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Biomedical subjects

A Sonntag

Publications and source records attributed to A Sonntag.

At least 19 recordsLinked to original sources
PubMed2006

[Presenile dementia in memory clinics--incidence rates and clinical features].

This study describes the clinical features of presenile dementia diagnosed in memory clinics. It further gives an estimate of the declared incidence for the German city of Munich and surrounding counties. Twelve memory clinics in Switzerland and Germany were considered, among them all of the four in Munich. A total of 267 patients with onset of illness under the age of 65 were included. Only 16 patients (6%) were younger than 50. Men and women were affected about equally often. The most common cause of dementia was Alzheimer's disease (67%), followed by frontotemporal degeneration (13.5%) and vascular (5.6%) dementia. The declared incidence was estimated at 8.3 new cases of dementia per year among 100,000 persons in the 50-64 age range, with an incidence rate of Alzheimer's disease at 6.3/100,000. It can be concluded that memory clinics fulfill an important function in the care of patients with presenile dementia, since they are highly utilized by younger patients in early stages of the illness.

Adult↗
PubMed2006

Does the context matter? Utilization of sedative drugs in nursing homes--a multilevel analysis.

BACKGROUND: The aim of this study is to assess the utilization of sedative drugs in nursing homes by means of a multilevel approach taking into account individual as well as institutional characteristics. METHODS: A retrospective chart review of the drugs consumed in nursing homes in an urban region of Germany was conducted. Individual characteristics were measured by analyzing nursing home files, by staff assessment and by a structured interview conducted by trained psychologists and physicians. Institutional characteristics were assessed by interviewing the management of each facility and ward and by using a staff questionnaire survey. The sample consisted of 1903 residents from 27 nursing homes with a total of 96 wards. Data analysis was carried out by means of a multilevel analysis, a strategy for analyzing hierarchically structured data. RESULTS: The utilization of sedative drugs (low potency neuroleptics, anxiolytics, hypnotics) in nursing homes is remarkably high. Thus, 33.3 % of the residents used sedative drugs on a regular basis. PRN prescriptions existed for 13.1 % of the residents, 5.3 % had been using sedative medication prescribed as PRN. Results indicate the influence of individual as well as institutional characteristics on residents' sedative drug utilization. In particular, the use of PRN medicine is determined by characteristics of the ward the individuals are living in. CONCLUSION: Methodological implications: The data analysis concerning the drug utilization of residents of nursing homes requires multilevel models and a distinction between regular and PRN medicine. Further research should focus on explaining institutional variance. PRACTICAL IMPLICATIONS: Staff training in nonpharmacological strategies to manage disturbing behavior of residents is required.

Adult↗
PubMed2005

Depression during therapy with interferon alpha--how long should an antidepressant treatment last?

Although depressive symptoms are well-known side effects of interferon alpha (IFNalpha), it is uncertain if these symptoms decline with the cessation of IFNalpha therapy. We report on a 47-year-old man who, apart from former drug abuse, never had suffered from a psychiatric disorder. However, he had a family history burdened with the suicide of his mother and his twin sister. After a depressive symptomatology during the IFNalpha therapy, which had been tolerably treated by mirtazapine, he committed a suicide attempt six months after the parallel termination of IFNalpha and antidepressant treatment. Two aspects of this case report should be emphasised. First, patients with an increased risk for psychiatric complications of interferon therapy must be followed closely for a depressive symptomatology and treated aggressively if symptoms arise. Second, this case report shows the relapse of depressive symptoms far beyond the end of the interferon treatment. If an antidepressant treatment is necessary during IFNalpha therapy this should not be stopped prematurely with the termination of the interferon medication.

Antidepressive Agents, Tricyclic↗
PubMed2003

[Wishes of nursing home residents concerning their life situation--results of a qualitative study].

OBJECTIVE: This study examined the wishes of nursing home residents concerning their life situation in the nursing home. METHODS: Using a qualitative study design, a representative sample of nursing home residents (n = 1656) of 24 nursing homes in a city situated in the eastern part of Germany were interviewed. RESULTS: The analyses of residents' wishes lead to major domains such as the quality of care, interpersonal contact, architecture and organization of the house, diversification, financial support, as well as themes like health and death and the wish to leave the nursing home. Residents focus on an individualized approach to care. CONCLUSIONS: Nursing home residents' views support the need to improve the psychological and social aspects of the quality of care. Implications of and consequences for the organization of care and concepts of nursing are discussed.

