Biomedical subjects

G Buchkremer

Publications and source records attributed to G Buchkremer.

At least 19 recordsLinked to original sources

PubMed2007

[A pilot project with clowns in psychiatric clinics].

BACKGROUND: This project examines whether visits of specially trained clinic clowns, as established in pediatrics, would also be useful in psychiatry. METHODS: We describe the effects of a 6-week phase with one clown visit per week in a ward for acutely ill geriatric patients. The patients and medical team were also questioned about their attitudes towards the clowns. RESULTS: We found more positive attitudes in patients after this phase. CONCLUSIONS: We interpret this result as an indication of positive effects and sufficient reason to initiate similar projects in the future.

Aged↗

PubMed2006

[Evidence-based psychotherapy of schizophrenic disorders].

In the past, treatment of schizophrenic disorders was limited to pharmacotherapy. Psychotherapy was not regarded as evidence-based. A number of randomised clinical trials have led to a different perspective during the last two decades. This paper highlights and discusses evidence-based strategies. In particular, cognitive behavioural therapy and family intervention have recently been recommended in evidence-based treatment guidelines. Additionally, psychoeducation and social skills training showed treatment effects. Psychotherapeutic treatment requires an individual case concept. Neuropsychological testing for cognitive deficits should be included in comprehensive assessment in order to avoid overstimulation and optimise rehabilitation. Major treatment goals are to reduce persistent symptoms and relapse rates.

Adult↗

PubMed2005

Stage-dependent BDNF serum concentrations in Alzheimer's disease.

Alzheimer's disease (AD) is characterized by cognitive decline and loss of neurons in specific brain regions. Recent findings have suggested an involvement of brain-derived neurotrophic factor (BDNF) in the pathogenesis of AD. BDNF is an endogenous protein involved in the maintenance of neuronal function, synaptic plasticity and structural integrity in the adult brain. To our knowledge, the present pilot study assessed for the first time BDNF serum and CSF concentrations in 30 patients with different stages of AD in comparison to 10 age-matched non-demendet controls. AD patients were divided in two groups according to their MMSE score: Group 1 (n = 15) in early stages with MMSE scores >or=21 (mean of 25.5) and Group 2 (n = 15) with more severe stages of dementia with MMSE scores <21 (mean of 13.3). As main results, we found in patients with early stages of probable AD significantly increased BDNF serum concentrations as compared to more severe stages of AD (p < 0.0001) and age-matched healthy controls (p = 0.028). BDNF serum values in all AD patients correlated significantly with MMSE scores (r = 0.486; p < 0.0001). Levels of BDNF were below the detection limit of the assay in unconcentrated CSF samples of AD patients and non-demendet controls.In summary, BDNF serum values are increased in early stages of Alzheimer's disease, which may reflect a compensatory repair mechanism in early neurodegeneration and could also contribute to increased degradation of beta-amyloid (Abeta). During the course of the disease, BDNF is decreasing, which correlates with the severity of dementia. The decrease of BDNF may constitute a lack of trophic support with an increase of Abeta accumulation and thus contribute to progressive degeneration of specific regions in the AD-affected brain. BDNF should be further evaluated as a candidate marker for clinical diagnosis and therapeutic monitoring in Alzheimer's disease.

Aged↗

PubMed2005

Diminished production of proinflammatory cytokines in patients with Alzheimer's disease.

Cerebral inflammation as well as systemic immunological alterations have been reported in Alzheimer's disease (AD). We examined the production of the proinflammatory cytokines interleukin-6, interleukin-12, interferon-gamma, and tumor necrosis factor-alpha in whole blood cell cultures of AD patients and age-matched controls. The production of all measured cytokines after mitogen stimulation is significantly decreased in the AD group compared to controls. The results reflect an attenuated secretory activity of monocytes/macrophages, but also of T-helper cells. The data sustain the assumption that a systemic, possibly age-related alteration of immune mechanisms may play a pathogenetic role in the development of AD.

Aged↗

PubMed2005

[Dementia as a primary symptom in late onset multiple sclerosis. Case series and review of the literature].

