PubMed Health⌕ Search

Biomedical subjects

H Folkerts

Publications and source records attributed to H Folkerts.

14 recordsLinked to original sources
PubMed2000

[Electroconvulsive therapy of depressive disorders].

Electroconvulsive therapy (ECT) is the most effective treatment in all types of major depression. On the other side ECT has long suffered from controversial public image, a reputation that has effectively removed it as treatment option for many patients. Today ECT is an effective and safe treatment for those with severe mental illness. Electroconvulsive therapy has undergone fundamental changes since its introduction 65 years ago. It is no longer a memory-modifying, fearsome treatment pictured in films. Anesthesia, controlled oxygenation, and muscle relaxation make the ECT so safe that the risks are less as those which accompany the use of several psychotropic drugs. Indeed, for the elderly, the systematic ill, and pregnant women, electroconvulsive therapy is a safer treatment for mental illness than any alternative.

Adult↗
PubMed1998

[Occupational rehabilitation of chronic psychiatric patients. Results of a prospective study over 3 years].

Vocational rehabilitation of mentally ill patients is now focused outside the psychiatric hospital. Three types of programmes play a major role: outpatient work therapy programmes at psychiatric hospitals, jobs in (partly) sheltered employment facilities as in companies specially adapted for employing mentally ill persons, and workshops for the mentally disabled. In the north-western German region of Westphalia-Lippe (population: 9 million) we carried out a three-year prospective study on a regionally representative sample from such rehabilitation institutions to assess the course and outcome of vocational rehabilitation. The sample comprised 295 men and 176 women with a mean age of 36.1 year (+/- 9.6). The majority were chronically ill patients with a history of frequent long-term hospitalisation. 61% of all probands were suffering from schizophrenic disorders. The outcome of vocational rehabilitation differs substantially among the three programme types, primarily due to varying baseline conditions, subjective expectations or goals, and courses of illness. The programmes are not alternatives but should be seen as supplementary components of a care system which has to meet a wide range of patient requirements. Vocational integration into the open labour market is a desirable and realistic objective for only some of those concerned.

Adult↗
PubMed1997

[Prevalence of psychiatric disorders and outcome of social integration of homeless men].

All 52 regular users of a shelter in a medium-sized German city underwent a baseline psychiatric examination in 1990. Mental disorders, especially alcohol addiction and schizophrenic disorders, were recorded among 40 (77%). After four years the residential situation and the number and duration of psychiatric hospitalisations was recorded for 42 of these men. 33 of them mentally ill and 9 with no mental disorders. The four-year follow-up revealed that half the mentally ill men were still living in a homeless environment or had died, whereas most users with no mental disorder had a home of their own again. Longer-term hospitalisation or guardianship was found to have a favourable impact on social integration of the homeless mentally ill. Although psychiatric help without the consent of those concerned cannot solve the social problem of homelessness, it can often improve the living situation of homeless mentally ill patients.

Adult↗
PubMed1996

The ictal electroencephalogram as a marker for the efficacy of electroconvulsive therapy.

The question of how to define a therapeutically adequate electroconvulsive therapy (ECT) has been under discussion since the early days of ECT. Although convention has asserted a demand for minimum seizure times, the complex electrophysiological conditions involved in developing a generalized seizure make it problematic for therapeutic efficacy of ECT to be linked only with seizure duration. Within the framework of an open clinical study of 40 patients, selected parameters of the ictal electroencephalogram (EEG) have now been examined with respect to differentiation between therapeutically effective and ineffective treatments. For this purpose a rating scale covering both quantitative and qualitative features of the ictal EEG was used. Although this study recorded no correlations between seizure duration and clinical improvement, correlations were established between clinical improvement, on the one hand, and the frequency of epileptic discharges and their slowing during the spike-wave phase as well as the stereotypy of the discharge or a "stable" pattern of rhythmic spike-wave or sharp wave complexes, on the other. The results suggest that several of these EEG parameters might be combined to form a marker for therapeutically adequate ECT, and that treatment might be controlled accordingly.

