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Biomedical subjects

K Junghanns

Publications and source records attributed to K Junghanns.

At least 19 recordsLinked to original sources
PubMed2004

Attenuated salivary cortisol secretion under cue exposure is associated with early relapse.

AIMS: To test whether the risk of relapse in alcohol dependence is predicted by the subjective experience of cue exposure (CE) and/or cortisol reactivity to alcohol cues. METHODS: Salivary cortisol and self-ratings of 'tension' and 'desire to drink' were measured in 32 detoxified alcohol-dependent inpatients during CE sessions conducted in the first and third week of motivation enhancement therapy. Subjects completed the Toronto Alexithymia Scale (TAS-20) and the Abbreviated Alcohol Expectancy Questionnaire (B-AEQ) towards the end of the inpatient treatment to measure emotional self-awareness and the expected positive effects of alcohol. RESULTS: Six weeks after the end of the inpatient treatment, 15 patients were abstinent. Relapse was verified or was presumed for 17 patients. Those who had relapsed had shown an attenuated response to CE in the third week as an inpatient but did not differ from abstainers in terms of subjective reaction to cues. Subjective ratings of CE were not related to salivary cortisol or relapse but showed several associations with factors one and two of the TAS-20. The expectancy of enhanced social contacts by using alcohol (factor 1 of the B-AEQ) correlated negatively with the decline in salivary cortisol during the CE session in the third week of treatment. Subjective ratings of CE correlated with Alexithymiascores. CONCLUSIONS: Alcoholic patients who use alcohol to enhance their social contacts typically lack hypothalamo-hypophysical-pituitary-adrenocortical (HPA) reactivity in the early period of abstention. They are at an increased risk of early relapse and perhaps use alcohol to increase cortisol secretion again.

Alcohol Drinking↗
PubMed2004

Smooth pursuit deficits in schizophrenia, affective disorder and obsessive-compulsive disorder.

BACKGROUND: In schizophrenia, affective disorders, and obsessive-compulsive disorder (OCD) dysfunction of frontal neuronal circuits has been suggested. Such impairments imply corresponding oculomotor deficits. METHOD: Eye movement response to foveofugal and foveopetal step-ramp stimuli was recorded within the same study design in patients with schizophrenia (N= 16), affective disorder (N= 15), and OCD (N= 18) and compared with controls (N=23) using infra-red reflection oculography. RESULTS: In the foveofugal task steady-state velocity was lower in all patient groups compared with controls. Post-saccadic eye velocity was also decreased in patients with schizophrenia and affective disorder. In the foveopetal stimulus steady-state velocity was reduced in schizophrenic patients, only. Changes of saccadic latencies or position errors were not found in any of the patient groups. Also, pursuit latency was unchanged and initial eye acceleration was not decreased. CONCLUSIONS: Unaltered saccadic parameters indicate intact motion perception in cortical visual area V5. Therefore, the observed deficit of pursuit maintenance implies a dysfunction of frontal networks in all patient groups including the pursuit region of the frontal eye field (FEF). In patients with schizophrenia and affective disorder reduced post-saccadic pursuit initiation may indicate an impaired interaction between the pursuit and the saccadic system.

Adult↗
PubMed2002

[Diagnosis and therapy of sleep disorders. Early assessment--prompt treatment].

Effective medications, as well as other effective options, are available for the treatment of insomnia. Since many patients do not inform their family doctors that they have sleep-related problems, the physician should himself question his patients on this point, with the aim of initiating specific treatment early enough to prevent such a condition becoming chronic.

Combined Modality Therapy↗
PubMed2002

[Addiction in the elderly - an underestimated diagnosis in clinical practice?].

According to several studies in the USA, alcohol abuse is common among elder people, particularly among those admitted to hospital. Corresponding data for Germany are lacking as yet. In this study, the frequency of addiction problems in the elderly admitted to hospital was investigated using the data from 1990 to 1998 of the psychiatric department at the General University Hospital of Lübeck, Germany. Furthermore, the documentations of all consultations in that period were reevaluated. The psychiatric consultation service covers two general hospitals providing inpatient treatment for about 200,000 inhabitants. Diagnoses were made according to the ICD-10 criteria. In 17.7% of the males older than 64 years and in 4.2% of the elderly females admitted to the psychiatric department, alcohol dependency was diagnosed, while 5.8% of the elderly patients showed substance abuse, most often of benzodiazepine. Among the patients visited in the psychiatric consultation service, 10.8% of the elderly males and 3.2% of the elderly females were alcohol addicts and 3.9% substance abusers. The frequency of alcohol-induced neuropsychiatric complications, particularly withdrawal delirium and amnestic syndrome, increased with age. Also, benzodiazepine withdrawal delirium most frequently occurred in older patients. These results underscore that, although the prevalence rate seems to be lower than among the younger population, in the elderly population substance abuse still is a relevant medical problem, since the rate of neuropsychiatric complications increased with age.

