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Biomedical subjects

L G Schmidt

Publications and source records attributed to L G Schmidt.

108 records · Page 6Linked to original sources
PubMed1986

Adverse drug reactions to first- and second-generation antidepressants: a critical evaluation of drug surveillance data.

We reviewed data on adverse drug reactions (ADRs) to first- and second-generation antidepressants, recorded by two different drug surveillance systems. The rate of ADRs that led to discontinuation of the drug in the individual case, assessed within a multi-centered hospital-based drug monitoring system (AMUP), was significantly higher in case of exposure to tricyclics (7.4%) than with the second-generation drugs (3.1%). On the basis of voluntary reports to the Medicines Commission of the German Medical Profession (AMK), profiles of ADRs to the drugs under survey were constructed and compared with data compiled by the WHO. The types of ADRs varied more between second-generation drugs than between tricyclics. Special attention was paid to rare but serious ADRs (e.g. seizures during treatment with maprotiline, and blood dyscrasias attributed to mianserin).

Adult↗
PubMed1985

Reliability of adverse drug reaction assessment in psychiatric inpatients.

Within an ongoing drug surveillance program in psychiatric hospitals the applicability of an algorithm for judgment on probability of causal relationship of adverse events and drug therapy was tested. Algorithmic interrater agreement was compared to agreement obtained with the conventional criteria used so far within the program in 80 cases by two raters, who had participated in the drug surveillance program since its beginning in 1979. With the use of the algorithm raters agreed on imputed drugs in 86% of all cases; total agreement on drugs and degree of probability was obtained in 69% (weighted kappa 0.618). Raters agreed on total score for the imputed medication in 49% and also on all subscores for the different axes of the algorithm in 43% of all cases. Differentiation of drug-related from illness-related changes, the use of judgmental terms within the algorithm and specific problems created by the frequent use of combinations of drugs with similar profiles of adverse drug reactions (ADR) in psychiatric patients were identified as the main sources of disagreement. Agreement on total judgment was comparable to results from similar studies in the literature using various algorithms, but in contrast to all these studies a higher percent of agreement (80%) was obtained with the use of the conventional criteria in this study.

Antidepressive Agents↗
PubMed1984

Assessment of adverse drug reactions in psychiatric hospitals.

A system for monitoring adverse drug reactions (ADR) in psychiatric inpatients was introduced in psychiatric hospitals in the FRG in May 1979. It consists of intensive drug monitoring (IDM) and a so-called "organized spontaneous reporting system" (OSR). ADR are rated separately according to impact on therapy and probability of causal relationship. With IDM all ADR (Grades I-III) are assessed in a randomly selected sample of inpatients. With OSR only ADR leading to discontinuation of the drugs in question (= ADR Grade III) are assessed. In 406 drug-treated inpatients monitored by IDM in the psychiatric hospitals of Berlin and Munich from May 1979 to Dec. 1981, ADR were observed in 60,4%. In 15% of IDM-patients ADR led to discontinuation of the drugs in question; with OSR the relative frequency of these Grade III ADR was 9,0% in 5096 patients monitored throughout the entire period. Life-threatening events were observed in 1,2% of patients undergoing IDM as well as 1.2% of those undergoing OSR. The most frequently observed ADR by IDM were sedation, extrapyramidal signs, disturbances of the autonomic nervous system and increase in transaminases, and by OSR Parkinsonism, akathisia, sedation, toxic delirium and increased transaminases. The relative frequency of Grade III ADR was similar for neuroleptics and antidepressants (5,4% and 5,3% in OSR); a very low relative frequency of ADR Grade III was found for tranquilizers and hypnotics (0,7% and 0,2%). Methodological aspects of this drug monitoring system are discussed in the light of current literature.

Antidepressive Agents↗
PubMed1984

Drug safety in psychiatry--an objective for drug monitoring in phase IV.

This survey deals with methods to achieve drug safety within the phase IV of psychotropic drug development. Data related to adverse drug reactions (ADRs) are very heterogeneous and have to be collected from very different sources. A sophisticated method, called hospital-based drug monitoring, serves as an important tool for assessment of ADRs in in-patients. The techniques of assessment developed in the context of drug monitoring will be described in detail in this paper. The data obtained may also serve for the evaluation of efficacy and economy of drug treatment in psychiatric in-patients. Moreover, drug monitoring in hospitals may have some value for residents' training in psychiatry, and for generating of hypotheses in clinical pharmacology and biological psychiatry.

Clinical Trials as Topic↗
PubMed1984

Adverse drug reactions. An epidemiological study at psychiatric hospitals.

