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Klaus Junghanns

Publications and source records attributed to Klaus Junghanns.

18 recordsLinked to original sources
PubMed2006

Development of a rating scale to predict the severity of alcohol withdrawal syndrome.

AIM: Various factors that may influence the severity of the alcohol withdrawal syndrome (AWS) have been identified. We tested the predictive value of these factors compiled in a newly developed scale, LARS (Luebeck alcohol withdrawal risk scale). METHOD: A total of 100 individuals (81 males, 19 females, mean age: 47.6 +/- 9.9 years) consecutively transferred to inpatient detoxification were included in this prospective study. All fulfilled the ICD-10 criteria for alcohol dependence. The LARS was applied at the time of admission. The course of the AWS was assessed by AWS-scale at least every 4 h. The maximum AWS-score was taken as indicator of the severity of AWS. RESULTS: The mean AWS-score(max) was 6.5 +/- 3.3. In all 20% of the patients developed a severe AWS (AWS-score(max) > or =10). The maximum score usually occurred within 36 h after the last drink. A short version, the LARS11, was developed by statistically grounded item reduction. The optimal cut-off of the LARS11 was calculated as 10. The positive predictive value for severe AWS was 76%, while the negative predictive value was 98.7%. The sensitivity and specificity were high (95 or 92.5%, respectively). CONCLUSION: LARS11 assessed immediately before detoxification appears to provide a useful estimate of mild/moderate versus severe AWS, and is now ready to be validated in an independent sample.

Alcoholism↗
PubMed2006

Daytime naps improve procedural motor memory.

BACKGROUND AND PURPOSE: To investigate the impact of a short daytime nap on procedural and declarative memory consolidation. PATIENTS AND METHODS: Following a normal night's sleep, 34 young healthy subjects were randomly assigned to a nap or wake condition of about 45min in the early afternoon after learning procedural and declarative memory tasks. Subjects were controlled for alertness and cortisol secretion. RESULTS: The afternoon naps were dominated by sleep stage 2 but contained some slow wave sleep (SWS) and rapid eye movement (REM) sleep as well. Naps significantly improved procedural, but not declarative, memory. Females showed more improvement than males in the declarative memory tasks irrespective of nap or wake. There was no difference between groups with respect to cortisol secretion or alertness. CONCLUSIONS: A short nap is favorable for consolidation of procedural memory. The possibly confounding effect of gender should always be considered in research on sleep and memory.

Adult↗
PubMed2006

Impaired declarative memory consolidation during sleep in patients with primary insomnia: Influence of sleep architecture and nocturnal cortisol release.

BACKGROUND: A central cognitive function of sleep is to consolidate newly acquired memories for long-term storage. Here, we investigated whether the overnight consolidation of declarative memory in patients with chronic sleep disturbances is impaired, owing to less slow wave sleep (SWS) and an increased cortisol release. METHODS: Polysomnographic recordings, serum cortisol concentrations, and overnight memory consolidation in 16 patients with primary insomnia were compared with those of 13 healthy control subjects. RESULTS: Patients displayed distinctly less overnight consolidation of declarative memory (p < .05), which was significantly correlated with SWS in the control subjects (r = .69) but with rapid eye movement (REM) sleep in the patients (r = .56), who had a diminished amount of SWS (p < .05). Increased cortisol levels in the middle of the night were associated with impaired retrieval of declarative memory after sleep for both control subjects (r = -.52) and patients (r = -.46). CONCLUSIONS: Primary insomnia is associated with a diminished sleep-related consolidation of declarative memory. Efficient overnight consolidation of declarative memory is associated with high amounts of SWS and low serum cortisol levels during the early part of the night. Where SWS is decreased, REM sleep might play a partly compensatory role in the consolidation of declarative memory.

Adult↗
PubMed2006

Evidence from increased anticipation of predictive saccades for a dysfunction of fronto-striatal circuits in obsessive-compulsive disorder.

