PubMed Health⌕ Search

Biomedical subjects

D Hell

Publications and source records attributed to D Hell.

At least 55 records · Page 3Linked to original sources
PubMed1999

[Scientific psychology in the works of Eugen Bleuler].

The name of Eugen Bleuler is usually known in the context of the definition and conceptualization of schizophrenic disorders. Main other topics, less known in literature, are alcoholism, forensic psychiatry and general psychological topics of meaning of consclousness, formation of motive and will. Bleulers point of view presents itself as an empirically-based and anti-philosophic one, definitely deterministic concerning the topic of human "freedom of will". Eugen Bleuler refers to an already (especially by Richard Semon) systematically developed theory called "mnemism" that he interpreted and applied to the psychological circumstances mentioned above. That theory of "mnemism", that can be most adequately described as a biogenetic-vitalistic theory, is assuming, that all organic life--independent of the possibility of a self-reflecting consciousness--is able to learn experiences made by analysis of environment and to pass it on following generations. Pattern of stimulus reactions are in the sense of this theory memorized and reactivated under similar situational circumstances by the psychological mode of association. The influence of psychoanalytical theories, especially the presumed importance of infantil sexuality, on Bleulers understanding of a medical psychology seems to fade over the years.

Germany↗
PubMed1998

Psilocybin induces schizophrenia-like psychosis in humans via a serotonin-2 agonist action.

Psilocybin, an indoleamine hallucinogen, produces a psychosis-like syndrome in humans that resembles first episodes of schizophrenia. In healthy human volunteers, the psychotomimetic effects of psilocybin were blocked dose-dependently by the serotonin-2A antagonist ketanserin or the atypical antipsychotic risperidone, but were increased by the dopamine antagonist and typical antipsychotic haloperidol. These data are consistent with animal studies and provide the first evidence in humans that psilocybin-induced psychosis is due to serotonin-2A receptor activation, independently of dopamine stimulation. Thus, serotonin-2A overactivity may be involved in the pathophysiology of schizophrenia and serotonin-2A antagonism may contribute to therapeutic effects of antipsychotics.

Adult↗
PubMed1998

[Ethics in psychiatry].

Psychiatric ethics are a part of general medical ethics. But there are some special ethic problems in psychiatry: The often especially intensive emotional relationship between patient and doctor, the need to make decisions for patients who have lost decisional capabilities, the question of involuntary treatment for patients who are dangerous to themselves or others and further some diagnostic and therapeutic difficulties.

Dangerous Behavior↗
PubMed1998

The speech analysis approach to determining onset of improvement under antidepressants.

In a study of 43 hospitalized depressive patients we investigated the course of recovery at a dense time resolution throughout the first two weeks of treatment. In addition to the assessment of the patients' psychopathology on the basis of HAMD and AMDP rating scales, speech recordings were carried out for each patient immediately before the psychiatric exploration. Our analyses yielded no evidence for a delayed onset of action of antidepressants. Onset of improvement occurred in the great majority of patients (79.1%) within the first 12 days of study, independently of the severity of depression at baseline. Early improvement was highly predictive of later outcome and could not be attributed to a few items, as score reductions were observed for virtually all HAMD items at very early stages of recovery. The analysis of the patients' speaking behavior and voice sound characteristics yielded in 62.8% of cases an essentially parallel development over time for the HAMD scores on the one hand, and acoustic variables on the other. In consequence, early improvement appears to have a biological background and is unlikely to be mainly attributable to the expectations of doctors and patients.

Adult↗
PubMed1998

[Parkinson syndrome and depression].

During the past decade investigators paid increasing attention to psychomotor retardation and "volitional inhibition" as central elements of thinking and action in depression. In line with this is an increasing appreciation of some striking clinical parallels between particular aspects of Parkinson's disease and psychomotor manifestations of melancholia. We provide an update of the clinical literature regarding diagnostic problems and phenomenology of depressive states in Parkinson's disease and review their relation to cognitive impairments in neuropsychological task performance. We emphasize that many divergent results in older studies concerning Parkinson's disease and depression can be explained by methodological differences and shortcomings. Although the genesis, course, and treatment responsiveness of depressions in Parkinson's disease are still only partially understood, consensus regarding frequency and symptom features is gradually beginning to grow. Recent studies have shown that the occurrence of moderate to severe depressive states meeting the DSM-III-R criteria for Major Depressive Episode in community-based populations of Parkinson's disease patients is considerably lower (less than 10%) than the results of previous studies had suggested. However, a substantial proportion of predominantly younger patients have less severe but clinically significant depressive symptoms. Depression in Parkinson's disease patients is frequently associated with cognitive impairment. The issue of complex relationships between depression and primary, disease-related cognitive dysfunction in Parkinson's disease patients is dealt with in greater detail.

Depressive Disorder↗
PubMed1998

[Sensation seeking--critical review of personality psychological concepts and its application].