Aged↗
PubMed2003

State markers of depression in sleep EEG: dependency on drug and gender in patients treated with tianeptine or paroxetine.

Tianeptine enhances while paroxetine inhibits serotonin reuptake into neurons; however, both show an antidepressive action. A subgroup of 38 depressed patients from a drug trial comparing the efficacy of tianeptine with that of paroxetine was studied with regard to their effects on sleep regulation, especially in relation to treatment response. We recorded sleep EEGs at day 7 and day 42 after the start of treatment with either compound, which allows measurement of changes due to the antidepressive medication in relation to the duration of treatment. Spectral analysis of the non-REM sleep EEG revealed a strong decline in the higher sigma frequency range (14-16 Hz) in male treatment responders independent of medication, whereas nonresponders did not show marked changes in this frequency range independent of gender. The patients receiving paroxetine showed less REM sleep and more intermittent wakefulness compared to the patients receiving tianeptine. REM density after 1 week of treatment was a predictor of treatment response in the whole sample. Psychopathological features with regard to the score in single items of the HAMD revealed predictive markers for response, some of which were opposite in the gender groups, especially those related to somatic anxiety. Changes in REM density were inversely correlated to the changes in HAMD in the paroxetine, but not the tianeptine, group. Our data suggest the importance of taking gender into account in the study of the biological effects of drugs. The study further points to the importance of the higher sigma frequency range in the sleep EEG of non-REM sleep and REM density as a marker of treatment response.

Adult↗
PubMed2003

Clinical outcome after trimipramine in patients with delusional depression - a pilot study.

The treatment of delusional depression is a major challenge in psychopharmacology. Hypothalamic-pituitary-adrenocortical (HPA) overdrive may contribute, via increased dopaminergic activity, to the pathophysiology of the disorder. Trimipramine appears to be an interesting potential candidate, since it is an atypical antidepressant that is known to inhibit HPA activity. In a four-week open trial we investigated its effects in 15 inpatients with delusional depression. The dosage was increased within 7 days up to 300 - 400 mg/d and was then maintained for three weeks. Psychometric assessments and safety monitoring were conducted weekly. Assessment of the HPA activity was achieved by a combined dexamethasone suppression/corticotropin-releasing hormone stimulation (Dex/CRH) test before and after four weeks of treatment. Therapeutic response was defined as a decrease in the HAMD-score of at least 50 %. Eight out of 13 completers were rated as responders. Therapeutic response was associated with L, D-trimipramine concentrations higher than 160 ng/ml. Intent-to-treat analysis showed significant improvement in psychometric variables. Despite the high dosage, the substance was generally well tolerated, with the exception of one patient who suffered from a hypotensive reaction. Mean +/- SD concentration of L-trimipramine and D-trimipramine were 138 +/- 61 ng/ml and 119 +/- 50 ng/ml at a final dose of 346 +/- 50 mg/d. The ACTH and cortisol area under the curve in the Dex/CRH tests decreased significantly, reflecting a decrease of activity in the HPA system. We suggest that the clinical use of high-dose trimipramine in delusional depression seems to be a promising treatment strategy.

Adult↗
PubMed2001

[Determinants of psychotropic drug utilization in homes for the elderly and in nursing homes].

A large proportion of the residential and nursing home population is mentally ill. The causes for increased prescription of psychotropic drugs other than mental disorders have been discussed. This study presents data on the role of the individual's characteristics and institutional conditions on psychotropic drug use in residents of residential and nursing homes. Therefore the psychotropic drug use of 4 old-people's homes in Leipzig (Germany) was reviewed. Sociodemographic characteristics and a number of behavioral patterns of the residents were examined. Regression analysis revealed associations of age, gender and certain behavioral patterns (e.g., agitation, insomnia with nightly disturbances) and psychotropic drug use. Beyond that, psychotropic drug use varied among the 4 institutions' practices. Further research should be aimed at gaining insight into the interplay of these individual and institutional influences on psychotropic drug use in order to develop specific interventions to optimize treatment.

