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Biomedical subjects

L G Schmidt

Publications and source records attributed to L G Schmidt.

At least 19 recordsLinked to original sources
PubMed2006

[Substance-induced disorders: moving towards DSM-V and ICD-11].

The development of substance abuse disorders (SUD) for DSM-V is put into perspective according to an expert meeting organized by APA and chaired by M.A. Schuckit and J.B. Saunders. Substantial compatibility with ICD-11 of WHO was expected to be achieved. A dependence syndrome, a non-dependence category as well as a subthreshold condition is supposed to be included in the SUD section in DSM-V. Categorical criteria will possibly be supplemented by dimensions conceptualized as quantitative formulations of criteria content. General and substance-specific criteria may be included for dependence. The comorbidity problem requires more research to separate substance-induced from substance-independent mental disorders in patients with SUDs. It was an open discussion, whether the aim to include biological criteria for better defining of SUDs will be achieved in DSM-V.

Alcoholism↗
PubMed2005

Galantamine: a cholinergic patch in the treatment of alcoholism: a randomized, placebo-controlled trial.

OBJECTIVES: The involvement of the central cholinergic system in alcohol abuse behavior is well known. It is possible that the reinforcing effects of ethanol are partially mediated by nicotinic receptors, which modulate neurotransmitter release. It was demonstrated that the application of a cholinesterase inhibitor reduces alcohol consumption in alcohol-preferring rats. This suggests that galantamine (GAL), a cholinesterase inhibitor, could be effective when seeking to prolong abstinence in recently detoxified alcoholics. This study represents the first reported clinical trial of a cholinergic drug in alcohol-relapse prevention. PATIENTS AND METHODS: We investigated the efficacy and safety of GAL by conducting a 24-week randomized, placebo-controlled, multicentric clinical trial on 149 recently detoxified alcoholics. Survival analyses (Kaplan-Meier) were performed to reveal evidence of prolonged abstinence periods in patients who received GAL. RESULTS: Our findings did not support our hypothesis. GAL did not extend the time to first severe relapse. However, additional post hoc analyses suggest that relapsed patients treated with GAL consume less ethanol per drinking day than patients treated with placebo. CONCLUSIONS: GAL seems to be ineffective when used in relapse prevention of detoxified alcoholics. It is possible that alcohol needs to be "on board" for GAL to be beneficial. This could explain why our post hoc analysis showed that GAL possibly reduces the alcohol consumption of relapsers. If confirmed, GAL could play a role in the reduction of harmful alcohol use and at-risk consumption.

Administration, Cutaneous↗
PubMed2005

[Psychiatric and neuropsychological signs and symptoms in patients with fabry disease: literature review].

Fabry Disease (FD) is an X-linked lysosomal storage disorder (prevalence about 1 : 100 000) caused by a genetic defect associated with a lack of alpha-galactosidase A (alpha-GAL) enzyme activity. As a consequence, neutral glycosphingolipides can not be cleaved and metabolized, and accumulate in lysosomes of several tissues, particularly in vascular endothelium and smooth muscle cells. The most prominent symptoms comprise pain attacks and acroparesthesia, angiokeratoma, corneal opacity, renal and cardiac dysfunction, hypo- and anhidrosis, gastrointestinal symptoms, and cerebrovascular dysfunction with vertigo, headache, and cerebral ischemia. Characteristic symptoms of FD can occur in male and female patients with the same prevalence, while females with FD seem to be less severely affected. The course of untreated illness is progressive with considerable interindividual variability. Since 2001 two enzyme replacement therapies are approved which can possibly stop the disease progress and alleviate symptoms. The very few reports and clinical observations have shown that a very high proportion of FD patients develop neuropsychiatric symptoms. However, accurate data are lacking. Although the pathophysiologic mechanisms are quite unknown, it is surmised that sphingolipid deposits in the endothelium of small cerebral vessels lead to regional cerebral ischemia accompanied by neuropsychiatric symptoms and deficits. Furthermore, patients with FD are chronically distressed by pain attacks and additional somatic and psychological impairment. Frequently, pain attacks are triggered by psychosocial stress. The high interindividual variability can, thus, also be interpreted on the basis of existing stress and coping models. The present paper will review the presently available psychiatric and neuropsychological findings in FD and will discuss difficulties associated with classification and differential diagnosis of psychiatric disorders occurring in patients with FD.

