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C Wurthmann

Publications and source records attributed to C Wurthmann.

29 records · Page 2Linked to original sources
PubMed1995

[Interaction of therapeutic effects and side effects in drug therapy of generalized anxiety disorders with low dosage fluspirilene].

The present study was designed to investigate the interaction between therapeutic effects and side-effects in fluspirilene treatment of generalised anxiety disorders (GAD). 205 outpatients received in an open trial 1.5 mg fluspirilene per week for 6 weeks. Confirming previous reports of our study group fluspirilene demonstrated marked efficacy and was generally well tolerated. However, the main finding of our study is that side effects, although rare in fluspirilene treatment, predict an unfavourable clinical outcome. This phenomenon is integrated in a psychological model implying that when GAD patients are aware of side-effects this induces anxiety. Again anxiety gives rise to somatic symptoms, both interacting in a forward loop. In conclusion, our data suggest that in the sense of Heinrich (1988) fluspirilene treatment of GAD should be guided by paying attention to possible side effects.

Adolescent↗
PubMed1995

[Validity of the neuroethological model of obsessive-compulsive disorder].

In the aetiology and pathogenesis of obsessive-compulsive disorders (OCD) multiple factors play a role. Among biographic, genetic and behavioral factors, biological mechanisms seem to be of relevance. Some authors have proposed a neuroethiological model. This model implies a disconnection in neural circuits, linking prefrontal cortex, basal ganglia and thalamus. This review article addressed the question as to whether brain imaging studies support this theory. Conclusions drawn from these studies must be viewed cautiously because findings are not consistent and because of methodological limitations. The validity of a neuroethiological model in OCD seems questionable.

Basal Ganglia↗
PubMed1995

[Differential pharmacologic therapy of generalized anxiety disorders--results of a study with 30 individual case experiments].

In pharmacotherapy of generalized anxiety disorders (GAD) different psychopharmacological agents (neuroleptics, diazepines, antidepressants) proved to be effective. However, there is a lack of predictors of therapeutic response. The present study was designed to address this question in 30 patients with treatment refractory GAD (12 male, 18 female). Amitriptyline 30 mg/d, flupentixol 1.5 mg/d, clotiazepam 15 mg/d, and placebo were administered double-blind and randomly. Each agent was given 4 times for one week. To avoid carry-over effects, all treatment weeks were interrupted by one week's wash-out periods. Thus each single-case experiment comprised 31 weeks. Primary efficacy criterion was Hamilton total score at the end of each treatment week. Statistical analysis (U-test) showed that in 19 patients one agent was significantly (p < 0.05) superior to the other substances (clotiazepam n = 11, flupentixol n = 3, amitriptyline n = 5). Placebo was not superior in any of these 30 patients. There was no significant difference between the drugs in 11 patients. However, metaanalysis showed that in chronic GAD, by means of single-case experiments, differences in efficacy between different drugs can be found (p < 0.01). ANOVA showed no drug x time interaction.

Adult↗
PubMed1995

Randomized, double-blind, controlled trial of risperidone versus clozapine in patients with chronic schizophrenia.

This study compares the antipsychotic efficacy and the tolerability of risperidone and clozapine in patients with schizophrenia. Patients were randomized to double-blind treatment with risperidone, 4 mg (N = 20), risperidone, 8 mg (N = 19), or clozapine, 400 mg (N = 20), daily for 28 days. Efficacy was assessed by improvement of psychotic symptoms, measured on the Brief Psychiatric Rating Scale, and Clinical Global Impression. The tolerability was assessed by the Simpson and Angus scale for extrapyramidal side effects (EPS), the Association for Methodology and Documentation in Psychiatry (AMDP) scale for somatic side effects, spontaneous reports of adverse events, clinical laboratory assessments, and vital signs. All treatments reduced psychotic symptoms. The global tolerability was significantly better in the risperidone than in the clozapine-treated patients (p < 0.01). There were no differences between treatments on the AMDP scale. The most frequent spontaneously reported adverse effects were dizziness, fatigue, accommodation disturbance, and EPS in all treatment groups and increased salivation, mainly in the clozapine-treated patients. Although there were no changes in vital signs during risperidone treatment, clozapine was associated with a mean reduction in heart rate of 10 beats/minute. Risperidone tolerability at endpoint was classified as "very good" by 60 and 47% of patients treated with risperidone, 4 and 8 mg daily, respectively; the corresponding figure in clozapine-treated patients was 30%. The results suggest that risperidone is at least as effective as an antipsychotic as clozapine, providing a valuable new approach for the treatment of schizophrenia.

Adult↗
PubMed1992

[Morphological brain changes in senile depressions. A morphometric computed tomographic study].