Aged↗
PubMed2001

Acceptance of pharmacotherapy for relapse prevention by chronic alcoholics.

The willingness to take medication is a major prerequisite for compliance with biological treatment approaches in psychiatric disorders. The aim of this study was to investigate the willingness of alcoholics to improve relapse prevention using drug therapy, since there has been little information about the acceptance of such a medication as yet. 261 chronic alcoholics consecutively referred for detoxification completed a newly developed questionnaire containing items on drinking history, recent treatments, and beliefs about drug therapy for relapse prevention. In order to draw comparisons, 67 self-help group attendees and 29 alcoholics consulting an outpatient advice service were also recruited. 67.8% of the recently detoxified alcoholics were prepared to take medication for relapse prevention, if prescribed, while 60% the self-help group attendees refused drug therapy. There was no correlation between the acceptance of drug treatment and duration of dependence. Subjects willing to take a medication more often believed their alcoholism to be curable, and they reported a higher craving frequency. 55% of those willing to take a medication were willing to pay for the drugs, but in most cases, at a level lower than the equivalent of 5 beers. As drug therapy acceptance is a crucial part of compliance with, and success of medical relapse prevention, our results underscore the necessity of a thorough exploration into the health beliefs of the patient and joint development of a treatment rationale prior to prescription.

Adult↗
PubMed2001

Detection of facial expressions of emotions in depression.

Research on perceptual and attentional processes in depression has shown that depressed as opposed to nondepressed individuals do not exhibit a positive perceptual bias in multistimulus representations. In the present study a face-in-the-crowd task was applied to examine the relationship between depression and spatial detection of facial expression of positive and negative emotions. A face-in-the-crowd task was administered to 30 subjects (15 clinically stabilized depressed inpatients and 15 normal subjects) using displays of schematic faces. Depressed subjects showed no performance differences in the detection of negative faces and no differences in decision latency for the control condition (all neutral faces) compared to normal subjects. Depressed subjects, however, were significantly slower in responding to positive faces than normal subjects. Our data suggest that depressive mood is associated with a reduced spatial attention to positive facial expression and not with an abnormal spatial processing of negative facial expression. An implication is that lowered vigilance for facial expressions of joy and happiness may affect adversely interpersonal relationships in depressed subjects.

Adult↗
PubMed2000

[Psychiatric consultation services for the elderly. Changes in utilization due to the new German legislation concerning guardianship and restructuring of health care providers].

In the discussion of increasing costs of health care in Germany, the frequent and long hospital stays of elderly patients are often pointed out. Since these patients very frequently suffer from psychiatric disorders, psychiatric consultation is often required. This study was aimed at investigating whether new German laws concerning guardianship and the structure of health care providers change conditions for psychiatric consultation services. For this purpose, the documentation of all consultations in the years 1991 to 1995 was retrospectively evaluated. In about 3% of all patients aged over 65 referred to the General University Hospital of Lübeck, psychiatric consultation was ordered. The most frequent diagnosis was senile dementia. Comparison of the requests and psychiatric recommendations show a significant increase in wishes and recommendations for guardianship. Moreover, there is evidence of the increasing need of consultation in elderly patients. Possibly due to the new law concerning the structure of health care providers and the number of requests and recommendations to transfer patients to psychiatric wards, these results show that the new laws do affect psychiatric consultation.

Aged↗
PubMed2000

Psychopathology of alcoholics during withdrawal and early abstinence.