In obsessive-compulsive disorder (OCD), a dysfunction of neuronal circuits involving prefrontal areas and the basal ganglia is discussed that implies specific oculomotor deficits. Performance during reflexive and predictive saccades, antisaccades and predictive smooth pursuit was compared between patients with OCD (n=22), patients with schizophrenia (n=21) and healthy subjects (n=24). Eye movements were recorded by infrared reflection oculography. In both patient groups, higher frequencies of anticipatory saccades with reduced amplitudes in the predictive saccade task were observed. Additionally, reduced smooth pursuit eye velocity and increased frequencies of saccadic intrusions during smooth pursuit as well as increased error rates in the antisaccade task were demonstrated for patients suffering from schizophrenia. Patients with OCD and schizophrenia revealed different patterns of oculomotor impairment: whereas increased anticipation of predictive saccades provides evidence for a dysfunction of the circuit between the frontal eye field and the basal ganglia in both groups, results from the antisaccade task imply additional deficits involving the dorsolateral prefrontal cortex in schizophrenic patients. Furthermore, the cortical network for smooth pursuit (especially the frontal eye field) is also assumed to be disturbed in schizophrenia.

Adult↗
PubMed2006

Alcohol dehydrogenase 1C*1 allele is a genetic marker for alcohol-associated cancer in heavy drinkers.

Chronic alcohol consumption is associated with an increased risk for upper aerodigestive tract cancer and hepatocellular carcinoma. Increased acetaldehyde production via alcohol dehydrogenase (ADH) has been implicated in the pathogenesis. The allele ADH1C*1 of ADH1C encodes for an enzyme with a high capacity to generate acetaldehyde. So far, the association between the ADH1C*1 allele and alcohol-related cancers among heavy drinkers is controversial. ADH1C genotypes were determined by polymerase chain reaction and restriction fragment length polymorphism in a total of 818 patients with alcohol-associated esophageal (n=123), head and neck (n=84) and hepatocellular cancer (n=86) as well as in patients with alcoholic pancreatitis (n=117), alcoholic liver cirrhosis (n=217), combined liver cirrhosis and pancreatitis (n=17) and in alcoholics without gastrointestinal organ damage (n=174). The ADH1C*1 allele and genotype ADH1C*1/1 were significantly more frequent in patients with alcohol-related cancers than that in individuals with nonmalignant alcohol-related organ damage. Using multivariate analysis, ADH1C*1 allele frequency and rate of homozygosity were significantly associated with an increased risk for alcohol-related cancers (p<0.001 in all instances). The odds ratio for genotype ADH1C*1/1 regarding the development of esophageal, hepatocellular and head and neck cancer were 2.93 (CI, 1.84-4.67), 3.56 (CI, 1.33-9.53) and 2.2 (CI, 1.11-4.36), respectively. The data identify genotype ADH1C*1/1 as an independent risk factor for the development of alcohol-associated tumors among heavy drinkers, indicating a genetic predisposition of individuals carrying this genotype.

Adult↗
PubMed2005

Proposal of a comprehensive clinical typology of alcohol withdrawal--a cluster analysis approach.

AIMS: To characterize the various courses of alcohol withdrawal. METHODS: The Alcohol Withdrawal Scale (AWS) was applied to 217 alcohol-dependent patients every 4 h till the symptoms of withdrawal had passed (until each of four consecutive scores were <3). Patients were medicated by a standardized treatment scheme according to AWS-scores. Hierarchical cluster analysis and discriminant analysis were applied. RESULTS: We found five clusters representing increasing severity of alcohol withdrawal. Each cluster is characterized by a combination of the two maximum subscores (vegetative and psychopathological subscore) and three additional psychopathological symptoms (anxiety, disorientation, and hallucination). In 18.4% of the patients, relevant symptoms were not observed (cluster 1), 18.9% developed mild or moderate vegetative symptoms only (cluster 2), and 40.6% additional anxiety (cluster 3). In cluster 4 (11.1%) the most frequent psychopathological symptoms were disorientation and anxiety but no hallucinations, which could be observed only in cluster 5 (11.1%). Discriminant analysis using the maximum subscores at the first day of treatment as independent variables correctly predicted 89.9% of the five clusters. CONCLUSIONS: Our findings support a model of alcohol withdrawal clustering along the two dimensions of vegetative and psychopathological severity. Furthermore, the AWS may be useful to predict the course of alcohol withdrawal already at the first day of treatment.

Adult↗
PubMed2005

The consumption of cigarettes, coffee and sweets in detoxified alcoholics and its association with relapse and a family history of alcoholism.

Thirty male alcohol dependent inpatients without concurrent depressive disorder, 13 of them with a positive family history of alcohol dependence in a first degree relative (PFH), were questioned about their desire and consumption habits with respect to cigarettes, coffee, and sweets while on a three-week inpatient treatment after detoxification from alcohol. Six weeks after discharge from hospital, the patients were reassessed for relapse. Eleven patients (36.6%) had relapsed at follow-up. Relapsers were younger than abstainers. The days until relapse correlated negatively with intensity of desire to drink alcohol, desire to smoke cigarettes, and with a higher consumption of cigarettes. PFH patients did not relapse earlier but they had a stronger desire to drink coffee and eat sweets and had a higher coffee consumption.

