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Biomedical subjects

P Kielholz

Publications and source records attributed to P Kielholz.

At least 19 recordsLinked to original sources
PubMed1990

Biological study of alcohol dependence syndrome with reference to ethnic difference: report of a WHO Collaborative Study.

Inherited deficiency of acetaldehyde dehydrogenase type I (ALDH-I) was found in 43% (50/117) of normals, 33% (27/82) of schizophrenics, but only 4% (5/113) of alcoholics among Japanese. The ALDH-I deficiency was never found, however, in 146 mostly schizophrenic subjects from Europe (Basel, Moscow, Zagreb), Australia (Nedlands), India (Lucknow), Morocco (Casablanca) and Mexico (Mexico City). It was demonstrated that ALDH-I deficiency produces the flushing syndrome which inhibits the development of drinking habit and alcohol dependence syndrome.

Alcoholism↗
PubMed1990

[Treatment of drug-resistant depression by intravenous administration of antidepressants].

The proportion of depressed patients no longer responding adequately to oral antidepressive medication combined with psychotherapy now amounts to as much as 15%. Depressive states failing to lift in response to antidepressants are referred to in Europe as "therapy-resistant". Before initiating some further form of treatment in a case of therapy resistance the diagnosis as well as the antidepressive treatment given hitherto (dosage, activity profile, compliance) should be reappraised. Where the diagnosis of "therapy-resistant depression" is confirmed, intravenous infusions of antidepressants in combination with psychotherapy have been found to offer the best prospects of success. With the help of daily infusions of maprotiline (ludiomil) and/or clomipramine (anafranil) it proved possible in over 1,000 patients suffering from therapy-resistant depression to achieve a remission in 60% and a marked improvement in 20%. At various research centres in Europe where intravenous drip infusions were administered in relatively low dosages, a more rapid onset of action was observed with fewer side effects, as well as higher plasma concentrations (thanks to avoidance of the first-pass effect) and no problems with respect to compliance.

Administration, Oral↗
PubMed1986

Light treatment of seasonal affective disorder in Switzerland.

Seasonal Affective Disorder (SAD) has been characterised by two or more depressive episodes in autumn or winter (with remission the following spring or summer), decreased energy, increased sleep, increased appetite, weight gain and carbohydrate craving. SAD patients were identified in a Swiss-German population; 22 participated in a light-therapy protocol (1 week bright white light 2,500 lux or dim yellow light 250 lux, from 06-08 h and 18-20 h). Both observer and self-ratings indicated a significant diminution of depressive symptoms with both lights. One week after withdrawal from yellow light, depression ratings relapsed to previous values; remission lasted longer after bright white light. Global VAS self-rating scales for "mood" and "well-being" however, and the Hamilton scale for atypical SAD symptoms, differentiated clearly between bright and dim light: only bright light showed an improvement that persisted after withdrawal. These results suggest that even though a placebo effect cannot be excluded, 4 h explicit light exposure/day may not be a negligible quantity. Light treatment promises to be a useful non-pharmacological intervention in certain forms of depressive illness.

Adult↗
PubMed1986

Treatment for therapy-resistant depression.

Thanks to progress in the diagnosis and treatment of depression it is now possible for most cases to be treated on an out-patient basis. Only 15-20% of patients require hospitalisation, most of them because their depression has proved resistant to therapy. To overcome therapy-resistance, the following methods of treatment are available: In therapy-resistant endogenous and psychogenic depressions, mono-infusion therapy is the treatment of choice; it can also be administered on an out-patient basis. In extremely intractable cases, it is advisable to resort to combined infusion therapy, preceded by five days of relaxation therapy with oral doses of a neuroleptic, and possibly reinforced by medication with 5-hydroxytryptophan (the precursor of serotonin) or by sleep deprival. In therapy-resistant cases of so-called masked depression, marked by overtones of anxiety and hypochondriasis, infusions of maprotiline are indicated, because this anti-depressant exerts a relaxing and mildly anxiolytic action, has a stabilising influence on the autonomic nervous system, and produces a mood-brightening effect. In patients who are apathetic and devoid of drive and suffering from involutional depression or depression of old age, infusion therapy plus administration of an MAO inhibitor can be recommended. Combination of an antidepressant with a neuroleptic agent also displaying certain antidepressive properties is really indicated only in the rare cases of schizo-affective psychosis. Electroconvulsive therapy should be employed only as a last resort in extremely retarded and apathetic patients with strong suicidal tendencies, and the indication for ECT should be established with the utmost reserve.

