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Biomedical subjects

A Deister

Publications and source records attributed to A Deister.

At least 19 recordsLinked to original sources
PubMed1998

Upregulation of the platelet Serotonin2A receptor and low blood serotonin in suicidal psychiatric patients.

Suicidality has been found to be associated with low pre- and postsynaptic serotonin functioning. The purpose of this study was to examine whether in acutely suicidal psychiatric inpatients, the blood serotonin concentration was related to the underlying psychiatric disorder and whether it was associated with changes in the affinity (dissociation constant, KD) or in the maximal binding capacity (Bmax) of the platelet serotonin2A receptor. We therefore determined the blood serotonin concentrations and the platelet serotonin2A receptor activities of 45 suicidal psychiatric patients and 20 healthy subjects. We found that the blood serotonin concentrations were significantly lower in suicidal patients compared to healthy subjects. In all diagnostic categories (affective disorder, schizophrenia and adjustment disorder) we noted a significantly higher maximal binding capacity of the platelet serotonin2A receptor. These findings support the notion that a reduction in the availability of serotonin and an upregulation of the serotonin2A receptors in psychiatric patients are associated with a loss of control over suicidal impulses.

Acute Disease↗
PubMed1998

Frequency and phenomenology of persisting alterations in affective, schizoaffective and schizophrenic disorders: a comparison.

Investigating the long-term outcome of affective, schizoaffective and schizophrenic disorders, a model that integrated the operationally gathered findings with the 'interactional atmosphere' experienced by the clinician was applied. Eight different types of phenomenological constellations of persisting alterations were delineated (depletion syndrome, apathetic-paranoid (respectively apathetic-hallucinatory) syndrome, adynamic deficiency syndrome, chronic psychosis, structural deformation, slight asthenic insufficiency syndrome, chronic subdepressive syndrome, chronic hyperthymic syndrome. Former assumptions that cross-sectionally the persisting alterations in affective disorders are usually indistinguishable from those in schizophrenia could not be confirmed.

Humans↗
PubMed1997

[Coincidence of epilepsy and Asperger syndrome. Case report and review].

Asperger syndrome is an autistic disorder and was first described by Hans Asperger in 1944 without further acceptance in the literature over almost four decades. Following several publications in the 1980s, for the disorder became more widely known and was first introduced into ICD-10 and DSM-IV as a new diagnosis in 1988 and 1994, respectively. The etiology is unknown. We present a female patient with typical features of Asperger syndrome, suffering also from epilepsy and internal medical disorders. The associated diseases, diagnostic criteria and possible therapeutic options are discussed.

Adolescent↗
PubMed1996

Low serum levels of tricyclic antidepressants in amitriptyline- and doxepin-treated inpatients with depressive syndromes are associated with nonresponse.

Nonresponse to tricyclic antidepressant (TCA) treatment is observed in about one-third of depressed patients. The cause(s) for nonresponse - apart from disease-specific effects - might be the failure to build up sufficiently high serum TCA levels due to noncompliance, substance abuse, rapid metabolism, or low dose. We carried out a retrospective analysis relating antidepressant serum levels to patient data obtained in the naturalistic setting of the Psychiatric Hospital of the Bonn University during the introductory phase of drug-monitoring. Case reports of 110 depressed inpatients who were treated with amitriptyline or doxepin were analyzed with respect to the following: medication and comedication, daily dose, type and duration of treatment, serum TCA concentrations (analyzed by the fluorescence polarization immunoassay), age, sex, body weight, abuse of nicotine or alcohol intake, serum transaminases (ALT, alanine aminotransferase, and AST, aspartate amino transferase), gamma-glutamyltranspeptidase (gamma-GT) and creatinine, compliance, and response. The salient findings were: 1. Serum TCA concentrations increased linearly with the daily amitriptyline dose but not with that of doxepin. 2. Interindividually, there was an eight to ten-fold difference in serum TCA concentrations at steady-state with 150 mg/day of either drug; longitudinally, we observed intraindividually a coefficient of variation of 8% and 12% for amitriptyline and doxepin respectively. 3. With amitriptyline (150 mg/day), the correlation between age and serum TCA concentrations was low (r = 0.33, p < 0.055) and no correlation was found after the administration of doxepin (150 mg/day), nor was there any correlation between age and dose-adjusted serum TCA concentrations after the administration of either drug. 4. Nonresponders had significantly lower serum levels than responders. These results suggest that patients should not qualify as nonresponders unless it can be demonstrated (and it is clinically applicable) that the steady-state serum TCA levels are stable within the upper limit of the recommended therapeutic range and serum level.