Adult↗
PubMed2005

Mean corpuscular volume and ADH1C genotype in white patients with alcohol-associated diseases.

BACKGROUND: Alcohol abuse is associated with several gastrointestinal diseases, such as esophageal carcinoma, chronic alcoholic pancreatitis, and liver cirrhosis. Increased mean corpuscular volume (MCV) has been recognized as a biomarker for alcohol abuse and heavy drinkers. Recent studies from Japan revealed that macrocytosis is related to ALDH-2/2 genotype, leading to increased acetaldehyde accumulation. It has also demonstrated that increased MCV values could also be an independent biomarker for esophageal cancer in Asians. Therefore, the aim of the current study was to investigate possible associations of MCV value with polymorphisms of ADH1C in white patients with alcohol-associated esophageal carcinoma, chronic alcoholic pancreatitis, and alcoholic cirrhosis as well as in heavy drinkers without organ damage. METHODS: In this study, a total of 510 alcoholic patients were enrolled with esophageal cancer (n = 98), chronic pancreatitis (n = 98), alcoholic liver cirrhosis (n = 151), and alcohol abuse without gastrointestinal disease (n = 163). ADH1C genotyping was performed by PCR-based restriction fragment length polymorphism (PCR-RFLP) analysis from whole blood. The relation between MCV and ADH1C gene polymorphisms (ADH1C*1 and 1C*2) controlled for the amount of drinking, smoking, and age were investigated using both univariate and multivariate analysis. RESULTS: In univariate analysis, higher alcohol consumption was associated with increased MCV. Other variables were not associated with macrocytosis. In multiple linear regression analysis, after adjustment for age and smoking, higher alcohol consumption and female sex were independently associated with higher MCV values. No other variables, including which alcohol-associated disease the patient had, had an independent effect. Adding ADH genotype rendered no independent significant effect on MCV value. CONCLUSIONS: In a white population, MCV values were not associated with genotype polymorphisms of ADH1C. In contrast to findings in Asians, macrocytosis does not seem to be an independent biomarker for esophageal cancer. The role of ADH1C polymorphism in increasing MCV and the potential use of MCV as a marker for esophageal carcinoma are still pending.

Adult↗
PubMed2005

Suppression of the HPA axis stress-response: implications for relapse.

This article presents the proceedings of a symposium held at the meeting of the International Society for Biomedical Research on Alcoholism (ISBRA) in Mannheim, Germany, in October 2004. This symposium explored the potential role of hypothalamic-pituitary-adrenal (HPA) axis dysregulation upon relapse. HPA axis stimulation induces the release of the glucocorticoid cortisol, a compound with profound effects upon behavior and emotion. Altered stress-responses of the HPA axis in abstinent alcohol-dependent subjects, therefore, may influence their affective and behavioral regulation, thus impacting their potential for relapse. Bryon Adinoff began the symposium with a review of HPA axis dysfunction in alcohol-dependent subjects, including recent studies from his lab demonstrating an attenuated glucocorticoid response to both endogenous and exogenous stimulation in one-month abstinent men. Klaus Junghanns presented his work demonstrating that a blunted ACTH or cortisol response to subjective stressors (social stressor or alcohol exposure) is predictive of a return to early drinking. The final two presenters examined the interaction between naltrexone and HPA responsiveness in alcohol-dependent or at-risk subjects, as naltrexone induces an increase in ACTH and cortisol. Falk Kiefer discussed the relationship between basal HPA axis responsivity and clinical outcome following treatment with naltrexone or acamprosate. Plasma ACTH significantly decreased over the course of the study in the placebo group, but not the medication groups [corrected] Lower basal concentrations of ACTH and cortisol were associated with quicker relapse in the placebo group only. Suchitra Krishnan-Sarin described her preliminary work, in which family-history positive (FH+) and family history negative (FH-) subjects were administered naltrexone, followed by an assessment of alcohol-induced craving. The cortisol response to alcohol was significantly and inversely related to craving in the FH+, but not the FH-, subjects. Alterations in HPA axis responsivity may therefore have a negative impact upon clinical outcome in alcohol-dependent subjects, and disinhibition of the axis with medication may have therapeutic potential.

