Biomedical subjects
P Berner
Publications and source records attributed to P Berner.
A multicenter double-blind study of three different doses of the new cAMP-phosphodiesterase inhibitor rolipram in patients with major depressive disorder.
A multicenter randomized 4-week interindividual double-blind study was carried out in 58 hospitalized patients with major depressive disorder (DSM III 296.23, 296.22, 296.33, 296.32, 296.53 and 296.52) to test the dose-effect relationship of three different doses of the new cAMP-phosphodiesterase inhibitor rolipram: 3 x 0.25 mg, 3 x 0.50 mg and 3 x 1.00 mg rolipram/day. With respect to the desired effect, the 3 x 0.50 mg dosage stood out from the others in almost all relevant parameters. With respect to the response rate, the efficacy of the 3 x 0.25 mg dosage was about the same as that reported in the literature for placebo. The inferior performance of the 3 x 1.00 mg dosage compared to the 3 x 0.50 mg dosage might indicate a reverse U-shaped dose-effect relationship. There was good tolerance to all three dosages. There were no findings that might cast doubt on the safety of the dosages tested.
[Development of the manic-depressive concept in German language psychiatry].
German language psychiatry has had and still has much difficulty in getting rid of the dichotomy of endogenous psychosis as set by Kraepelin. The concept which makes a distinction between schizophrenic psychosis and manic-depressive psychosis grants the former a predominant position by applying Jasper's hierarchic rule: the presence of symptoms regarded as schizophrenic indubitably attributes the disorder to schizophrenia. Such classification, however, does not necessarily imply that schizophrenia and cyclothymia (word proposed by K. Schneider for manic-depressive psychosis) represent separate nosological entities. It is admitted that it is possible for each group to include diseases whose hereditary transmission is not necessarily due to the same genetic predisposition. Thus, German language psychiatry has well accepted the possibility that bipolar manic-depressive psychosis and unipolar depressions represent separate etiologies. For most German-speaking psychiatrists, however, the distinction between endogenous and psychogenic depressions still remains a current assumption. The distinction between these two types of depression is generally made with reference to an "endogenous item profile" or to a depressive endogenomorphous axial syndrome. Only a few authors have accepted the model of continuity between these two types of depression proposed by the London school. The Hamburg school gave a new dimension to the conceptualization of manic-depressive psychosis by drawing attention on the existence of "rapidly alternating mixed states" which are much more common than the stable mixed conditions described by Kraepelin. On the basis of this concept and by questioning the validity of Jaspers' hierarchic rule, the Vienna school has considerably extended the limits of affectives psychosis to the detriment of the wide concept of schizophrenia described by K. Schneider.(ABSTRACT TRUNCATED AT 250 WORDS)
Clinical and epidemiological aspects of dementia in the elderly.
Dementia of the Alzheimer's type (DAT) is the most significant disease of the aging brain. Descriptive epidemiology of DAT found a constant doubling of prevalence rates every 5 years. Analytic epidemiology so far failed to reliably detect risk factors for DAT other than age. This might depend on the difficulties encountered in the clinical diagnosis and differential diagnosis of dementia in the elderly, which are discussed with special reference to 1) the definition of dementia, to 2) the grading of severity of dementia, to 3) the differentiation between dementia and depression, and to 4) the differentiation between multi-infarct dementia and DAT.
Predicting course and outcome in delusional psychoses.
Eighty-four of 90 patients with delusional syndromes of different nosological attribution underwent a 7-year follow-up. From 179 items covering the whole spectrum of psychiatric description of index examination, 20 were found to be statistically significant in predicting different aspects of course and outcome by stepwise discriminant analysis. Course and outcome were defined by 6 criteria (course of illness, course of delusion, development of deficiency, length of inpatient care, adequate activity and social adjustment) encompassing separate (but only partly independent) aspects of a disorder. In contrast to the literature, clinical and psychopathological variables have major prognostic weight for different psychopathological as well as psychosocial aspects of outcome. Ten of the 20 significant items cover psychopathology, 4 pre-index course, 3 precipating events, 2 data from childhood, and 1 premorbid personality. Our results stress the importance of sensitive data collection and a clear separation of different outcome variables.
Methodological aspects of follow-up studies on psychotic patients in a polydiagnostic perspective.
Polydiagnostic follow-up studies should explore whether certain definitions of a given disorder permit better prediction of the illness course than others and whether this good predictive validity is related to specific etiopathogenetic conditions. In order to carry out such studies successfully they should be based on broadly defined samples and comprise provisions for additional validation such as genetic data, neuropsychological testing etc. After an assessment at baseline and at discharge from hospital, the follow-up assessments should comprise five steps: (1) Identification of successful and unsuccessful diagnostic systems; (2) identification of features determining successful attribution; (3) analysis of successful systems; (4) analysis of unsuccessful systems, and (5) analysis of cases which have changed diagnostic attribution. The conclusions drawn from these analyses are intended to refine classification in psychiatry.
Temporal stability of diagnostic criteria for functional psychoses. Results from the Vienna follow-up study.