Aged↗
PubMed2000

Involvement of CCK in the paraventricular nucleus of the hypothalamus in the CNS regulation of colonic motility.

The effects of cholecystokinin octapeptide (CCK(8)), the CCK-A receptor antagonist, MK-329, and the CCK-B receptor antagonist, L-365, 260, microinfused into the paraventricular nucleus of hypothalamus (PVN) on colonic motor function was investigated in awake rats, chronically implanted with a microinjection cannula into the PVN and a catheter into the proximal colon. In fasted rats, bilateral microinfusion of CCK(8) at doses of 1.5 and 3.0 microg/rat into the PVN stimulated colonic transit, as shown by a significant increase in the geometric center by 47 and 54%, respectively. This effect of CCK(8) was site-specific to the PVN, since microinjection of the peptide into sites outside of but adjacent to PVN had no effect. In non-fasted rats, L-365,260 bilaterally microinjected into the PVN at a dose of 1.5 microg/rat inhibited propulsive colonic motor function; colonic transit time significantly increased by 73% in comparison to the control condition. Microinfusion of the CCK-A antagonist into in the PVN did not affect colonic transit. These results show that the PVN is a responsive site for the central CCK(8)-induced modulation of colonic motility. The data suggest, that endogenous CCK in the paraventricular nucleus of the hypothalamus unfolds a stimulatory effect on colonic transit through action on CCK-B receptors.

Animals↗
PubMed1999

[Dependency of non-benzodiazepine hypnotics. Two case reports].

With the introduction of the non-benzodiazepine hypnotics zopiclone and zolpidem it was expected to have hypnotics without side effects and risks characteristically seen with benzodiazepines. We report two cases with high-dose usage and dependency of non-benzodiazepine hypnotics. Both patients were prescribed the drugs to treat sleep disturbances occurring during a depressive episode. While one patient had a polysubstance abuse there was no evidence for an abuse history in the other patient. To reduce withdrawal symptoms long-acting benzodiazepines were given to both patients. Thus, it seems that not only patients with a history of substance abuse but also patients with a psychiatric disorder are at risk for abuse of non-benzodiazepine hypnotics. Considering the increasing number of case reports with abuse and dependence of zopiclone and zolpidem it seems necessary to reevaluate the dependency risk of the currently available non-benzodiazepine hypnotics.

Adult↗
PubMed1996

Trimipramine and imipramine exert different effects on the sleep EEG and on nocturnal hormone secretion during treatment of major depression.

In a 4-week double-blind clinical trial we compared the effects of the tricyclic antidepressants trimipramine and imipramine on the sleep EEG and on nocturnal bormone secretion in 20 male inpatients with major depression. Both treatments produced rapid significant clinical improvement in depression without severe adverse effects. However, the two drugs had markedly different neurobiologic profiles. Trimipramine enhanced rapid eye movement (REM) sleep and slow wave sleep, whereas imipramine suppressed REM sleep and showed no effect on slow wave sleep. Total sleep time and the sleep efficiency index increased under trimipramine but not under imipramine. Nocturnal cortisol secretion decreased with trimipramine but remained unchanged with imipramine. In contrast to imipramine, trimipramine induced an increase in prolactin secretion compatible with its known antagonism at dopamine (D2) receptors. Imipramine induced a decrease in growth hormone secretion during the first half of the night. Neither of the drugs induced significant changes in plasma testosterone concentration. We conclude that trimipramine is an antidepressant with sleep-improving qualities that possibly acts through inhibition of hypothalamic-pituitary-adrenocortical system activity by a yet unknown mechanism.

Adult↗
PubMed1996

Protective effect of taurine on hypoxia and reoxygenation-induced damage of human colon cells (HT 29).

In this experimental model, taurine administered during hypoxia markedly reduced the cell damage due to O2 deficiency, and the beneficial effect outlasted the period of reoxygenation. The mechanisms for the improved survival rates are postulated to be a reduced osmoregulatory disturbance of cellular integrity, improved Ca2+ homeostasis and induction of accelerated cellular growth processes. In our simplified cell culture model the UW solution seems to be the most appropriate solution for the cold (hypoxic) preservation of human colon cells. We conclude, that within this experimental model and under these experimental conditions, taurine supplementation of the conventionally used preservation solutions improved the solutions markedly. Considering our previous studies, taurine seems to be a potent endogenous protective agent against cellular deterioration due to hypoxia and reoxygenation.

