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Biomedical subjects

O Presslich

Publications and source records attributed to O Presslich.

At least 19 recordsLinked to original sources
PubMed1999

Treatment of severe mania with intravenous magnesium sulphate as a supplementary therapy.

Ten patients with severe, therapy-resistant manic agitation received magnesium sulphate infusions with a continuous magnesium (Mg) flow of approximately 200 mg/h (4353+/-836 mg/day; daily monitored Mg plasma level: 2.44+/-0.34 mmol/l) for periods ranging from 7 to 23 days. Concomitant psychotropic treatment consisted of lithium (n = 10), haloperidol (n = 5) and clonazepam (n = 10). During i.v. Mg treatment the mean values of the maximum dosages of neuroleptics (in chlorpromazine equivalents) and benzodiazepines (in diazepam equivalents) were significantly lower than during the last day of pretreatment (= baseline). Seven patients showed a marked improvement in the Clinical Global Impression scale. In case of bradycardia detected by the ECG monitor (n = 5), Mg flow was reduced and bradycardia disappeared promptly. Mg i.v. may be a useful supplementary therapy for the clinical management of severe manic agitation. This open study needs double-blind confirmation.

Adult↗
PubMed1991

Psychophysiological reactions in methadone maintenance patients do not correlate with methadone plasma levels.

In methadone maintenance therapy methadone plasma concentrations of 400 ng/ml are necessary to suppress any further opiate action and to provide stabilized maintenance. In a controlled study we have searched for a differentiation in autonomous activation between patients having low and high methadone plasma levels, using static and dynamic pupillometry and habituation of skin conductance response. Results show that there is no difference in psychophysiological response between patients with high (greater than 400 ng/ml) or low (less than 400 ng/ml) plasma levels of methadone. This indicates that there is no reduction in behavioral arousal in patients with high plasma methadone levels. On the basis of these findings, there is no rationale to maintain patients on plasma levels below 400 ng/ml.

Adult↗
PubMed1991

Combined naloxone/methadone preparations for opiate substitution therapy.

Every opportunity should be used to reduce the risk of HIV-1 infection and transmission among intravenous drug users (IVDUs). Methadone maintenance is widely accepted to keep the drug user away from risk-laden practices and to stop intravenous drug use. In order to minimize the diversion and intravenous abuse of methadone in maintenance programs, the effects of a combined naloxone/methadone preparation through oral intake and the effects of an intravenous administration were tested. In opiate addicts, the intravenous administration of this mixture caused a severe withdrawal syndrome lasting for 15 to 30 minutes. The oral administration of this combination was indistinguishable from methadone alone. It is argued that this combination therapy prevents the intravenous abuse of methadone in maintenance programs.

Administration, Oral↗
PubMed1991

Sharing spoons: a risk factor for HIV-1 infection in Vienna.

Sharing of needles and syringes plays a central role in HIV-1 transmission among intravenous drug users (IVDUs). There have been several suggestions to protect the injecting population from further harm, but focused mainly on the use of sterile needles and syringes as well as information about safer sexual behavior. This study examined a total of 366 IVDUs at the drug dependence out-patient ward of the Psychiatric University Clinic of Vienna. HIV-1 antibodies were found in 29.7% (58) in 1989 and in 26.9% (42) in 1990. The results show that in 1989 14% and in 1990 5% IVDUs who never shared needles or syringes or other drug paraphernalia were found to be HIV-1 positive. In spite of the high information standard among Viennese drug addicts on risk reduction, the underestimated co-factors during drug administration might be responsible for a further HIV-1 transmission. Educational interventions on this subject should address even IVDUs who do not share needles and have adjusted to 'safer sex' practices.

Austria↗
PubMed1991

Technique for greatly shortening the transition from methadone to naltrexone maintenance of patients addicted to opiates.

Acute methadone detoxification was induced by the intravenous administration of naloxone during simultaneous intravenous sedation with midazolam, a fully reversible short-acting benzodiazepine, in seven patients addicted to opiates. Within hours the patients tolerated full doses of naltrexone. This technique enables patients to transfer easily, quickly, and safely from methadone to naltrexone maintenance.

Adult↗
PubMed1991

[Nicotine--drug addiction--AIDS. Drug use habits of Vienna addicts].

