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Georg Kemmler

Publications and source records attributed to Georg Kemmler.

At least 55 records · Page 3Linked to original sources
PubMed2004

["How Nice that Someone is Interested in me for a Change"].

OBJECTIVE: To obtain indicators for the setup and further development of appropriate provisions for relatives of long-term schizophrenia patients in Tyrol (Austria), the quality of life of the main caring relatives of these patients was assessed and compared to that of a control group from the general population. In addition we were interested in identifying variables that may be useful predictors of the relatives' quality of life. METHOD: Fourty-four relatives of long-term schizophrenia patients and 90 controls of the general population were included in the study. To assess their quality of life we employed the generic questionnaire WHOQOL-100, complemented by own questions reflecting the special situation of the relatives. RESULTS: The quality of life of the relatives was significantly lower than that of the general population in almost all domains assessed. Fear of discrimination, concern about the care of the patient in later life and the feeling of a lack of security because of the patient correlated significantly with a reduced quality of life of the relative. Living in separate households went along with a higher quality of life of the relative. The association between the relatives' quality of life and their involvement in self-help groups or patient participation in social-psychiatric rehabilitation was unexpectedly low. CONCLUSIONS: The results of our investigation indicate in which domains there is a need to improve mental-health services and to develop and extend efforts of self-help groups in order to raise the quality of life of relatives of long-term schizophrenia patients.

Activities of Daily Living↗
PubMed2004

Schizophrenia: attitudes of patients and professional carers towards the illness and antipsychotic medication.

BACKGROUND: Non-compliance with antipsychotic medication is known to be one of the major reasons for relapse in patients with schizophrenia. Carers might be able to reduce noncompliance by enhancing the patient's knowledge about the illness and antipsychotic medication and by carrying out regular benefit/risk discussions concerning the treatment plan, thereby improving the patient's attitudes towards pharmacological treatment. METHODS: In this cross-sectional study we used a semistructured interview to investigate the attitudes towards the illness and antipsychotic medication of patients with schizophrenia and of medical and non-medical professionals involved in their treatment. An array of 24 outpatients with schizophrenia, 21 psychiatrists, 26 nurses and 42 non-medical health professionals were investigated. RESULTS: We found compliance in 54.2%, partial compliance in 8.3% and non-compliance in 37.5% of patients. More patients than carers judged other disorders like epilepsy and diabetes to be worse than schizophrenia. Patients stated more often, that they would not encourage a relative to take antipsychotic medication. An extent of 71.4% of psychiatrists and 35% of non-medical professionals reported a general willingness to take antipsychotic medication themselves, if they were to suffer from schizophrenia. CONCLUSIONS: Our results indicate that the attitude of carers is not only different from patients but also remarkably heterogeneous within the group of carers. This needs to be taken into account when planning compliance-enhancing measures.

Adult↗
PubMed2004

Normative data for functional assessment of cancer therapy--general scale and its use for the interpretation of quality of life scores in cancer survivors.

The aims of this study were to derive population-based reference values for the Functional Assessment of Cancer Therapy Scale-General (FACT-G) and to investigate the impact of sociodemographic variables (e.g. age, sex, health status) on these quality of life (QOL) scores, and to compare the normative QOL scores with those of various groups of cancer survivors. A random sample of 2 000 members of the Austrian public were sent questionnaires containing the FACT-G and questions relating to demographic data and health status. A total of 968 questionnaires were returned giving an overall response rate of 50.6% (females 48.3%, age 49.3 +/- 16.8). Subjects with higher education reported higher QOL values; divorced and widowed persons had significantly lower QOL scores. Higher age was also associated with lower QOL scores. After bone marrow transplantation, patients generally showed lower QOL scores than the age- and sex-matched population-based sample, whilst in breast cancer survivors there was reduced QOL regarding social well-being. Survivors of Hodgkin's disease were found to have higher functional and social well-being scores than those of the general population sample. Sociodemographic variables should always be taken into consideration when interpreting QOL scores. Furthermore, unless patient data are compared with normative values, phenomena such as adaptation and response shift might be missed or misinterpreted.

Adolescent↗
PubMed2004

Clock drawing, clock reading, clock setting, and judgment of clock faces in elderly people with dementia and depression.

