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M Wolfersdorf

Publications and source records attributed to M Wolfersdorf.

At least 19 recordsLinked to original sources
PubMed2006

[Stability of the "amok runner syndrome"].

BACKGROUND: Running amok is considered a rare but dangerous act of violence which has been investigated predominantly on a case by case basis. German-wide data on amok cases covering the decades 1980 - 1989 and 1991 - 2000 were used to perform the first epidemiological study world-wide on the stability of socio-demographic, criminological and psychiatric variables of amok behaviour. METHODS: A content analysis study on nation-wide press reports of amok cases included a total of 104 subjects who were identified by combined homicidal-suicidal acts of violence and fulfilled structured criteria originally defined according to former Malayan amok events. RESULTS: Amok cases in both decades were comparable except for the significant increase of weapon use, especially of firearms. Total prevalence showed a tendency to decline from 1 : 5.5 million to 1 : 8.5 million men per year, females were involved in rare single cases only. The male offenders showed a bimodal age distribution with a mean of 35 years. They were professionally well qualified, but had a 5 - 7fold higher risk of unemployment than the normal population. Motives and reasons for running amok were serious but not unusual, they varied widely and addressed all areas of daily life. Most offenders were characterized by abnormal personality patterns such as passive, aggressive, impulsive and paranoid and were in possession of firearms and previously convicted. Psychiatric diseases such as psychosis, paranoia, depression or personality disorders were present in more than 50 % of cases; further 20 % were intoxicated. The presence of psychiatric disorders influenced patterns of violent behaviour in individual subjects. Victims were predominantly unknown to the offenders. Close to one third of the amok runners committed suicide or were killed by legal authorities. CONCLUSION: Amok represents a temporarily stable syndrome of extreme violent behaviour even in modern industrialized societies. Subjects exhibit a complex combination of serious causative motives, social burden and psychiatric diseases which do not explain common causes of amok rather than the origin of amok behaviour in individual cases. Amok joins the wide spectrum of human homicidal-suicidal acts which show similarities in many aspects.

Adult↗
PubMed2005

[Differential indications for atypical neuroleptics: Amisulprid, Clozapin, Olanzapin, Quetiapin und Risperidon. Results of a pilot study of prescription habits in psychiatric clinical usage in the BRD].

With the introduction of atypical neuroleptics, the therapy of schizophrenia has been improved by a group of antipsychotic substances characterized by better tolerability concerning extrapyramidal side effects and higher efficiency against negative symptoms. However, these atypical antipsychotics are not a homogeneous class of drugs but rather represent a group of substances with very different neurobiologic, pharmacologic, and clinical features. This fact and the growing variety of available atypical neuroleptics illustrate the difficulty in choosing the "right" antipsychotic drug for each patient. The aim of this investigation was to evaluate preliminary empirical data for possible differential indication of atypical neuroleptics by a questionnaire-based survey of 192 physicians in ten psychiatric hospitals active in the biological psychiatry work group of the German Federal Directors' Conference.

Antipsychotic Agents↗
PubMed2004

[Psychiatric-psychotherapeutic inpatient treatment for depression. Process and outcome quality based on a model project in Baden-Wurttemberg].

During 1998-2000 a quality assurance program for diagnosis and treatment of depression was conducted in 24 hospitals for psychiatry and psychotherapy in Baden-Wurttemberg (southern Germany). Process and outcome quality of 3,000 depressive patients was documented at admission and discharge. The article focuses on therapeutic measures, duration, outcome, patient satisfaction, and their interactions. The results show that the patients' satisfaction with the care received is very high and the pre-post effect sizes of inpatient treatment for depression are high.

Adjustment Disorders↗
PubMed2003

[Suicide prevention by the general practitioner].

Although suicides in Germany are on the decrease, for the care-providing physician a suicidal patient must always be considered an emergency. An elevated risk is to be seen above all in patients with psychological/mental problems, in particular those suffering from depression, but also those experiencing a crisis associated with ageing, physical illnesses or intolerable social situations. A range of factors may influence suicidal behavior, such as the specific situation of the patient or the loss of protective factors. When his/her coping strategies or outside help then fails, a triggering event may prompt suicide. As a rule, the suicide-endangered patient goes through three stages--a period of weighing up, ambivalence and decision-taking. For the care-providing physician it is of particular importance to recognize the ambivalence stage in good time, for it is here that the patient gives expression to thoughts of suicide and the physician has an opportunity to intervene. Major preventive measures are the build-up of a doctor-patient relationship and a readiness to "talk things through". Further crisis management includes, for example, the use of psychopharmaceuticals or the initiation of psychotherapy.