Adult↗
PubMed1996

[Parkinson syndrome after CO poisoning. Unexpected late manifestation and favorable prognosis].

Although individual extrapyramidal symptoms as a consequence of carbon monoxide intoxication have frequently been reported, typical (complete) Parkinson's syndrome has very rarely been documented. This report presents for the first time a case of acute Parkinson's syndrome with delayed manifestation after the initially occurring organic psychosis. A 53-year-old man with a long history of schizoaffective psychosis first developed a severe acute organic psychosis with disturbances of orientation and marked amnestic disturbances after carbon monoxide intoxication as a result of a suicide attempt. On the 21st day after intoxication, acute Parkinson's syndrome with right accentuation was recorded, with CCT identification of lesions on both sides of the basal ganglia area. Full remission of the Parkinson's syndrome was achieved with rheological treatment and L-dopa therapy.

Carbon Monoxide↗
PubMed1995

Suspension therapy in acute schizophrenia. Clinical and neuroendocrine/biochemical effects of abrupt discontinuation of neuroleptic medication.

22 acutely schizophrenic patients with partial remission under standard haloperidol therapy (reduction in BPRS total score by 50% or less) were included in this prospective study. There was a significant correlation between the BPRS total score or the BPRS factors Anxiety/depression and Anergia and extrapyramidal side effects at the end of the 3-week neuroleptic treatment phase. In these patients abrupt discontinuation of neuroleptic medication (suspension therapy) brings about a significant further reduction in BPRS total scores together with a favorable effect on the BPRS factors Anxiety/depression, Anergia and Thought disturbance. There was a trend towards low serum prolactin values before neuroleptic discontinuation being linked with a favorable effect of subsequent suspension therapy. Urinary dopamine and homovanillic acid excretion before neuroleptic discontinuation did not predict the clinical suspension effect. Thus peripheral neuroendocrine and biochemical effects of haloperidol-induced dopamine blockade and their changes after discontinuation of neuroleptic medication seem not to be linked with the clinical effect of suspension therapy in acute schizophrenia. There was, however, a significant relationship between low urinary epinephrine, norepinephrine, vanillylmandelic acid and cortisol excretion before suspension therapy and a favorable suspension effect. On the other hand, the more pronounced a nonspecific stress constellation (catecholamines, cortisol) was in patients with an unsatisfactory remission under neuroleptics, the less favorable was the clinical effect of suspension therapy. Until now, the treatment courses of suspension therapy have been evaluated in 43 schizophrenic patients. According to both clinical aspects and observer rating, three types of therapeutic suspension effects have been distinguished in one-third of the cases respectively; none (at best temporary remission, no improvement in the overall treatment situation); partial (substantial remission, neuroleptic medication resumed for therapeutic reasons), and favorable (almost complete remission, neuroleptic medication resumed for prophylactic reasons).

Acute Disease↗
PubMed1995

[Electroconvulsive therapy in neurologic diseases].

Numerous developments have improved the safety and efficacy of electroconvulsive therapy (ECT) in recent years, so that ECT is now one of the safest forms of treatment under anesthesia. The indications for psychiatric patients are clearly defined. ECT is also under discussion with respect to certain neurological disorders. This discussion has, however, been largely ignored by the German medical profession. Critical evaluation of previous experience, especially in the United States and in Scandinavia, reveals some clinical situations (e.g., akinetic crisis in Parkinson's disease) in which a primary neurological indication for ECT might be present. ECT is frequently indicated in other brain diseases if pronounced psychopathological disturbances (especially of a depressive type) occur and fail to respond to conventional treatment with psychotropic drugs. ECT may then be indicated on a case-by-case basis. ECT should not be withheld from such patients; on the other hand, there is the risk of uncontrolled expansion of these indications for ECT.

Depressive Disorder↗
PubMed1995

Migraine after electroconvulsive therapy.