A drug monitoring system has been established at psychiatric university hospitals in Berlin, Goettingen, and Munich since 1979 in order to investigate adverse reactions to psychotropic drugs. This report describes the system and presents results obtained over 3 years. 504 randomly selected patients were observed by Intensive Drug Monitoring; 75% of them had an adverse drug reaction (ADR) during hospitalization that was assessed as possible, probable, or definite including all grades (I-III) of severity. 5,096 other patients were monitored by Organized Spontaneous Reporting during treatment with psychotropic drugs: ADRs were responsible for drug withdrawal (severity grade III) in about 10% of them. Parkinsonism, psychomotor disturbance, akathisia, delirium, oversedation and increased transaminases were the most frequent ADRs of this kind. The relative frequency of ADRs was calculated, and ADR-profiles established for drugs most frequently withdrawn. The impact of ADRs on ongoing therapy of patients was assessed. Reliable data obtained by drug monitoring systems can be expected to aid in therapeutic decisions in patients with special risks of side effects to psychotropic drugs.

Adult↗
PubMed1983

Drug prescribing pattern of a psychiatric university hospital in Germany.

1. The drug treatment of 1,263 psychiatric patients (= 96% of all in-patients admitted during a period of 2 years) was analyzed by means of case histories. During hospitalization 7.4% of all patients were treated completely drug-free; 12.5% received no psychoactive drugs. 2. The patients were hospitalized for 50 days on the average, and received psychoactive drugs on 43 days. During the total treatment period, they were prescribed an average of 4.3 (median 3.8) different drugs; of these, 2.7 (median 2.3) were various psychoactive drugs. Neuroleptics were the most frequently used drugs; they were prescribed at least once during treatment for 62% of all patients. Antidepressants were prescribed for almost 30% of the patients. 3. For the neuroleptics prescriptions decreased with patient's age; they increased for the antidepressants. Antiparkinsonian agents were prescribed to 51% of neuroleptic-treated patients under 45 years of age, and to 26% of these patients over 45. 4. Neuroleptics were prescribed more frequently in male patients, antidepressants in female patients. 5. Among the individual prescriptions, perazine was the most favoured of the neuroleptics, and amitriptyline of the antidepressants. Clozapine was prescribed for the longest period among all psychotropic agents except lithium salts. Antiparkinsonian agents were used for shorter periods than the neuroleptics administered simultaneously. One-fifth of the patients were given analgesics for brief periods. 6. Medication pattern is related to specific nosology. 95% of schizophrenic patients received neuroleptics for at least an average of 41 days; every second patient in this group received antiparkinsonian agents. 90% of unipolar depressed patients were given antidepressants; during one course of treatment at least 2 different antipressant drugs were prescribed for 32% of these patients. 43% of unipolar depressed patients received neuroleptics for an average of 33 days. Lithium salts were administered for an average of 45 days to 43% of the patients with affective disorders. 7. Treatment surveys of this kind supplement the collection of data on adverse drug reactions by drug monitoring systems. The relationship between the side effects of drugs and the prescription pattern of individual drugs allows one to determine the incidence rates of drug side effects.

Age Factors↗
PubMed1982

[The inpatient group in a psychiatric clinic--structure, interaction regulations, patient judgments].

Structure and functioning of a group therapy comprising all patients of a psychiatric ward is described in terms of psychoanalytic and group dynamics, behaviour therapy and cognitive psychology. 34 acutely-ill patients with heterogenic diagnoses reported their experiences with this group technique at day of discharge. Aims of therapy are discussed in respect of desired effects and risks for delusional patients. This psychotherapeutic procedure with inpatients is conceived as part of "psychiatric psychotherapy".

Adult↗
PubMed1976

Communication patterns of doctors and their assistants.

Communication patterns between physicians and their assistants (Medex) were observed in 19 practices to describe and evaluated the nature of their relationship. Observations demonstrated that interaction around patient problems was approximately 30 minures per day and informal, with the Medex more often initiating the contact. Medex were more likely to ask for, and physicians were more likely to give, suggestions. Physicians appeared to regard the accomplishment of the immediate task as more important than maintaining good relations. In most practices, supervision was available when requested. Generally, both the physician and the Medex show a striking similarity in communication styles.

Communication↗
PubMedDate not supplied

Psychiatric admissions due to adverse drug reactions.

This is a report of the findings of a 6-year study of hospitalizations caused by adverse psychiatric reactions to prescribed medications. Of 15,800 consecutive psychiatric admissions to two university hospitals, 112 (0.7%) were caused by adverse reactions to medications. In 67% of cases these admissions were due to extrapyramidal symptoms such as parkinsonism and/or akathisia, and coexisting neuroleptic-related depression. In 25% the admitting diagnosis was drug-induced delirium or psychosis; one third of these patients suffered from Parkinson's disease and had been treated with a combination of two or more antiparkinsonian agents. Older age, polydrug therapy, and the parenteral administration of neuroleptics at high dosages were important risk factors for severe adverse drug reactions leading to hospitalization.

