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Biomedical subjects

R J Boerner

Publications and source records attributed to R J Boerner.

At least 19 recordsLinked to original sources

[Panic attacks and panic disorder: recognition and treatment].

To recognize and treat panic attacks or a panic disorder are still an important function of the family doctor. For a one-time panic attack, specific counseling is normally sufficient. A panic disorder should be treated early with drugs and/or with psychotherapy and, in particular, with behavioral therapy. It is also recommended that a psychiatric specialist or a neurologist be consulted and to coordinate the differential diagnostics and therapeutic procedure with the specialist.

Adult↗

[Anxiety in elderly people -- epidemiology, diagnostic features and therapeutic options].

Anxiety disorders in older age represent with a prevalence rate of 10 % an important psychiatric problem, which has not been adequately recognised and diagnosed. This can be explained from the idea, that pathologic anxiety was evaluated as a normal reaction by elderly people. The actual classification of anxiety disorders with ICD-10 or DSM-IV was not sufficient and should be complemented by a syndromanal approach. The comorbidity of anxiety disorders with other psychiatric disorders, e. g. depression, and also with somatic diseases was high. The psychosocial consequences are important. Psychopharmacological and psychotherapeutic interventions have been proven in some studies and should be practised more in the future.

Aged↗

[Panic attacks and panic disorder. Checklist for the diagnosis].

After looking for possible organic factors, other psychiatric disorders must be considered, e.g. depression or other anxiety disorders. With respect of the different neurobiologic and psychologic factors of panic attacks the therapy should be complex. Psychotherapy (e.g. behavior therapy) and psychopharmacologic treatments were proved very well. For the general practitioner the treatment with SSRI is very helpful. This approach provides a 60% full remission. For an uncomplicated disorder prophylactic treatment is necessary.

Adult↗

Kava-Kava extract LI 150 is as effective as Opipramol and Buspirone in Generalised Anxiety Disorder--an 8-week randomized, double-blind multi-centre clinical trial in 129 out-patients.

OBJECTIVE: An 8-week randomized, reference-controlled, double-blind, multi-centre clinical trial investigated Kava-Kava LI 150 in Generalized Anxiety Disorder (GAD; ICD-10: F41.1). METHOD: 129 out-patients received either 400 mg Kava LI 150, 10 mg Buspirone or 100 mg Opipramol daily for 8 weeks. At week 9, subjects were seen to check for symptoms of withdrawal or relapse. Primary outcome measures comprised the HAMA scale and the proportion of responders at week 8. Secondary measures were the Boerner Anxiety Scale (BOEAS), SAS, CGI, a self-rating scale for well-being (Bf-S), a sleep questionnaire (SF-B), a quality-of-life questionnaire (AL) and global judgements by investigator and patients. RESULTS: In 127 patients (ITT) no significant differences could be observed regarding all efficacy and safety measures. About 75% of patients were classified as responders (50% reduction of HAMA score) in each treatment group, about 60% achieved full remission. CONCLUSION: Kava-Kava LI150 is well tolerated and as effective as Buspirone and Opipramol in the acute treatment of out-patients suffering from GAD.

Adult↗

[Psychotherapy and drugs. Conquering panic].

The panic disorder with a lifetime prevalence of estimated 3.5% is an important psychiatric disorder of common comorbidity and long term course. The adequate diagnosis is rare, the common therapeutic strategies are not sufficient. Besides behaviour therapy the therapy with SSRIs provides a 60% remission within a few weeks for an uncomplicated panic disorder.

Arousal↗

Kava kava in the treatment of generalized anxiety disorder, simple phobia and specific social phobia.

A 37-year-old female outpatient with generalized anxiety disorder, a simple phobia and a specific social phobia was treated with phytotherapy (Kava kava). Within 4 weeks, symptoms had improved by 75% and by 6 months an almost total remission of symptoms was observed. The herbal medicine was well tolerated. Kava has considerable potential value in the treatment of anxiety disorders.

Adult↗

[Generalized anxiety disorders (GAD)--a neglected illness? Background und aims of the GAD-P study].