Adrenocorticotropic Hormone↗
PubMed2004

Affective disorders in older inpatients.

BACKGROUND: After dementia the group of depressive disorders is considered to be the second most common psychiatric disorder in the elderly. There is dispute regarding whether depression in the elderly differs from depression in the younger age groups by a longer duration of inpatient treatment, a more frequent occurrence of delusions, more cognitive impairment or by a more frequent co-occurrence of physical disease. This study aimed to compare younger with older inpatients with respect to these aspects. METHODS: Retrospective chart review of all admissions to the psychiatric department of a General University Hospital (n=9400) and review of the documentation of 15 348 psychiatric consultations in the years 1990-1998. The clinical diagnoses were made according to the ICD-10 criteria. RESULTS: 15.5% of the psychiatric inpatients in this period suffered from depressive episodes (ICD-10 F31.3-31.5,32,33). The proportion of depressive episodes increased with age, making up 5.4% in the age group below 30 years and 37.4% in the age group of 70-79 years. On the basis of the ICD-10 criteria for the severity of depressive episodes no significant differences could be demonstrated between the younger (< 65 years) and the older inpatients (>/= 65 years). In particular, no higher frequency of psychotic symptoms with increasing age could be found. The length of inpatient treatment did not significantly differ between both age groups. The elder patients showed less suicidal attempts prior to admission and less psychiatric comorbidity, but a significantly higher rate of concurrent physical illness. In 923 inpatients a psychiatrist was consulted by the other medical departments because of a co-occurrence of physical with affective disorders, making up 8.6% of the total seen by the psychiatric consultation service. Here again, the proportion of depressive episodes increased with age. The pattern of the depressive episodes in these patients did not differ from that seen in the psychiatric inpatients. LIMITATIONS: Only clinical diagnoses made by experienced psychiatrists were evaluated. CONCLUSIONS: According to our results older depressive inpatients differ from younger ones only with regard to concurrent comorbidity but not with respect to the duration of inpatient treatment or the pattern or severity of depressive symptoms. They more frequently suffered from physical illness but less often showed concurrent psychiatric comorbidity.

Age Distribution↗
PubMed2004

Sleep disturbances are correlated with decreased morning awakening salivary cortisol.

Morning and evening salivary cortisol levels were correlated with sleep parameters in 14 patients with primary insomnia and 15 healthy controls. Salivary cortisol was sampled immediately after awakening (T1), 15 min later (T2), and immediately before going to bed (T3) for 1 week at home. In parallel with this, subjects estimated parameters of sleep in a daily sleep log. Patients and controls were all non-smokers who did not differ regarding morning awakening time or bedtime. Cortisol after awakening was significantly decreased in primary insomnia. Salivary cortisol at the time of awakening correlated negatively with the subjective estimation of sleep quality, i.e. a low salivary cortisol level directly after awakening correlated with a higher frequency of nightly awakenings (r = -0.50), a diminished sleep quality (r = -0.34) and a decreased feeling of recovery after awakening (r = -0.35; all p < 0.05). Furthermore, awakening cortisol was negatively correlated with the Pittsburgh Sleep Quality Index (r = -0.43) and with a questionnaire on sleep-related cognitions with the subscales rumination in bed (r = -0.56 ) and focusing on sleep-related thoughts (r = -0.46; all p < 0.05).

Adult↗
PubMed2002

Short-term training increases diagnostic and treatment rate for insomnia in general practice.

OBJECTIVE: To evaluate the effect of short-term training of general practitioners (GPs) on their diagnosis and treatment of chronic insomnia. METHODS: A three-step randomized control group design was used: After baseline evaluation (T1) a group of 9 GPs underwent a training of half a day, while 7 GPs served as a control group. The diagnostic and therapeutic handling of insomnia patients was reevaluated under obligatory use of a structured diagnostic questionnaire (T2) and under optional use of it (T3). RESULTS: From 16 general practices, 4,754 patients were included. The frequency rate of insomnia was 19.3 %. The lowest diagnostic and treatment rate was found for insomnia patients without comorbidity (15 % at T1). Systematic non-pharmacological treatment was not offered by the GPs. At T2 the diagnosis rate increased significantly from 37.9 % (T1) to 71.5 % (T2, p = 0.038). It fell back to lower levels at T3 but remained better than at T1. At T3 non-pharmacological treatments and referral to a sleep expert were advised more often. CONCLUSION: Short-term training of GPs can significantly improve their diagnostic sensitivity and first-line treatment efforts against insomnia.