5-Hydroxytryptophan↗
PubMed1983

[Multifactorial treatment of depression].

According to the results of all recent epidemiological enquiries, the number of cases of depression diagnosed is steadily increasing, especially in urban communities. Parallel with this increase, there has been a clear tendency for the symptomatology of depression to change in the direction of somatization. Essential prerequisites for the success of treatment of depression are not only a carefully established diagnosis but - ordinarily - also combination of the psycho-, pharmaco-, socio- and physiotherapy. In case of depressive states the nosological diagnosis determines the choice of basic therapy and the phenomenological diagnosis the selection of the right antidepressant. All antidepressants have a delayed onset of action and are apt to provoke side effects of varying severity. Prior to the initiation of treatment the patient's attention should be drawn to the possibility of side effects. The basic principles of psychotherapy for depression are briefly outlined. The possibilities to treat therapy-resistant depressions with a combined infusion therapy are prescribed. The recent improvements in biological psychiatry are shown.

Antidepressive Agents↗
PubMed1982

[Treatment of therapy-resistant depressions. Results of combined infusion treatment].

230 patients with therapy-resistant depression were given intravenous drip infusion treatment with clomipramine (a predominantly serotonin-uptake inhibitor) and maprotiline (a predominantly noradrenaline-uptake inhibitor), preceded by a five-day tranquilizing regimen with a neuroleptic drug. During the treatment period of 10-20 days the patients were given one infusion daily, while later both antidepressants were taken orally. The neuroleptic drug was given at night from the start of the infusion phase to the end of hospitalization. After four weeks' treatment 68% of the endogenous depressives and 54% of the exhaustion depressives had completely remitted. In patients who fail to respond the infusion regimen can be repeated after carefully rechecking the patient's diagnosis. After discharge and resumption of work the antidepressants should be reduced stepwise. A prerequisite for success in the management of refractory depression is the combination of drug administration with adequate psychotherapeutic and physiotherapeutic measures. The infusion regimen is relatively easy to administer, can be given on an outpatient basis and could be the treatment of choice in the future not only for treatment-resistant depression but also for patients whose depressive state requires rapidly effective antidepressive measures. In view of the encouraging experience obtained to date with this treatment, the World Health Organization is conducting an international collaborative research project involving 12 psychiatric centres to elucidate the effectiveness of intravenous infusion therapy in different races with different dietary habits and varying climatic conditions.

Anthracenes↗
PubMed1982

Changes in EEG, blood levels, mood scales and performance scores during long term treatment with diazepam, phenobarbital or placebo in patients.

1. The patient population consisting of fifteen patients was divided into three groups, namely: diazepam group, phenobarbital group and placebo group. After three weeks the medicated groups were switched to placebo for a week and the placebo group was given phenobarbital. 2. The parameters to be assessed once a week comprised frequency-analyzed EEG recordings, performance in two attention tests and subjectively estimated mood modalities. 3. The EEG analysis suggested that EEG patterns: a) were drug-dependent, with a differential distribution for each drug of the four frequency bands analyzed; b) showed no change during the three-week treatment period; c) changed on cessation of medication or on switch from placebo to active medication; d) were task-dependent and changed in a systematic way with the level of activation (stress, vigilance or relaxation). 4. The results would allow a better understanding of the clinical course, the choice of therapeutic measures and of the underlying mechanisms of action.

Adult↗
PubMed1982

Driving ability of depressive patients under antidepressants.