Depression↗
PubMed2003

Hospital admission circumstances and prevalence of frontotemporal lobar degeneration: a multicenter psychiatric state hospital study in Germany.

Frontotemporal lobar degeneration (FTLD) is a heterogenous, non-Alzheimer's disease, dementia complex with variable clinical presentation. We carried out a prospective nationwide hospital-based clinico-epidemiologic study in geriatric psychiatry to estimate the prevalence and admission circumstances of patients with FTLD. During a 4-week period 33 patients with clinical FTLD were prospectively ascertained in 36 psychiatric state hospitals in Germany with a total catchment area of >20,000,000 people. The relative portion of FTLD patients within the primary dementia population accounted for 1.9%. The estimated prevalence of FTLD in Germany was 47.9/100,000 population aged between 45 and 79 years. The admission circumstances were mainly behavioral disturbances (54.5%), unclear syndromes of dementia (18.1%) and further remarkably heterogeneous psychiatric syndromes. FTLD is a common cause of dementia in geriatric psychiatry with a variable clinical presentation that could mimic most of the major psychiatric diseases. Patients with FTLD may be older than previously assumed (mean age at admission 63.9 years) and show their maximum age-related prevalence between 60 and 70 years (78.7/100,000).

Aged↗
PubMed2001

[How and to what extent is suicide postvention part of the routine of health care professionals in psychiatric hospitals after inpatient suicide?].

OBJECTIVE: To elucidate how and to what extent suicide postvention is part of the routine of health care professionals in psychiatric hospitals after inpatient suicide was aim of the study. METHODS: In 11 South German psychiatric hospitals the head of the nursing team of the ward, the therapist and the medical assistant director were asked how suicide postvention after the last suicide was handled. RESULTS: Suicide postvention is part of the routine in these hospitals and discussion on the issue is rather open. The members of the team confronted with suicide feel mostly sufficiently supported. (2/3) of both therapists and heads of nursing teams considered the procedere to be adequate. CONCLUSION: Mainly for the nursing team there seems to be a need to further improve procedures for suicide postvention to gain more team satisfaction with regard to how the situation is managed.

Adaptation, Psychological↗
PubMed2001

[The development of suicide rates in the Bezirkskrankenhaus Bayreuth 1976 - (including) 2000].

Newer publications about psychiatric in-patient suicide discuss the so-called "increase hypothesis" of suicide of mentally ill in-patients controversially. In our study of in-patient suicides of the Bezirkskrankenhaus Bayreuth, a state mental hospital for adult psychiatry, the number of suicides and suicide rate over 25 years 1979 - 2000 did not show any increase. During the last 4 - 5 years we observe a trend toward a decrease.

Adult↗
PubMed2001

[The aftermath of suicide of a psychiatric inpatient - experiences in psychiatric hospitals with relatives as suicide survivors].

OBJECTIVE: In a first part we describe the situation of suicide survivors after the suicide of a family member in USA and Germany by reviewing the literature. In a second part we try to elucidate typical patterns of reactions and coping of relatives. METHODS: On the basis of either own experience or from supervision cases, we try to elaborate reaction types of relatives of inpatients who committed suicide. RESULTS: Relatives as suicide survivors show reactions from shock, disbelief, grief, guilt, self-doubt, anger and relief to accusation and threat of lawsuit toward therapists. An attempt is made to subsummarize these reactions in three preliminary categories. CONCLUSIONS: Generally, relatives should be offered the opportunity of more than one common talk with the health care professionals. Postvention is preventive work, that aims at avoiding that the suicide survivors becomes a patient himself.

Adaptation, Psychological↗
PubMed2001

First experiences in combination therapy using olanzapine with SSRIs (citalopram, paroxetine) in delusional depression.

In an open prospective study, 26 patients with delusional depression (mood-congruent psychotic features: DSM-IV 296.4) were treated over 5 weeks with a combination of SSRI (citalopram, n = 22, or paroxetine, n = 4) and the neuroleptic olanzapine. The course of therapy was evaluated with the Hamilton depression scale (HAMD). Not only the total HAMD score, but also the subscores for affectivity and delusional symptoms decreased significantly. After the end of the 5-week combination therapy, 18 out of 26 patients (69%) could be discharged as responders to outpatient treatment. The course of treatment was characterized by excellent tolerance.