OBJECTIVES: To assess patient performance on different clock tasks. DESIGN: Group comparisons. SETTING: A hospital-based memory clinic; inpatient and outpatient memory clinic. PARTICIPANTS: Patients with dementia (n=30), patients with depression (n=30), and healthy controls (n=30). MEASUREMENTS: General neuropsychological tests, clock drawing tests, and three additional clock tasks: clock reading, clock setting, and judgment of clock faces (each comprising 12 items). RESULTS: Demented patients differed significantly from the control and depression groups on all clock tasks; controls and depressed patients differed only in the clock-setting task. A comparison between tasks showed that clock setting was the most difficult, which differentiated best between diagnostic groups. Groups differed not only in overall performance scores, but also in error characteristics. CONCLUSION: Overall, study results indicate that clock setting is a sensitive task that may prove to be a valuable tool when screening for dementia.

Aged↗
PubMed2004

Quality of life of patients with chronic lymphocytic leukemia: results of a longitudinal investigation over 1 yr.

OBJECTIVES: The aim of this longitudinal study was to determine the long-term quality of life (QoL) of patients with chronic lymphocytic leukemia (CLL) and to investigate the relationship between QoL and sociodemographic and clinical parameters. METHODS: Ninety-seven patients suffering from CLL were asked to complete the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) four times over a period of 1 yr. Clinical data on disease and treatment characteristics were collected from medical records. For the purpose of comparison, EORTC QLQ-C30 scores were collected from 152 age- and gender-matched healthy controls. RESULTS: Seventy-six patients (age: median 68 yr, range 41-89) returned one or more questionnaires and were included in the statistical analysis. Compared with healthy controls CLL patients reported a lower QoL in almost all domains. No differences regarding QoL could be observed between CLL patients who had already received chemotherapy and those who had not. Moreover, female CLL patients were found to have remarkably lower QoL scores in the areas of emotional and social functioning than male patients. CONCLUSION: Patients suffering from CLL could have their QoL improved by more effective symptom management and psycho-oncological support. This could focus on specific symptoms such as fatigue and might have particular benefits for female patients with respect to their emotional and social well-being.

Aged↗
PubMed2004

Is higher income and educational status associated with poorer outcome in patients with Hodgkin's disease?

OBJECTIVES: The aim of the study was to determine the impact of socioeconomic status on relapse-free survival (RFS) in patients with Hodgkin's disease. METHODS: A number of factors were analyzed for their impact on relapse-free and overall survival in Hodgkin's disease using Cox regression. These factors included socioeconomic status (as defined by education and income), different treatment modalities and established clinical risk factors [e.g. age at diagnosis, stage of disease, involvement of three or more lymph nodes, presence or absence of a large mediastinal mass, E stages or elevation of erythrocyte sedimentation rate (ESR)]. The study used an initial sample of 126 patients recruited between 1969 and 1995 and a larger sample of 218 patients (recruited until 2002). Clinical data on disease and treatment characteristics were collected from medical records. RESULTS: In a univariate analysis, the following parameters had impact on RFS: treatment modality (combined treatment resulted in an improved RFS compared with patients treated with chemo- or radiotherapy alone), educational status and income. The 5- and 10-yr relapse-free survival rates were found to increase with decreasing educational level and decreasing average income per month. These results were significant in the initial and total samples and were also significant using multivariate analysis (hazard ratio for highest vs. lowest education group: 5.88; 95% confidence interval 1.87-18.52; for highest vs. lowest income group: 4.36; 95% confidence interval 1.35-14.05). CONCLUSION: Hodgkin's disease appears to be a striking exception from the usual positive correlation between high socioeconomic status and favorable treatment outcome in patients suffering from tumor. It is suggested that future studies on tumor genetics and biology and more detailed analysis of further socioeconomic parameters may be useful in clarifying this observation.

Adult↗
PubMed2004

Subjective effects of slow-release bupropion versus caffeine as determined in a quasi-naturalistic setting.