The first detailed case report of recurrent common migraine after electroconvulsive therapy (ECT) is presented; it involves a 52-year-old woman with major depressive disorder. The migraine symptoms corresponded to those of the infrequent spontaneous migraine attacks she had. After a change to propofol as the anesthetic because of methohexital intolerance, the migraine attacks ceased, apparently due to seizure generalization being inhibited by propofol. In patients with migraine, ECT may be expected to trigger a migraine attack, probably in the same way as spontaneous seizures. The possible reasons and significance are discussed.

Antidepressive Agents↗
PubMed1993

[Automobile driving capacity of the elderly from the psychiatric viewpoint].

BASIC REMARKS: As the percentage of senior citizens in the general population increases, the number of elderly drivers is also increasing. This raises the general question as to the fitness of the elderly to participate in road traffic; the answer to this question must be considered within the larger context of ageing. Main points discussed: Acute psychiatric conditions (schizophrenic psychosis, melancholia, mania, organic psychosis, neurosis, addictive diseases) and decompensated neurosis and progressive dementia all render the victim unfit to drive. However, when the acute phase has been overcome, driving ability may well be re-established. Here, consideration must be given to psychopharmacological therapy. CONCLUSIONS: An elderly person's fitness to drive does not depend per se on chronological age or a given diagnosis. Rather, an individual assessment must take account of such parameters as psychopathology, personality, the ability to come to an agreement, the course of any psychiatric illness, and the effects of other somatic diseases and drugs.

Accidents, Traffic↗
PubMed1992

[Psychotic episode caused by prevention of malaria with mefloquine. A case report].

We report on a 41 year old woman, who after 750 mg mefloquine, a newer antimalarial agent, developed a psychosis with dizziness, confusion and delusions. The symptoms were more intensive and remained longer than hitherto reported in the literature. A total of 23 patients are known to have had psychiatric adverse effects under mefloquine. Psychotic episodes are undoubtedly though rarely associated with the intake of mefloquine.

Adult↗
PubMed1990

[The early prognosis of massive infarcts of the cerebral cortex. Follow-up of 49 patients].

Mass cerebral infarction have a high lethality already in the first week after onset. Surviving patients often have severe residual neurological deficits. We analysed the clinical course of 49 patients with space-occupying cerebral infarctions in a retrospective study. We differ subtotal infarction in the region of middle cerebral artery (MCA) from complete infarction and from complete infarction in the region of MCA with additional infarction on the same hemisphere. The quick development from depression of consciousness, the Babinski-phenomena on both sides and the central failure of respiration were the most valuable clinical predictors. Together with the clinical parameters, the Mathew-score and the CT and EEG-results it is possible, to estimate a reliable prognosis. The reduction and termination of no longer useful treatments will be discussed.

Adult↗
PubMedDate not supplied

Comorbid anxiety and affective disorder in alcohol-dependent patients seeking treatment: the first Multicentre Study in Germany.

The goals of this study were to describe demographic variables, drinking history, and the 6-month prevalence of Axis I comorbidity among alcohol-dependent subjects in GERMANY: The variables: amount of alcohol consumption, age at onset of the first alcohol consumed, age at onset of daily alcohol consumption, age at onset of withdrawal symptoms and number of detoxifications were related to the different comorbid disorders and gender. In this study, 556 patients from 25 alcohol treatment centres were enrolled between 1 January 1999 and 30 April 1999. After a minimum of 10 days of sobriety patients who fulfilled ICD-10 and DSM-IV criteria of alcohol dependence were interviewed for data collection using the Mini-DIPS (German version of the Anxiety Disorders Interview Schedule) and a standardized psychosocial interview. The 6-month prevalence of comorbid Axis I disorders was 53.1%. Among the patients with comorbidity, affective and anxiety disorders were most frequent. Comorbid stress disorder was associated with an early start of drinking, an early beginning of withdrawal symptoms, highest number of detoxifications, and the highest amount of alcohol consumed. Female patients with anxiety disorder consumed more alcohol and started earlier than females without this comorbid disorder. The data do not answer the question of the pathogenesis of comorbid disorders and alcoholism, but indicate that stress disorders in alcoholic patients and anxiety disorders in female alcoholics influence the course and severity of alcoholism.

Adult↗