Adult↗
PubMedDate not supplied

Harman (1-methyl-beta-carboline) in blood plasma and erythrocytes of nonalcoholics following ethanol loading.

Eleven subjects having no history of substance abuse or dependence who agreed to abstain from alcohol for one week prior to the investigation were selected to participate in the present study. On two occasions, separated by four to six weeks, blood was drawn over an 8-hour period (0, 0.5, 1, 2, 4 and 8 hours). On the first occasion, subjects were given an oral dose of ethanol (1 g/kg) after the first blood sample was drawn (ethanol-loading condition). On the second occasion no ethanol was administered (control condition). On both occasions no detectable harman was found in the plasma of subjects. In the control condition harman was detected in the erythrocytes of 7 subjects which remained relatively stable over time. In the ethanol-loading condition, however, a time-dependent increase of harman in the erythrocytes was observed. The concentration of ethanol, acetaldehyde, and erythrocyte-harman showed a parallel trend over time. These findings demonstrate an increased level of harman following ethanol loading in humans.

Acetaldehyde↗
PubMedDate not supplied

Determination of (R)- and (S)-salsolinol sulfate and dopamine sulfate levels in plasma of nonalcoholics and alcoholics.

We have developed a new method to determine free as well as sulfoconjugated salsolinol (SAL), separated into both enantiomers, and free and sulfoconjugated dopamine in human blood plasma. Among the group of nonalcoholics (R)-SAL (mean +/- SEM: 0.24 +/- 0.07 ng/ml) was found in all blood samples and (S)-SAL in 1 out of 20 (0.08 ng/ml). Ethanol loading induced a rise of both enantiomers as well as of dopamine whereby (S)-SAL was detected in the plasma of 13 subjects only [(R)-SAL: 0.79 +/- 0.24 ng/ml; (S)-SAL: 0.49 +/- 0.15 ng/ml; DA: 8.84 +/- 0.75 ng/ml]. The later finding favors the notion of an enzymatic formation of (S)-SAL. In alcoholics, (R)-SAL and (S)-SAL were elevated at the day of admission for detoxification [(R)-SAL: 0.65 +/- 0.82 ng/ml; (S)-SAL: 0.35 +/- 0.05 ng/ml] and normalized after several months, suggesting intoxication marker characteristics [month 6: (R)-SAL: 0.24 +/- 0.14 ng/ml; (S)-SAL: 0.20 +/- 0.05 ng/ml]. Patients with alcoholic parents had lowered (R)-SAL and (S)-SAL levels compared with family history negative alcoholics, suggesting genetic association of disturbance of the SAL biosynthesis and alcoholism. Among the personality traits, suicidality was linked with low (R)-SAL and (S)-SAL concentrations in contrast to novelty seeking, impulsivity, and harm avoidance scores. The scores on the self-rating anxiety scale correlated positive with (R)-SAL. These findings suggest trait marker characteristics of salsolinol.

Adaptation, Physiological↗
PubMedDate not supplied

Transition to alcohol dependence: clinical and neurobiological considerations.

The transition to alcohol dependence is supposed to occur during a critical period that begins with increased drinking and ends with a loss of control. This process may last about 3 to 4 years, and is modified by gender and accelerated by premorbid traits (e.g., novelty-seeking) and comorbid disorders (e.g., dissocial personality disorders according to ICD-10). Genetic disposition, environmental influences (e.g., stress), and sensitization by exposure are factors implicated in dependence that alter brain functions, some possibly in an irreversible way. Underlying neurobiological mechanisms that may have different time patterns are beginning to be characterized on a systemic, cellular, and molecular level. Repeated free choices of the rewarding compound seem to be necessary for the transition to dependence.

Adult↗
PubMedDate not supplied

Five exon 1 variants of mu opioid receptor and vulnerability to alcohol dependence.

The human mu opioid receptor (hMOR) gene is a prime candidate gene responsible for addictive disorders. The present association study tested the hypothesis that hMOR exon 1 variants elicit susceptibility to alcohol dependence. We have analyzed five nucleotide changes in exon 1 of the hMOR gene. Three of them are in the 5'untranslated region of exon 1 at positions -172G/T,-111C/T and -3 8C/A, the remaining two variants cause amino acid substitutions: +17C/T (Ala6Val) and +118A/G (Asn40Asp). Our population-based association study included 327 German alcohol-dependent subjects and 340 ethnically matched controls. The lack of an allelic association suggests that the analyzed hMOR exon 1 variants do not contribute a common and substantial effect to the genetically determined vulnerability of alcohol dependence.

5' Untranslated Regions↗