Fabry Disease↗
PubMed2005

Prescribing practices in German and Swiss psychiatric university and in non-university hospitals: national differences.

OBJECTIVE: There are great variations between hospitals in the way drugs are prescribed, and these variations may be due to multiple factors such as local prescribing traditions, pharmacoeconomic considerations, drug availability, regional differences of population, disease prevalence etc. Available studies on prescribing habits, apart from studies performed in a unique center, have until now been mainly restricted to single countries or regions and the comparisons across countries or regions have often been limited by the use of diverse methodologies and definitions. The aim of the present study was to compare drug prescriptions between German and Swiss psychiatric services with regard to their preference of newer psychotropics. MATERIAL AND METHODS: Five psychiatric hospitals, associated to the AMSP project, were chosen to represent Swiss and German clinics, university and non-university settings. Data were available from one index day on 572 patients and 1,745 prescriptions. The comparisons were adjusted for age and gender. RESULTS: There was a significant difference (p < 0.001) with regard to the prescription of newer antidepressants (NAD), Swiss clinicians giving proportionally more (65.2%) than the German psychiatrists (48.3%). No significant difference was, on the other hand, found as to the proportion of atypical antipsychotics, the lack of difference being due to the higher proportion of clozapine among the atypical antipsychotics in Germany. CONCLUSION: There seems, therefore, to be a higher propensity for Swiss hospital psychiatrists to prescribe newer antidepressants. This seems to be due to national or regional prescribing traditions. Further studies are needed to investigate the economical influences on antidepressant prescribing in Swiss and German clinics.

Adolescent↗
PubMed2004

[Helping smokers kick the habit].

The family doctor has an increasingly important role to play as a "gatekeeper", with many advantages for the initiation and implementation of a successful weaning program. Controlled studies have demonstrated the effectiveness of a short-term intervention based on motivational talks by the family doctor together with the application of such weaning drugs as nicotine substitutes and bupropion. The latter substance should be offered to adult smokers consuming in excess of ten cigarettes daily. The chances that a smoker can successfully stop smoking is doubled by the use of weaning medication. Ideally,the physician should, at the same time, draw the patient's attention to the significance of a healthy diet and physical exercise.

Cardiovascular Diseases↗
PubMed2004

The AMUP study for drug surveillance in psychiatry - a summary of inpatient data.

From 1979 to 1989 the AMUP study (AMUP = Arzneimittelüberwachung in der Psychiatrie) was conducted in two psychiatric hospitals in Germany with the aim to provide a systematic and standardized assessment of all adverse reactions to psychotropic drugs under conditions of routine practice. A total of 60.7 % of patients experienced at least one adverse drug reaction (ADR) with probable or definite causality during their stay in the hospital; 37.1 % of patients exhibited ADRs that had some therapeutic impact on further treatment. ADRs that led to drug discontinuation were observed in 8.6 %. This rate ranged from 9.5 to 5.1 % for haloperidol and perazine, the most common neuroleptics at that time; sedating antidepressants (AD) rated lower than non-sedating (amitriptyline 5.1 %, clomipramine 10.4 %). Lithium salts, antiparkinson drugs, and benzodiazepines were associated with considerably lower rates of ADRs than neuroleptics or antidepressants. Severe ADRs occurred in 1.4 % of exposed patients (e. g., toxic delirium, grand mal seizures, malignant neuroleptic syndrome, or agranulocytosis). The AMUP data suggest that administration of psychotropic drugs in psychiatric hospitals at that time was a safe, but also inconvenient treatment for many patients due to a wide range of bothersome side effects that compromised patient compliance. The data can serve as a reference base for comparisons with newer compounds introduced to the market over the last decade such as serotonin reuptake inhibitors (SSRIs) and other new AD, atypical neuroleptics, or other new generation psychotropic drugs.

Adverse Drug Reaction Reporting Systems↗
PubMed2004

Severe adverse drug reactions of antidepressants: results of the German multicenter drug surveillance program AMSP.

