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Biomedical subjects

A Erfurth

Publications and source records attributed to A Erfurth.

At least 19 recordsLinked to original sources
PubMed2004

The impact of the selective monoamine reuptake inhibitors reboxetine and citalopram on visually-evoked event-related potentials in depressed patients.

OBJECTIVE: The aim of our study was to assess the possible relationship between event-related potentials (ERP) and serotonergic or noradrenergic activity in depression. Therefore, we were interested in the impact of different monoamine reuptake inhibitors on ERP. METHODS: Thirty-six inpatients with major depression were treated with either reboxetine (n = 17) or citalopram (n = 19) in a prospective randomized study. Before and after four weeks of treatment, visually-evoked ERP were investigated. Twenty-two patients completed the study. Monoaminergic function was determined by oral reboxetine and citalopram challenge tests. RESULTS: P3 latency significantly decreased after a four-week treatment with either drug. There was no significant difference in the decrease of P3 latency between both drugs. We detected a significant inverse correlation between serotonergic hypofunction before treatment and the P3 latency (r = -0.739, p = 0.001). CONCLUSIONS: These results show that, in depressed patients, the P3 latency is decreased by antidepressive treatment. Furthermore, the results suggest that P3 latency might depend on the serotonergic rather than the noradrenergic system.

Adolescent↗
PubMed2003

[The spectrum of bipolar disorders].

On the basis of epidemiology, neurobiology and clinical observation, the classification of bipolar disorders has shown considerable development and expansion in recent years. In particular, the recognition of mixed states, the introduction of bipolar II disorders, increasing awareness of the diagnosis of hypomania, as well as the interest in cyclothymic disorders and temperament have led to a shift in diagnostic attitudes in the USA, as well as in European countries. In this article, the possible clinical and scientific benefits of such tendencies are discussed, as are the risks of broadening bipolar disorders beyond DSM-IV. Also demonstrated is how several "modern" concepts of bipolarity have deep roots in the history of German psychiatry; a mixity scale based on Kraepelin's classification of affective mixed states is presented.

Bipolar Disorder↗
PubMed2003

Metabolic changes within the left dorsolateral prefrontal cortex occurring with electroconvulsive therapy in patients with treatment resistant unipolar depression.

BACKGROUND: The dorsolateral prefrontal cortex (DLPFC) is involved in the pathophysiology of major depression. In particular, metabolic (functional hypometabolism) and structural alterations have been described. In this study metabolic changes within the DLPFC of severely depressed patients before and after electroconvulsive therapy (ECT) were evaluated by proton STEAM spectroscopy (1H-MRS). METHOD: Twelve severely depressed patients with a diagnosis of major depressive episode, unipolar with melancholic features (DSM-IV), were enrolled, and the left dorsolateral prefrontal cortex (DLPFC) was investigated before and after unilateral ECT by 1H-MRS. Three of the four non-responding patients were remeasured a third time after a combined ECT/antidepressant pharmacotherapy. The results were compared with 12 age- and gender-matched controls. RESULTS: In depressed patients reduced glutamate/glutamine (Glx) levels were measured pre-ECT; Glx concentrations correlated negatively with severity of depression. After successful treatment, Glx increased significantly and levels no longer differed from those of age-matched controls. CONCLUSIONS: Our results indicate that major depressive disorder is accompanied by state-dependent metabolic alterations, especially in glutamate/glutamine metabolism, which can be reversed by successful ECT.

Aged↗
PubMed2001

[Depressive disorders in neurologic rehabilitation: therapy with paroxetine].

OBJECTIVE: Depression is a common problem in neurological rehabilitation. Although three double-blind studies have shown the efficacy of trazodone, citalopram and nortriptyline, antidepressant drug therapy of poststroke depression is not yet considered a state-of-the-art strategy. In a hospital for neurological rehabilitation we have performed an open study on the effects of the SSRI, paroxetine, in depressive disorders caused by neurological diseases. METHOD: 111 consecutive admissions were screened for depression and 9 patients were admitted to the study having a HDRS score > or = 14. RESULTS: 10-40 mg of paroxetine were well tolerated and led to a > or = 50% reduction of the HDRS score in 8/9 patients. A patient with pathological crying, but without depression, was also successfully treated with 20 mg of paroxetine. CONCLUSIONS: We conclude that the SSRI, paroxetine, is an effective and well-tolerated therapy of depressive disorders caused by various neurological diseases, including also other diagnoses than stroke.

Adult↗
PubMed2001

Association of short-term response to haloperidol treatment with a polymorphism in the dopamine D(2) receptor gene.