In Austria it is illegal to sell tobacco to young adolescents. A diverse sample of 358 narcotic addicts was investigated at the Psychiatric University Clinic of Vienna. Data were obtained from on site confidential interviews and a HIV-test was conducted. The individual drug use history was recorded and, interestingly, tobacco addiction was the first stage in starting a drug career. Furthermore, a strong correlation was observed between onset of heroin use and HIV-1 infection. It is concluded that in Austria not only the availability nicotine and alcohol to young adolescents should be prohibited, but also their use should be punishable. Easy access to nicotine as in public restaurants or from automatic distributors, has to be withdrawn. Tobacco advertisements may drive vulnerable young adolescents to early nicotine abuse and this may be followed by addition to other drugs and diseases causing death, including AIDS. Socioeconomic data, as well as the methadone data are presented. 180 out of the 358 patients were on methadone maintenance. Methadone treatment offers a first step toward social rehabilitation for drug addicts who have been living as criminals on the fringe of society. Physicians have a clear responsibility to lead the effort on all fronts against tobacco, especially in view of the HIV epidemic.

Adolescent↗
PubMed1991

[Stabilizing the social and health status of drug dependent patients with methadone. Long-term maintainance therapy--Vienna results].

On September 25th, 1987 methadone was legalized in Austria for therapeutic use in drug addiction treatment in case of: 1. Long-term drug addiction with intravenous application of the drug, and several unsuccessful withdrawal therapies and/or 2. opiate addiction through intravenous application of the drug along with an existing HIV-1 infection. Since than, 291 patients were treated with methadone at the drug-dependency outpatient clinic of the Psychiatric Clinic of the University of Vienna. In 1990, 96 patients treated for more than one year were investigated using a standardized questionnaire. The image in which crime, prostitution, poverty, ill health all merge was broken by this decriminalization. Methadone treatment offers a first step toward social rehabilitation for drug addicts who have been living as criminals on the fringe of society.

Austria↗
PubMed1990

[Epidemiology of attempted suicide and overdose in drug dependent patients].

48 fatalities (11 female, 37 male) among drug addicts are registered in Vienna in 1988. 96 committed suicides and 401 suicide attempts are reported among young Viennese in 1987. In order to examine the connection between suicide, parasuicide and drug addiction at the drug out patient clinic of the Psychiatric University Hospital of Vienna, 223 patients were investigated in February 1989.

Adolescent↗
PubMed1990

[Prevalence of HIV-1 infection in intravenous drug dependent patients 1986 to 1989 in Vienna].

We report the results of a survey of a total of 553 intravenous drug users (IVDUs) investigated at the drug addiction out-patient unit of the Psychiatric Department of Vienna University for antibodies to human immunodeficiency virus (HIV-1) using both enzyme-linked immuno sorbent and Western blot assays. HIV-1 antibodies were found 1985/86 in 8.5%, 1986/87 in 14.5%, 1988 in 27.7% and 1989 in 29.7% of IVDUs. The introduction of methadone maintenance in 1987 attracted many IVDUs and increased the number of patients at the out-patient clinic. In 1989 more than 50% of the IVDUs are on methadone maintenance and already 84.5% of the HIV-1 infected drug users are treated with methadone.

AIDS Serodiagnosis↗
PubMed1990

Static and dynamic pupillometry for determination of the course of gradual detoxification of opiate-addicted patients.

In order to assess the course of methadone (Heptadone) substitution therapy, 29 inpatients at the Vienna Psychiatric University Clinic (21 males, mean age = 27 years, SD 4 years; 8 females, mean age 29.75 years, SD 5.28 years) who were addicted to opium tea or to a mixture of opium and heroin were investigated by means of computer-assisted "static"- and "light-evoked dynamic" pupillometry. Pupillary measurements were carried out before the start of withdrawal, on the 2nd day 48 h after the administration of 10 mg methadone, and again after the maximum and half of the maximum dose of methadone had been administered. The constricted pupils (the effect of opiate) showed dilatation after the withdrawal syndrome appeared, but immediately after the start of the detoxification treatment, as well as 1 day after administration of the maximum methadone dose a decrease of pupillary diameter was observed. The narrowing of the pupil was followed by an increase in pupillary diameter, which peaked 48 h after the last minimal dose of methadone and nearly reached the normal level. The widening of the pupil reflects an increase of noradrenergic activity under conditions of opiate withdrawal. An increase of spontaneous fluctuations was observed during withdrawal and was only inhibited by the maximum dose of methadone. Finally, pupillary dynamics (shortening of latency time and increase of relative changes) improved during therapy. The pupillary measurement corresponded with clinical observations as well as with self-evaluation during treatment. Thus pupillometry seems to be a useful instrument for assessment of treatment of opiate-addicted patients.

