Biomedical subjects

H Kuhs

Publications and source records attributed to H Kuhs.

At least 19 recordsLinked to original sources

PubMed1998

[Unmasking pheochromocytoma by amitriptyline].

A report is given about a 57-year-old woman with a major depression, melancholic subtype. While under amitriptyline 75 mg/day no adverse effects were observed, immediately after increasing the dosage to 150 mg/day "head spasms" with headache, profuse sweating and arterial hypertension appeared. The diagnosis of a pheochromcytoma was made and adrenalectomy was performed. This is the first case of unmasking a pheochromcytoma by amitriptyline; furthermore a connexion was found with the daily dosage of the antidepressant.

Adrenal Gland Neoplasms↗

PubMed1998

Repeated sleep deprivation once versus twice a week in combination with amitriptyline.

OBJECTIVE: Although a combination of antidepressive pharmacotherapy with repeated sleep deprivation therapy has proved to be an effective and easily applied treatment strategy, no systematic study investigating the most favourable interval between the sleep deprivation trials is available. METHOD: In a cross-over design, 44 patients with a major depressive episode (ICD-10) were randomly allocated to 4 weeks treatment with amitriptyline (150 mg/d) in combination with either late sleep deprivation (of the second half of the night, LSD) twice weekly during week 1 and 2 followed by LSDs once weekly during week 3 and 4 or vice versa. Two hypotheses were tested: Does LSD twice weekly during week 1 and 2 accelerate the clinical response compared with LSD once weekly? Does LSD twice weekly during week 3 and 4 improve the response rate compared with LSD once weekly? RESULTS: According to both observer rating (Hamilton Rating for Depression, 21-item version) and self-rating (Visual Analogue Mood Scale), no significant differences could be ascertained between the groups compared at any time of the investigation. With respect to drop-outs and immediate LSD effects there is a trend for patients undergoing twice weekly LSDs followed by once weekly LSD trials to have a more favourable treatment course than the control group. CONCLUSION: The hypotheses tested were answered in the negative. "High dose" LSD administration does not prove to be clearly superior to "low dose" LSD. This finding is in line with most of the corresponding data on antidepressive pharmacotherapy.

Adult↗

PubMed1996

Serum prolactin, growth hormone, total corticoids, thyroid hormones and thyrotropine during serial therapeutic sleep deprivation.

In 13 patients fulfilling DSM-III-R criteria for a major depressive episode, hormone serum levels were measured at 8 AM on the day before and on the first and second days after partial sleep deprivation (PSD) late in the night during a 4-week course of therapy with amitriptyline in combination with 6 PSDs. Prolactin, human growth hormone (HGH) and total corticoids were not influenced by PSD. In contrast, T3 and thyrotropine (TSH) were elevated significantly on the 1st day after PSD throughout the series, but T4 less regularly. Although TSH reverted regularly to baseline values on the 2nd day after PSD, i.e. after a full night's sleep, T3 remained elevated. The hormones under discussion do not predict the therapeutic PSD effect. Nor can any correlation be determined between endocrine and clinical changes on the 1st or 2nd day after PSD. In connection with findings from sleep deprivation research in animals and in healthy subjects, the results suggest that thyroid changes under PSD may be nonspecific and unrelated to antidepressive PSD effects.

Adrenal Cortex Hormones↗

PubMed1996

Amitriptyline in combination with repeated late sleep deprivation versus amitriptyline alone in major depression. A randomised study.

Only few systematic studies are available on the status of sleep deprivation therapy in the overall treatment regimen of depressive patients. 51 patients suffering from a major depressive episode (ICD-10) were randomly allocated to 4 weeks' treatment with amitriptyline (150 mg/day) or to a combination of amitriptyline with six partial-sleep-deprivation treatments late in the night (at 4-5 day intervals). According to observer rating (Hamilton Rating Scale for Depression, 21- and 10-item version), a highly significant amelioration was recorded in both groups until the 14th day of treatment. A further improvement occurred, however, only in those patients treated with both antidepressants and sleep deprivation. Hence the response rate ( > or = 50% HAMD reduction) after 4 weeks' treatment was distinctly more favourable in this group than in those patients under pharmacotherapy alone. The superiority of the combined therapy cannot be confirmed statistically by self-rating (Befindlichkeitsskala: von Zerssen; Visual Analogue Mood Scale). The immediate antidepressive effect of sleep deprivation diminished in the course of the sleep deprivation series. The response to the first sleep deprivation was a predictor neither for the response to further sleep deprivation treatments nor for the overall treatment outcome.

