Brain potential amplitude varies as a function of Borna disease virus-specific immune complexes in obsessive-compulsive disorder.
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Adult↗
Biomedical subjects
D E Dietrich
Publications and source records attributed to D E Dietrich.
Lycanthropy--psychopathological and psychodynamical aspects.
OBJECTIVE: The imagination of being transformed into an animal or being an animal is called lycanthropy. The phenomenon is presented and psychodynamical aspects are discussed. METHOD: A literature review forms the base of this discussion of a psychopathological phenomenon. RESULTS: The lycanthropic symptomatology represents a spectrum of continuity of developmental and culture-dependent normal behaviour via partial forms to the complete picture of lycanthropy. It is observed in different mental disorders. CONCLUSION: Lycanthropy is interpreted by the authors as a delusion in the sense of the self-identity disorder defined by Scharfetter. It is mainly found in affective and schizophrenic disorders but can be a symptom of other psychiatric disorders as well. Psychodynamically this kind of delusion can be interpreted as an attempt to project suppressed affects, especially with aggressive or sexual content, into the figure of an animal. Psychotherapy and/or neuroleptic medication can be effective.
Delusions↗
Lamotrigine in the treatment of confusion psychosis. A case report.
We report on the successful treatment of four patients suffering from confusion psychosis according to the classification of Leonhard. The patients did not sufficiently respond to neuroleptic treatment or mood stabilizers like carbamazepine and valproate, but improved when lamotrigine was added, showing a marked reduction in clinical signs and symptoms. The implications of these findings including the possible mechanisms involved are discussed.
Adult↗
[Oxcarbazepine in the treatment of affective and schizoaffective disorders].
The therapeutic value of anticonvulsants in affective and schizoaffective disorders was documented in several clinical trials. Oxcarbazepine (OXC), a keto-derivative of carbamazepine, which appears to have a preferable side effect profile compared to carbamazepine, has also shown antimanic efficacy in affective and schizoaffective disorders in clinical studies since the early 80's, but was not further investigated regarding these indications. Therefore, the value of OXC in the treatment of affective and schizoaffective disorders requires evaluation. Literature was reviewed with regard to pharmacokinetic and pharmacodynamic characteristics of OXC, drug-drug interactions relevant in pharmacopsychiatry, and clinical effects in these disorders. According to the literature OXC is regarded effective in acute mania and appears to allow reduction of the neuroleptic medication required for the treatment of affective and schizoaffective disorders. In addition, it has a preferable pharmacokinetic profile with less severe side effects compared to other anticonvulsants and neuroleptics. Furthermore, it appears to be well tolerated if augmented to neuroleptics or antidepressants, since OXC does not interact substantially with the cytochrome P450-enzyme-system. However, despite promising effects of OXC, few clinical studies have been published in the last 16 years. We conclude that further studies should validate the antimanic efficacy of OXC and evaluate possible pharmacopsychiatric indications as well as limitations of this psychotropic compound.
Anticonvulsants↗
[Paranoia with late onset. Psychopathology and psychodynamics].
We report on a 70-year-old man who suffered from persecutory delusions during the last 20 years. During first visits, he showed neither cognitive impairment nor Schneiderian first rank symptoms. Inpatient and day clinic treatment as well as further outpatient therapy led to reintegration into social life and trusting relationships between the patient and the therapeutic team, although the persecutory delusions still persisted. During following years, symptoms of cognitive impairment increased gradually and neurological symptoms could be observed. We present a psychodynamic hypothesis regarding the reported psychopathology and discuss alternative diagnoses and pharmacological treatment.
Aged↗
Discrepant target detection and action monitoring in obsessive-compulsive disorder.
