Biomedical subjects

Alexander Brunnauer

Publications and source records attributed to Alexander Brunnauer.

8 recordsLinked to original sources

PubMed2006

Antidepressants and driving ability: results from a clinical study.

OBJECTIVE: Psychomotor disturbances can frequently be found in depressed patients and may have an important influence on the ability to drive. Additionally, effects of sedation, as seen with some antidepressants, probably impair driving performance. The present study was designed to evaluate the effects of antidepressant monotherapy on psychomotor functions related to car-driving skills in depressive patients in a routine clinical setting. METHOD: Inpatients (N = 100) who met the ICD-10 and DSM-IV criteria for major depressive disorder were tested under steady-state plasma level conditions prior to being discharged to out-patient treatment. The study ran from January 2004 through March 2005. All patients participated voluntarily and gave informed consent. According to the German guidelines for road and traffic safety, data were collected with the computerized Act & React Testsystem ART-90 and the Wiener Testsystem, measuring visual perception, reaction time, selective attention, vigilance, and stress tolerance. Psychopathologic symptoms were rated with the Hamilton Rating Scale for Depression. RESULTS: Before discharge to outpatient treatment, 24% of the patients tested were without clinically relevant psychomotor disturbances. In 60% of the cases, mild to moderate impairments could be seen, and about 16% of the patients were considered as severely impaired in psychomotor functions related to car-driving abilities. Data show that patients treated with selective serotonin reuptake inhibitors (SSRIs) or the noradrenergic and specific serotonergic antidepressant (NaSSA) mirtazapine had an altogether better test performance in comparison with patients receiving tricyclic antidepressants (TCAs). Differences were most pronounced in measures of reactivity, stress tolerance, and selective attention. Statistically significant differences between patients treated with TCAs or the serotonin-norepinephrine reuptake inhibitor (SNRI) venlafaxine could not be found. Among the newer antidepressants there is an advantage for patients treated with mirtazapine, especially in tasks with high multi-channel perception and output demands. CONCLUSION: About 16% of depressive patients discharged from hospital to outpatient treatment must be considered unfit to drive. In 60% of the cases, patients performed at a questionable level of fitness for driving, and it seems justified to counsel patients individually, taking into account compensational factors. Data point to an advantage for patients treated with SSRIs or mirtazapine when compared with TCAs or venlafaxine. However, causal relationships cannot be drawn from our data.

Adult↗

PubMed2004

[Antipsychotics and memory functions in schizophrenic patients].

OBJECTIVE: The aim of this study was to evaluate the effects of antipsychotics on memory functions in schizophrenic patients under clinical routine conditions. METHOD: Schizophrenic patients (n = 111) before discharge to outpatient treatment were evaluated on verbal memory function. Data were analyzed according to pharmacological treatment controlling for age. RESULTS: We observed that treatment with atypical antipsychotics (n = 80) compared with conventional neuroleptics (n = 31) was significantly associated with a more favorable effect on memory function. In short-term- and working-memory and retention a clear advantage of atypical antipsychotics could be seen. CONCLUSIONS: Results from this study suggest that even under clinical routine conditions atypical antipsychotics have an advantage on memory function when compared with conventional antipsychotics.

Adult↗

PubMed2004

The impact of antipsychotics on psychomotor performance with regards to car driving skills.

Cognitive and psychomotor impairments are a core feature of most patients with schizophrenia and may have an important influence on driving ability. The present study investigated the effects of neuroleptic monotherapy on psychomotor functions related to car driving skills in schizophrenic patients. Consecutively admitted schizophrenic inpatients (n = 120) were tested under steady state plasma level conditions before discharge to outpatient treatment. Patients met the International Classification of Diseases, Tenth Revision criteria for schizophrenia. The study followed a naturalistic nonrandomized design. Data were collected with the computerized Act & React Testsystem and were analyzed according to medication, severity of illness, and age. Only 32.5% of the schizophrenic inpatients passed the tests without major impairments. Patients treated with atypical neuroleptics or clozapine showed a better test performance on skills related to driving ability when compared with patients on typical neuroleptics. Differences were most pronounced in measures of divided attention, stress tolerance, and attention. Data also suggest that treatment with clozapine had an overall positive impact on measures of reactivity and stress tolerance. These results show that even under steady state pharmacologic conditions psychomotor functions of most schizophrenic patients partly remitted must be considered as impaired. To evaluate these effects, a systematic neuropsychologic examination is recommended.