OBJECTIVE: Pharmacogenetic influences on therapeutic response to neuroleptic treatment are poorly understood. This study investigates the association of response to short-term haloperidol treatment with a Taq I polymorphism in the DRD2 gene. METHOD: Fifty-seven patients with acute psychosis were treated with haloperidol for up to 28 days. Improvement and response were measured by using the Positive and Negative Syndrome SCALE: Forty-one patients were homozygous for allele 2, and 16 were heterozygous. RESULTS: Heterozygous patients showed a greater improvement in positive, but not in negative, symptoms on all treatment days than patients homozygous for allele 2. Differences in improvement of positive symptoms reached statistical significance on days 14, 21, and 28. On treatment day 14, 10 (62.5%) of 16 heterozygous patients had at least 50% improvement of positive symptoms, compared with 11 (28.9%) of 38 homozygous patients. CONCLUSIONS: These results support the hypothesis that genetic variations in the DRD2 gene may influence the individual response to antipsychotics.

Adult↗
PubMed2000

Mad scenes in early 19th-century opera.

OBJECTIVE: It is our objective to examine the phenomenon of mad scenes in bel canto opera from a modern perspective. METHOD: The development of psychiatry and music at the beginning of the 19th century is described. Common elements of romantic music and mental disorders are discussed. It is shown how bel canto composers represent psychiatric illness by musical means. The psychopathology depicted in a prototypical mad scene is evaluated. RESULTS: Early romantic music is characterized by imagination, illusion and loss of structure; characteristics which can be well expressed in mad scenes. While madness (withdrawal into a utopian world) gained a certain attraction in society, clinical psychiatry increasingly focused on emotional causes of illness and on drug-induction of mental disorders. CONCLUSION: Mad scenes in bel canto opera can be understood as expression of an increasing interest in emotional aspects in music and society as well as in clinical psychiatry.

History, 19th Century↗
PubMed2000

Possible association of the short allele of the serotonin transporter promoter gene polymorphism (5-HTTLPR) with violent suicide.

There is abundant evidence that the serotonin (5-HT) system is modulating mood and several behavioural traits and that disturbances in the regulation of this system can be associated with severe behavioural malfunctions, as aggressive implusive and suicidal behaviour.1 Recently a functional polymorphism in the promoter region of the serotonin transporter gene (5-HTTLPR) was identified2 and the presence of one or two short alleles was associated with anxiety-related personality traits3 and several psychiatric disturbances, such as affective disorder4 or severe alcohol dependence.5 With respect to the importance of the 5-HT transporter in serotonergic transmission, we have genotyped the DNA of 58 Caucasian suicide victims (with unknown psychiatric diagnoses) and 110 healthy controls for the biallelic functional polymorphism in the 5-HTTLPR. We found a highly significant increased frequency of suicide victims being carriers of one or two short alleles (Fisher's Exact Test, two sided, P = 0.0003), which suggests that a genetically altered protein function within the serotonergic pathway might be involved in suicidality, independently from the clinical diagnosis.

Alleles↗
PubMed2000

Topiramate monotherapy in the maintenance treatment of bipolar I disorder: effects on mood, weight and serum lipids.

Topiramate is a newly developed anticonvulsant agent with possible mood-stabilizing properties. Little is known about the short- and long-term effects of topiramate monotherapy in bipolar disorder. We here present the case of a 60-year-old female bipolar patient who received topiramate alone as maintenance treatment after recovering from euphoric mania. During 7 months, she was free from new manic symptomatology and she was able to reduce her overweight by 16.5 kg. The patient who is known to have a strongly hyperthymic temperament described symptoms of fatigue and sedation and eventually discontinued topiramate monotherapy. When she presented again in our bipolar clinic, severe euphoric mania had developed. After hospitalization, she slowly responded to oral sodium valproate loading plus zotepine. Her weight increased again and so did her triglyceride serum levels. Topiramate treatment and discontinuation did not seem to affect cholesterol serum levels.

Adult↗
PubMed1999

[Electroconvulsive therapy in the treatment of severe mania. Case report and a state-of-art review].

Despite newly developed pharmacological possibilities, treatment of acute mania may still be a problem in single patients. Independent of the first choice of medication, i.e. neuroleptics, lithium, carbamazepine or valproate, the average response rate is only approximately 50-70%. Therefore, treating mania often implies a number of monotherapeutic and polypharmaceutic attempts for several months, until a sufficient mood stabilization has been reached. The aim of this case report is to remind that electroconvulsive therapy (ECT) is still in use for treating mania, which has been widely neglected in Germany despite its high success rate, mainly reported from Anglo-Saxon countries. As demonstrated in this report, ECT may be a useful tool for a fast antimanic response in patients which may be either refractory to standard treatment or are medically severely ill, and should, in our opinion, therefore be considered already at an earlier stage of treatment in this group. However, persistence of improvement can usually only be achieved with the overlapping start of drug treatment unless the option of maintenance ECT is given.