Cognitive impairment is meanwhile accepted as a well-known symptomatology affecting up to 60% of the patients even in the early disease course of multiple sclerosis (MS). After a longer duration the development of dementia is not unusual. However, cognitive dysfunction as the primary or only manifestation of MS is thought to be rare. We report on four elderly patients referred to the memory clinic of our psychiatric university hospital because of beginning dementia. All of them were found to have evidence of a chronic inflammatory CNS process compatible with the diagnosis of MS. At the beginning of their symptomatology all patients were older than 60 years . Just in one case, progressive gait disturbances beginning after cognitive decline contributed to restriction in the activities of daily living. Data of 239 cases of the literature were reviewed and revealed motor disturbances as the main initial symptom and often a primary progressive course with unfavourable prognosis in late onset MS. Until now dementia as the primary symptomatology has not been described in patients older than 60 years. Possibly MS as a differential diagnosis in dementia as well as cognitive impairment as an initial symptom of MS is under-recognized.

Age of Onset↗

PubMed2005

[Depression in Hashimoto's encephalopathy. Successful treatment of a severe depressive episode with a glucocorticoid as an add-on therapy].

Characteristic clinical findings of Hashimoto's encephalopathy (HE) are stroke-like episodes, epileptic seizures, myoclonus, psychosis, and progressive cognitive impairment. Diagnosis of HE is supported by elevated antithyroid antibodies, an abnormal EEG, and by good response to steroids. We report on a 74-year-old female patient with a severe depressive episode who showed no treatment response to citalopram 40 mg/day and venlafaxine 150 mg/day. Diagnostic examination revealed an abnormal EEG, elevated thyroid peroxidase antibodies (TPO-Ab), and older postinflammatory changes in thyroidal sonography. We diagnosed a depression in HE and began treatment with prednisolone 70 mg/day with stepwise dose reduction, continuing treatment with venlafaxine 150 mg/day. Within 4 weeks of treatment, the severe depressive episode disappeared as well as abnormal EEG. In addition, serum values of TPO-Ab decreased. In HE, depressive symptoms can possibly be seen in a subgroup of patients or in the early course of the disease. Diagnosis of HE should be included in diagnostic procedures in cases of therapy-refractory depression because of a good response of HE to steroids.

Aged↗

PubMed2005

CADASIL: underdiagnosed in psychiatric patients?

OBJECTIVE: Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is exclusively related to symptoms of the central nervous system. Retrospectively in up to 15% the initial presentation is psychiatric disturbances. In these cases the diagnosis often is delayed or missed. METHOD: Two cases of CADASIL diagnosed in a psychiatric hospital are presented. RESULTS: Both patients were admitted to the gerontopsychiatric department (one because of a suicidal attempt and a depressive episode, the other because of cognitive decline and progressive personal neglect). Brain magnetic resonance imaging (MRI) showed severe leukoencephalopathy in the absence of cardiovascular risk factors. In both cases, diagnosis of CADASIL was made by the identification of specific granular osmiophilic material in skin biopsies. CONCLUSION: Brain MRI should be performed in all cases of late onset of severe psychiatric symptoms. CADASIL should be considered as a possible differential diagnosis whenever a marked leukoencephalopathy is detectable. Diagnosis can be verified by taking a skin biopsy or by specific genetic testing.

Aged↗

PubMed2004

[Alzheimer's disease with secondary Parkinson's syndrome. Case report of a patient with dementia and Parkinson's syndrome after long-term occupational exposure to insecticides, herbicides, and pesticides].

This case report describes long-term occupational exposure to agricultural insecticides, herbicides, and pesticides as possible environmental risk factors of Alzheimer's disease (AD) and Parkinson's syndrome in a 59-year-old man. Initially the patient complained about disturbances in concentration, mnestic deficits, and problems finding words. In the further course of the disease, he developed Parkinson's syndrome with predominant hypokinesia and rigor in addition to mild-to-moderate dementia. Low levels of beta-amyloid 1-42 were found in the CSF. Electroencephalography showed left frontotemporal theta waves. Cranial MRI revealed general brain atrophy with a maximum biparietally. In cerebral positron emission tomography, general hypometabolism was found with maxima biparietally and left frontally. The possible differential diagnosis of AD and Parkinson's syndrome is discussed.