Epidemiologic surveys show a high lifetime co-morbidity with psychiatric disorders (e.g., depression and anxiety) in alcoholics. However, alcoholics frequently complained about psychopathologic symptoms, particularly during alcohol withdrawal. There is some evidence that symptomatology decreases spontaneously with prolonged abstinence. Thus, the question arises whether high levels of psychopathology could be accounted for by withdrawal effects. This study was aimed at examining the impact of the alcohol withdrawal severity (assessed by the AWS scale) on psychopathologic symptoms. The psychopathologic profile of 110 alcoholics as measured by the Symptom Checklist-90 revised (SCL-90-R) was compared to that of 253 patients with adjustment, anxiety or depressive disorders (according to ICD-10 criteria). No relationship between the severity of alcohol withdrawal and psychopathology could be found which might hint at two different neurobiological processes underlying these phenomena. The comparison with patients suffering from depression or anxiety disorders revealed that the global symptom severity of alcoholics undergoing withdrawal was similar, but recovery was achieved more rapidly than in the other groups. On the other hand, the self-rated psychopathologic symptom profile of alcoholics was rather similar to that of patients with adjustment disorders. While about one-quarter of the alcoholics reported severe psychopathology on admission, only about 10% showed symptomatology at discharge about three weeks later, predominantly depression or anxiety. These results underline the notion that much of the psychopathology described by alcoholics decreases within 2-3 weeks after withdrawal without specific treatment.

Acute Disease↗
PubMed2000

[New antidepressive drugs in comparison with classical tricyclics. Mechanism of action and clinical evaluation].

During the last decade several new agents have been introduced in the treatment of depressive disorders. In comparison to classical tricyclic antidepressants, these agents have less side effects and a very low toxicity. Selective inhibitors of serotonin reuptake do not produce sedation; however, in the initial phase of treatment this is not always an advantage. In contrast, receptor antagonists, such as mirtazapin and nefazodone have moderate sleep-inducing properties. Selective agents are also characterized by certain pharmacologic interactions which can lead to considerable inhibition of the metabolism of other drugs. Classical antidepressants still play an important role in the treatment of severe depressive episodes. Different synaptic effects of new antidepressants lead to an increased availability of monoaminergic neurotransmitters. The article summarizes the most important neurobiological consequences of these acute synaptic effects which might be more closely associated with neurobiological correlates of depression. The authors conclude about the advantages and disadvantages of the different classes of antidepressants from a clinical point of view.

Animals↗
PubMed2000

Craving shift in chronic alcoholics.

In order to investigate changes in the consumption of substances that stimulate the reward system, 222 recently detoxified alcoholics were asked about their consumptional habits before as compared to after detoxification (mixed prospective and retrospective design). Seventy-eight point two percent reported an increase in consumption of coffee, cigarettes, chocolate and other sweets, while 34.9% managed to reduce at least one of these substances. The increase was significant for coffee, chocolate and other sweets. The desire for consumption of these substances was correlated with the maximum ever experienced desire for alcohol (0.232 for coffee, 0.213 for cigarettes, 0.193 for chocolate and 0.176 for other sweets), and the actual consumption of coffee, cigarettes and sweets was correlated with the actual desire for alcohol (0.172, 0.157 and 0.245, respectively). The results lend some support to the hypothesis that psychotropic substances might serve as a kind of self-regulation against craving in this group. A possible link to biochemical theories is discussed.

Adult↗
PubMed1999

[Cost-efficacy analysis of clinically evaluated therapeutic programs. An expanded withdrawal therapy in alcohol dependence].

BACKGROUND: Cost-effectiveness analyses complete clinical evaluation studies and thereby support the a well based estimation of therapy efficiency. AIM: A qualified (extended) alcohol withdrawal treatment programme (II), which was previously described and evaluated by face-to-face follow-up studies, was analyzed with regard to cost-effectiveness. SAMPLE: 57 alcohol-dependent patients, which had undergone programme II, were compared with 37 patients after a medical detoxification programme (I). METHODS: Health insurance data (number and length of all hospitalizations, days of incapacity to work, days of financial substitution for incapacity to work) were assessed for the five years before and after index therapy and for each year, separately. RESULTS: While there were no substantial differences for the time before index therapy, programme II patients were hospitalized after index therapy (i) less frequently (3.5 + 4.4 vs. 7.3 + 11.3 times), (ii) for fewer days (66 + 75 vs. 136 + 167) than programme I patients, and they received financial support for fewer days (67 +/- 73 vs 220 +/- 187 days). CONCLUSION: Considering a somewhat better clinical outcome of programme II vs. programme I patients (14% greater abstinence rate within one year) the significantly lower rates and fewer days of follow-up hospitalisations support a sufficient efficiency of the extended alcohol withdrawal treatment programme.

Adult↗
PubMed1998

Target anticipation and impairment of smooth pursuit eye movements in schizophrenia.