Administration, Oral↗
PubMed2000

Schizophrenic psychosis: a contraindication for treatment of hepatitis C with interferon alpha?

Depressive or psychotic symptoms are a well known side-effect of interferon alpha (INF-alpha). Therefore, the questions arises whether a chronic psychosis should be considered a contraindication for the treatment of active hepatitis C with INF-alpha. We report on a 38-year-old woman with a chronic schizophrenic psychosis, who acquired chronic aggressive hepatitis C. Considering the young age of the woman, the potential risk of developing a hepatocellular carcinoma and the result of the liver biopsy, treatment with interferon alpha 2 b (3x5 million IU/week) was started. The patient was seen three times a week, her psychiatric condition was monitored using the positive and negative symptoms score (PANSS). No signs of psychotic or depressive symptoms appeared during INF-alpha therapy. During the first 6 months the liver enzymes dropped slowly but the virus load was increasing. After adding ribavirin to the therapy, the liver enzymes dropped again, and the PCR carried out 9 months after initiation and 6 months after the end of the 12 months INF-alpha treatment did not detect any virus RNA. This positive result should encourage prospective studies including patients with these two diagnoses on whether patients benefit from INF-alpha.

Adult↗
PubMed2000

Effect of paroxetine on thyroid hormone levels in severely depressed patients.

There are very divergent appraisals of the effect of antidepressants on thyroid parameters and their possible correlation with the response. Whereas there are numerous investigations of tricyclic antidepressants, so far, there are only limited data on the possible effect of serotonin-selective reuptake inhibitors on neuroendocrine parameters. The present study showed a significant reduction of 11. 2% in thyroxine during treatment with 20 mg paroxetine in 25 severely depressed patients.

Adult↗
PubMed2000

[Substance dependence and suicide in hospitalized patients. A description].

OBJECTIVE: The research group "Suicide and Psychiatric Hospital" has studied inpatient suicides in psychiatric hospitals in Baden-Württemberg and Bavaria (Germany) from 1970-1996. Whereas suicides in depression and schizophrenia are described very well, a description of addicted inpatients who committed suicide is still missing. PATIENTS AND METHODS: We studied the data of substance dependent patients of the collective of 726 inpatient suicides. RESULTS AND CONCLUSIONS: Among the generally rare suicides of addicted inpatiens--33 of 726--about 81% were alcohol dependent. The frequency of suicide in this group of patients decreased from 6.7% in the years 1970-1984 to 1.4% between 1990 and 1996. Whereas the age remained more or less stable in the middle of the fifth decade, the time from hospitalisation until suicide shortened from 192 days (mean) to 52 days. Suicide of alcohol dependent and poly-drug-abusing patients today almost exclusively takes place during treatment on an open station and among patients being in treatment on a voluntary basis. Suicide attempts in the anamnesis are extraordinarily rare in alcohol dependent suiciders.

Adult↗
PubMed1998

[Inpatient treatment of depressed patents. Conceptual considerations and results of a pilot project for quality assurance in Baden-Württemberg].

Quality-assurance activities will become more important in psychiatry during the next few years. In relation to other medical disciplines, some special aspects concerning structure, process and outcome quality as well as practical realization and methodologic aspects must be considered. These specific issues were the focus of a study dealing with the treatment of depressed inpatients. The experiences and results as well as considerations concerning future quality-assurance projects are discussed.

Adult↗
PubMed1998

Thyroid parameters during therapy with zotepine in delusional depression. Preliminary results.

There are only few data on the effects of atpyical neuroleptics on thyroid function. In an open pilot study of 12 inpatients with delusional depression, thyroid hormone levels and TRH-TSH test were determined during neuroleptic treatment with zotepine. No significant changes in triiodothyronine (T3), thyroxine (T4) and delta-TSH levels were found in this observation period (28 days).

Adult↗
PubMed1998

[Suicide in depression, lost years of life and gross social consequences. What is the outcome of suicide prevention?].

In recent years there has been a tendency in research and clinical treatment to discuss also economic aspects of mental illness in the context of outcome and consequences of treatment for the individual and society. In our study on economic consequences of suicide prevention we could show that a reduction of suicide mortality of depressed patients could save money to the tune of thousands of million Deutschmark.

Cost Savings↗