The goal of the German drug safety program in psychiatry AMSP (Arzneimittelsicherheit in der Psychiatrie) is the assessment of severe or new adverse drug reactions (ADRs). Here we report on 53,042 of 122,562 patients treated with antidepressants who were monitored from 1993 to 2000 in 35 psychiatric hospitals in German-speaking countries. The overall incidence of severe ADRs of antidepressants was 1.4 % of exposed patients; when only ADRs rated as probable or definite were considered, a rate of 0.9 % in patients treated with antidepressants was observed. ADR rates were higher for TCAs (imputed in 1.0 % of patients overall, respectively in 0.6 % of patients when only ADs were imputed) and lower for MAO inhibitors and SSRIs (0.7 % for both, respectively 0.3 % and 0.4 %). Within the TCA group there was a difference among clomipramine (2.1 %, respectively 1.0 %), amitriptyline (1.0 %, respectively 0.6 %), and doxepin or trimipramine (both 0.6 %, respectively 0.3 %). With regard to single SSRI, similar rates were observed for paroxetine (0.8 %, respectively 0.5 %) and for citalopram (0.7 %, respectively 0.4 %). Of the new dual-acting antidepressants, venlafaxine ranged at 0.9 %, (respectively 0.5 %) and mirtazapine at 0.6 % (respectively 0.5 %). In particular, TCAs were associated with known risks, such as toxic delirium, grand mal seizures, and hepatic (i. e., increased liver enzymes), urologic (i. e., urinary retention), allergic (i. e., exanthema), or cardiovascular (i. e., mainly orthostatic collapse) reactions. In SSRI-treated patients (non-delirious) psychic and neurological ADRs were most prominent, followed by gastrointestinal, dermatologic, and endocrinological/electrolyte reactions, with agitation, hyponatremia (probably as part of the SIADH syndrome and associated with severe neurologic or psychiatric symptoms in 64 % of all cases), increased liver enzymes, nausea, and the serotonin syndrome as leading unwanted symptoms. Venlafaxine (in the immediate-release formulation) was associated with adverse CNS and somatic symptoms such as severe agitation, diarrhea, increased liver enzymes, hypertension, and hyponatremia. Mirtazapine was mostly connected with increased liver enzymes, cutaneous edema, and collapse, but with no case of significant hyponatremia. For drugs that potently inhibit serotonin uptake, serum sodium concentration should be controlled when applied in high-dose therapy or in vulnerable patients.

Adult↗
PubMed2003

[Early diagnosis of alcohol abuse and alcohol dependence in general practice].

The doctor's office offers the best chance of an early diagnosis of alcohol-related disorders. The physician can make the most of his opportunity by always taking this possibility into account in patients with unspecific symptoms. Since so-called low-risk alcohol consumption may develop into damaging drinking and finally addictive drinking leading to dependence, the physician must be familiar with the features of these different drinking patterns to be able to intervene prophylactically in the early forms, and therapeutically in later stages. Diagnostic talks with the patient should always contain elements of motivational interviewing so as to enable the physician to react appropriately to the degree of readiness of the patient to make necessary changes in his lifestyle.

Adult↗
PubMed2001

[Alcohol drinking at the threshold of abuse. When is it really critical?].

The risk of developing a given alcohol-related illness must be considered on an individual basis. In patients with mood and anxiety disorders even moderate amounts of alcohol may lead to psychiatric problems. Comorbid alcohol-related disorders are found to be accumulated in patients with personality disturbances and in those with bipolar affective disorders. The reported favorable effects of moderate consumption of alcohol apply only when cardiovascular risks are present in the absence of other health risks that are aggravated by alcohol use. The concept of the "hazardous use of alcohol" is contained in the current issue of ICD-10. The transition to alcohol-induced disorders is characterized by the criteria for intoxication, injurious use and the dependency syndrome. A need for treatment or preventive measures may, however, be given even when these criteria have not (yet) been met.

Alcoholic Beverages↗
PubMed2001

Relapse prevention in alcoholics by cigarette smoking? Involvement of nicotinic-dopaminergic mechanisms.

