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Biomedical subjects

H Helmchen

Publications and source records attributed to H Helmchen.

At least 37 records · Page 2Linked to original sources
PubMed1994

Demented subjects' competence to consent to participate in field studies: the Berlin Ageing Study.

A violation of the right to self-determination appears to be the main individual risk for participants in the Berlin Ageing Study, which is a community based non-therapeutic study with minimal health risk. In order to minimize the risk, a procedure to test the competence to consent to participate had to be introduced. To protect the participants' right to self-determination, basic capabilities of judgment and reasoning appear to be sufficient to give informed consent in this study. As a result of testing competency, 76% of the severely demented persons had to be excluded from the study, whereas a majority of the persons with mild to moderate dementia could be included.

Aged↗
PubMed1993

Adverse psychic reactions to psychotropic drugs--a report from the AMUP study.

The AMUP study (AMUP = Arzneimittelüberwachung in der Psychiatrie (Drug Monitoring in Psychiatry)) was conducted from 1979 to 1989 in order to provide for a systematic and standardized assessment of all adverse reactions to psychotropic drugs under the conditions of routine clinical treatment at two psychiatric hospitals. This paper presents data from the AMUP study on the type and frequency of adverse psychic reactions to psychotropic drug groups and relevant single drugs. Psychic ADR leading to drug discontinuation were observed in 4.5% of 15,264 inpatients monitored over an eight-year period. Only neurological ADR were more frequent (4.9%). Neuroleptics and antidepressants were involved with similar frequencies in ADR that were at least "probably" drug-related (3.3 and 3.5%). Lithium salts and benzodiazepines were only rarely involved in psychic ADR. Toxic delirium (1.0%), agitation (0.9%), and sedation (0.8%) were the most frequent single events, usually rated as "probably" drug-related. Depression and psychotic states were next in frequency, but judged as only "possibly" drug-related in a considerable proportion of cases. Haloperidol, the most common high-potency neuroleptic, was imputed mainly for depression, sedation, agitation, and (malignant) neuroleptic syndrome; with medium-potency perazine, toxic delirium and sedation prevailed; among the most common antidepressants, amitriptyline was above all connected with toxic delirium, while with clomipramine agitation predominated. The paper discusses the particular difficulties encountered in the field of psychic ADR in psychiatric patients regarding causality assessment, and emphasizes the need for continuous ADR assessment studies including state hospitals.

Adult↗
PubMed1991

[Pathobiochemistry and pharmacotherapy of alcohol withdrawal delirium].

The spectrum and time course of different symptoms during alcohol withdrawal may be caused by the involvement of various neurotransmitter systems that are differentially vulnerable to the effects of ethanol. Withdrawal symptomatology results from increased activity of excitatory mechanisms (NMDA-receptor, catecholamines among others) and from reduced functioning of inhibitory receptors (GABAA-, alpha 2-adreno-receptor among others). The neuronal mechanisms are subject to different dynamics of restitution following intoxication. Some of these probably contribute to long-lasting changes in CNS functions by "kindling" processes. Therapeutic guidelines are deduced from results of basic research and clinical trials. It is concluded that clomethiazole and benzodiazepines are superior in treating delirium tremens and certain risk-patients, whereas carbamazepine and clonidine may be helpful in moderate withdrawal syndromes or as adjunctive agents. However, the need for improved methodological standards of method in clinical research is evident.

Alcohol Withdrawal Delirium↗
PubMed1990

Summary of the qualitative criticisms made during the ICD-10 field trial and remarks on the German translation of ICD-10.

The 1987 draft of ICD-10 presents many new aspects of the psychiatric diagnostic evaluation. Some were readily accepted by the participants of the field study, including: the purely descriptive approach with the abautonment of many theoretical concepts; the more operationalized descriptions of the diagnoses; similarity in structure and terms to DSM-III-R. Others proved controversial: extension of the term dementia to include even mild and moderately severe organic psychosyndromes; inclusion of all forms of depression in one chapter, and their subdivisioning only by severity; different time criteria for the diagnosis of schizophrenia in DSM-III-R (6 months) and ICD-10 (1 month). Considerable criticism was levelled at the overly long and often tediously formulated text, and the lack of didactic organisation. A number of examples of translation difficulties are given, and the differences between a too literal and a technically correct equivalent translation disu-used.

Adolescent↗
PubMed1990

The problem of informed consent in dementia research.

The increasing frequency of dementia has considerable impact on the ill person, his relatives, and society. However, an effective therapy does not yet exist. This indicates a compelling need for dementia research. But the necessary informed consent often cannot be given by the ill person, since the dementing disease diminishes or destroys his consent capability. Possible solutions to this problem are put forward.

Aged↗
PubMed1989

Clinical experience with clozapine in Germany.