Acute Disease↗
PubMed1999

[Gabapentin in the treatment of mania].

We present the case of a 60-year old bipolar-I-patient showing a rapid antimanic response to gabapentin after having been non-responsive to lithium and perazine. This case encouraged us to further evaluate the antimanic potency of gabapentin in an open label trial. 20 patients with acute mania were treated for up to 21 days with gabapentin in a dose range from 1200 to 4800 mg/day. Ten patients were treated with gabapentin as add-on medication and ten patients were treated with a high dose of gabapentin alone. The BRMAS score declined significantly in patients with moderate mania, whereas gabapentin alone was not efficacious in patients with very severe mania. Keeping in mind the limitations of an open study, it can still be said that gabapentin as add-on medication with other effective mood stabilizers appears to be safe and efficacious in the treatment of moderate mania.

Acetates↗
PubMed1999

Intravenous valproate loading in acutely manic and depressed bipolar I patients.

Recently, valproate has emerged as a drug of primary choice for the treatment of acute mania, especially mixed mania and, partially, rapid cycling. Because of its relative safety, it can be administered in high doses as an oral loading therapy, with approximately 60% to 70% of patients showing a favorable response. Here we report on seven bipolar I patients, two of which have euphoric mania, three have a mixed manic state (including one patient with ultra-rapid cycling and one with very prominent depressed features), and two have solely depressed mood. All but one of the manic patients showed a rapid and favorable response to intravenous valproate loading, which built up sufficient blood levels that were maintained by subsequent oral treatment. Of the two patients with solely depressed mood, however, one experienced only minor benefits and the other showed no change in the depressive symptomatology. Intravenous valproate was tolerated without problems and also led to a drastic reduction in and eventual withdrawal of benzodiazepine treatment in two cases. All of the patients showed a drastic remission of mania with valproate blood levels at or only slightly above 50 microg/mL (blood drawn 12 hours after last application). It is interesting to note that one patient who was previously nonresponsive to oral valproate loading responded well to intravenous valproate. Besides the obvious efficacy and safety of this treatment regimen, these findings may also imply that a difference in pharmacokinetics with intravenous loading may result in a quick saturation of plasma-binding proteins, and hence, peak concentrations of valproate may be reached rapidly, which could contribute to the beneficial action, even in patients previously nonresponsive to oral valproate.

Acute Disease↗
PubMed1999

Tiagabine appears not to be efficacious in the treatment of acute mania.

BACKGROUND: Because a GABAergic hypofunction has been implied in the pathophysiology of mania, we have tested the antimanic properties of the GABA transporter 1 inhibitor tiagabine. METHOD: An open trial was conducted in 8 acutely manic inpatients with DSM-IV bipolar I disorder, 2 of them with tiagabine monotherapy and 6 with tiagabine as an add-on to previously insufficient mood-stabilizing medication. The study duration was 14 days. Changes in psychopathology were assessed by the Bech-Rafaelsen Mania Rating Scale. RESULTS: None of the patients showed clear-cut relief from manic symptoms during the 2-week observation period. In 2 patients, we saw pronounced side effects (nausea and vomiting in one and a generalized tonic-clonic seizure in the other). CONCLUSION: The results from this open trial suggest that tiagabine seems to have no pronounced antimanic efficacy compared with standard treatments such as valproate, lithium, or neuroleptics. It also appears that rapid dosage increases for antimanic treatment can cause potentially severe side effects.

Acute Disease↗
PubMed1999

[Severe therapy refractory depression as initial manifestation of Parkinson disease].

A 60-year old female patient was referred to our University hospital with the diagnosis of severe treatment-resistant major depression to perform electroconvulsive therapy (ECT). For almost two years the patient had been treated with several antidepressants and, temporarily, neuroleptics. After showing no favourable response to ECT, the diagnosis of idiopathic Parkinson's disease was made and the patient was treated with L-dopa plus benserazide and pergolide in combination with the monoamine oxidase inhibitor moclobemide. Both depressed mood and motor symptoms showed dramatic improvement under this therapy.

Aged↗
PubMed1998

[ECG changes after paroxetine. 3 case reports].

Selective serotonin reuptake inhibitors (SSRI) are known to exhibit far less cardiac side effects than tricyclic antidepressants. We report three cases in which the SSRI, paroxetine, induced clinically relevant ECG changes in patients with high risk profile. In two cases an increase in QTc time was observed, severe bradycardia was also observed twice.

Aged↗