Adolescent↗

PubMed2003

[Antidepressants and Driving Ability]

OBJECTIVE: The aim of our study was to investigate the influence of antidepressants on psychomotor function related to car driving abilities. METHOD: Depressive inpatients (n = 64) were investigated under steady state plasma level conditions. Data were collected with the ART 90 (Act and React Testsystem) measuring visual perception, reactivity, stress tolerance, selective attention and vigilance and were analyzed according to medication, severity of illness and age. RESULTS: Only 23,8 % of the sample reached the criteria of at least 15 % of normal controls performance. We also observed that treatment with newer antidepressants (n = 31) was altogether associated with a better performance than treatment with tricyclics (n = 33). CONCLUSIONS: These findings have important implications for a systematic examination of driving ability in depressive patients and data show that newer antidepressants may have more salutary effects on psychomotor function than tricyclic antidepressants.

Journal Article↗

PubMed2003

[Neuroleptics and Cognition]

OBJECTIVE: The aim of this study was to evaluate the effects of atypical antipsychotics on cognitive function in schizophrenic patients under clinical routine conditions. METHOD: Schizophrenic patients (n = 78) were evaluated on neuropsychological tests of attention, short-term- and working memory, learning, long-term memory (retention) and executive function. Data were analyzed according to medication, severity of illness and age. RESULTS: We observed that treatment with atypical antipsychotics compared to conventional neuroleptics was significantly associated with a more favorable effect on cognitive function. Especially in short-term memory and retention a clear advantage of atypical antipsychotics could be seen. CONCLUSION: Results from this study suggest that even under clinical routine conditions atypical antipsychotics have an advantage on cognitive function when compared with conventional neuroleptics.

Journal Article↗

PubMed2003

Clinical and neurobiological effects of tianeptine and paroxetine in major depression.

Selective serotonin reuptake inhibitors (SSRIs) are widely used as effective pharmacological agents to treat depressive disorders. In contrast to the SSRIs, which block the presynaptic serotonin (5-HT) transporter and by this route increase the concentration of serotonin in the synaptic cleft, the antidepressant tianeptine enhances the presynaptic neuronal reuptake of 5-HT and thus decreases serotonergic neurotransmission. Both SSRIs and tianeptine are clinically effective; however, their opposite modes of action challenge the prevailing concepts on the need of enhancement of serotonergic neurotransmission. To better understand the differences between these two opposite pharmacological modes of action, we compared the changes induced by tianeptine and paroxetine on psychopathology, the hypothalamic-pituitary-adrenocortical (HPA) system, and cognitive functions in a double-blind, randomized, controlled trial including 44 depressed inpatients over a period of 42 days. Depressive symptomatology significantly improved in all efficacy measures, with no significant differences between tianeptine and paroxetine. There was a trend toward better response to the SSRI among women. Assessment of the HPA system showed marked hyperactivity before the beginning of treatment, which then normalized in most of the patients, without significant differences between the two antidepressants. Cognitive assessments showed no significant differences between the two drugs investigated. The results of the current study suggest that the initial effect, i.e., enhancement or decrease of 5-HT release, is only indirectly responsible for antidepressant efficacy, and they support the notion that downstream adaptations within and between nerve cells are crucial. The normalization of the HPA system as a common mode of action of different antidepressants seems to be of special interest.

Adult↗

PubMed2003

[Driving capacity and antidepressive drugs].

OBJECTIVE: The aim of our study was to investigate the influence of antidepressants on psychomotor function related to car driving abilities. METHOD: Depressive inpatients (n = 64) were investigated under steady state plasma level conditions. Data were collected with the ART 90 (Act and React Testsystem) measuring visual perception, reactivity, stress tolerance, selective attention and vigilance and were analyzed according to medication, severity of illness and age. RESULTS: Only 23.8% of the sample reached the criteria of at least 15% of normal controls performance. We also observed that treatment with newer antidepressants (n = 31) was altogether associated with a better performance than treatment with tricyclics (n = 33). CONCLUSIONS: These findings have important implications for a systematic examination of driving ability in depressive patients and data show that newer antidepressants may have more salutary effects on psychomotor function than tricyclic antidepressants.

Adult↗

PubMed2003

[Neuroleptics and cognition].

Adult↗