In the past Generalized anxiety disorder (GAD)--previously classified as anxiety neurosis--was regarded as not being a separate diagnostic entity. On the basis of new explicit criteria for GAD in the 90ies, GAD-specific pharmacological (i.e. SNRI) and psychological treatments with improved efficacy have become available. The Generalized Anxiety and Depression in Primary care study (GAD-P) investigates the prevalence of GAD in primary care settings and evaluates the patterns of care provided. Aims, methods and findings of the GAD-P study are described in this supplement.

Anti-Anxiety Agents↗

Psychopathological changes and cognitive impairment in encephalomyelitis disseminata.

Two hundred and twelve patients with clinically evidenced encephalomyelitis disseminata (ED), hospitalized in a neurological hospital, were observed with regard to psychopathological characteristics and cognitive changes in conformity with ICD-10 diagnostic criteria. The basis of this investigation was a standardized psychiatric interview. The age of the patients averaged 47 years whereas the duration of the disease averaged 14.3 years. 83.5% of the patients had a disease history of more than 6 years. The medium range of EDSS scores was 5.95%, the BPRS 36.7%. In 5.2% of the patients the course of ED was primarily chronic-progressive while 48% suffered from the intermittent, incomplete-reversible form: 47.6% developed secondary chronic-progressive symptoms. 18 psychopathological symptoms could be identified, the main symptom was depressive mood (49%), followed by impairment of affective sensitivity (34.9%) and affective instability/incontinence (31.1%). The most prevalent diagnoses were dementia (23.1%), organic personality disorder (18.5%), mild cognitive impairment (9%), and depressive disorder (7.6%) Only 33.5% were psychopathologically unaffected. The duration of the disease in all demented patients exceeded 6 years. Patients with an organic personality disorder showed a marked increase in the later stages of their illness in contrast to patients suffering from depressive disorder. At the beginning of ED, a highly significant (p < 0.0001) impairment of vision was found in all psychiatric patients. Dementia patients and organic personality patients, on the other hand, showed an advanced degree of ataxia. Actually, there was a considerably lesser incidence of pareses in the non-psychopathological group whereas ataxia was significantly more prevalent in the three cognitively impaired ED-subgroups than in the control group. These findings set the stage for constructive discussions, taking due consideration of existing research results on ED with particular reference to the implications regarding future research as well as the clinical therapy of patients.

Ataxia↗

The importance of new antidepressants in the treatment of anxiety/depressive disorders.

Patients suffering from anxiety and depression are often seen in clinical practice. In accordance with the diagnostic criteria of DSM-III/IV and ICD-10, respectively, there may be various combinations of symptoms and degrees of severity. The symptoms of these patients may range from subthreshold anxiety or depression to a combination of anxiety and depressive disorders. Besides giving an extensive survey of diagnostic problems and the epidemiological incidence of such combinations, pharmacotherapeutic approaches are critically reviewed. Metaanalyses have shown that various serotonin reuptake inhibitors (SSRI) are equivalent, if not superior, to tricyclic antidepressants (TCA) in their anti-anxiety effectiveness. Hence, SSRI may be considered a therapy of choice, not least on account of very few adverse effects and good tolerance. More recent antidepressants are under scrutiny for their anti-anxiety efficacy. Citalopram, venlafaxine and, because of its established sedative action, nefazodone seem to be particularly suited to fill a possible therapeutic gap and to provide agitated patients with an alternative to TCA.

Affective Symptoms↗

SH2- and SH3-mediated interactions between focal adhesion kinase and Src.

Intramolecular SH2 and SH3 interactions mediate enzymatic repression of the Src kinases. One mechanism of activation is disruption of these interactions by the formation of higher affinity SH2 and SH3 interactions with specific ligands. We show that a consensus Src SH3-binding site residing upstream of the Src SH2-binding site in FAK can function as a ligand for the Src SH3 domain. Surface plasmon resonance experiments indicate that a FAK peptide containing both the Src SH2- and SH3-binding sites exhibits increased affinity for Src. Furthermore, the presence of both sites in vitro more potently activates c-Src. A FAK mutant (FAKPro-2) with substitutions destroying the SH3-binding site shows reduced binding to Src in vivo. This mutation also reduces Src-dependent tyrosine phosphorylation on the mutant itself and downstream substrates, such as paxillin. These observations suggest that an SH3-mediated interaction between Src-like kinases and FAK may be important for complex formation and downstream signaling in vivo.