Bupropion (BUP), which in its slow-release formulation (Zyban) is used as a smoking-cessation drug, increases dopamine overflow in the nucleus accumbens and serves as a reinforcer in animal experiments, both suggesting that BUP may possess some abuse liability. The present study examined if BUP produced subjective effects indicative of abuse liability in a quasi-naturalistic setting, with caffeine (CAF) serving as a positive control. In a randomized double-blind crossover design, male smokers (n = 50) ingested two doses (interdosing interval, 6 h) of placebo (PLC), 178 mg CAF, or 150 mg slow-release BUP in their normal mid-week work environment. They completed questionnaires administered by telephone at regular intervals. CAF significantly increased ratings of 'pleasant effects' (p = 0.008) and 'high' (p = 0.03), whereas BUP produced a 'high' of only very moderate size (p = 0.02). In 3 subjects each, BUP or CAF produced ratings of 'pleasant effects' that were >9-fold higher than those for PLC. Finally, BUP increased the number of cigarettes smoked by 29% (i.e., from 24 to 31 per day; p = 0.004) only in those subjects who were unable to report any effect of either BUP or CAF. CAF had no effect on cigarette consumption. These findings suggest that BUP, like CAF, might be of some abuse liability in a small subgroup of smokers (i.e., 6% each of the present sample), and it may transiently increase, rather than decrease, smoking during early phases of treatment in continuing smokers.

Adolescent↗
PubMed2004

No deterioration of cognitive performance in an aggressive unilateral and bilateral antidepressant rTMS add-on trial.

BACKGROUND: Cognitive functions were assessed before and following a course of repetitive transcranial magnetic stimulation (rTMS) in patients with depression participating in a sham-controlled, randomized trial of rTMS as adjunct to antidepressant treatment. METHOD: Forty-one medicated inpatients with a DSM-IV diagnosis of a depressive episode were consecutively randomly assigned to 1 of 3 groups comparing 2 active rTMS conditions with sham stimulation. The rTMS was applied either at high frequency over the left dorsolateral-prefrontal cortex (DLPFC) (10 sessions x 10 trains x 10 seconds 20 Hz at 100% motor threshold [MT], 90-second intertrain interval) or in a combined high- and low-frequency manner to the left and right DLPFC, respectively (10 sessions x 1 train x 10 minutes at 120% MT). Thirty-eight patients completed a neuropsychological test battery at baseline and following day 14. The cognitive assessment focused on motor skills, attention, executive functions, learning, and memory. Data were collected from November 1999 to August 2002. RESULTS: Active treatment groups did not differ with respect to assessed cognitive measures and thus were pooled. A comparison of short-term changes (baseline-day 14) in neuropsychological performance revealed a more favorable time course of the actively treated patients for encoding in the verbal memory test compared with the sham-stimulated patients. CONCLUSIONS: Unilateral rTMS as well as bilateral combined rTMS revealed no detrimental effects on cognition, as compared with the sham group. Moreover, neither the add-on design nor the used aggressive parameters had a negative impact on cognitive measures in comparison with sham. Repetitive transcranial magnetic stimulation might have mild beneficial cognitive effects partly independent of its antidepressant efficacy.

Adult↗
PubMed2004

Compliance in schizophrenia: psychopathology, side effects, and patients' attitudes toward the illness and medication.

OBJECTIVE: In a cross-sectional study, we investigated the influence of several factors on compliance in schizophrenia outpatients, including patients' attitudes toward the illness and medication, specifically antipsychotic medication; adverse effects; and attitudes of caregivers and relatives toward the illness and medication. METHOD: Patients suffering from schizophrenia (ICD-10 diagnosis) of at least 1-year's duration whose discharge from an inpatient ward was at least 6 weeks prior to inclusion in the study were investigated. Study instruments included a semi-structured compliance interview, the Positive and Negative Syndrome Scale, the Udvalg for Klinske Undersogelser Side Effect Rating Scale, the St. Hans Rating Scale, and the Hillside Akathisia Scale. Data were collected from May 1998 to December 2001. RESULTS: 52.5% (N = 32) of the 61 investigated patients were fully compliant, 39.3% (N = 24) were partially compliant, and only 8.2% (N = 5) were noncompliant. We found positive correlations between compliance and the patients' feelings of a positive effect of the drug on the illness, between compliance and negative symptoms, and between compliance and antipsychotic-induced psychological side effects. CONCLUSION: Our findings reemphasize the importance of taking subjective attitudes and concerns of patients with respect to their illness and medication seriously. Therefore, it is indispensable to include patients and, if possible, their relatives in the treatment decision process to enhance medication compliance in schizophrenia patients.

