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Michael Linden

Publications and source records attributed to Michael Linden.

At least 19 recordsLinked to original sources
PubMed2006

Nerve growth factor serum concentrations rise after successful cognitive-behavioural therapy of generalized anxiety disorder.

Generalized anxiety disorder (GAD) is a chronic stress disease with permanent physical tension and cognitive strain. Raised nerve growth factor (NGF) serum levels were reported as an acute stress reaction in soldiers before their first parachute jump even before the rise in cortisol. Taking GAD as a clinical model of chronic stress, we measured NGF in the serum of 22 patients with GAD before and after cognitive-behavioural therapy (CBT) and compared them to those of healthy normal controls. Treatment response was tested by the values of the State and Trait of Anxiety Inventory (STAI) and the Hamilton Anxiety Scale (HAM-A) as treatment outcome variables. The NGF values of patients and controls were similar at baseline (p=0.8941); however, with successful treatment, corresponding to a mean reduction in the HAM-A by more than 50% and a reduction in the clinical global impression scale (CGI) median from 4 to 1, the patients' NGF serum concentrations rose significantly (p=0.0006) which might correspond to an altered stress reaction, possibly contributing to good therapeutic response with CBT. There were 3 patients with a HAM-A decrease of less than 15%. In those patients NGF rose only marginally. Hence, the increase in serum NGF seems to indicate good treatment response.

Adolescent↗
PubMed2006

Anxiety disorders and workplace-related anxieties.

BACKGROUND: Workplace-related anxieties are often connected with sick leave. There are no established instruments which allow to assess this phenomenologically heterogeneous group of disorders. METHOD: One hundred and thirty-two psychosomatic inpatients were interviewed with a standardized diagnostic interview in respect to mental illnesses, especially primary anxiety disorders, and in addition in respect to different work-related anxiety disorders. RESULTS: Seventy-one percent of women and 54% of men complained about work-related anxiety. 20.5% of participants are suffering from work-related panic, 58% from work-related phobia, 34.1% from work-related social phobia, 39.4% from work-related generalized anxiety, and 1.5% from work-related PTSD. There is a moderate relation between mental disorders or primary anxiety disorders and work-related anxiety. Fourteen percent of the participants did only suffer from workplace-related anxiety and did not report any other anxiety disorder outside the workplace situation. CONCLUSION: There are various types of workplace-related anxieties. They are partly independent clinical phenomena deserving special diagnostic and therapeutic attention.

Adult↗
PubMed2006

[The ecologic milieu in inpatient treatment].

OBJECTIVE: Therapeutic milieus can be characterized by interactional qualities ("social atmosphere") and by ecological conditions. The paper gives a literature review on ecological aspects of the therapeutic milieu. Furthermore, a questionnaire is introduced operationalizing and measuring the quality of ecological milieus. METHOD: 127 patients of two psychosomatic inpatient units were asked to evaluate the ecological milieu at home and in the hospital, using the housing milieu questionnaire. RESULTS: Patients rated both the quality of their home and of the hospital-milieu rather positive. In a comparison of both milieus the patients rated the hospital better in respect to space availability, noise, building status, and conflicts with others, while the home milieu gets higher ratings for cleanliness, the availability of household devices, and the possibility to pursue own interests. The housing milieu questionnaire has a high internal consistency (home: Cronbach's alpha=0.82, clinic: Cronbach's alpha=0.83) and good retest reliability (home: r=0.895; clinic: r=0.854). CONCLUSIONS: The literature review shows that the ecological milieu is an important part of the therapeutic milieu and should get more attention in science and practice. The housing milieu questionnaire allows to describe ecological aspects of the therapeutic milieu. Differences between home and hospital argue for the sensitivity of the scale. The questionnaire can be used to analyze the quality of ecological aspects of the therapeutic milieu.

Adult↗
PubMed2006

Her-2/neu expression in primary breast cancer with sentinel lymph node metastasis.

