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Biomedical subjects

F Tretter

Publications and source records attributed to F Tretter.

At least 19 recordsLinked to original sources
PubMed2007

[The brain-mind debate. Problems in the philosophy of science with regard to psychiatry].

The present interdisciplinary brain-mind debate with regard to neurobiology shows deficits in the criticism of methods and in the precision of language and argumentation. Simplifying localisations of psychic functions, insufficient explanations and over-interpretations in the sense of physical determinism are the consequence. This can be demonstrated in deficits of neurobiological theories of volitional action. Therefore, the current concept of man is less perturbed than is proposed by neurobiologists. For psychiatry besides the neurobiological approach also a separate way of building models seems to be useful if present theoretical psychology and systems science would be regarded. In particular, the systems science of natural systems offers new opportunities to bridge gaps between disciplines involved in the brain-mind debate.

Awareness↗
PubMed2006

Towards systemic theories in biological psychiatry.

Although still rather controversial, empirical data on the neurobiology of schizophrenia have reached a degree of complexity that makes it hard to obtain a coherent picture of the malfunctions of the brain in schizophrenia. Theoretical neuropsychiatry should therefore use the tools of theoretical sciences like cybernetics, informatics, computational neuroscience or systems science. The methodology of systems science permits the modeling of complex dynamic nonlinear systems. Such procedures might help us to understand brain functions and the disorders and actions of psychiatric drugs better.

Antipsychotic Agents↗
PubMed2006

Schizophrenia, neurobiology and the methodology of systemic modeling.

Progress in the pharmacological treatment of schizophrenia is dependent on the extent of our understanding of the brain as the basis of this disease. Detailed examination of neurobiological data shows that only a systemic approach will integrate this wealth of information. For this reason, the steps involved in model building should be clarified, as further progress will necessitate closer cooperation between neuropsychiatrists, neurobiologists and systems scientists.

Brain↗
PubMed2005

[Assessment of cost-benefit analysis in integration projects on drug addiction].

The purpose of this study is to make a cost-benefit-analysis for integration projects helping drug addicts and substitutes to reintegrate into society. The study is intended to contribute to a better allocation of resources under the trade-off-situation that only a limited number of integration projects can be realized due to budget limitations. This pilot study represents an economic evaluation of health activities on integration based on the example of study projects offered by Mudra e. V. As a result the study showed that the evaluated projects are economically advantageous during the investigated research period. Furthermore, the study contains a non-monetary analysis of intangible effects which shows significant improvements in quality of life. Although the results are substantial, further research is mandatory focussing on the economic benefits of integration projects.

Cost of Illness↗
PubMed2005

[A patient flow analysis within the Munich addiction treatment system--a pilot study].

BACKGROUND: The highest efficiency in addiction treatment is attributed to a multistage programme consisting of several intervention types (e. g., counselling, withdrawal, therapy, community adjustment) in a specific order. AIM: The pilot study described focuses on the interactions between treatment modalities (i. e. on the process quality) within the addiction treatment system in Munich and the broader environs. METHOD: In eleven institutions out of the several intervention types 452 persons were anonymously queried. The interview was conducted by means of a questionnaire, which gathered information about the sequence of interventions. RESULTS: The results suggest that the treatment sequences (i. e. the patient flow) investigated are consistent with the intended cooperation within the multistage treatment programme. Furthermore, the results also indicate that more than a quarter of the participants came sought treatment/counselling of their own initiative. Particularly interesting is the observation that the participating institutions rarely checked where "their" patients pursue aftercare/treatment follow-up upon completion of the prescribed programme. Regarding the actual referrals during the four week investigation period, relatively low referrals among the participants in the drop-in center were observed. CRITICISM: It remains doubtful whether the selected institutions are really representative of the different intervention types, because the participating institutions within an intervention type operate from diverse conceptual backgrounds. Furthermore, the sample size obtained was both small and contained a diverse number of participants per institution type. Therefore, whether or not the results can be generalized is questionable. CONCLUSION: Based on these results the BAS supports the deployment and legal establishment of case managers in the coordination of a patient's global treatment process. It is believed that this step would result in a more purposeful and economical treatment within the multistage addiction treatment programme.

Adolescent↗
PubMed2001

[Opiate dependent pregnant patients and mothers. What must be regarded in drug substitution and detoxification].

Substitution treatment with methadone, is a major addition to the therapeutic options available to opiate-dependent patients. In the case of opiate-dependent pregnant women and mothers with children, however, it brings other problems with it. Thus, for example, cases of methadone poisoning of children have become known. In part these are accidental, but some are a result of deliberate attempts on the part of mothers to quieten their children. The present report from an outpatient addiction service describes specific possibilities for treatment, and offers of organized help for this group of patients.

Ambulatory Care↗
PubMed2001

[Approaches to systematic analysis of addiction management].

The aim to calculate the functions of health care also considers the care system for addicts. The scientific basis of these intentions are organizational analyses, health economy and systems analysis. Those approaches however do not fit well into quality assessments of care systems for people with psychic problems. Especially the functions and the structure of the health care system for addicts are of considerable heterogeneity and complexity. These features represent a great methodological challenge for systems analysis. Already the causal analysis of essential parameters like the number of drug deaths depends on so many variables, so that it cannot be ascertained that any particular intervention has a specific definite effect on drug mortality. Besides, the waiting period for withdrawal facilities is determined by many factors. Hence, unique measures of addiction policies probably do not have essential effects. On the contrary, waiting periods of few days lead to a higher occurrence of drop-outs at detoxification programmes. For the future, in order to obtain quantitative functional analysis of the addiction care system research projects have to be designed based on a unification of the documentary systems which help to better understand the flow of patients.