Because of a controversial view on the role of smoking in the recovery process of alcoholism, outcome data obtained for alcoholics who had been included in a long-term clinical trial with a putative anticraving drug were analyzed. To avoid unknown interactions between the drug under study and smoking behavior, only placebo-treated patients were evaluated in this investigation. After 12 months of rehabilitation, there was no significant difference regarding abstinence rate between 48 smoking alcoholics (who reported that they smoked 32 cigarettes on average per day) and 15 nonsmoking alcoholics (33% vs. 20%). However, smokers tended to be abstinent longer than nonsmokers (173 vs. 114 days; P= .092). This possible advantage might be related to nicotinic effects on central dopamine systems in smokers, as indicated by higher growth hormone secretion after apomorphine stimulation obtained in smokers, compared with findings for nonsmokers (area under the curve during chronic intoxication: 2253 vs. 1247 microg/min/l; P= .019). Multivariate regression analysis revealed a decreasing effect of ethanol blood level (P= .006) and the number of fullfilled International Classification of Diseases, 10th edition (ICD-10) criteria of the alcohol dependence syndrome (P= .012) on stimulated growth hormone secretion. In contrast, the reported number of smoked cigarettes per day had an increasing effect (P= .034), accounting for 6% of the variance of growth hormone secretion. However, differences in outcome could also be explained by other clinical features as smokers, compared with nonsmokers, were more frequently males (78.3% vs. 60.7%) and younger when studied at index episode (mean age 44.45 vs. 48.21 years; P= .054), reported higher ethanol consumption in the month before hospital admission (262 g vs. 192 g; P= .044), and met more criteria for the ICD-10 alcohol dependence syndrome (6.6 vs. 6.0; P= .047). Therefore, it cannot be stringently inferred from our data that a possible advantage of smoking for alcoholism recovery is causally related to the effects of nicotine on cerebral systems or human behavior, as our findings had not been based on a randomized design.

Aged↗
PubMed2001

Genetic analysis of the mu-opioid receptor in alcohol-dependent individuals.

On the basis of various study results, it is suggested that the ethanol-induced activation of the endogenous opioid system may play an important role in mediating the reinforcing effects of ethanol. The mesolimbic dopamine reward system is activated by both ethanol and opioids, and genetic differences in the sensitivity of the endogenous opioid system to alcohol may be an important factor determining the risk for the development of excessive alcohol consumption. Thus, variants of the mu-opioid receptor (muOR) gene may confer vulnerability to alcohol dependence. Five exon 1 variants of the muOR were investigated in 327 alcohol-dependent and 340 healthy control subjects. The Val6 variant of the +17C/T polymorphism and the Asp40 variant of the +118A/G polymorphism showed a trend to an increased allele frequency in alcohol-dependent subjects. The latter polymorphism was investigated in more detail. The dopamine receptor agonist apomorphine causes an increase in growth hormone (GH) levels in the blood by stimulating the release of growth hormone-releasing hormone. beta-endorphin also activates this regulatory circuit. We found a blunted response in intoxicated alcohol-dependent subjects, but no difference in GH response between the groups of alcohol-dependent subjects with and without the variant Asp allele. However, alcohol-dependent subjects with the Asp allele showed a significantly higher GH response at day 7 after alcohol withdrawal and a tendency to lower novelty seeking. These results suggest to us that there is reduced dopaminergic neuronal activity in alcohol-dependent subjects with the muOR Asp40 allele, along with a compensating increase in dopamine receptor activity. The difference between the two groups of alcohol-dependent subjects can be demonstrated only under certain conditions such as alcohol withdrawal, which necessitates the adaptation of the neurones to a new homeostasis.

Adult↗
PubMed2001

Psychopathological correlates of reduced dopamine receptor sensitivity in depression, schizophrenia, and opiate and alcohol dependence.

A dysfunction of central dopaminergic neurotransmission has been found in various neuropsychiatric diseases, and may be associated with a common psychopathological correlate. One hypothesis suggests that dopaminergic stimulation of the brain reward system reinforces behavior because it is experienced as pleasurable, and that dopaminergic dysfunction leads to anhedonia, the inability to experience pleasure. An alternative hypothesis assumes that dopaminergic stimulation does not promote pleasure or "liking" of a reward but rather mediates "wanting" of a reward, and suggests that dopaminergic dysfunction is associated with a failure to be motivated by stimuli that indicate reward. We measured negative symptoms, psychomotor slowing and dopamine receptor sensitivity in twelve drug-free patients with major depression, seventeen alcohol-dependent and sixteen opiate-dependent patients, ten schizophrenics with neuroleptic medication, and ten healthy controls. The sensitivity of central dopamine receptors was assessed with the growth hormone response to apomorphine application. Psychomotor slowing was measured in a reaction-time test and anhedonia and other negative symptoms were assessed with self-rating scales and the Scale for the Assessment of Negative Symptoms. Patients with major depression, alcohol dependence and neuroleptic medication displayed a reduced sensitivity of central dopamine receptors compared to control subjects. Anhedonia was not a common correlate of dopamine receptor dysfunction. Instead, affective flattening was associated with both dopamine receptor sensitivity and psychomotor slowing. Our findings thus do not support the anhedonia hypothesis of central dopaminergic dysfunction. Rather, affective flattening may result from the lack of an emotional response towards reward-indicating stimuli. These findings indicate that patients with dopaminergic dysfunction are not unable to experience pleasure, but may fail to be motivated by environmental stimuli to seek reward.