Adult↗
PubMed1995

Validity of the negative/positive dichotomy of schizophrenic disorders under long-term conditions.

Based on the phenomenological distinction of positive and negative symptoms, some authors discuss the existence of two subtypes of schizophrenia (positive vs. negative schizophrenia). Investigating the long-term course of 100 schizophrenic patients (on average 23 years after onset) it was found that only 24% of the patients had a stable monomorphous course (only once type of episode). The results of the presented longitudinal study do not support the assumption of 'purely positive' or 'purely negative' schizophrenic disorders. The relevance of positive and negative onset of illness for the long-term course and outcome is discussed with reference to the literature.

Cognition Disorders↗
PubMed1994

Patient acceptance of implantable cardioverter defibrillator devices: changing attitudes.

Clinical experience suggests that the implantable cardioverter defibrillator (ICD) can reduce sudden cardiac death and total mortality in patients with malignant ventricular arrhythmia who meet the selection criteria for implantation. In addition to surgical problems, patients are faced with psychological and social adjustments. Patient acceptance for such therapy is marked by perceived concerns regarding device discharge, life-style alterations, and complications. We included 57 patients with ICDs in a study of their acceptance of the device. Results of a specially designed questionnaire (state-trait personality inventory) showed that 47 of 57 patients felt that their symptoms improved with the ICD system, 32 were constantly aware of the device, and 24 patients acclimated to the ICD system within less than 2 months. With respect to the need for battery replacement, only 27 patients requested a repeat electrophysiologic evaluation, 20 patients stated fear of ICD discharges, 12 patients revealed physical discomfort from the device, and limited quality of life occurred in eight patients. Fifty-five of 57 patients answered that it was worth having an ICD device implanted, 30 (53%) patients returned to active life, and 56 (98%) would advise another patient to have an ICD implantation if necessary. In conclusion, in general, the acceptance of the ICD as a tool for management of life-threatening ventricular tachyarrhythmias is very high. Quality of life and patient acceptance are important criteria for successful ICD therapy in addition to the improved survival rate.

Attitude to Health↗
PubMed1994

Prognostic value of initial subtype in schizophrenic disorders.

The prognostic value of the subtype diagnosis at the initial episode was investigated in 148 narrowly defined schizophrenic patients. Every initial episode was classified according to multiple criteria: DSM-III-R, ICD-10, the positive/negative dichotomy, and Schneider's first rank symptoms. Patients were followed up on average 23 years later (range 10-50 years). Different aspects of long-term outcome were evaluated (global functioning, social adjustment, negative social consequences). In 93% of the patients persisting alterations were found at the end of the observation time. The influence of the predominant clinical features at the initial episode on various aspects of long-term outcome was found to differ depending on which of the four diagnostic systems was used. The highest power for discrimination was found for the subtypes of DSM-III-R, while the presence of first rank symptoms had no prognostic value. It was found that patients with an initial paranoid or positive episode had a significantly better long-term outcome than patients initially having a disorganised/hebephrenic or catatonic episode. The frequency of negative social consequences was not influenced by the initial subtype, with the exception of permanent hospitalisation.

Adolescent↗
PubMed1994

Monitoring tricyclic antidepressant concentrations in serum by fluorescence polarization immunoassay compared with gas chromatography and HPLC.

The fluorescence polarization immunoassay (FPIA) developed by Abbott to diagnose intoxication with tricyclic antidepressants was adapted for therapeutic drug monitoring and validated with chromatograpic methods to investigate its potential for this use. We compared serum concentrations of tricyclic antidepressants in vivo and in vitro obtained by FPIA with those by gas chromatography and HPLC. For amitriptyline, imipramine, clomipramine, and doxepin, the detection limit of the FPIA was 72, 71, 64, and 72 nmol/L (approximately 20 micrograms/L), respectively; that by gas chromatography was 18, 18, and 16 nmol/L (approximately 5 micrograms/L) for amitriptyline, imipramine and clomipramine, respectively; with HPLC the lower limit of detection for doxepin was 36 nmol/L (10 micrograms/L). The intra- and interassay CVs ranged from 3% to 6%. In patients being treated with amitriptyline, imipramine, clomipramine, and doxepin, at steady-state the correlation coefficients between FPIA and GC/HPLC results for split samples were 0.95, 0.92, 0.90 and 0.70, respectively. However, the slopes were close to unity only for amitriptyline and doxepin, being 0.6 for imipramine and 1.9 for clomipramine.

Antidepressive Agents, Tricyclic↗
PubMed1993

[The quality of life after the implantation of a cardioverter/defibrillator in malignant arrhythmias].