200 first admissions with functional psychoses were interviewed with PSE and rated simultaneously according to different diagnostic criteria (ICD-9, RDC, DSM-III, St. Louis, Taylor, Vienna Research Criteria). At follow-up 7 years later 186 patients could be traced and a course diagnosis was applied to each patient. Temporal stability of diagnostic criteria was calculated for ICD-9, RDC and DSM-III by stability coefficient and kappa values and was used as a criterion for validity. Schizophrenia and affective disorder display considerable stability over time, no matter whether one uses ICD-9, RDC or DSM-III. The data for schizoaffective disorder are less impressive, the stability coefficient is much higher for schizoaffective bipolar than for schizoaffective depressive patients.
Neurotic, stress-related and somatoform disorders (section F4) and physiological dysfunction associated with mental or behavioural factors (section F5): results of the ICD-10 field trial.
The results of the ICD-10 field trial in German-speaking countries relevant to sections F4 (neurotic, stress-related and somatoform disorders) and F5 (physiological dysfunction associated with mental or behavioural factors) show a comparatively low level of acceptance. Interrater-reliability in various diagnostic categories is not always adequate. In particular the allocation of some of the "old" diagnostic entities of ICD-9 to various sections of ICD-10, and in part unsatisfactory classificatory distinctions gave rise to certain problems.
Delusional theme, sex and age.
In a retrospective study of 865 delusional syndromes, connections were investigated between delusional themes and the sex of patients, and the ages in which these themes extensively occurred. According to previous reports, the results of this investigation indicated that differences exist between the ages of manifestation regarding the themes of hypochondria, persecution, love and jealously. Furthermore, differences could be observed between males and females in relation to the frequency of choice of particular themes, as well as the age of occurrence. Based on psychological studies concerned with the content's dependence on motives we conclude that the age distribution of delusional themes corresponds to the main existential concerns in different life periods.
Emotion, affect and mood: a terminological introduction.
It is difficult to establish clear distinctions between emotion, affect and mood, because they belong to the same physiological dimension which may be conceived as 'background' activity'; for the purposes of research definitions should be as precise as possible. After a review of the most commonly used and sometimes contradictory definitions of these and related terms, a modified version of Janzarik's model of the 'structural-dynamic coherency' is proposed as a frame of reference for improvement in defining different 'dynamic states'. The clear distinction between emotional resonance, mood and drive for the description of pathological modifications of the background activity is discussed.
[Viennese psychiatry between Freud and Wagner von Jauregg].
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Psychopathological concepts of dysphoria.
Dysphoric conditions are increasingly postulated as representing independent mood disorders. However, despite much effort at clarification, their psychopathological definitions remain unclear and variable. This paper reviews some examples of these divergent definitions, most of which are based on quality of mood, as well as responsiveness to external stimuli. The paper then introduces a strategy in possible solution of the above-mentioned definition problems. Setting out from restriction of the term dysphoria to conditions of a morose, tense and irritated mood, as suggested by Snaith and Taylor, we support the opinion that dysphoria should be accepted as a third possibility of mood swing, as a psychopathological disturbance which can be well distinguished from stable and unstable mixed states.
[Treatment modalities in sleep disorder--neurophysiological introduction and behavior modification (author's transl)].
Neurophysiological studies have yielded new insights into sleep disorders. Neurophysiological processes play a major roll in sleep disorders in children. Learning theory can be used for the explanation and treatment of sleeping disorders.
Classification and bioavailability studies with WE 941 by quantitative pharmaco-EEG and clinical analyses.
Psychoactivity, pharmacodynamic properties and drug tolerance of 2-bromo-4-(2-chlorophenyl)-9-methyl-6H-thieno[3,2-f]1,2-(4-triazolo)[4,3-a][1,4]diazepine (WE 941), a new triazolodiazepine, were studied in 10 normal subjects utilizing quantitative pharmaco-EEG and clinical evaluation methods. In the double-blind, placebo-controlled trial, the subjects received randomized at weekly intervals oral single doses of 0.1 mg, 0.3 mg and 0.5 mg WE 941, placebo, and 30 mg flurazepam as reference substance. Measurements were obtained before and at the 2nd, 4th, 6th h post drug. EEG power spectral density analysis demonstrated no changes after placebo, while WE 941 and flurazepam induced statistically significant alterations characterized by an increase in beta-activity, a decrease in alpha-activity and increase in average frequency ("anxiolytic pharmaco-EEG profile"). In addition, 0.3 mg and 0.5 mg WE 941 and 30 mg flurazepam produced a significant augmentation of delta-activity indicating hypnotic qualities. Considering spontaneous and placebo-induced alterations, evaluation of the time- and dose-effect relationship indicated that all active substances exerted a tranquilizing effect throughout 8 h, while the hypnotic properties of 0.1 mg WE 941 were minimal (up to the 4th h), those of 0.3 mg WE 941 were moderate (up to 6 h) and those of 0.5 mg WE 941 were marked (up to 8 h). The dosage equipotent to 30 mg flurazepam is 0.3 mg WE 941. Heart rate and blood pressure exhibited no relevant changes, while side effects including fatigue, drowsiness and dizziness were mostly observed after the highest dosage of WE 941.
On the existence of two populations of mitochondria in a single organ. Respiration, calcium transport and enzyme activities.
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[Psychopathological research in delusions and general psychiatric models (author's transl)].
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