Adult↗
PubMed2001

Ethanol and gene expression in brain.

This article represents the proceedings of a symposium at the 2000 ISBRA Meeting in Yokohama, Japan. The chairs were Izuru Matusmoto and Peter A. Wilce. The presentations were (1) GABA receptor subunit expression in the human alcoholic brain, by Tracey Buckley and Peter Dodd; (2) NMDAR gene expression during ethanol addiction, by Jorg Puzke, Rainer Spanagel, Walther Zieglgansberger, and Gerald Wolf; (3) Differentially expressed gene in the nucleus accumbens from ethanol-administered rat, by Shuangying Leng; (4) Expression of a novel gene in the alcoholic brain, by Peter A. Wilce; and (5) Investigations of haplotypes of the dopamine D2-receptor gene in alcoholics, by Hans Rommelspacher, Ulrich Finckh, and Lutz G. Schmidt.

Alcoholism↗
PubMed2001

Mechanisms of alcohol-nicotine interactions: alcoholics versus smokers.

This article represents the proceedings of a symposium at the 2000 ISBRA Meeting in Yokohama, Japan. The chairs were Toshio Narahashi and Bo Söderpalm. The presentations were (1) Nicotinic mechanisms and ethanol reinforcement: Behavioral and neurochemical studies, by Bo Söderpalm, M. Ericson, P. Olausson, and J. A. Engel; (2) Chronic nicotine and ethanol: Differential regulation in gene expression of nicotinic acetylcholine receptor subunits, by X. Zhang and A. Nordberg; (3) Nicotine-ethanol interactions at neuronal nicotinic acetylcholine receptors, by Toshio Narahashi, William Marszalec, and Gary L. Aistrup; (4) Relapse prevention in alcoholics by cigarette smoking? Treatment outcome in an observational study with acamprosate, by L.G. Schmidt, U. Kalouti, M. Smolka, and M. Soyka; and (5) Effect of nicotine on voluntary ethanol intake and development of alcohol dependence in male rats, by L. Hedlund and G. Wahlström.

Acamprosate↗
PubMed2000

Different allele distribution of a regulatory MAOA gene promoter polymorphism in antisocial and anxious-depressive alcoholics.

Heritable factors account for approximately 40-60% of the total variance of liability to alcohol dependence. The present study tested whether a novel functional polymorphism in the promotor region of the X-chromosomal monoamine oxidase A gene (MAOA) was related to antisocial and anxious-depressive traits in alcoholics. Due to the X-chromosomal localization of the MAOA gene, psychobiological traits were compared separately for both genders of 298 male and 66 female alcoholics. In males, 30 of 59 alcoholics with antisocial personality disorder carried the low-activity 3-repeat allele in contrast to only 7 of 31 anxious-depressive alcoholics (51% vs. 23%; p = 0.02). Likewise, female anxious-depressive alcoholics showed a trend towards a low frequency of genotypes with the 3 repeat allele compared to female alcoholics without these symptoms (29% vs. 53%; p = 0.09). Taken together, these findings suggest that the 3-repeat allele of the MAOA polymorphism contributes modestly to the dimension of overand underreactive behaviors as possible antecedents of alcoholism.

Adult↗
PubMed2000

Genetics of alcohol withdrawal.

Alcohol withdrawal is a clinically and etiologically heterogeneous syndrome caused by a complex interaction of environmental (e.g., amount of ethanol) and genetic factors. Multiple genes are considered to be involved in various components of the syndrome, each of them contributing only modestly to withdrawal vulnerability. Association studies using candidate genes of the dopamine, serotonin, gabaergic and opioidergic systems are reviewed and methodological limitations are discussed.

Adult↗