A group of twenty depressive patients was compared during a 3-4 month course of antidepressant therapy (Maprotiline: n = 6, age = 46.1; dibenzepin: n = 4, age = 43.0; lithium: n = 6, age = 44.5; "mixed" (maprotiline, dibenzepin trimeprimine): n = 4, age = 50.2) with a healthy control group (n = 32, age = 38.2) for subjective assessment of their depressive mood and performance as well as objective measurement of variables relating to driving behaviour. The measurements were taken 2-4 weeks after a pre-treatment period (day 1) and after 2-3 months of further therapy (day 2). During therapy, all patients felt "less depressive" and "more capable" in subjective terms. All patient groups made learning progress in the objectively measured variables (psychomotor co-ordination and attentiveness tests). By day 2, the patient groups had almost reached the performance level of the control group, providing they received antidepressant therapy (regardless of the action profile) which was suitable for the basic disorder and the symptoms, and therapy was successful in the opinion of the physician. It may be concluded that depressive patients, assuming suitable antidepressant treatment and good response, are capable of driving while under maintenance therapy.

Adult↗
PubMed1981

[The effect of bromazepam on fitness to drive (author's transl)].

On 3 days (1, 8, 15) the acute (on day 1) and subacute (days 8 und 15) effects of bromazepam (Lexotanil) on variables of driving ability were studied in 55 young male medical students, randomly divided into 3 groups (placebo, 1.5 mg, 3.0 mg). The drug was well tolerated (no notable side effects). Dose-effects showed trends in group 3 (3.0 mg) with a stronger subjective impression of performance impairment which was, however, not confirmed by objective performance assessment, although time of reaction to optical stimuli was significantly longer after the 3 mg dose. In the discussion, it is pointed out that the results of this type of study in healthy subjects can only be regarded as indicative.

Adult↗
PubMed1981

[Management of treatment-resistant depression without ECT (author's transl)].

Intravenous infusions of clomipramine and maprotiline, preceded by a five-day tranquilising regimen with a neuroleptic drug, were given to 177 patients with treatment-resistant depression. During the treatment period of 10-20 days the patients were given one infusion daily followed by both antidepressants taken orally. The neuroleptic drug was given at night, from the start of the infusion phase to the end of hospitalisation. After four weeks 66% of the endogenous depressions and 53% of the exhaustion depressions had completely regressed. In patients who failed to respond the infusion regimen can be repeated, if necessary with nomifensin (Alival) instead of clomipramine (Anafranil) and maprotiline (Ludiomil) in order to achieve the desired improvement without ECT. In addition to careful diagnosis, a prerequisite for likely success in the management of treatment-resistant depression is the combination of drug administration with adequate psychotherapeutic and physiotherapeutic measures. The infusion regimen is relatively easy to undertake, can also be used on an out-patient basis and could be the treatment of choice in the future, not only for treatment-resistant depressions but also for patients whose depressive state requires rapidly effective antidepressive measures.

Antipsychotic Agents↗
PubMed1981

How capable of driving are hospitalized psychiatric patients under psycho-active drug therapy?

In an open investigation design two patient groups, under neuroleptics (n=30) and under antidepressants (n=31), were examined three times, the third time under steady-state conditions. A matched control group (n=32) provided the normative values. Various variables, thought to be psychologically relevant in traffic situations were measured on two test apparatus (tracking and complex reaction time). The result shows that the antidepressant group closely approaches the achievement of the control group on the most important variables measured. It may be concluded that psychopharmacologically well balanced depressive patients at the time of the steady-state are capable of producing results comparable to a control group with respect to traffic-relevant cognitive-psychomotor functions. The neuroleptic group, however, exhibits deviations on the same variables. In this sub-sample the primary disturbances of the underlying morbus (maintaining attention, continuous focusing ability) become conspicuous. From the medical point of view, the call for an individual clinical judgement of driving capacity by the treating physician continues to remain necessary, although the results produced offer some general decision aids.

Adult↗