of August and September. The two seasonal patterns were found to be weakly correlated: Spearman's rank correlation coefficient rho=0.41 (95% CI: -0.22 to 0.80). This was the largest European study on birth seasonality in schizophrenia. The hypothesis that a common factor is responsible for a seasonal excess of stillbirths and for a seasonal birth excess of people who develop schizophrenia was not supported. The possibility remains, however, that a common factor explains seasonal (birth rate) deficits in these disorders.
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Affiliation(s)
- J P Selten
- Department of Psychiatry, University Hospital, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
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