Quality of life after implantation of an automatic implantable cardioverter/defibrillator (ICD) was assessed by questionnaire in 43 patients (38 males, 5 females; mean age 57 +/- 16 years) with treatment-resistant symptomatic ventricular arrhythmias. 37 of the 43 patients felt better after ICD implantation. 23 were always conscious of having an ICD, but 18 had got used to it in less than 2 months. 15 patients reported being afraid of an ICD shock, while eight noted physical discomfort caused by the ICD. Limitations concerning their professional, recreational and social activities were reported by six patients. 41 of the 43 patients confirmed that the ICD had been helpful, enabling 23 to return to an active life. 42 would recommend implantation to others if indicated. These data demonstrate that there is a remarkably high degree of acceptance of the ICD. Survival rate after implantation is thus not the only criterion of success. All aspects of the quality of life should be taken into consideration before implantation is decided upon.

Adult↗
PubMed1993

Subtypes in schizophrenic disorders: frequencies in long-term course and premorbid features.

The subclassification of schizophrenic disorders according to four diagnostic systems (DSM-III-R, ICD-10, the positive vs. negative dichotomy and Schneider's first rank symptoms) was compared over the long-term course of the disease in 148 narrowly defined schizophrenic patients. A total of 595 episodes were classified over a mean observation period of 23 years (range 10-50 years). Initially, paranoid/positive subtypes predominated, while later in the course episodes fulfilling the symptomatological criteria of residual/negative subtypes became more frequent. Disorganised/hebephrenic and catatonic subtypes were found to be rare. Some premorbid features were investigated as non-symptomatological validators for subclassification. Significant differences were found with regard to age at onset. Patients whose first episode was paranoid or positive had the highest age at onset. Patients with initial disorganised/hebephrenic or "residual" episodes had the most unfavourable premorbid social adjustment, even when the influence of age at onset was discounted. The diagnostic systems investigated showed similarities and differences as a result of the underlying concepts. Methodological implications are discussed.

Adult↗
PubMed1993

Long-term stability of subtypes in schizophrenic disorders: a comparison of four diagnostic systems.

The long-term stability of subtypes of schizophrenic disorders in 148 narrowly defined schizophrenic patients according to four diagnostic systems was compared. The patients were investigated longitudinally for 23 years on average (range 10-50 years). Patients who experienced only one episode and those who were permanently hospitalised were excluded on methodological grounds. Of the remaining 100 patients, a total of 461 episodes were classified into various subtypes according to the criteria of DSM-III-R, ICD-10, the positive/negative dichotomy, and Schneider's first-rank symptoms. It was found that long-term stability of subtype in schizophrenic disorder was not the rule but the exception. The frequency of stable course was found to be depend on the type of the initial episode. In most cases a subtype change occurred within the first few years of the illness with no clear direction. In later stages of the illness the relative frequency of episodes predominated by negative symptomatology increased. The findings were similar for DSM-III-R, ICD-10 and positive/negative dichotomy. Only in patients beginning without first-rank symptoms were more stable than non-stable courses found. The results of this study do not support the assumption that stable subtypes are nosological or etiopathogenetic subentities of schizophrenic disorders.

Adolescent↗
PubMed1993

Functional cortical interaction patterns in visual perception and visuospatial problem solving.

To explore the integration of functional neuronal interactions in human higher cortical functions, we applied multivariate mathematical techniques to regional cerebral blood flow (rCBF) increases induced by mental activity. rCBF was measured using the intravenous xenon-133 clearance technique with 32 bihemispheric detectors in 84 normal volunteers at rest and during both a visuoperceptual accuracy task and a visuospatial problem solving task. Both paradigms activated rCBF in bilateral premotor, motor and postcentral regions. Bilateral prefrontal activation occurred during problem solving but not during the perceptual accuracy task. Partial correlations coefficients and factor analysis identified significant interactions between numerous cortex regions in both tasks. There were highly ordered and integrated patterns of functional interaction patterns between cortex areas subserving elementary subfunctions of complex behavior. Cortical interaction analysis by such techniques is a useful tool to describe the functional anatomy of large-scale neurocognitive networks in the intact human brain. Imaging functional interactions between active cortex areas are complementary to other experimental neurophysiologic methods to explore brain-behavior relationships in health and disease.

Adolescent↗
PubMed1993

Patient acceptance of the implantable cardioverter defibrillator in ventricular tachyarrhythmias.