The so-far successful development of the atypical neuroleptic clozapine had been interrupted by the Finnish epidemic of agranulocytosis in 1975. However, though the strong regulatory control of prescribing clozapine, since then its clinical use has increased steadily, particularly recently. This may be due mainly to the considerable number of patients whose psychotic states or at least whose negative symptoms do not respond to other neuroleptics, or who have problems with extrapyramidal side effects. Due to its significant antipsychotic, and to its probable even if mild antidepressive efficacy as well as to its possible efficacy against some negative symptoms of schizophrenia, clozapine is currently a real and indispensable alternative to other existing neuroleptics. Further research should be directed both to the clinical validation of the latter mentioned therapeutically desired effects and to the causes and predictability of agranulocytosis, as yet the main risk of clozapine therapy. Theoretically profitable would be the clarification of the causes of hyperthermia and particularly of those of the mutual independency of extrapyramidal motor disturbances and antipsychotic efficacy.

Antipsychotic Agents↗
PubMed1989

Eye movements and psychopathology.

The article outlines in brief why psychiatrists use disturbances of various types of eye movements as biological indicators of functional disturbances of brain systems that may be linked to psychopathology, as well as by which strategies these indicators will be applied. Basic as well as specific questions that remain to be resolved are addressed.

Eye Movements↗
PubMed1988

[Methodologic and strategic considerations in schizophrenia research].

So far, schizophrenia can only be regarded as a heterogeneous syndrome in view of the fact that both concept and phenomenology themselves are heterogeneous and also that aetiology and pathogenesis are likewise largely unknown. Furthermore, the diagnosis "schizophrenia" is merely a convention and nothing more, which, in turn, considerably hampers aetiopathogenetic research. Hence, we cannot expect highly valid results if we examine the nosological specificity of certain variables by means of internosological comparisons. However, a clinically more relevant approach could be the examination of the clinical validity especially the prognostic and predictive validity of variables, even though such examination has so far not led to convincing results in individual cases. A more striking relevance for aetiopathogenetic groupings could be obtained, above all, by a "reversal of the dependence of variables". This reversal should concern variables that are as homogeneous and clearly defined as possible and are reliably measurable. This applies mainly if by "horizontal" characterisation a) they have proved to be time-stable trait markers on the grounds of prospective intraindividual comparisons; b) furthermore, if by being present before the diseased state is manifest they have proved to be vulnerability markers either retrospectively by anamnesis of relevant signs and symptoms or prospectively in still (?) healthy subjects by means of high-risk studies; c) and, finally, if they are found to be markers in the true sense of the word on the grounds of their mass occurrence in healthy blood relatives, i.e. as variables under genetic control. We think that mainly such variables appear to be promising for an aetiopathogenetically oriented "vertical" strategy. This strategy aims via multidisciplinary multilevel analyses, utilising strategies, techniques and results of the rapidly developing neurosciences, at establishing connections of variables between various levels, as the "uppermost" of which we can consider to be the clinico-psychopathological level and as "lowermost" the molecular-biological level. This is discussed on the basis of examples.

Humans↗
PubMed1988

Early phase-II semi double-blind study of the new alkaline propanolamine derivative enciprazine (short communication).

A new alkaline propanolamine derivative, enciprazine, was tested in an early phase-II semi double-blind placebo-controlled A-B-A design to verify the hypothesis that the substance may have tranquilizing properties. No sedative or anxiolytic effect comparable to minor or major tranquilizers could be observed. According to clinical impression some patients showed an improved goal orientation and self-control which could be effects worth to be followed up.

Adult↗
PubMed1987

Strategies of clinical research on neurobiological determinants of psychosis.

Despite great efforts in clinical psychiatric research in the last decades, many simple questions still remain open. Present day clinical practice still lacks theoretically founded and generally accepted therapeutic rules, especially in the individual case. Similarly, in basic research we are far from understanding the etiopathogenetics of psychiatric illness. From summarizing some aspects of previous research strategies and results in neurobiological determinants in psychosis, future research strategies are outlined, which already have proven successful and thus should be pursued more rigorously. Not least because of general limited research capacities with respect to time and costs, future research has to proceed economically, i.e. guided by clear strategies.

Antipsychotic Agents↗
PubMed1984

The private practice study group as phase-IV research tool.

Research in the routine field of psychiatry must include psychiatrists in private practice. A majority of psychiatric patients is treated as outpatients and many of these are only seen by private psychiatrists. Setting or patient variables pose restrictions on the therapy which leads to the development of specific treatment strategies. Because these are empirically based, it can be expected that the knowledge of practitioners can make a major contribution to the development of optimal treatment recommendations. Research in private practice requires special organisational efforts. One way to get access to this field are collaborative study groups which bring together scientists and their research facilities with practitioners and their surgeries. Such an instrument may allow: access to patients, which may never show up in any other research institution; monitoring of patient characteristics and treatment modalities under routine conditions; elaboration of special skills, insights and treatment strategies developed by the practitioner. These study groups can vary with regard to type of practice, type of collaboration and type of research. Studies can rely on information from patient self-reports, observations by the practitioners themselves or their office assistants and on data gathered by scientific staff working occasionally or continuously in the practice.

Clinical Trials as Topic↗