Adult↗
PubMed2002

Test-retest reliability and validity of the Pittsburgh Sleep Quality Index in primary insomnia.

OBJECTIVE: Psychometric evaluation of the Pittsburgh Sleep Quality Index (PSQI) for primary insomnia. METHODS: The study sample consisted of 80 patients with primary insomnia (DSM-IV). The length of the test-retest interval was either 2 days or several weeks. Validity analyses were calculated for PSQI data and data from sleep diaries, as well as polysomnography. To evaluate the specificity of the PSQI, insomnia patients were compared with a control group of 45 healthy subjects. RESULTS: In primary insomnia patients, the overall PSQI global score correlation coefficient for test-retest reliability was .87. Validity analyses showed high correlations between PSQI and sleep log data and lower correlations with polysomnography data. A PSQI global score > 5 resulted in a sensitivity of 98.7 and specificity of 84.4 as a marker for sleep disturbances in insomnia patients versus controls. CONCLUSION: The PSQI has a high test-retest reliability and a good validity for patients with primary insomnia.

Adult↗
PubMed2002

[Informing psychiatric patients about medication - results of a query].

PURPOSE: Physicians are obliged to inform all patients about the purpose and risks of therapeutic procedures, also drug treatment. However, although there may be some severe difficulties in informing psychiatric patients only very few data concerning this topic are available as yet. Thus, the aim of this query was to evaluate the patients' opinion of the information about medication. METHODS: In this investigation 255 psychiatric inpatients were asked to complete a questionnaire. RESULTS: 42 % of the patients complained about no or insufficient information of the expected effects of the prescribed medication and 62 % about no or insufficient information of side-effects. An association was found between the willingness to take the medication for a long time and insight in their psychic condition, but not with satisfying informing. CONCLUSION: This query showed the need of a more precise and satisfying information on medication and the need to develop strategies for a better information about side-effects.

Adult↗
PubMed2002

[Gerontopsychiatric consultation service].

In the discussion of the increasing costs of health care in Germany the frequent and often times long inpatient treatments of elderly patients are pointed out. Since these patients also suffer from psychiatric disorders very frequently, a psychiatric consultation is required rather often. This study was aimed to evaluate the requirements of a consultation service for elder inpatients. For this purpose all 9363 consultation reports from 1994 to 1998 were evaluated retrospectively. 2152 (31.4 %) of the patients visited by the psychiatric consultation service were over 64 years old. The most frequent diagnoses were organic brain syndrome (ICD-10: F0), particularly senile dementia (ICD-10: F00 - 03), adjustment disorder (ICD-10: F43) and affective disorders, particularly depressive disorders (ICD-10: F3). In 139 patients (6,5 %) a consultation was requested because of a suicidal attempt prior to admission. Our results suggest that in a gerontopsychiatric consultation service predominantly old patients with internal diseases and with the need of psychosocial help are visited and that the specific knowledge of psychopharmacological treatment in multimorbid patients as well as the psychosocial help and legal advice is requested. These aspects should therefore be a special focus in educational programs for a gerontopsychiatric consultation service.

Adjustment Disorders↗
PubMedDate not supplied

Mildly disturbed hepatic and pancreatic function during early abstention from alcohol is associated with brain atrophy and with disturbed psychometric performance.

AIMS: To investigate the relation of liver status and pancreatic function to disorders of the central nervous system during early abstention from alcohol. METHODS: Sixty-seven alcohol-dependent patients (47 male) with a mean age of 42.3 +/- 12.5 years, were assessed by clinical history, abdominal sonography, computerized tomography of the brain and with neuropsychological and serum enzyme tests. Patients with sonographically diagnosed cirrhosis were excluded. RESULTS: Patients with fatty liver had more previous complicated detoxifications, but not more current signs of brain atrophy or impairment on neuropsychological tests. However, elevations in alpha amylase (AA), and gamma glutamyl transpeptidase (GGT) were associated with signs of cerebral atrophy. Higher serum GGT was related to impaired score on a number sequencing task (NST), and high AA with impairment on NST and on two tests of speed and perception. GGT and AA levels tended to be higher in older subjects. CONCLUSIONS: After detoxification from alcohol even mildly disturbed liver and pancreatic parameters, but not fatty liver itself, are associated with signs of brain atrophy and impaired psychometric performance. Age may be a confounding or contributing factor.

Adult↗