Besides surgical problems, recipients of implantable cardioverter defibrillators (ICDs) are faced with psychological and social adjustments. Successful ICD therapy is influenced by the patients' perceived concerns regarding device, discharge, changes in life style, and complications. In order to assess patients' acceptance of the ICD, the psychological profile of 57 consecutive patients was evaluated using a specifically designed questionnaire and the State Trait Anxiety Inventory (STAI). The results showed that 20 patients stated fear of ICD discharge, 12 patients revealed physical discomfort due to the device, and limited quality-of-life occurred in 8 patients. Fifty-five of 57 patients answered that it was worth having an ICD device implanted, 30 (53%) patients returned to active life, and 56 (98%) would advise another patient to undergo implantation if necessary. Overall, there was only a slight, but insignificant, decrease in the level of anxiety within the total patient population after ICD implantation. However, a comparison of two subgroups indicated that the state of anxiety was significantly higher in patients < 50 years of age as well as in patients having received > 5 shocks versus those > 50 years of age and having experienced < 5 shocks. In general, the acceptance of the ICD as a tool in managing life-threatening ventricular tachyarrhythmias is high. Besides the increased survival rate, quality-of-life and patient acceptance are important criteria for successful ICD therapy.

Activities of Daily Living↗
PubMed1993

Predicting the long-term outcome of affective disorders.

Factors influencing the long-term outcome of affective disorders were investigated in 106 patients with an average length of course of 28 years. Univariate statistical analyses, stepwise multiple discriminance analyses and path analysis were applied. A direct unfavourable influence on the frequency of persisting alteration (evaluated according to the Global Assessment Scale) was found to have the low self-confident premorbid personality and a higher number of episodes during course, whereas only the variable "male" had such an influence on the social consequences of the illness. The variable "manic episode" (bipolarity) and "age at onset" had only an indirect influence, in that bipolar patients had more episodes, and younger patients more frequently had a bipolar course and therefore had more episodes. The unfavourable long-term outcome was due in those cases to the higher number of episodes.

Achievement↗
PubMed1993

Factors influencing the long-term outcome of schizoaffective disorders.

Factors influencing the long-term outcome of schizoaffective disorders were investigated in 101 patients with a mean duration of illness of 25.5 years. Univariate statistical analyses and stepwise multiple discriminance analyses were applied. The most important factors influencing the development of persisting psychosocial alterations proved to be the absence of pure melancholic episodes during course and life events at onset, and the presence of first rank schizophrenic symptoms, schizomanic-depressive mixed episodes, higher number of episodes and higher annual frequency of episodes. The most relevant factors influencing the development of negative social consequences due to the illness were found to be an asthenic/low self-confident premorbid personality and the higher number of episodes and cycles. There are only partial similarities with schizophrenic or affective disorders.

Adult↗
PubMed1992

Validity of the negative/positive dichotomy for schizophrenic disorders under long-term conditions.

A total of 148 patients fulfilling the DSM-III symptomatological criteria of schizophrenia were classified according to Andreasen's criteria of positive, negative and mixed symptomatology. After excluding cases of permanent hospitalisation and patients with monoepisodic course the remaining 100 patients had a total of 458 episodes. Of these episodes, 213 were identified as positive, 134 as negative and 111 as mixed. During the course of illness the proportion of negative episodes increased and the proportion of positive episodes decreased. The great majority of the patients (76%) had a bimorphous course, i.e. one showing both types of schizophrenic symptomatology, positive and negative. Only 6% of the patients had only negative episodes, and only 18% had only positive episodes. The shift from one type of episode to another is dependent on the length of illness. Stability was not greater later during the course of illness than at the beginning.

Adult↗
PubMed1992

[Sex-dependent differences in endogenous psychoses. A comparison between schizophrenic, schizoaffective and affective psychoses].

Sex differences in 355 patients with functional psychoses were investigated longitudinally (mean observation time more than 25 years). Using narrow criteria, 148 patients were diagnosed as having a schizophrenic disorder, 101 as having a schizoaffective and 106 as having an affective disorder. Similarities and differences between male and female patients in these three diagnostic groups were investigated and compared on four levels (premorbid and sociodemographic features, elements of course, symptomatology and the different aspects of outcome) using international standardised instruments of evaluation. A different sex distribution in the three groups was found. Female schizophrenic patients showed a better premorbid social adjustment and a better long-term psychopathological and social outcome than male patients. Differences between male and female schizoaffective patients were found only regarding premorbid personality and polarity, but not regarding symptomatology and outcome. In affective psychoses female patients showed a better social outcome than male patients, but no relevant differences regarding premorbid adjustment were found. Gender differences were found as an important variable for research in functional psychoses, but interactions with other variables have to be considered.

Activities of Daily Living↗