Obsessive-compulsive disorder (OCD) has been related to altered mechanisms of action monitoring and target detection, and it has been hypothesized that hyperactive striatal-cortical circuits constitute the underlying pathophysiology. This study used event-related brain potentials (ERPs) to explore this hypothesis. A choice reaction time experiment was carried out in a group of OCD patients and a normal comparison group. The P3b component of the ERP to targets was taken as an indicator of the target-evaluation process and the response-locked error-related negativity (ERN) served as an indicator of action monitoring. We hypothesized that the OCD group would show a shortened P3b latency and an amplitude-enhanced ERN. Consistent with our expectations, the P3b latency was shorter and the ERN amplitude was higher in the OCD group. Unexpectedly, we also observed a prolonged ERN latency in the OCD group and a more posterior topography of this component. The data provide partial support for the hypothesis of a hyperactive neural network in OCD. In addition the disorder must involve pathophysiological processes that are presumably related to other aspects of its complex and heterogeneous clinical hallmarks.
Adult↗
[Legal requirements for medical interventions in patients needing psychiatric treatment].
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Algorithms↗
Borna disease virus-specific circulating immune complexes, antigenemia, and free antibodies--the key marker triplet determining infection and prevailing in severe mood disorders.
Borna disease virus (BDV), a unique genetically highly conserved RNA virus (Bornaviridae; Mononegavirales), preferentially targets neurons of limbic structures causing behavioral abnormalities in animals. Markers and virus in patients with affective disorders and schizophrenia have raised worldwide interest. A persistent infection was suggestive from follow-up studies, but inconstant detectability weakened a possible linkage.This study for the first time discloses that detection gaps are caused by BDV-specific circulating immune complexes (CIC), and their interplay with free antibodies and plasma antigens (p40/p24). Screening 3000 sera each from human and equine patients over the past 4 years by new enzyme immunoassays (EIAs) revealed that BDV-CICs indicate 10 times higher infection rates (up to 30% in controls, up to 100% in patients) than did previous serology. Persistence of high amounts of CICs and plasma antigens correlates with severity of depression. Even BDV RNA could be detected in plasma samples with strong antigenemia. Our discovery not only explains the course of persistent infection, but offers novel easy-to-use diagnostic tools by which new insights into BDV-related etiopathogenesis of disease and epidemiology are possible.
Adult↗
[Lycanthropy-zooanthropism--discussion of a psychopathological phenomenon].
The belief to be transformed into an animal is named Lycanthropy. "Zooanthropismus" is the German equivalent. Three case reports raised the question how this phenomenon, in our cases to be transformed into a frog, a bee or a wolf/dog, can be interpreted in a psychopathological and diagnostic regard. Is it pathognomonic for a special disease? With the three case reports and a survey of the literature this paper deals with Lycanthropy trying to put this perhaps neglected topic back into the focus of psychiatric interest and place it in psychopathology.
Adult↗
[Clomethiazole as an adjuvant in the treatment of confusional psychosis].
We report on the successful treatment of two female patients with the clinical features of severe confusional psychosis. The clinical picture of these cases was characterized by lability of mood, disorientation, delusions, hallucinations, misidentification of persons, severe thought disorder and impaired memory. A 55-year old female inpatient suffered from a psychotic episode with the clinical features of confusional psychosis. Medical history showed three proceeding confusional psychotic episodes. In the second case a 32-year old female inpatient suffered from a severe postpartum psychosis with the clinical features of confusional psychosis. In this case there was no clinical history of psychotic episodes. After nonresponsive treatment with neuroleptics and mood-stabilizers, both responded rapidly to additional medication with clomethiazole within a week, exhibiting a marked reduction in clinical signs and symptoms. A brief review about this delirium-like psychosis and current knowledge of therapeutic strategies is presented. We discuss clomethiazole as a possible potential adjunct in the treatment of confusional psychoses.
Adult↗
Oxcarbazepine in affective and schizoaffective disorders.