Adult↗

PubMed1996

Diurnal mood variation in melancholic patients and healthy controls.

In 30 melancholic patients and 21 healthy controls, diurnal mood variation was investigated on 3 successive days at 7.30 a.m., 11.30 a.m., 3.30 p.m. and 7.30 p.m. Daily courses with no variation or with a so-called typical variation (morning low, afternoon/evening high) occurred with the same frequency in both samples. Circadian mood variations vary substantially inter- and intraindividually in both depressive patients and healthy controls. However, the controls reported short (ultradian) mood variations more frequently than the patients. Using a semistructured interview, the subjective experience of diurnal mood variations was compared: In melancholic patients, mood variations occur spontaneously in more than half of all cases, whereas healthy controls attribute them almost exclusively to their own activities and/or external circumstances. It is discussed whether "typical' diurnal variations in melancholic patients may have been emphasized in earlier psychopathological literature not because of their frequency but because patients experience the circadian mood rhythm as uninfluenceable.

Adult↗

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

[Stages of treatment resistance in depressive disorders, defined after somatotherapeutic methods].

This brief survey is not a systematic review of the literature on treatment-resistant depression (TRD). Rather, in the light of results of controlled clinical trials, proposals for assessment of TRD are made: First-degree treatment resistance implies nonresponse to standard antidepressive therapy (two successive adequate treatments with antidepressants, combined with induced-wakefulness therapy). Second-degree treatment resistance is defined by nonresponse to alternative treatment strategies (MAO inhibitors, lithium augmentation, electroconvulsive therapy, infusion therapy) that have proved to be effective in TRD both in clinical practice and in systematic investigations. In this therapeutic situation, the only option still open is to resort to previously ineffective therapy or to turn (as yet) inadequately established therapeutic strategies. Criteria for third-degree treatment resistance should not be based on nonresponse to specific further therapeutic trials but on the duration of the treatment (at least 2 years).

Humans↗

PubMed1992

[A case report on a 9-day-long abuse of propofol].

This case report deals with the case of an alcohol-dependent, but abstinent patient, who took 3 x 5 ml/d (= 150 mg) propofol intravenously for nine days. Anxiety, inner tension and restlessness routine which had previously occurred during his daily vanished. No other psychotropic effects occurred.

Adult↗

PubMed1992

Relationship between parameters of serotonin transport and antidepressant plasma levels or therapeutic response in depressive patients treated with paroxetine and amitriptyline.

In a double-blind clinical study, antidepressant plasma levels, parameters of platelet serotonin (5-HT) transport (Km, Vmax and basal platelet 5-HT content) and therapeutic response were measured in depressive patients treated with either paroxetine (30 mg/day) or amitriptyline (150 mg/day) for 6 weeks. No correlation could be found between paroxetine plasma levels and therapeutic outcome after 2, 4 and 6 weeks of treatment. In contrast to the amitriptyline group, a marked increase in Km from baseline to week 2 was determined in paroxetine-treated patients, with Km increase being correlated with paroxetine plasma levels at week 2. However, no significant relationship could be found between 5-HT transport parameters and any of the outcome measures in either treatment group.

Adult↗

PubMed1992

Psychomotor activity in unipolar and bipolar depressive patients.

Findings on the psychomotor activity of unipolar versus bipolar depressive patients and on the relationship between psychomotor activity and sleep are divergent. In this study, the psychomotor activity of 37 depressive patients (25 unipolar, 12 bipolar) was examined by means of continuous actometric monitoring (48 h). The mean activity level of the unipolar depressives is higher (though not at a significant level) than that of the bipolar group. There is a weak but significant negative correlation between psychomotor activity and self-rated sleep time. Elderly and female patients display greater psychomotor activity than younger depressives and male patients. After matching for age and gender, the psychomotor activity of unipolar and bipolar patients is virtually identical; a significant correlation between psychomotor activity and sleep time cannot be established any more.

Age Factors↗

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↗

PubMed1991

Sleep deprivation therapy.

This review reports, with as much detail as possible, on the literature relating to therapeutic sleep deprivation (or induced-wakefulness therapy) since it was first described in 1971. The antidepressive effect of sleep deprivation has been substantiated by numerous studies. A series of clinical predictors of response to sleep deprivation are also described. Partial sleep deprivation late in the night is equivalent to total sleep deprivation in terms of therapeutic value and--because of its simpler application--can be regarded today as the sleep deprivation method of choice. The status of sleep deprivation in the overall treatment schedule for depressive disorders is discussed in detail. Numerous findings, some of them contradictory, have been published on the effect of sleep deprivation on biological variables. To date, no unequivocal explanation has been found for the mechanism of action of sleep deprivation.