The inner and outer cerebrovascular spaces visualized by CT were measured planimetrically in 34 patients (6 men, 28 women; mean age 70.7 years) with senile depression. The purpose was to ascertain whether computed tomography (CT) can detect morphological changes in the brain of patients with senile depression. Compared with a control group without evidence of neurological and psychiatric abnormalities (10 men; 33 women; mean age 70.8 years), there was an enlargement in the group with senile depression of the lateral ventricles (P less than 0.05), occipital sulci (P less than 0.05) and lateral sulci (P less than 0.01). There was no correlation with the duration of illness or the stage of depression. These findings point to the cerebral structural changes having already been present previously and argue against a progressive process of atrophy. In the case of senile psychiatric changes, cerebral morphological changes should be paid more attention, in addition to any results from research into psychosocial causes.

Aged↗
PubMed1992

[Possibilities in therapy of anxiety disorders in DSM-III-R].

Between 2% and 5% of the population are affected by anxiety disorders. Several studies have shown that imipramine possesses anti-panic and anti-phobic properties. Its response rate is at least 70%. In panic disorder with agoraphobia it is therefore the medication of first choice. Agoraphobia, simple and social phobias are highly responsive to behavioural therapy (desensitization, flooding, social skills training, cognitive restructuring). Drugs have not been found useful in controlled studies. In conjunction with the tricyclic antidepressant clomipramine, behavioural therapy is superior to other psychotherapeutic strategies in the treatment of obsessive-compulsive disorders. Patients suffering from posttraumatic stress disorders require first of all supportive psychotherapy. Pharmacological treatment is of limited value. Neuroleptics, benzodiazepines, sedating antidepressants and beta-blockers are the most appropriate agents for the treatment of generalised anxiety disorders. In addition to that, intense psychotherapy and relaxation techniques should be applied. Further research should address the question of relapse rates after termination of therapy and the elaboration of therapeutic strategies that take individual psychopathology into consideration.

Anxiety Disorders↗
PubMed1991

[Kleine-Levin syndrome].

The Kleine-Levin syndrome is generally considered to be a benign functional disorder of hypothalamic structures. Its onset is usually in adolescence. The most characteristic symptoms are periodic hypersomnia, excessive eating, hypersexuality, irritability and apathy. Associated features are depressive and schizophrenic symptoms. A biological relationship between the Klein-Levin syndrome and endogenous psychoses is discussed.

Adolescent↗
PubMed1991

[Kleine-Levin syndrome].

The Kleine-Levin syndrome is generally considered to be a benign functional disorder of hypothalamic structures. Its onset is usually in adolescence. The most characteristic symptoms are periodic hypersomnia, excessive eating, hypersexuality, irritability and apathy. Associated features are depressive and schizophrenic symptoms. A biological relationship between the Kleine-Levin syndrome and endogenous psychoses is discussed.

Disorders of Excessive Somnolence↗
PubMed1989

[Kleine-Levin syndrome. The provocation of manic symptoms by an antidepressant and a therapeutic trial of carbamazepine].

A 17-year-old adolescent had a recurrent episode of somnolence and morbid hunger (Kleine-Levin syndrome) three years after a first attack, from which he had spontaneously recovered. He was treated with 50 mg daily of clomipramine for the somnolence accompanied by disturbance of attention and memory. Under this treatment he developed thymoleptic symptoms with polyphagia, logorrhea and hyperactivity. Placed on a trial dose of at first 600 mg, then 400 mg carbamazepine daily the abnormal findings disappeared within a few days, and there has been no recurrence after some months. It is postulated, based on the observations of this case, that the Kleine-Levin syndrome, presumably a functional hypothalamic disorder, is closely related to the endogenous psychoses.

Adolescent↗
PubMed1987

[Brain substance deficit with paralimbic and limbic involvement in computerized tomography studies of schizophrenic patients].

In order to determine whether ventricular enlargement in schizophrenia is due to a general brain atrophy or to a more regionally confined reduction of brain tissue, in CT scans of 54 schizophrenics (ICD 9 295.0-6) and 54 controls matched for age and sex the size of all cortical sulci, the Silvian fissures, lateral, third and fourth ventricles were determined by blind planimetry. The left Silvian fissure was on several levels most enlarged (by 79-233%), followed by the right Silvian fissure (42-96%), the frontal parts of the interhemispheric fissure (84%), the left and right frontal sulci (40%, 46%), the VBR (32%), and the third ventricle (25%), whereas the parietal and occipital sulci and the fourth ventricle were not significantly altered. With the exception of one parameter, there was no correlation between any of the data and the duration of the illness. The data indicate that paralimbic and limbic structures of the anterior temporal lobe and of the parasagittal frontal cortex are most affected in schizophrenia. With respect to recent neuroanatomical and neurophysiological findings, an explanation is offered for the close association of some positive schizophrenic symptoms with limbic and paralimbic brain deficiency.

Adolescent↗