Anticonvulsants have been successfully used in pharmacopsychiatry after their therapeutic value in affective and schizoaffective disorders had been documented in several clinical trials. As the authorities in several countries registered newer anticonvulsants with fewer side effects, their therapeutic value in psychiatric disorders was studied. Clinical studies from the early 80's onward have demonstrated the efficacy of oxcarbazepine (OCBZ), a keto derivative of carbamazepine, in treating mania in affective and schizoaffective disorders. In addition, OCBZ has a distinct pharmacokinetic profile concerning drug-drug interactions compared to carbamazepine and other anticonvulsants. Therefore, the value of OCBZ in the treatment of affective and schizoaffective disorders needs to be evaluated. We reviewed the literature with regard to pharmacokinetic and pharmacodynamic characteristics of OCBZ, drug-drug interactions relevant in pharmacopsychiatry, and the clinical effects of OCBZ in the treatment of patients with affective and schizoaffective disorders. According to the literature, OCBZ is regarded as effective in acute mania and appears to reduce the dosage of neuroleptics required for the treatment of affective and schizoaffective disorders. In addition, it has a preferable pharmacokinetic profile with less severe side effects compared to carbamazepine and neuroleptics. Furthermore, since OCBZ does not interact substantially with the cytochrome P450 enzyme system, co-administration with neuroleptics or antidepressants appears to be well tolerated in affective disorders. However, despite promising effects of OCBZ, few clinical studies have been published in the last 15 years. We conclude that further studies should validate the efficacy of OCBZ in treating mania and evaluate possible pharmacopsychiatric indications as well as limitations for this psychotropic compound.
Anticonvulsants↗
Differential effects of emotional content on event-related potentials in word recognition memory.
The aim of this study was to delineate the influence of the emotional content of stimuli to be remembered on the recognition performance of normal subjects by means of the event-related potential (ERP) technique. When words are presented repeatedly, brain responses to repeated and recognized items are characterized by a more positive waveform, referred to as "old/new effect". Words judged for their emotional connotation ("negative", "positive" and "neutral") were presented successively on a video monitor to subjects, who had the task to indicate whether a given word occurred for the first ("new") or second ("old") time within the list by pressing one of two buttons. For each word category, the ERPs of the old words were more positive compared to those of the new items from about 250 ms after stimulus. The old/new effect was significantly enhanced for the negative and positive items compared to the neutral stimuli between 450 and 650 ms after stimulus pointing to a significant influence of the emotional content of words on verbal memory processes. This paradigm appears to be feasible to investigate interactions of emotion and cognition in psychiatric patients.
Adult↗
Emotion/cognition-coupling in word recognition memory of depressive patients: an event-related potential study.
Depressive patients show deficits in memory functions. However, the underlying mechanisms remain unclear. Experiments with a special emphasis on the link between emotion and cognition appear challenging. The aim of this study is to investigate the influence of the emotional content of words on memory in non-medicated depressive patients (n=11) compared with a control group (n=11) utilizing event-related brain potentials (ERPs). In a continuous word recognition paradigm brain responses to repeated items are characterized by more positive waveforms of ERPs. This recognition effect ('old/new effect') has been shown to be sensitive to parameters relevant for memory processing. For the purpose of this ERP experiment visually presented words were classified into three different categories of emotional content. The ERPs for the correctly detected 'old' (repeated) words showed an increased positivity beginning approximately 250 ms post-stimulus, concurring with a good recognition performance. In addition, old/new effect and behavioral data were sensitive to words' different emotional connotations in the control group. In contrast, the depressive patients performed worse and showed no significant old/new effect. Nevertheless, their recognition performance was also enhanced by the emotional content. Furthermore, a differential effect of the emotional content on frontal ERPs was found between groups. In contrast to the control group, a reduced old/new effect indicates a reduced working memory capacity in the moderately depressed patients. This is suggested to be partially due to changes of the emotion/cognition coupling related to ruminations with preferably negative emotional connotation. However, the emotional content also affects recognition performance in the depressive patients.
Adult↗
Amantadine in depressive patients with Borna disease virus (BDV) infection: an open trial.