The term "sensation seeking" is part of a self-contained theory on personality psychology. It is meant to denote a disposition--peculiar to a certain personality, probably genetically founded and correlating with biological, f. e. neuroendocrine measures--to explore one's social environment in order to find new and diversified stimuli. In their work, researchers mainly refer to Zuckerman's Sensation Seeking Scale in its fifth version (SSS-V), which distinguishes between four aspects of sensation seeking based on factor analysis of the 40 SSS-V-items. There is partly an overlapping of the phenomenon with impulsiveness and extraversion. Whereas application studies show inter alia links between sensation seeking and dangerous driving or dangerous sexual practices, data on the expression of this trait in addictive persons do not point to definitely consistent links. In forensic terms, there is on a link between "boredom susceptibility"--the inability to stand uneventful, monotonous situations--and "disinhibition"--a lack of control of impulses--figuring as subscales of the SSS-V, on the one hand, and hyperkinetic attention deficit syndromes and "disactualisation weakness", as described by Janzarik, on the other. At present, there is no German-language SSS-inventory in line with basal testing theory requirements. Because of the apparently different modi of sensation seeking influenced by other cultural traditions, such a scale must be basically adapted to the life-style in Western Europe.

Exploratory Behavior↗
PubMed1998

Familial brain wave patterns: study of a 12-sib family.

In the sense of a paradigm for the heritability of complex psychiatric disorders, we compared the brain wave patterns of a 12-sib family with those of 144 unrelated controls and with those of 14 pairs of monozygotic twins. Under constant experimental conditions, electroencephalogram (EEG) parameters generally displayed a broad range of inter-individual differences, but were also remarkably stable over time within each subject, thus suggesting that the variation of EEG parameters forms a continuous phenotypic range rather than discrete phenotype classes. The distributions of all EEG parameters were found to be unimodal but significantly different from a normal distribution. Although an unimodal distribution speaks in favor of a polygenic additive mode of inheritance, this may not necessarily be true. Our findings might reflect the fact that a symmetric environmental distribution is converted through the underlying genotypes' norm of reaction into an asymmetric phenotype distribution. On the other hand, the distributions of the power-related EEG parameters were not that clearly unimodal, and with a larger sample size a trimodal solution might have become significant. With respect to the between-sib EEG similarity, we found the empirically derived value to be approximately half that of the within-subject similarity at 14-day intervals and of the within-pair similarity of monozygotic twins. This finding confirmed earlier results on monozygotic twins brought up together and reared apart, concerning the estimated value of h2. All in all, the EEG paradigm has clearly demonstrated that the methods of quantitative genetics represent a powerful tool once phenotypes designed to assess the variation of a trait are based on dimensional quantities.

Action Potentials↗
PubMed1997

[Acute life threatening catatonia--clinical significance and therapeutic possibilities].

Malignant catatonia, associated with different somatic and psychiatric disorders, is a rare, life-threatening syndrome. Immediate recognition and adequate treatment are essential and may be life-saving. We describe a case of malignant catatonia and discuss the clinical implications. Additionally, we review the recent literature regarding epidemiology, nosology, current pathophysiological concepts, differential diagnosis, and treatment recommendations.

Adult↗
PubMed1997

Use of potentially abusive psychotropic substances in psychiatric inpatients.

A series of 417 consecutively admitted psychiatric inpatients were studied with regard to their use of potentially abusive psychotropic substances in the last 3 months preceding admission. In all patients face-to-face interviews were performed; in 354 of them urine specimens could also be tested. Alcohol and benzodiazepines belonged to the most frequently used substances followed by cannabis, opiates and cocaine. Barbiturates, hallucinogens and amphetamine derivatives were only exceptionally reported. The most important finding of the study is that every fifth patient regularly used "hard" drugs (opiates and/or cocaine), every fourth patient illegal drugs and every third patient alcohol. Substances were found in 54% of all urine specimens; methadone, opiates and cocaine were hardly found alone. For the latter substances excellent agreement was found between interview reports and urine exams. Excluding patients diagnosed as substance-use disorders, there were no statistically significant differences between schizophrenic, affective, neurotic/stress/somatoform and other disorders with regard to the use of "hard" drugs and illegal drugs. Regular substance use correlated with much worse psychosocial adjustment. Substance use has to be explored and considered in every individual psychiatric inpatient.

Adult↗
PubMed1997

Differential psychopathology and patterns of cerebral glucose utilisation produced by (S)- and (R)-ketamine in healthy volunteers using positron emission tomography (PET).