Combined Modality Therapy↗

PubMed1991

The predictability of relapses in schizophrenic patients.

The objective of this study was to identify clinically relevant predictors of short-term (2 years) outcome in schizophrenic patients and to gather these predictors into one simple prognosis model for the course of the disease. Ninety-nine schizophrenic outpatients classified according to DSM-III criteria were observed for 3 years with regard to their relapse (rehospitalization) frequency. Predictors of both a high and a low relapse risk permitting a prognostic assessment of the individual case were based on various sources: case history data, especially those relating to the previous course of the disease: social and therapeutic situation; psychopathological findings; emotional family atmosphere; and prognosis scales.

Adult↗

PubMed1991

Time estimation and the experience of time in endogenous depression (Melancholia): an experimental investigation.

The importance of disturbances in time experience in endogenous depression (melancholia) has long been under discussion. In the present study alterations of time experience were examined by means of time estimation experiments. 25 endogenous depressive patients (according to ICD-9) underestimated prospectively a 30-second interval by 6 s, whereas 12 healthy controls overestimated this interval by more than 10 s. The results are based on eight successive measurements over a period of 2 days. In the endogenous depressives, a feeling of being unwell was accompanied by a more pronounced time estimation error than a relatively good state of well-being. The influence of various patient data on the results of time estimation is also discussed in detail. The findings show clearly that time estimation provides a satisfactory delineation between depressive patients and healthy controls.

Adaptation, Psychological↗

PubMed1991

Depressive delusion.

In this study of 160 consecutively admitted inpatients who met ICD-9 criteria of endogenous depression, mood-congruent depressive delusions were ascertained in 14.4% (n = 23). The total HRSD score was significantly higher in the delusional than in the nondelusional group. Delusions of guilt were recorded by far the most frequently. There was a correlation between delusions of guilt in the current depressive episode and suicide attempts in the past. In the delusional patients the individual courses of the illness were characterized by marked symptomatological differences from one depressive episode to another. In all but one of the patients, depressive delusions coincided with a thematically identical experience of anxiety. How often anxiety occurs in delusional form depends substantially on the respective theme of anxiety. In accordance with earlier psychopathological literature the findings confirm that depressive delusion is closely linked to the experience of anxiety.

Adult↗

PubMed1990

Cardiovascular effects of paroxetine.

In a double-blind clinical study, electrocardiogram, blood pressure and systolic time intervals were measured in 40 depressive patients treated with either paroxetine (30 mg/day) or amitriptyline (150 mg/day) for 6 weeks. While amitriptyline significantly increased the heart rate, the QTc interval and the PEP/LVET ratio, paroxetine did not alter any of the cardiovascular parameters measured.

Adult↗

PubMed1990

[Nonspecific melancholic anxiety].

In this psychopathological study the role of unfathomableness in the experience of anxiety is investigated from semistructured interviews of melancholic (N = 160) and neurotic depressive (N = 93) patients (diagnostic criteria acc. to ICD-9). In melancholic patients groundless anxiety is found as rarely as in the neurotic control group. The patients' reports about their experience of anxiety show that concrete and groundless anxiety are felt as equally unpleasant. Transitional forms between groundless and concrete anxiety can be identified, the frequency of which however, does not contribute to the distinction between melancholic and non-melancholic anxiety. Anxiety with interchangeable content, i.e. anxiety about all and everything (see Kraepelin's pantophobia) is mainly reported by melancholic patients. In contrast anxiety related to concrete situations (phobia) is almost exclusively restricted to neurotic depressive patients. On the one hand the empirical data point to the fact that unfathomableness is a fundamental and typical characteristic of anxiety, on the other hand the importance of unfathomableness in understanding the experience of anxiety in melancholia is stressed.

Adult↗

PubMed1990

[Subjective aspects of psychopathologic research. A method for assessing anxiety in melancholic patients].

Psychopathological assessment of anxiety is subject to considerable methodological problems. An immediate access to an understanding of anxiety is not possible. Rather, anxiety reveals itself to the investigator from the patients' experience, as it comes to light in their self-reports, i.e. from a subjective aspect. Based on these considerations, a semistructured clinical interview was developed for recording anxiety in endogenous depression (syn. melancholia). The decision not to employ a highly structured interview procedure is substantiated by clinical examples. Nevertheless the rules of psychopathometry can be applied to the interview. With the reliability-validity dilemma in mind, the method of psychopathological research proposed occupies an intermediate position between descriptive-phenomenological and "quantitative" psychopathology.

Anxiety Disorders↗