Cause of Death↗
PubMed1999

Problems with psychodiagnostics at "environmental patients".

The classification of environmental illnesses (e.i.) as a somatic disease is related to several problems with regard to the proof of chemical agents causing the syndrome. Also the understanding of those disorders as a mental illness interferes with some problems. One problem is the fact that in literature there are some dozen different terms for e.i. Nobody knows if the various authors talk about the same group of patients or if there are subgroups of patients etc. Further on there are quite marked differences at the symptom profiles which have to be explained. For those reasons a more sophisticated measurement and analysis of symptoms of environmental patients is necessary. If e.i. is supposed to be a psychopathological phenomenon the peculiarities of the criteria of the various diagnostic categories must be carefully considered. For instance, the classification according to somatization disorders does not fit well into clinical experience and also therapeutically seems to be not very fruitful.

Diagnosis, Differential↗
PubMed1998

Forced opiate withdrawal under anaesthesia augments and prolongs the occurrence of withdrawal signs in rats.

A newly developed treatment for rapid detoxification of opiate addicts is the use of continuous naloxone/naltrexone administration under general anaesthesia. This method is now introduced in several European countries despite the fact that there is only spare evidence for its effectiveness. Here we report on the assessment of withdrawal symptoms in morphine-dependent rats which received continuous naloxone administration combined with barbiturate anaesthesia. Morphine-dependent rats were implanted with osmotic minipumps filled with either saline or naloxone (delivering 0.5 mg/kg per hour) under barbiturate anaesthesia (lasting for 8 h). Animals were tested daily for the occurrence of withdrawal signs for the subsequent 7 days. All signs of withdrawal which are frequently observed in rats undergoing morphine withdrawal such as body weight loss, diarrhea, writhing, teeth chattering and wet dog shakes were significantly augmented and observed over longer time periods in morphine-dependent animals treated continuously with naloxone versus rats receiving saline. The present study demonstrates that continuous naloxone treatment under anaesthesia worsen and prolongs the detoxification phase in rats. This conflicts with reported clinical observations, and strongly suggests a need for controlled clinical studies before this method enters the everyday clinical routine.

Anesthesia, General↗
PubMed1998

Clinical experience with antagonist-induced opiate withdrawal under anaesthesia.

AIMS: The study describes experience with antagonist-induced opiate withdrawal under anaesthesia in standard clinical conditions. DESIGN: The study was restricted to patients who had undergone failed withdrawal treatments with usual methods over the past months. No control group was used. SETTING AND PROCEDURE: The patients were selected after history-taking and examination. A multi-axial diagnosis was performed. They were then admitted to an inpatient treatment unit for addicted patients. On the second day they were put into neurological intensive care. There they were intubated, ventilated and anaesthetized with propofol for 6 hours. Shortly after induction of anaesthesia, naloxone and naltrexone were administered. A high amount of fluid was used to balance changes in water and electrolytes. After anaesthesia the patients were transferred back to the addiction ward and sedated with clonidine. The patients were then fully mobilized. On discharge 50 mg naltrexone were given daily. PARTICIPANTS: Eighty-eight patients were treated. They were long-term opiate users. Preference was given to methadone-substituted patients who were unable to rid themselves of methadone. MEASUREMENTS: The account given is based solely on clinical observations. FINDINGS: The first 14 patients were observed in detail and it is on them that this report is based. It was found that withdrawal from codeine and methadone can be shortened to approximately 2-3 days. No patient was in a condition to go home immediately after anaesthesia. Twelve patients showed significant symptoms on the day following anaesthesia. The majority of patients treated by this method will continue to suffer withdrawal symptoms for a few days after detoxification, after which time most can be treated in an outpatient setting. Dysfunction of the cardiovascular system, the lungs, the kidneys or other organs was not observed. Taking into account all the 88 patients, five had to stay in hospital for a longer period (up to 2 weeks) because of a prolonged withdrawal syndrome.

Anesthesia↗
PubMed1998

[Social ecology of the drug problem].

The intrinsic dynamics of addiction problems which--as it can be seen at the current Ecstacy epidemy--are growing, requires a more precise analytical consideration of macro social risk factors. In this case, different action programs of the society and also of the different youth subcultures have to be considered ("maximize": performance, consumption, fun etc.). A conclusive unimodal interpretation of these programs in our pluralistic society hardly helps to understand these phenomena. It is even so, that each of these subprograms represents a multiple risk factor for consumption of stimulants for increasing the performance as tranquilizers can be used to identify leisure time. Also social geographical factors should be considered at such analyses and of course economic aspects are of central interest. The complexity of analytical problems at the social sciences resulted in a reduction of interest during the last years. The boundary between journalistic texts and scientific texts devoted to social analysis of addiction is indistinct. Therefore, it seems to be reasonable, to turn down the level of sociological consideration of the drug problem onto the regional level: City-related rates of prevalence of consumption of illegal drugs are very helpful for understanding social risk factors of drug consumption. A pilot analysis of this issue is presented here.

Cross-Sectional Studies↗
PubMed1997

[The experiences of the Munich methadone outpatient clinics].

In 1994, two methadone outpatient treatment departments, providing a combined therapy of substitution and psychosocial care, were set up in Munich. Indication for treatment is established according to the guidelines for new treatment and diagnostic methods (NUB guidelines), focussing mainly on NUB 2.3, on account of the high psychiatric comorbidity. After 1 1/2 years a total of 102 addicts had received treatment. More than half of these patients were then hospitalized for detoxification. Substitution therapy enabled many of these patients to improve their work and home situations. A corresponding reduction in the use of drugs was also observed, especially in the case of opiates. The programme has therefore been successful similar to the results of the substitution study of Hamburg.

Adult↗