Adenosine↗
PubMed1996

[Determinations of MAG3 clearance according to the whole-body principle and to related methods].

To answer the question for the most effective use of all usually available information, the MAG3 clearance was determined by different methods: firstly in an optimated whole-body technique for reference, further for comparison by means of a camera background-curve and a dedicated evaluating procedure, and in addition according to the compartmental principle (Sapirstein), by the latter method also simultaneously together with the hippurate clearance. Two simplified methods were applied as well, a non-invasive one and a single-sample method. The results revealed the relatively unpretentious camera technique to be nearly equivalent to more expensive procedures, but qualitatively superior to those methods, which are unnecessarily oversimplified.

Humans↗
PubMed1994

Correlates of cognitive impairment and depressive mood disorder in multiple sclerosis.

The psychopathological status of 25 inpatients suffering from clinically definite multiple sclerosis (MS) according to Poser criteria was assessed by using standardized methods (Structured Clinical Interview for DSM-III-R, Inpatient Multidimensional Psychiatric Scale, Hamilton and Montgomery-Asberg Depression Rating Scales and the Structured Interview for the Diagnosis of Alzheimer Dementia and Dementias of other Aetiology (SIDAM). Magnetic resonance (MRT) (0.5 T; T2-weighted sequence) of the brain was analysed by measuring the ventricular brain ration (VBR), the area of the corpus callosum (CC) and the extension of hyperintense lesions of the brainstem, the temporal lobes and the brain at all. Six of 25 (24%) of these moderately disabled patients (mean Extended Disability Score (EDSS) 3.3) were diagnosed to suffer from depressive mood disorder (major depression or dysthymia); 2 were demented. In correlation analysis, depression was unrelated to age, gender, duration of illness, status of disability (EDSS) or the results of cognitive assessment. No relationship between the depression scores and the different MRT measures could be identified. The presence or absence of gadolinium enhancement was also uncorrelated to depressive symptoms. Fatigue as measured by the Fatigue Severity Scale was unrelated to depression or subcortical brain atrophy (increased VBR) but significantly correlated to the area of hyperintense MRT changes in brainstem and midbrain. Cognitive impairment (decreased SIDAM scores) was correlated to the total area of hyperintense MRT changes of the brain parenchyma. The type of clinical course (relapsing-remitting vs chronic progredient) was not found to influence the affective or cognitive state in our MS patient's sample.

Adult↗
PubMed1986

Subtypes of panic attacks and ICD-9 classification.

No single ICD-9 category corresponds to panic disorder (DSM-III). To investigate whether patients with panic attacks can be identified by means of ICD-9, 97 patients with three panic attacks within 3 weeks were recruited from various medical centers, and were classified independently according to DSM-III and ICD-9. The ICD-9 diagnoses were scattered over a broad range of categories, and it was impossible to identify patients with panic disorder in this manner. Anxiety state, affective psychosis, and depressive neurosis were the most frequent ICD-9 diagnoses. The boundary between affective psychosis on the one hand and anxiety state and depressive neurosis on the other hand was validated by present and previous symptomatology and by cluster analysis. The boundary between anxiety state and depressive neurosis could not be validated in this way. Correspondingly, modifications of the ICD-9 classifications are proposed.

Agoraphobia↗
PubMed1984

[Comparison of simple nuclear medical methods of determining renal clearance].

Comparative clearance determinations with a partially shielded whole-body counter, a shoulder probe, a gamma camera and also exclusively by use of the plasma activity concentration at 45 min p.i. revealed the following results: The partially shielded whole-body counter can be substituted by the shoulder probe without major loss of quality, provided that this is taken into consideration in the subsequent calculations. However, values below 250 ml/min may possibly be wrong, i.e. too high, when the camera background-curve is used for clearance determination. The very simple 45-min-clearance is recommended mostly as a method in addition or in reserve.

Humans↗