Agricultural Workers' Diseases↗

PubMed2003

[Neuroleptics--psychotherapy--psychiatric social work. In schizophrenia help is needed from many sides].

Schizophrenic disorders require a complex, multidimensional treatment strategy. Throughout the entire course of the illness, psychopharmacologic, psychotherapeutic and psychosocial therapeutic measures must be integrated within an overall management plan. Although treatment planning should be orientated to the needs and expectations of the patient, current therapeutic guidelines must also be taken into account. Management decisions are based on such central questions as the patient's ability to cope with the requirements of daily life, or the attitude to the illness of the patient and family members. Inpatient treatment concepts include, in addition to pharmacotherapy, a cognitive-behavioral therapeutic program. In the outpatient setting, the question as to supportive rehabilitation measures and social integration aids needs to be dealt with.

Antipsychotic Agents↗

PubMed2002

[Cerebral toxocariasis: a rare cause of cognitive disorders. A contribution to differential dementia diagnosis].

We report on a 65-year-old woman with depressive symptoms and cognitive deficits confirmed by psychometric tests. Routine blood tests, serology, EEG, and cranial computed tomography (CCT) being normal, the CSF revealed an eosinophilic reaction and a positive antibody titre against Toxocara canis. After treatment with two oral courses of albendazole, the eosinophils had disappeared, whereas the antibody titre had increased. One year later, the patient's cognitive symptoms had improved, and new antibodies against toxocara were seen in the peripheral blood. This increase in antibodies represents an expected immunological reaction to the increased exposition to toxocara antigen under effective therapy. The infection might go back to the patient's youth, when she was a shepherd for several years and in close contact to dogs. A review of the literature did not yield other reports of toxocara infections leading to cognitive or other psychiatric symptoms. Taking the toxocara infection as the cause of this patient's cognitive defects, we propose that lumbar punction becomes part of the diagnostic standard in differential diagnosis of dementia.

Aged↗

PubMed2002

[Effects of autogenic training in elderly patients].

Autogenic training (AT) is a widely available relaxation method with beneficial outcome on physiological and psychological functioning. In our study, we wanted to test the effects of an AT course in cognitively impaired, frail elderly. After a 3 month waiting period (control), AT courses (intervention) of 3 months duration were offered in 2 nursing homes. Thirty-two frail elderly took part in the study, 24 of them had a psychiatric diagnosis (mean age 82.1 +/- 7.2 years, CAMCOG 75.5 +/- 15.7, MMSE 23.3 +/- 4.3, HAMD 10.0 +/- 3.6, NOSGER 57.2 +/- 18.4, AT-SYM 32.9 +/- 17.6 points). Eight participants dropped out during the waiting period, 8 during the course. From the 16 participants, 15 (94%) were able to learn the AT according to subjective, 9 (54%) according to objective criteria. The ability to practice the AT successfully correlated with the CAMCOG (p = 0.001) and the NOSGER (p = 0.01) score. Participants with a dementia syndrome had major difficulties, whereas age, depressiveness, and number of complaints (AT-SYM) had no influence on the ability to learn the AT. There was no intervention effect, measured with the HAMD, NOSGER, AT-SYM and MMSE. In the pre-post comparison of training sessions, a significant improvement in general well being was found (p < 0.001). Mentally impaired, frail elderly participants are able to learn the AT. Cognitive impairment is disadvantageous for a successful participation.

Adaptation, Psychological↗

PubMed2001

[What is science-based psychotherapy? On the discussion of guidelines for psychotherapy research].