Adult↗
PubMed2004

Quality of life in schizophrenia: the impact of psychopathology, attitude toward medication, and side effects.

BACKGROUND: Quality of life (QOL) is now seen as a key outcome variable in schizophrenia. Factors deemed relevant in this context include severity of symptoms, antipsychotic-induced side effects, sociodemographic variables, and patients' subjective response to medication. METHOD: In the current cross-sectional study, 80 patients with a schizophrenic disorder according to ICD-10 criteria who had a duration of illness over 1 year and whose discharge from an inpatient unit had been at least 6 weeks earlier were investigated. Apart from the registration of demographic data, various rating scales were used: the Positive and Negative Syndrome Scale (PANSS), the St. Hans Rating Scale for Extrapy-ramidal Syndromes, the UKU Side Effect Rating Scale, the Drug Attitude Inventory, and the Lancashire Quality of Life Profile. RESULTS: More than half of all patients (47/80) indicated that they were satisfied with their life in general. The specific areas of subjective dissatisfaction that were most commonly noted in the present sample concerned partnership and mental health. The depression/anxiety component of the PANSS, parkinsonism, and a negative attitude toward antipsychotic medication negatively influenced the patients' QOL, while cognitive symptoms and employment status correlated with higher QOL. CONCLUSION: Our results highlight the importance of recognizing the complex nature of QOL in schizophrenia patients. They suggest that special attention should be paid to patients who experience anxiety and depressive symptoms or parkinsonism, to those who are unemployed, and to those with negative feelings and attitudes toward antipsychotics.

Antipsychotic Agents↗
PubMed2003

Brain activation patterns during a selective attention test-a functional MRI study in healthy volunteers and patients with schizophrenia.

Functional magnetic resonance imaging was used to compare cortical activation patterns in healthy volunteers with those in patients with schizophrenia during a modified verbal Stroop task. Healthy subjects (n=13) and patients with schizophrenia (n=13) on stable antipsychotic treatment, matched on demographic variables, were included. Patients were preselected on the basis of good performance on a selective attention test. Patients with schizophrenia showed a significantly increased pattern of activation in the left and right inferior frontal cortex and the anterior cingulate cortex. A significant negative correlation between activation of the left prefrontal cortex and accuracy in the modified Stroop test was observed for healthy controls but not schizophrenia patients. Although both groups recruited the prefrontal cortex during the modified Stroop task, for the schizophrenia patients this activation was bilateral, whereas for the controls this activation was primarily in the left hemisphere, suggesting that patients with schizophrenia recruited more prefrontal regions to perform the task with the same accuracy as healthy controls. Our findings of increased activity across multiple areas of the brain, including dorsolateral frontal cortex and anterior cingulate, in patients with schizophrenia who perform relatively well on a task of selective attention give further evidence that task performance may be a confounding factor in the interpretation of neuroimaging results.

Adult↗
PubMed2003

Fatigue in ovarian carcinoma patients: a neglected issue?

BACKGROUND: Although fatigue is a commonly reported symptom in cancer patients it is rarely investigated, especially in patients with ovarian carcinoma. The main focus of the current study was to assess fatigue in these patients and to investigate the impact of fatigue and other clinical and psychosocial variables on their quality of life (QOL). METHODS: Ninety-eight ovarian carcinoma survivors (average age of 57.4 +/- 12.5 years) were included in the study. All women had received cancer therapy but had not been treated for at least 6 months. The average time elapsed since first diagnosis was 5.7 +/- 5.5 years. Fatigue was measured with the Multidimensional Fatigue Inventory (MFI-20) and QOL was measured with the Functional Assessment of Cancer Therapy (FACT)-ovarian carcinoma part and the European Organization for Research and Treatment of Cancer Care Questionnaire, including the ovarian carcinoma module. RESULTS: Thirty-two of 98 ovarian carcinoma patients (32.7%, 95% confidence interval, 23.5-42.9%) reported MFI-20 General Fatigue scores >/= 12.0 and therefore could be characterized as suffering from fatigue. This group of patients had a significantly lower QOL, had higher scores of anxiety and depression, and perceived that they had less social support. In a multiple regression model, mental adjustment, social support, anxiety, and depression as well as fatigue were significant predictors of QOL (FACT-generic part total score) whereas clinical and sociodemographic variables were not. CONCLUSION: A remarkably high proportion of ovarian carcinoma survivors suffered from fatigue. Because this symptom is a key predictor of QOL, it should be given more attention in aftercare programs.

