Biomedical subjects

P Dobmeier

Publications and source records attributed to P Dobmeier.

5 recordsLinked to original sources

PubMed2002

Neuroleptic malignant syndrome due to atypical neuroleptics: three episodes in one patient.

Neuroleptic malignant syndrome (NMS) is a rare, but potentially lethal complication of antipsychotic medication. The risk of developing NMS under atypical neuroleptics seems lower than under typical neuroleptics. However, the use of atypical neuroleptics in modern psychopharmacotherapy is increasing, so the incidence of NMS under these drugs may also increase. Here, we will describe three episodes of NMS that fulfilled the DSM-IV criteria for NMS (APA, 1994). The epivodes of NMS occured under treatment with clozapine, risperidone, and amisulpride. These episodes had some atypical features that will be discussed with regard to the pathophysiological mechanisms leading to NMS.

Amisulpride↗

PubMed1998

[Artifactual disorders--between deception and self-mutilation. Experiences in consultation psychiatry at a university clinic].

During a 18-year-period 93 patients (f = 76, m = 17) with a factitious disorder were identified in the psychiatric consultation service of a university hospital (incidence: 0.62%). 50% of women were working in medical professions whereas only 6% of men. Chronic courses of illness were prevailing, but at least one quarter of female patients showed an intermittent type. There was a classical Munchhausen syndrome in 11% of patients. Depressive and anxiety disorders (10%, 4%) were to be respected as psychiatric comorbidity. Ca 25% of the patients suffered from a somatic illness in addition to the factitious disorder, and one third of the women had symptoms of psychosomatic, especially of eating disorders. Previous somatoform disorders, deliberate self harm and attempts of suicide were to be noted in the psychiatric history of many patients. There were frequent traumatizing events (foster home, disturbing family disharmony, physical and sexual abuse, early losses, serious illnesses) in the early biography. Various psychosocial stressors could be identified in the actual eliciting situation. The results are discussed in respect of epidemiology, development and clinical phenomenology of factitious disorders, psychodynamics and psychopathology of deception and self harm, and therapeutic options in the psychiatric consultation service.

Adult↗

PubMed1998

[ECG changes after paroxetine. 3 case reports].

Selective serotonin reuptake inhibitors (SSRI) are known to exhibit far less cardiac side effects than tricyclic antidepressants. We report three cases in which the SSRI, paroxetine, induced clinically relevant ECG changes in patients with high risk profile. In two cases an increase in QTc time was observed, severe bradycardia was also observed twice.

Aged↗

PubMed1998

[The effect of selective serotonin-reuptake inhibitors in blood coagulation].

Nowadays, Selective Serotonin Reuptake Inhibitors (SSRI) are well established in psychopharmacological therapy. They have been shown to be very effective and having a favourable side effect profile. However, bleeding events are rare but there may be potentially severe complications under treatment with SSRI. These complications can occur under SSRI alone and in combination with anticoagulative drugs, whereas the coagulation parameters can remain unchanged. Pathophysiologically these bleeding complications are related to a reduced concentration of serotonin in the blood and platelets. Reduction of serotonin, which occurs under treatment with SSRI, can lead to disturbances of platelet function and may also activate the fibrinolytic system. Both effects increase the risk of bleeding complications. In combination with anticoagulants, besides the serotonin-related bleeding events, additionally influences of SSRI on metabolism of the anticoagulative drugs due to their interactions with the Zytochrom-P450 system and changes of free plasma levels of the anticoagulative drugs, caused by a displacement from the plasma proteins through the SSRI, must be taken into consideration.

Animals↗

PubMed1998

[Conversion syndromes in neurology. A psychopathological and psychodynamic differentiation of conversion disorder, somatization disorder and factitious disorder].

Conversion syndromes are frequent among medically unexplained somatic symptoms in neurology. A careful differential diagnosis must be carried out in a psychiatric consultation service. In a prospective study lasting for over four years 169 patients with pseudoneurological signs of conversion were included. From a clinical point of view the following conversion syndromes were presented: astasia/abasia: 27.2%, paresis/plegia: 24.3%, aphonia: 1.8%, hyp-/anaesthesia: 21.9%, blindness: 5.3%, non-epileptic seizures: 19.5%. According to the diagnostic criteria of DSM-III-R three subgroups were differentiated: conversion disorder (n = 132), somatisation disorder (n = 28), factitious disorder (n = 9). Intermittent courses of illness were prevailing in conversion disorder, whereas chronic courses predominated in the other two subgroups. High rates of psychiatric comorbidity were typical signs of somatisation disorder. Frequent autodestructive motives (suicidality, deliberate and covert self-harm, chronic pain, high rate of operations) in illness behaviour had to be registered in somatisation and factitious disorder. Both subgroups were characterised by frequent traumatic events during early development. Important socio-economic aspects of illness behaviour above all in somatisation and factitious disorder were underlined. The results are discussed in terms of psychiatric differential diagnosis and psychiatric comorbidity, psychodynamic evaluation, illness behaviour and therapeutic options in a C/L-service.

Adult↗