The scientific nature of psychotherapy can be defined by two partially interrelated criteria: validity of the theory underlying a therapy and efficacy or effectiveness of a therapy. To enhance the scientific basis of a psychotherapeutic approach, research is needed on therapeutic objectives, principles, and processes, measuring methods, process-outcome relationships, and efficacy and effectiveness of therapies. Determination of efficacy requires randomized clinical trials (RCT). The scientific basis must be seen as the continuous development of a psychotherapeutic approach. In contrast, the question of whether a psychotherapeutic approach is well established is dichotomous. In addition to scientific criteria, those deriving from mental health policy and economics are also important. This paper presents various approaches to ascertaining efficacy. According to the criteria of the American Psychological Association Task Force, to be "well-established," treatments for specific disorders must be shown efficacious in at least two independent randomized clinical trials. Although comparability is limited, we propose that psychotherapeutic research be conceptualized into phases, as in pharmacotherapeutic research.

Evidence-Based Medicine↗

PubMed2001

A statistical model for length of psychiatric in-patient treatment and an analysis of contributing factors.

OBJECTIVE: Direct illness costs in psychiatry are strongly related to the length of in-patient stay (LOS). Prior studies have shown that LOS depends upon many factors; however, there is no systematic work on their interrelation and relative contribution. METHOD: A detailed statistical analysis of the factors explaining LOS for n = 4,706 consecutive admissions (1994-97) to the psychiatric hospital of the University of Tübingen is presented. RESULTS: The distribution of LOS follows an exponential decay function, suggesting a hazard-based process. Cox regression indicates that the incidence of discharge and hence LOS is modulated by a number of illness-related and other factors, and their relationship is explored. CONCLUSION: While a linear model is commonly assumed, LOS in psychiatry is governed by a hazard-based process. As a tool in quality management, LOS data for psychiatric hospitals might be routinely analyzed and the effects of non-illness-related factors minimized.

Adolescent↗

PubMed2001

[Short- and medium-term outcome of outpatient treatment of alcohol dependent patients. A 6-, 18- and 36-month follow-up].

The aim of this study was to investigate the short- and medium-term outcome of alcohol dependent patients in Germany after a one-year outpatient treatment. For this purpose, a 6-, 18- and 36-month follow-up of 97 socially well adapted alcohol dependent patients treated between 1992 and 1997 at three "psychosocial advice center" run by the Diakonie Württemberg, Germany, was carried out. Based on the time period between treatment and follow-up, all 97 patients could be followed up for 6 months, 71 for 18 months, and 33 for 36 months. 83% of patients could be interviewed at 6 months, 80% at 18 months, and 78% at 36 months. The statistical analyses were based on the "intention to treat" model. All patients treated between 1992 and 1997 were included. Patients for whom no information was available were classified as relapsers. 6 months after the outpatient treatment 59% of patients were abstinent, 4% had lapsed and 37% were relapsers. At the 18- and 36-month follow-ups 61% of patients had been abstinent in the 6 months before the interview. 53% and 39% of patients respectively were continuously abstinent over the entire follow-up period of 18 and 36 months. Prognostic criteria for a relapse were regular completion of treatment (p < 0.001) and no prior detoxification or abstinence oriented treatment (p < 0.01). Patients without a partner showed a tendency towards higher relapse rates (p < 0.10). The results of this study indicate that an outpatient treatment program can be as effective as inpatient or combined inpatient/outpatient treatments, at least for some patients with good social integration.

Adult↗

PubMed2001

[Cognitive behavioral treatment of schizophrenia - ways towards differential indication].

Cognitive-behavioral treatment of schizophrenia is increasingly manifold and sophisticated. The empirical evidence for the efficacy with respect to relapse prevention is most convincing for family psychoeducation. Furthermore, treatment programs for patients and relatives could show efficacy in randomized controlled intervention studies. These programs are designed to improve the patients cooperation and medication compliance, to enhance skills to manage early signs of relapse and to give support in stress management. Work with relatives aims at easing the burden of care, improving the knowledge concerning the illness and enhancing the coping skills of the relatives. A randomized clinical trial of our group could show a significant reduction of the readmission rate by a combined patient and relative-focused intervention. Even five years after completion of therapy we observed a clinical meaningful effect. We found that a favorable prognosis and good social adaptation was a positive predictor of treatment success. However, further research should investigate differential effects in more detail. Symptom reduction is another important issue of cognitive-behavioral treatments. The cognitive therapy of persistent positive symptoms resistant to neuroleptic treatment has recently attracted attention. Three work groups in Great Britain could show independently that positive symptoms could be reduced significantly by strategies of cognitive-behavioral treatment. However, treatment strategies for the reduction of negative symptoms remain to be developed and evaluated. With respect to the implementation of the mentioned treatment strategies in the routine care there are several problems that will be outlined finally.