BACKGROUND: Amplification of the protein product of the HER-2/neu oncogene in primary breast cancer specimens is associated with an adverse prognosis. We hypothesized that overexpression of HER-2/neu would predict metastases to the sentinel lymph nodes (SLNs). METHODS: A retrospective review of a prospective nonrandomized evaluation of 1055 clinically node-negative breast cancer patients undergoing 1063 SLN biopsies was performed. HER-2/neu analysis was performed by immunohistochemistry and, in selected cases, by fluorescence in situ hybridization. Clinical, demographic, surgical, radiological, and pathologic data were analyzed by using generalized estimating equations logistic regression models. RESULTS: Two hundred thirty-two (23.6%) of 985 operations in which the SLN was found at operation resulted in positive nodes. In a multivariate analysis, size (P < .0001) and HER-2/neu overexpression (P = .026) were independent predictors of SLN metastasis. CONCLUSIONS: Size is a known predictor of SLN metastasis in the modern SLN era, as it was in the pre-SLN eras. HER-2/neu was found to be significantly predictive of SLN metastasis in our study. We anticipate a future when even the relatively minor procedure of SLN biopsy might be avoided with the predictive information gained from studying the pathology and molecular markers of primary breast cancers.

Adult↗
PubMed2006

Improvement of patient compliance after switching from conventional neuroleptics to the atypical neuroleptic amisulpride.

Medication noncompliance of schizophrenic outpatients is an important problem in clinical practice, causing relapse and illness deterioration. Because atypical neuroleptics have, in controlled clinical studies, been shown to be better tolerated and accepted by patients, the question is whether switching from conventional to atypical neuroleptics such as amisulpride can increase patient compliance also under conditions of routine care. In a drug utilization observation study 570 schizophrenic outpatients, who had been pretreated with conventional neuroleptics and then been switched for individual clinical reasons to amisulpride, were observed for 3 months. Sociodemographic, illness and treatment related variables (e.g. Positive and Negative Symptom Scale, side effects), patients' subjective attitudes, and premedication and treatment compliance were assessed using standardized instruments. A total of 43.7% were rated as being noncompliant with the premedication, while 85.8% were rated as compliant after being switched to amisulpride, including 82.7% of the former noncompliant patients. Patients who had become compliant showed a signicantly better psychopathological status after 3 months as compared to still noncompliant patients, including a lower rate of inpatient stays. Switching noncompliant patients from conventional to atypical neuroleptics like amisulpride can improve patient compliance and psychopathology under conditions of routine treatment.

Adolescent↗
PubMed2006

Why do physicians switch from one antipsychotic agent to another? The "physician drug stereotype".

There is a lack of research on why physicians select a certain drug in an individual case and not another available alternative, although this drug selection process is important for quality assurance and cost control. Four hundred ninety-five psychiatrists documented in a standardized form patient and illness characteristics of 1711 schizophrenic outpatients who were switched for individual clinical reasons from an ongoing neuroleptic treatment to olanzapine, and of another 1654 schizophrenic outpatients whose present neuroleptic medication was continued. Physicians also filled in the "Reason for Treatment Selection Questionnaire." Patients who were switched to olanzapine were more ill and showed more preexisting extrapyramidal symptoms and less patient compliance. Reasons of psychiatrists to switch to olanzapine were the expectation of better efficacy and tolerability of the present treatment and patient preferences to continue with the present medication. The price of olanzapine is seen as a reason not to select olanzapine but has no effect on the treatment decision. The "physician drug stereotype" of olanzapine corresponds with clinical data on the efficacy and tolerability of olanzapine. The data show that medical decisions about drug selection are multidimensional, integrating knowledge about the clinical properties of the drug, personal experiences and information about the individual case. The Reason for Treatment Selection Questionnaire is an instrument that allows to objectively assess important aspects of medical decision making, to generate psychological drug profile, and to understand why physicians prefer one drug over alternatives.

Adolescent↗
PubMed2005

Race modifies the association between breast carcinoma pathologic prognostic indicators and the positive status for HER-2/neu.

BACKGROUND: Inferences about the variations in the biology of breast carcinoma between African-Americans and Caucasians have been reported. The difference in the prevalence of positive HER-2/neu breast carcinoma was evaluated and the race-specific risk was assessed for positive HER-2/neu among a cohort of women diagnosed with their first primary breast carcinoma, given the accepted prognostic pathologic indicators for positive HER-2/neu status. METHODS: Demographic, clinical, and pathologic data were collected from existing databases. The status of HER-2/neu was considered positive if the immunohistochemistry score was 3+ or if the fluorescent in situ hybridization indicated a ratio greater than 2. Multivariable logistic regression was used to determine the race-specific risk for HER-2/neu positive breast carcinoma. RESULTS: The difference in the prevalence of HER-2/neu-positive status between African-American and Caucasian women was not statistically significant (P = 0.46). For Caucasian women the likelihood for positive HER-2/neu was statistically significant and increased almost linearly within each stage with nuclear grade dedifferentiation relative to the reference group, women with Stage 1, Grade 1 carcinomas. For African-American women, this risk was not significantly associated with stage, nuclear grade, their interaction term, or other pathologic prognostic indicators. CONCLUSIONS: The findings suggest that race modifies the association between the pathologic prognostic indicators of breast carcinoma and the likelihood of HER-2/neu-positive carcinoma. So far, clinical correlative studies of HER-2/neu have not included race as an independent variable. Concerns about the limited generalizability and the need for validation of the findings across racial lines have been expressed previously.