Adult↗
PubMed1990

Monitoring HIV-1 infection prevalence among intravenous drug users in Vienna 1986-1990.

A standardised method to monitor HIV-1 infection levels and trends among injecting drug users (IDUs) was periodically administered at the drug addiction outpatient ward of the Psychiatric University Clinic of Vienna. A total of 715 injecting drug users were examined. HIV-1 antibodies were found in 8.5% of the IDUs in 1985/86, 14.5% in 1986/87, 27.7% in 1988, 29.7% in 1989 and 26.9% in 1990. Sharing was extensive in infected IDUs. After introduction of methadone maintenance in Austria more than 50% of the IDUs were receiving methadone and, in 1990, 88% of the infected IDUs were treated with methadone.

Adult↗
PubMed1990

Acute blocking of naloxone-precipitated opiate withdrawal symptoms by methohexitone.

In a double-blind placebo-controlled trial of 18 patients, methohexitone blocked objective signs of opiate withdrawal caused by a bolus injection of naloxone. Furthermore, in continuing the naloxone therapy for 48 hours, no withdrawal signs appeared. Levels of withdrawal distress returned to normal levels within six days. This approach can be regarded as an effective and well tolerated withdrawal therapy with low drop-out rates.

Adult↗
PubMed1989

[HIV infection in intravenous drug dependent patients--Vienna 1988 results].

The rapid spread of HIV infection among intravenous drug abusers plays an increasing role in the AIDS epidemic. In this context the Austrian government changed politics and introduced a methadone maintenance program 1987, to reach more intravenous drug addicts and to stop intravenous drug abuse of this clients. 119 intravenous drug users were anonymously tested for HIV antibodies between April 18 and May 17, 1988 at the out-patient clinic of the Psychiatric University clinic of Vienna and were examined by means of a standardized questionnaire. The data are discussed in respect of the benefits of a methadone maintenance program to decrease HIV-infection among intravenous drug abusers in Vienna.

Acquired Immunodeficiency Syndrome↗
PubMed1989

["Induced detoxification treatment" of opiate dependent patients--a new therapy concept].

Induced detoxification treatment of opiate addicts by means of naloxone was developed at the intensive care unit of the Department of Psychiatry at the University of Vienna. Two methods were tested 1. Rapid opiate withdrawal by means of a staggered naloxone regimen. 2. Ultrashort opiate detoxification during general anaesthesia using high doses of naloxone. In an open trial 15 patients were treated with staggered doses of naloxone while under tiapride. The various discomforts were satisfactorily reduced, and the detoxification syndrome was limited to 50 hours. In a second open trial 6 patients were administered 10 mg naloxone under general anaesthesia. All naloxone induced withdrawal syndromes can be suppressed by barbiturate anaesthesia. They do not appear even after the effect of the anaesthesia wears off if the patient is kept on a naloxone regimen as long as opiates remain present in the circulatory system. Both methods shorten detoxification treatment and provide smooth transition to a naltrexone maintenance programme.

Adult↗
PubMed1989

Continuous naloxone administration suppresses opiate withdrawal symptoms in human opiate addicts during detoxification treatment.

In a small clinical trial, a new therapeutic approach was studied, whether naloxone, in high dosage over a prolonged period of time, will attenuate withdrawal symptoms in acute opiate detoxification. Six opiate addicts, satisfying DSM III-R criteria of opiate dependence, were given 10 mg naloxone under short barbiturate anaesthesia, followed by repeated doses of 0.4 mg/h naloxone for at least 72 h. Acute onset of withdrawal symptoms brought about a high dose of naloxone could be suppressed by the short barbiturate anaesthetic; neither continuous supply nor cessation of the naloxone regimen after 96 h caused any severe withdrawal symptoms. Morphine and naloxone measurements in blood at the start of naloxone therapy enabled pharmacokinetic explanations for this paradoxical action of naloxone to be excluded.

Adult↗