Adult↗
PubMed2003

Placebo or active control trials of antipsychotic drugs?

The placebo-controlled trial has been the standard method to demonstrate efficacy and safety of antipsychotic drugs. We reviewed the scientific and ethical advantages and disadvantages of the placebo-controlled trial and an alternative method, the active-control trial, focusing more specifically on the active-control noninferiority trial. Recent meta-analyses indicate that a therapeutic dose of second-generation antipsychotic will very likely be statistically superior to placebo in an adequate trial, and that the average improvement of schizophrenia symptoms in a placebo arm will be small. These findings strengthen the scientific and ethical justification for the active-control noninferiority trial. New drugs in the pharmacotherapy for schizophrenia are often claimed to differ from their marketed competitors in their safety profile rather than in antipsychotic efficacy. Thus, in many cases, it appears sufficient to demonstrate mere noninferiority (rather than superiority) of antipsychotic efficacy in comparison with a standard antipsychotic. The active-control noninferiority trial is suitable for such demonstration. Sample size requirements for various equivalence margins in noninferiority trials are provided. Scientific and ethical arguments should lead to a more frequent use of the active-control noninferiority trial design.

Antipsychotic Agents↗
PubMed2003

Alcohol and/or benzodiazepine use in injured road users.

Blood samples of all patients (269) involved in a traffic accident and admitted to the Emergency Room of the University Hospital of Trauma Surgery in Innsbruck were analysed for alcohol and benzodiazepines. The large majority were drivers (55%) followed by passengers (19.7%), cyclists (12.6%) and pedestrians (12.3%). Alcohol was obviously the most commonly found drug in all groups (drivers: 36.9%; passengers: 15.1%; cyclists: 29.4%; pedestrians: 18.2%), with a mean BAC (blood alcohol concentration) high above the legal limit at the time of the study in Austria of 0.8 g/l (drivers: 1.49 +/- 54 g/l; passengers: 1.52 +/- 71 g/l; cyclists: 1.72 +/- 51 g/l; pedestrians: 1.67 +/- 25 g/l). The percentage of alcohol users was highest in drivers. Concerning BAC levels no significant differences were found between the groups. The most commonly detected benzodiazepine was diazepam. Benzodiazepine consumption (drivers: 8.1%; passengers: 5.7%; cyclists: 8.8%; pedestrians: 3%) as well as plasma levels (drivers: 68.7 +/- 62.6 microg/l; passengers: 61.0 +/- 69.3 microg/l; cyclists: 135.7 +/- 118.3 microg/l; pedestrians: 18 microg/l) were nearly equal in all groups. Concerning alcohol or benzodiazepine use, females showed lower frequencies of both alcohol and benzodiazepine positive blood samples. The frequency of alcohol use was higher in patients <or= 60 years of age.

Accidents, Traffic↗
PubMed2003

The safety of clozapine in the treatment of first- and multiple-episode patients with treatment-resistant schizophrenia.

The importance of antipsychotics in the treatment of schizophrenia has been documented in numerous clinical trials. In addition to its established superiority over other antipsychotics in treatment-resistant patients, clozapine has been consistently shown to improve psychopathology and other psychosocial outcome variables in patients with schizophrenia. To determine whether the course of the illness has an influence on response and side-effects to clozapine, we directly contrasted first- and multiple-episode patients with schizophrenia, who had histories of failing response to traditional antipsychotics, during the acute treatment phase. Thirty-nine first-episode patients with schizophrenia and 56 patients who had suffered from at least two episodes of this illness were investigated. Severity of illness and clinical improvement were rated by means of the CGI Scale. Vital signs were recorded weekly. Side-effects were regularly assessed with the UKU Side Effect Rating Scale. Compliance was regularly assessed by clinical interviews and plasma level monitoring. By using comparable mean clozapine doses, the number of treatment responders was similar in both groups (first-episode patients, 51.3%; multiple-episode patients, 46.4%). However, we found a negative association between age and response rate. With regard to side-effects, we could not find any significant difference between groups. Altogether, response and side-effects to clozapine treatment do not seem to be determined by the chronicity of the disorder.