Black or African American↗
PubMed2005

Electroencephalographic biofeedback in the treatment of attention-deficit/hyperactivity disorder.

Historically, pharmacological treatments for attention-deficit/hyperactivity disorder (ADHD) have been considered to be the only type of interventions effective for reducing the core symptoms of this condition. However, during the past three decades, a series of case and controlled group studies examining the effects of EEG biofeedback have reported improved attention and behavioral control, increased cortical activation on quantitative electroencephalographic examination, and gains on tests of intelligence and academic achievement in response to this type of treatment. This review paper critically examines the empirical evidence, applying the efficacy guidelines jointly established by the Association for Applied Psychophysiology and Biofeedback (AAPB) and the International Society for Neuronal Regulation (ISNR). On the basis of these scientific principles, EEG biofeedback was determined to be "probably efficacious" for the treatment of ADHD. Although significant clinical improvement was reported in approximately 75% of the patients in each of the published research studies, additional randomized, controlled group studies are needed in order to provide a better estimate of the percentage of patients with ADHD who will demonstrate such gains in clinical practice.

Attention Deficit Disorder with Hyperactivity↗
PubMed2005

[Instruments for the measurement of the social network].

The social network can be an important pathogenic, pathoplastic, or protective factor in the development and course of mental and somatic illnesses. "Social network" describes a complex construct which has been understood, defined, and operationalized in many different ways. In research and clinical practice it is advisable to refer to scientifically elaborated instruments when measuring or evaluating the social network of patients. In this paper a review is given on available instruments for the measurement of the social network. They are discussed in respect to their clinical usefulness. Only few measures can be recommended for clinical practice because of the time needed to get the information or because of their content.

Animals↗
PubMed2005

Gender differences in routine treatment of depressed outpatients with the selective serotonin reuptake inhibitor sertraline.

Gender is known to have an influence on medical treatment and the prescribing and outcome of drug treatment. This has also been suggested for selective serotonin reuptake inhibitors (SSRIs). To examine sex differences in the treatment with the SSRI sertraline in routine treatment of depression, data from a 6-month prospective drug utilization observation study on 3,858 women and 1,594 men were analysed for gender differences. Compared to men, women were more often treated by a general practitioner, were somewhat older, had a later onset of illness, were more likely to suffer from a recurrent rather than a first episode of depression, had been treated for depression before, and showed more anxious and less neurasthenic or retarded syndromes. There was no difference regarding duration of the present episode or severity of illness. The mean prescribed dose of sertraline was marginally lower for females compared to males (45.5 versus 46.5 mg/day) with no difference in the rate of psychoactive concomitant medication (6.76% versus 6.80%). There was no difference in side-effects, treatment termination or treatment response.

Adult↗
PubMed2004

ABL-MYC retroviral infection elicits bone marrow plasma cell tumors in Bcl-X(L) transgenic mice.

Multiple myeloma is characterized by the accumulation of malignant plasma cells in the bone marrow. While there have been many attempts to genetically recapitulate this disease in animal models, few reports describe plasma cell tumors that exhibit bone marrow involvement. We recently described a Bcl-X(L) transgenic mouse that developed polyclonal non-malignant B-cell expansions in the bone marrow and lymphoid organs. In this report, we describe induction of plasma cell tumors in littermate control and Bcl-X(L) transgenic mice with a retrovirus expressing v-Abl and c-Myc. Nearly 100% of the ABL-MYC-infected littermate control and Bcl-X(L) mice developed plasma cell tumors. There was no difference in tumor latency in young mice infected; however, following ABL-MYC infection, aged Bcl-X(L) mice demonstrated a median survival of 9 weeks, while littermate control mice demonstrated a median survival of 19 weeks. Interestingly, while both littermate control and Bcl-X(L) mice infected with the ABL-MYC retrovirus developed extramedullary plasma cell tumors, only the ABL-MYC-infected Bcl-X(L) mice, but not the ABL-MYC-infected littermate control mice, developed bone marrow plasma cell tumors with characteristic radiolucent bone lesions. Tumor cell populations were clonally related, and analysis of tumor immunoglobulin genes demonstrated evidence consistent with somatic hypermutation. This report implicates an unidentified role of Bcl-X(L) in bone marrow plasma cell tumor formation, as ABL-MYC retroviral infection only elicits bone marrow plasma cell tumors in mice that ectopically express Bcl-X(L) in their B- and plasma cells.

