Biomedical subjects
Publications and source records attributed to A Forsthoff.
The Internet has a powerful effect on society and thereby also on psychiatric patients. It offers suicide prevention services but also is a source of information and exchange of thoughts on how to commit suicide. This paper describes an 18-year-old female who learned about methods of suicide in the Internet and then ordered barbiturates. She survived because of early intervention.
Despite many advances in making the diagnosis of bipolar disorder, five to twelve years lie between the first affective episode and the introduction of an effective treatment. However, it is estimated that approximately only one-fourth of the patients with bipolar disorder are recognized as such at all. Clinical experience plays an important role in the diagnosis. Manias are often the cause for the first treatment with drugs, but the daily lives of patients with bipolar depression are often clearly more negatively affected. The acute therapy of bipolar depression is more complicated than that of mania and the difficult long-term treatment is always associated with a high suicide risk. A long-term therapy of bipolar disorders is not only meaningful for the prevention of new disease episodes, but also because it has a positive effect on comorbidities.
Bipolar disorders are often diagnosed too late with an average of ten years elapsing between the first disease episode and the correct diagnosis and treatment. The most common misdiagnoses are unipolar depression, schizophrenia and ADHD (Attention Deficit Hyperactivity Disorder). The suicide rate associated with bipolar disease is very high. Treatment consists in the administration of mood stabilizers, in the first instance lithium, but also atypical neuroleptics or lamotrigine. In the depressive phase, additional antidepressants or lamotrigine, in the manic phase valproate or an antipsychotic agent may be needed. Medication must be continued unchanged for several months beyond acute treatment. The subsequent relapse prophylaxis depends on effectiveness, tolerability, comorbidity, suicidal risk and compliance. Pharmacotherapy is supplemented by psychotherapy and psycho-education.
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Atypical neuroleptics are increasingly used in the treatment of bipolar and schizoaffective disorders. Currently, numerous controlled short-term studies are available for clozapine, olanzapine, risperidone or quetiapine, but long-term data are still missing. Three patients (2 with bipolar disorder, 1 with schizoaffective disorder) are described who showed a marked reduction of affective symptomatology after clozapine had been added to mood stabilizer pretreatment. The patients were seen once a month before and after the introduction of clozapine for at least 6 months. Treatment response was evaluated using different rating scales (IDS, YMRS; GAF; CGI-BP) and the NIMH Life Chart Methodology. All patients showed a marked improvement after the add-on treatment with clozapine had been initiated. Clozapine was tolerated well with only transient and moderate weight gain and fatigue as only side effects. This case series underlines the safety and efficacy of clozapine as add-on medication in the treatment of bipolar and schizoaffective disorders.
The Stanley Foundation Bipolar Network (SFBN) is an international, multisite network investigating the characteristics and course of bipolar disorder. Methods (history, ratings and longitudinal follow-up) are standardized and equally applied in all 7 centres. This article describes demographics and illness characteristics of the first 152 German patients enrolled in the SFBN as well as the results of 2.5 years of follow-up. Patients in Germany were usually enrolled after hospitalisation. More than 72% of the study population suffered from bipolar I disorder and 25% from bipolar II disorder. The mean +/- SD age of the study participants was 42.08 +/- 13.5 years, and the mean +/- SD age of onset 24.44 +/- 10.9 years. More than 40% of the sample reported a rapid-cycling course in history, and even more a cycle acceleration over time. 37% attempted suicide at least once. 36% had an additional Axis I disorder, with alcohol abuse being the most common one, followed by anxiety disorders. During the follow-up period, only 27% remained stable, 56% had a recurrence, 12.8% perceived subsyndromal symptoms despite treatment and regular visits. 27% suffered from a rapid-cycling course during the follow-up period. Recurrences were significantly associated with bipolar I disorder, an additional comorbid Axis I disorder, rapid cycling in history, a higher number of mood stabilizers and the long-term use of typical antipsychotics. Rapid cycling during follow-up was only associated with a rapid-cycling course in history, a higher number of mood stabilizers and at least one suicide attempt in history.
For International Standard ISO 7933 (Hot environments-analytical determination and interpretation of thermal stress using calculation of required sweat rate. International Organization for Standardization, Geneva, 1989) it has been questioned whether the heat stress index "required sweat rate" is applicable in environments where mean radiant temperature (t(r)) exceeds dry air temperature (t(a)). Based on a re-analysis of 556 climatic chamber experiments on 16 subjects the observed sweat rates were compared with required sweat rates predicted according to the ISO standard. Under climatic conditions with t(r) > t(a) the predictions overestimate the observed sweat rates on average by 86% in clothed subjects and by 25% in nude subjects. In climates with t(r) = t(a) the predictions highly agreed with the observed sweat rates in nude subjects and were slightly overestimated (13%) in clothed subjects. The misjudgement of the present ISO standard is obviously caused by an inappropriate calculation of radiative heat exchange. Corrections are proposed to improve the validity concerning climates with t(r) > t(a).
Six female and 33 male workers of the food industry (16-55 years), divided into three groups according to climatic conditions at the workplaces, were monitored during a typical shift. Fourteen subjects worked continuously in 0-7 degrees C, 18 in 13-15 degrees C and seven moved frequently between these climatic areas. Mean metabolic rates, heart rates, rectal temperatures and skin temperatures at the trunk and at the feet were similar between each of the three groups. Considerable differences between estimated clothing insulations worn and calculated required clothing insulations (IREQneutral) were statistically analyzed. The results suggest that--apart from a limited overestimation--this discrepancy is mainly related to the difference between time-adjusted averages of metabolic rates of the single activities and the respective daily minimum suggesting the need for an adequate weighting for the metabolic rates, particularly if workers are at least temporarily exposed to air temperatures of more than 7-13 degrees C.
At industrial workplaces radiant heat load is often the dominant heat stress factor. Based on 900 climatic chamber experiments on humans, this study was conducted to develop a physiologically validated index-method to evaluate climates with intensified heat radiation. A comparison shows that the international recommended heat stress indices are not suitable to evaluate such climates correctly. By application of the new index-method into the commonly used indices, the improvement for the prediction of thermal stress effects in view of climates with increased heat radiation is discussed.
Six men wearing shorts performed treadmill work in about 150 climatic chamber experiments at several temperatures of Vernon's globe thermometer (tg) from 25 to 50 degrees C. Each tg was produced partly by an equal air temperature (ta) and a mean radiant temperature (MRT), partly by a lowered ta (minimum 5 degrees C) and an MRT elevated up to about 80 degrees C above the ta. With an increasing MRT and lowered ta, respectively, body temperature, heart rates, and sweat losses decreased significantly. In another 55 experiments physiologically equivalent combinations of ta and MRT were derived. According to the results a modified globe thermometer was built. It reduced the errors of Vernon's instrument by about 75%. The remaining error of 25% was due to changes in air velocity between 0.5 and 2 m.s-1. The applicability of simple instruments like globe thermometers is obviously limited for the description of physiologically equivalent conditions of unequal ta and MRT at various air velocities.