Clinical Trials as Topic↗

PubMed2000

Left prefrontal activation predicts therapeutic effects of repetitive transcranial magnetic stimulation (rTMS) in major depression.

There is evidence that repetitive transcranial magnetic stimulation (rTMS) applied to the prefrontal cortex has antidepressive properties. In the present study we evaluated the clinical status and the hemodynamic responses during mental work in the prefrontal cortex before therapeutic rTMS. Twelve patients diagnosed with major depression (DSM-IV) were randomized in a sham-controlled cross-over treatment protocol of 4 weeks' duration consisting of two periods of 5 days with rTMS separated by 9 days of no stimulation. rTMS (10 Hz) was applied to the left dorsolateral prefrontal cortex. Hemodynamic changes in the prefrontal cortex during mental work were evaluated by multi-site near-infrared spectroscopy (NIRS). Scores on the Hamilton Depression Rating Scale (HAMD) decreased significantly by -5.4 points after 5 days of active stimulation, whereas it did not change (+1.6 points) after sham stimulation. Absence of a task-related increase of total hemoglobin concentrations at the stimulation site (P<0.005), but not at other locations, before the first active rTMS significantly predicted the clinical response to active rTMS. Clinical benefits of rTMS are predicted by low local hemodynamic responses and support the idea of activation-dependent targeting of rTMS location.

Brain Mapping↗

PubMed2000

[Community psychiatric management of severely ill schizophrenic patients. An exemplary case study].

Psychiatric care for chronic schizophrenic patients has improved in recent years, but for severely ill patients, often with multiple comorbid psychiatric conditions and in great need of care, the situation remains unsatisfactory. Community-based psychiatric care is limited and psychiatric hospitals are now cutting back on inpatient care. The quality of care that chronically mentally ill patients receive at independent psychiatric nursing homes removed from population centers is undetermined, and many patients end up in asylums or homeless shelters unable to provide for their psychiatric needs. Neither a reliable way to assess the needs of these complicated patients nor a scientific basis for therapeutic intervention exists yet. The case study presented here illustrates an interdisciplinary approach to the care and treatment of a chronic schizophrenic patient with several comorbid conditions. Based on the individual needs of the patient and developed over the last 4 years, this approach had positive effects on the course and outcome of treatment and resulted in an impressive reduction of costs. The average annual number of days of hospitalization over a 3-year period was reduced from 206 to two and the total cost of care was reduced from US$70,000 annually to $8000. The results from this single case study are promising. Further investigation of the development and evaluation of highly individualized treatment plans for severely disturbed schizophrenic patients is warranted.

Case Management↗

PubMed2000

[Prognostic and therapeutic relevance of cognitive characteristics for the long-term course of schizophrenic illness following psychoeducational psychotherapeutic treatment].

In a prospective, randomized clinical trial cognitive characteristics of schizophrenic patients were examined as predictors of the efficacy of a psychoeducational psychotherapeutic intervention. The aim of this study was to select adequate cognitive predictors. The reduction of the selected cognitive deficits by means of a psychoeducational psychotherapy was measured. Additionally, the prophylactic effects of the improvement of cognitive deficits were examined. Predictors of the course of illness were basic cognitive deficits and metacognitive constructs of 106 schizophrenic outpatients. Additionally, the modification of the cognitive skills of these patients was taken into account. Relevant factors of the course of illness representing the therapeutic effect of the intervention were investigated within a five-year follow-up. By means of logistic regression analyses thought disorders (AMDP system) and idiosyncratic and fatalistic assumptions (KK-scale) were obtained as appropriate cognitive predictors of the long-term course of illness. Thought disorders and attentional deficits could not be improved significantly. Though, there was a correlation between the therapeutic improvement of idiosyncratic and fatalistic assumptions and the rehospitalization rate within the follow-up.

Adult↗