A reduced gain of smooth pursuit eye velocity has frequently been reported in schizophrenic patients. With respect to predictable stimuli, this could be due to a deficit in predicting the target path. To determine this contribution to smooth pursuit eye movement performance, we analyzed the ocular smooth pursuit response to a sinusoidally moving target that was suddenly stopped after some cycles of regular movement. Horizontal eye movements were recorded with infrared reflection oculography in a group of 17 schizophrenic in-patients and 16 age-matched healthy subjects for controls. The patients exhibited a reduced gain of smooth pursuit velocity, but phase lag was not different from the control group. After the unpredictable stop of target movement, predictive sinusoidal smooth pursuit was maintained for 150 to 200 ms in both groups. The resulting maximal position and velocity error was larger in the patient group. In conclusion, schizophrenic patients were able to generate a normal anticipatory component of smooth pursuit and to switch it off in response to external demands. They showed, however, an increased velocity of anticipatory pursuit, which might be used to compensate for the primary deficit of smooth pursuit velocity frequently found in schizophrenics.

Adaptation, Physiological↗
PubMed1998

Relations between neuropsychological vulnerability markers and negative symptoms in schizophrenia.

In neuropsychological vulnerability research the visual backward masking task, the Span of Apprehension, the degraded stimulus Continuous Performance Test (dsCPT), and the Wisconsin Card Sorting Test have been described as putative indicators for the predisposition to develop negative (schizophrenic) symptoms. The present study assesses the stability of the association between neuropsychological tests and negative symptoms by examining clinically improved patients. The interdependence between the four cognitive measures and clinical symptomatology was examined in 31 patients with DSM III-R and ICD-10 schizophrenia suffering predominantly from negative symptoms. Backward masking performance was related to affective flattening and anxiety-depression. False alarm rate on dsCPT was associated positively with affective flattening and hallucinations, and negatively with avolition. Card sorting preseverative errors correlated negatively with anhedonia, non-preservative errors correlated positively with avolition. Correlations notwithstanding, the data provide evidence in support of the relative independence of neuropsychological functions and negative symptoms in clinically improved schizophrenics.

Adult↗
PubMed1998

[Alexithymia and automatic activation of emotional-evaluative information].

The emotional valence of stimuli seems to be stored in the associative network and is automatically activated on the mere observation of a stimulus. A principal characteristic of alexithymia represents the difficulty to symbolize emotions verbally. The present study examines the relationship between the dimensions of the alexithymia construct and emotional priming effects in a word-word paradigma. The 20-Item Toronto Alexithymia Scale was administered to 32 subjects along with two word reading tasks as measures of emotional and semantic priming effects. The subscale "difficulty describing feelings" correlated as expected negatively with the negative inhibition effect. The subscale "externally oriented thinking" tended to correlate negatively with the negative facilitation effect. Thus, these dimensions of alexithymia are inversely related to the degree of automatic emotional priming. In summary, there is evidence for an impaired structural integration of emotion and language in persons with difficulties in describing feelings. Poor "symbolization" of emotions in alexithymia is discussed from a cognitive perspective.

Adult↗
PubMed1998

[Quality assurance in the psychiatric clinic. How can therapy outcome be assessed in a preferably easy manner?].

PURPOSE: The German Social law requires quality assurance of inpatient treatment, i.e. of the quality of therapy, allowing the comparison of different hospitals. METHODS: Since easy administrable assessment instruments are required, in this study (part of a greater survey on quality assurance at the Department of Psychiatry in Luebeck) a global self-rating by means of a visual analog scale (VAS) and the GAF (Global Assessment of Function) were compared with the ratings on the SCL-90-R scale in 386 psychiatric inpatients (mean age: 44.0 +/- 15.2 years). RESULTS: The comparison of the values on admission and at discharge yielded good correlations between the global VAS-value and the SCL-90-R symptom scores only at discharge. As parameter of therapeutic efficacy the difference of the scores on admission and at discharge was calculated. While the global self-rating (VAS) correlated well with the SCL-90-R scores, no relationship between the GAF-scores and the SCL-90-R scores were found. Schizophrenics and patients suffering behaviour or personality disorders often showed discrepancies of the self- and the therapist rating. CONCLUSIONS: These discrepancies offer some hints for the identification of problematic patients. However, the global assessment of therapeutic efficacy often yield controversial results, if the limits of such scores are not considered.

Activities of Daily Living↗