Until recently, racemic ketamine (S-ketamine/R-ketamine = 50:50) has been used to study NMDA receptor hypofunction in relation to pathophysiological models of schizophrenia. Ketamine given to normal humans in subanesthetic doses produces a model psychosis including both positive and negative symptoms of schizophrenia. More recently it has been shown that at subanesthetic doses the pure (S)- and (R)-ketamine enantiomeres interact differently with the NMDA and sigma receptor sites in human brain. It was found that (S)-ketamine binds with a 3-4 time higher affinity to the PCP binding site of the NMDA receptor than (R)-ketamine, and that at these concentrations (R)-ketamine interacts also weakly with the sigma receptor sites, where (S)-ketamine binds only negligibly. To further investigate the role of NMDA-receptor mediated neurotransmission in schizophrenic psychosis, the effects of pure (S)- and (R)-ketamine enantiomeres on brain energy metabolism in normal humans using positron emission tomography and [18F]fluorodeoxyglucose (FDG) are reported here. Psychotomimetic doses of (S)-ketamine increased cerebral metabolic rates of glucose (CMRglu) markedly in the frontal cortex including the anterior cingulate, parietal and left sensorimotor cortex, and in the thalamus. The metabolic changes in the frontal and left temporal cortex correlated with ego-disintegration and hallucinatory phenomena. Equimolar doses of (R)-ketamine tended to decrease CMRglu across brain regions and significantly suppressed CMRglu in the temporomedial cortex and left insula. (R)-ketamine did not produce psychotic symptoms, but a state of relaxation. The (S)-ketamine-induced metabolic hyperfrontality appears to parallel similar metabolic findings in acute psychotic schizophrenic patients and encourages further investigations of glutamatergic disturbances in schizophrenia.

Adult↗
PubMed1997

[The development of criminal psychology in the work of Eugen Bleuler].

The study refers to Eugen Bleuler's first systematic publications on "the natural born criminal" (1896) and his subsequent forensic-psychiatric expertise, written by Bleuler as Director of the psychiatric Department of Psychiatry of the University of Zurich ("Burghölzli"). It could be clearly shown that Bleuler was influenced by a deterministic understanding of human behaviour. He referred to the Anglo-American concept of "moral insanity" as a circumscribed defect of altruistic feelings despite other psychic functions being normal and tended to include this psychopathic deviation in psychiatry. Although this theoretic position remained unchanged, the elderly E. Beuler--under pragmatic points of view--accepted the traditional differentiation between mental illness in a narrower sense and "moral insanity" as a personality feature of most delinquents, falling under the responsibility of law and penal institutions. In his publications as emeritus (after 1927). Bleuler was influenced by the natural philosophic and vitalistic concept of the so-called "Minemism", which, however, still made him reject the postulate of "freedom of will".

Criminal Psychology↗
PubMed1997

[Psychoses (schizophrenias)].

We are speaking with E. Bleuler about the "group of schizophrenic disorders". We describe the different symptoms, varieties of life-long courses and possible predictors of outcome. Currently, patients with schizophrenic disorders are frequently treated in Switzerland as outpatients by primary care physicians. The vulnerability models allows the recognition of different pathogenetic factors and also the integration of various treatment modalities, like pharmacotherapy treatment, family treatment and psychotherapy.

Ambulatory Care↗
PubMed1997

[How quickly do the effects of sector division appear? The initial results of the companion research of the Zurich sector division project].

Dividing the delivery system of larger psychiatric hospitals into defined smaller catchment areas called sectors, implies a contribution to quality assurance. Continuous monitoring and evaluation of a period before and after this reorganisation, which took place in 1994 for the central region of Zürich (Psychiatric University Hospital), allows perception of expected and possible unexpected changes. All newly registered patients were recorded within a time span divided into five periods of six month five each, the last one covering the first six months after sectorisation. This design permits to answer the question as to how fast the intended changes after sectorisation occur, and also to control side effects. Results show that sectorisation resulted in a marked increase of registrations from the defined catchment area of each sector, and that the investigated institutions achieve attainment of the aim to effect a special selection of psychiatric patients characterised by considerable psycho-social deficits. The two sectors display differences in respect of socio-demographic characteristics of newly registered patients.

Ambulatory Care↗
PubMed1995

[Practice-oriented treatment of depression today].

The modern treatment methods which are relevant for everyday practice are summarized, and their application is discussed based on an integrative depression model. The biological and psychosocial therapeutic methods can be complementary, if the actual stage of illness is taken into consideration. An antidepressive medication is needed, especially in severe depressive episodes. The application of some simple rules can assist in the choice of antidepressive medication. But also the employment of sound principles for the psychosocial treatment of depressive patients is recommended.

Antidepressive Agents↗
PubMed1995

[100 years of conflict about schizophrenias].

A systematic concept of a homogeneous group of psychoses, which Eugen Bleuler subsequently termed "Schizophrenia", goes back to Emil Kraepelin initially, in fact it has not existed for more than 100 years. The dynamics inherent in its history show that it is advisable to make allowance for contemporary influences when arriving at conclusions on schizophrenia in our times. The article in question presents a brief review of the origins and the historic development of the concept of schizophrenia, and attempts to set the present-day "neo-kraepelian" re-assessment of schizophrenic disorders in a modifying historic context.

Germany↗
PubMed1993

[Treatment of schizophrenia in clinical practice].

Currently, patients with schizophrenia are frequently treated as outpatients by primary care physicians, both for prevention and during acute psychotic crises. Yet, this therapeutic approach is associated with several problems. This article offers relevant treatment guidelines based on current scientific knowledge and under the assumption of the vulnerability model. This model allows the recognition of different pathogenic factors and also the integration of various treatment modalities, like pharmacotherapy treatment, family treatment and supportive psychotherapy.

Antipsychotic Agents↗