OBJECTIVE: Originally introduced into pharmacotherapy as an antiviral compound, amantadine was shown to also have multiple pharmacological eftfects on the central nervous system. In addition. only a few studies reported on certain antidepressive properties of amantadine. This effect was highlighted by the discovery of its antiviral effect on Borna disease virus (BDV), which is hypothesized to be an etiopathogenetic factor to subtypes of affective disorders. Therefore, the therapeutical use of amantadine in BDV-infected depressive patients was investigated. METHODS: In this open trial, amantadine was added to antidepressive and or mood-stabilizing compounds treating BDV-infected depressed patients (n = 25) with bipolar or major depressive disorders. Amantadine was given twice a day (100-300 mg/day) for a mean of 11 weeks. Antidepressive treatment response was measured on the Hamilton rating scale for depression (HAM-D) and/or with an operationalized diagnostic criteria system (OPCRIT: version 3.31). Virological response was measured by expression of BDV infection parameters in blood samples. RESULTS: The overall response rate of the amantadine augmentation in the BDV-infected patients with regard to depressive symptoms was 68% after a mean of 2.9 weeks of treatment. Bipolar I patients improved faster and did not show any following hypomania. In addition, the decrease of depression tended to correspond with the decrease in viral activity. CONCLUSION: Amantadine appears to show a remarkable antidepressive efficacy in BDV-infected depressive patients. The antidepressive effect in this open trial appeared to be comparable to standard antidepressives, possibly being a result of its antiviral effect against BDV as a potentially relevant etiopathogenetic factor in these disorders.
Adult↗
[Remembering, forgetting and depression. Time-conceptual implications of affective disorders].
As a consequence of reflections about the relevance of remembering and forgetting in psychiatric disorders, aspects of the psychopathology of the dimension of time in phenomenological psychiatry are represented. From the perspectives of research on consciousness, cognition and neurobiology of the temporal lobes with special emphasis on memory processes, the impact of time in depressive illness is investigated. Based on Freud's concept of "Todestrieb" (death-instinct) and "Nirvana-Prinzip" (nirvana-principle) with regard to the possible impact on a theory of forgetting--based on Michael Theunissens time-philosophical concept, which demonstrates coping of "dominance of time" i.e. intrusion of the past into the presence and the failure of these coping-processes in depressive patients--it is hypothesized, that "nirvana-energy" is a major constituent of processes for forgetting.
Humans↗
[Diagnostic steps in Alzheimer dementia before treatment with new antidimentives].
The dementia of the Alzheimer type (DAT) is a chronic neurodegenerative illness. It will continue to increase because of rising life expectancy in the industrialized countries. Apart from the physicians interest to treat, there is also an economically justified interest to reduce the disease progression in this group of patients. The main intention of the treating physicians is to keep their patients independent as long as possible. Up to now Alzheimer's disease can only be treated symptomatically. The verified diagnosis of DAT still depends on the neuropathological investigation of brain tissue. Therefore the clinical diagnosis of DAT during lifetime should be supported by chemical analysis of typical changes in the cerebrospinal fluid (CSF) at an early stage. Meanwhile, several therapeutics with proven effectiveness in clinical studies are certified for the symptomatic treatment of DAT. However, these therapeutics are still relatively expansive. Due to this fact the clinical diagnosis of DAT should be supported by clinical-chemical markers before the beginning of such a treatment. In this paper we present the diagnostic steps in dementia patients, who are examined in our departments. Patients suspicious of DAT always are asked for a spinal tap in addition to other diagnostic tools. In case of a typical clinical constellation, the exclusion of a primarily vascular dementia as well as the proof of decreased A beta 1-42 peptides and an increased tau protein in CSF we recommend the new drugs for DAT as meaningful and justified therapeutics to yield optimal treatment.
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Word recognition memory before and after successful treatment of depression.
One of the most frequent and neuropsychologically well investigated symptoms in depression is reduced memory capacity. In this study, we investigated the course of disease in 16 patients with moderate depression and Borna disease virus (BDV) infection. Recently, it could be shown that BDV infection might play an important role in the etiology of subtypes of depression. Amantadine treatment was used as an antidepressant and antiviral compound. In order to assess memory capacity, event-related potentials (ERPs) were evaluated in ten of sixteen patients in a continuous word recognition experiment using a series of emotionally neutral, positive or negative words. During the treatment period the patients' clinical condition improved significantly. ERPs showed a reduced old/new effect before and after treatment independent of the words' emotional content. These findings suggest a reduced memory capacity being relatively independent of clinical outcome and ability to use emotional connotations for memory mechanisms. However, a significant positive shift over frontal electrodes did occur, which was concomitant with the improvement of depression, suggesting evidence for changed frontal cortical activity.
Adult↗