Adult↗
PubMed2003

Reduced olfactory sensitivity, discrimination, and identification in patients with alcohol dependence.

BACKGROUND: Various olfactory deficits have been reported in the alcohol-induced amnestic syndrome (Korsakoff's syndrome). Less is known about olfactory functioning in nonamnesic and nondemented alcoholic patients. METHODS: Olfactory performance of 30 alcohol-dependent patients was assessed unirhinally using the Sniffin' Sticks (threshold, discrimination, identification, composite TDI score) and compared with that of 30 healthy controls, matched for sex, age, and smoking status. RESULTS: Patients showed significantly reduced olfactory sensitivity (higher threshold), discrimination, and identification compared with controls. No group differences were observed in laterality. Identification and discrimination group differences remained significant after controlling for differences in sensitivity. Olfactory deficits in patients were present independent of age, gender, and duration of abstinence (<3 months) and were not attributable to smoking or general cognitive abilities. More than half of the patients (56.7%) could be classified as hyposmic. Lower overall olfactory functioning (TDI) was associated with longer duration of a regular alcohol intake and higher values of gamma-glutamyltransferase (GGT). CONCLUSIONS: Olfactory dysfunction is common in nonamnesic and nondemented patients with alcohol dependence. Results suggest a detrimental effect of alcohol on central olfactory processing.

Adult↗
PubMed2003

[Social network and social support in patients with chronic inflammatory bowel disease].

OBJECTIVES: The aim of the present study was to make a precise analysis of social network and social support to patients with chronic inflammatory bowel diseases (CEDE) in comparison with healthy controls. METHODS: 35 patients with colitis ulcerosa and 47 patients with Morbus Crohn were interviewed using the questionnaire for investigating social network and social support (SONET). Medical data on disease activity were also assessed. CEDE patients were compared with healthy controls, and patients with active disease were compared with those whose disease was in remission. RESULTS: In comparison to healthy controls, the patients demonstrated a significantly smaller network, comprising fewer extra-familial persons but more relationships to the closest core family members. CEDE patients also reported a significantly smaller number of persons from whom they received social support. Patients with active disease were generally more unsatisfied with the support received than those whose disease was in remission. CONCLUSIONS: Our study shows that the closest family members are usually responsible for the patient's social support. Further investigation is necessary to assess the needs of the core family in this stressful situation.

Adaptation, Psychological↗
PubMed2003

Cognitive impairment: assessment with brain magnetic resonance imaging and proton magnetic resonance spectroscopy.

BACKGROUND: In vivo proton magnetic resonance spectroscopy is a safe and noninvasive tool that can be used to study aspects of brain chemistry and metabolism. This study was designed to evaluate its role in routine application to reveal the diagnostic reasons for cognitive impairment. METHOD: 37 Alzheimer's disease patients (NINCDS-ADRDA criteria), 31 patients with subcortical ischemic vascular dementia (Chui et al. criteria), and 13 subjects with subjective cognitive impairment (DSM-IV criteria) were included in this retrospective study. Magnetic resonance images were used for atrophy rating; additionally, proton magnetic resonance spectroscopy was performed. RESULTS: Significantly reduced N-acetylaspartate levels (p <.05) were found in both patients with Alzheimer's disease and patients with subcortical ischemic vascular dementia compared to the group with subjective memory complaints. The ratios of N-acetylaspartate/creatine and N-acetylaspartate/myo-inositol were significantly lower in Alzheimer's disease patients compared to patients with vascular dementia (p =.012) or patients with subjective memory impairment (p =.002). N-acetylaspartate/creatine and N-acetylaspartate/myo-inositol ratios were positively correlated to the degree of cerebral atrophy. Disoriented patients displayed a low N-acetylaspartate/creatine ratio. In contrast, we were not able to relate concurrent psychotic or behavioral symptoms to any spectroscopic parameter. CONCLUSION: This study indicates that proton magnetic resonance spectroscopy parameters could provide additional information in differentiating between Alzheimer's disease, subcortical ischemic vascular dementia, and subjective cognitive impairment. Therefore, this method can contribute to the routine diagnosis of dementia. Psychiatric and behavioral symptoms associated with dementia or due to a major psychiatric disorder cannot be related to changes in the measured proton magnetic resonance spectroscopy parameters.

Aged↗