Aging↗
PubMed2004

Treatment of panic disorder with agoraphobia in an anxiety disorders clinic: factors influencing psychiatrists' treatment choices.

The main objective of this report was to identify patient characteristics that led psychiatrists in an academic anxiety disorders clinic to make a decision about intensive treatment of patients with panic disorder with agoraphobia (PDA) with cognitive-behavioral therapy (CBT) alone, CBT plus a high-potency benzodiazepine (CBT+BZ) or CBT combined with BZ and an antidepressant, fluoxetine (CBT+BZ+AD). On the basis of their clinical judgment and collaborative negotiation with the patient, psychiatrists chose one of the three treatment modalities for 102 PDA outpatients. Two stepwise logistic regressions were performed to explore pre-treatment patient characteristics the psychiatrists may have considered in choosing among these treatments. One regression examined the decision to add BZ to CBT, while the other examined the decision to add AD to CBT+BZ. Psychiatrists generally used combination treatments in patients with more severe PDA. CBT alone was a more likely choice for dominant anxiety-related cognitive phenomena. Patients with prominent panic attacks and somatic symptoms were more likely to be treated with CBT+BZ, while those who also had significant depressive symptoms and higher disability levels were more likely to receive CBT+BZ+AD. Patients in all three treatment groups showed significant reduction in symptoms during intensive treatment and reached similar end states. In a clinic setting where CBT is accepted as the basic treatment for PDA, psychiatrists added BZ to control prominent panic symptoms and added AD to elevate depressed mood and help cope with marked disability. These choices appear rational and resulted in substantial clinical improvement at the end of intensive treatment in the clinic.

Adult↗
PubMed2004

Panic disorders and agoraphobia: side effects of treatment with an implantable cardioverter/defibrillator.

BACKGROUND: Implantable cardioverter/defibrillator (ICD) treatment has reduced the mortality of patients with a high risk of sudden cardiac death. However, ICD discharges may cause anxiety with respect to new discharges and lead to preventive, for example, phobic, behavior. This study evaluated the frequency of panic disorders and agoraphobia in patients with ICD and assessed the risk factors in their development. HYPOTHESIS: Treatment with ICD represents a risk factor in the development of anxiety disorders. METHODS: Ninety patients with ICD were examined using a standardized lifetime Diagnostic Interview of Psychiatric Syndromes (DIPS). This interview makes it possible to estimate the incidence of panic disorders and agoraphobia. The impact of the severity of the underlying cardiac disease, the number of ICD discharges, and the subjective appraisal of the shock experience on the development of panic disorders and agoraphobia was assessed. RESULTS: Fifteen patients (16.7%) developed anxiety disorders after ICD implantation. The incidence was 21% in patients with and 6.9% in patients without ICD discharge. In patients with two or more ICD discharges annually, the incidence of panic disorders and agoraphobia was higher than that in patients with a single ICD discharge annually (62 vs. 10%, p<0.01). The intensity of self-observation of their body was significantly related to the development of anxiety disorders (p<0.001). CONCLUSION: Panic disorders and agoraphobia are frequent side effects of ICD treatment. Risk factors in the development of these disorders are two or more ICD discharges annually and a negative cognitive appraisal of ICD discharges. Therapeutic efforts should aim at reducing the number of ICD discharges and provide early psychological treatment.

Adaptation, Psychological↗
PubMed2004

Dosage finding and outcome in the treatment of schizophrenic inpatients with amisulpride. Results of a drug utilization observation study.

OBJECTIVES: Amisulpride is an unique neuroleptic drug insofar as it has a dual pharmacodynamic effect. At low doses it blocks selectively presynaptic autoreceptors, and at high doses it blocks postsynaptic D(2)/D(3) receptors. This allows the dosage to be adjusted and the treatment tailored to various clinical situations. It is unknown whether this pharmacological property has any bearing for routine treatment. The questions are: which dosages of amisulpride are chosen by physicians in the treatment of schizophrenic inpatients and does this dosage handling deviate from prescription guidelines?; which factors can explain dosage selection, and what is the treatment outcome with different dosages? The study pertains to drug management and dosage finding as principal factors in explaining positive and negative medication results. METHODS: In a drug utilization observation study the prescribing of amisulpride for 811 schizophrenic inpatients from 240 psychiatric hospitals was monitored for 8 weeks. Standardized assessment included dosage, the positive and negative symptom scale (PANSS), the clinical global impression rating (CGI), the patients' subjective reaction to amisulpride, psychosocial functioning, EPS and other adverse events. The mean observation period was 49 days. RESULTS: The mean initial daily dose of amisulpride was 361 mg/day. The mean daily dose at day 56 was on average 550 (SD 266) mg/d, ranging from 100 mg to 1600 mg. 17.9% of patients received a maximum dose up to 399 mg/d, 48.1% between 400 and 799 mg/d, and 25.5% 800 mg/d and higher. Higher doses were preferably prescribed for males, patients with involuntary admission, patients with paranoid schizophrenia with acute exacerbation, high CGI and high PANSS-positive scores. Patients with higher doses of amisulpride at the same time received higher rates of additional other neuroleptic drugs. Higher doses yield better results in very severe cases. CONCLUSIONS: Prescribed dosages were in the lower range of what is recommended for acute cases. Dosage was significantly influenced by the severity of the illness. Polypharmacy was the rule rather than the exception. Efficacy rates under conditions of routine care were similar to the results from controlled clinical trials, which speaks for their generalizability. Very severe cases profit from higher doses.

Adult↗
PubMed2004

A prospective study on the course of anxiety after vestibular neuronitis.

OBJECTIVE: Critical life events trigger intense emotions. Anxiety is one of the most frequent of these emotions. It is unclear which factors determine the intensity and course of anxiety after a critical life event. METHOD: Anxiety levels of 92 patients in the 6 weeks after experiencing an acute vestibular disorder were examined. The influence of cognitive, personality and illness variables on the course of their anxiety was analyzed. RESULTS: Acute vestibular disorder is accompanied by intensive anxiety. In most patients, anxiety decreased as vertigo regressed. Catastrophizing and dysfunctional cognitions and different personality styles predicted 17.6% of the anxiety 6 weeks after the functional loss of vestibular equilibrium. CONCLUSIONS: Acute vestibular disorder is a critical life event. Most individuals cope successfully with acute vestibular disorder. However, dysfunctional cognitions are risk factors for the persistence of anxiety.

Acute Disease↗
PubMed2004

Prevalence and appropriateness of psychotropic drug use in old age: results from the Berlin Aging Study (BASE).

BACKGROUND: The aim of this epidemiological study is to examine the prevalence and correlates of psychotropic drug use in the very old and to evaluate the appropriateness of psychotropic drug use in very old age. METHODS: Data from the Berlin Aging Study (BASE), a multidisciplinary study of an age- and gender-stratified, randomly selected sample of elderly people living in Berlin are presented. Over-sampling, especially very old men, allows for powerful analyses of this population. All participants went through extensive psychiatric and somatic examinations. Medication intake was assessed by different data sources (interviewing patients and their family physicians, drug inspection at home). Results were brought together in a consensus-conference and research physicians gave operationalized ratings of medication appropriateness. RESULTS: The prevalence of elderly people who were taking at least one psychotropic medication within the 14 days immediately preceding investigation was 29.8%. Of these medications, 68.4% had been taken for longer than one year. There was no effect of age or gender on the scope of psychotropic drug use. Benzodiazepines were taken by 19.8% of the elderly. Antidepressants, neuroleptics and anti-dementia drugs were taken by about 3-4% each. People taking psychotropic drugs had significantly higher levels of psychiatric morbidity, as measured by syndromes and specified diagnoses. Psychotropic drugs were significantly less often judged to be indicated than somatic medications. This is mostly due to benzodiazepines. CONCLUSIONS: Psychotropic drug use is common in old age, but there is no additional increase in usage beyond the age of 70. Intake of psychotropics is mostly oriented at symptoms or syndromes, which explains why benzodiazepines are still the most commonly prescribed psychotropics.

Aged↗