Amino Acid Sequence↗

Correlation of the phosphorylation states of pp60c-src with tyrosine kinase activity: the intramolecular pY530-SH2 complex retains significant activity if Y419 is phosphorylated.

Rapid digestion of pp60c-src tyrosine kinase (src TK) in combination with electrospray ionization mass spectrometry enabled the determination of the time course for autophosphorylation of three tyrosine sites (Y338, Y419, and Y530) and a correlation with src TK activity. A form of src TK was purified from baculovirus-infected cells which contains only Y338 partially phosphorylated. Incubation with MgATP increases the phosphorylation of all three sites. The autophosphorylation and dephosphorylation of Y419 are directly correlated with the level of src TK activity. The role of Y338 phosphorylation is unknown. Conditions resulting in complete autophosphorylation of Y530 were identified by electrospray ionization mass spectrometry. Surface plasmon resonance detection and size exclusion chromatography provide direct evidence for an intramolecular pY530-SH2 complex, supporting previous models [Matsuda, M., Mayer, B.J., Fukui, Y., & Hanafusa, H. (1990) Science 248, 1537-1539]. Contrary to these models, when the enzyme is fully phosphorylated on Y530, phosphorylated on Y419, and present only as the intramolecular pY530-SH2 complex, 20% of the kinase activity is retained. In addition, the k(m)'s for substrates are unaffected. Disruption of the pY530-SH2 interaction and activation of kinase activity by a high-affinity SH2 ligand yield a Kactivation which is 200-fold larger than the Kd for ligand binding to the uncomplexed src SH2 domain. These data suggest a Keq of 200 (unitless) for the intramolecular association of pY530 with the SH2 domain. We propose that the pY530-SH2 interaction modulates signal transduction by down-regulating src TK activity 5-fold, and perhaps more importantly by inhibiting protein-protein interactions with the SH2 domain. These results have significant implications relative to the development of SH2 ligands as therapeutics to control aberrant signal transduction. These ligands will be 200-fold less effective at inhibiting protein-protein interactions versus down-regulated src TK than versus activated src TK. This should minimize activation of src TK activity in normal cells and lead to an increased therapeutic index.

Adenosine Triphosphate↗

Reversible hepatotoxicity of paroxetine in a patient with major depression.

Selective serotonin reuptake inhibitors (SSRIs) are becoming widely used because of their favorable side-effect profile and their safety in overdose. We report about a patient with recurring major depression (DSM-IIIR) who was treated with paroxetine and developed a severe hepatotoxic reaction, which was reversed after withdrawal of the drug. Individual, patient-related causes for this side-effect were not found. To our knowledge, this is the first published case of a probably paroxetine-induced severe hepatotoxicity. Hepatotoxicity should be taken into account as a rare complication that may occur not only with tricyclic antidepressants (TCAs) but also with SSRIs.

Antidepressive Agents, Second-Generation↗

Kinetic mechanisms of the forward and reverse pp60c-src tyrosine kinase reactions.

The kinetic mechanism of the pp60c-src tyrosine kinase (src TK) reaction was investigated in the forward and reverse directions. In the forward direction, initial velocities obtained by varying ATP and the peptide (FGE)3Y(GEF)2GD indicated a sequential addition of the two substrates. The peptide analog, (FGE)3F(GEF)2GD, was a competitive inhibitor versus the peptide substrate and a noncompetitive inhibitor versus MgATP. Interestingly, the tyrosine hydroxyl group imparts only a 6-fold increase in binding. AMP-PCP was a competitive inhibitor versus MgATP and a noncompetitive inhibitor versus the peptide substrate. These results prove that the addition of substrates is random. Furthermore, there appears to be little binding synergy as the KiMgATP approximately equal to 2.4KmMgATP. The phosphorylated peptide (FGE)3-pY-(GEF)2GD was a competitive inhibitor versus peptide and a noncompetitive inhibitor against MgATP, suggesting that a dead end complex can form between MgATP, the phosphorylated peptide product, and the enzyme. The reverse reaction was investigated by varying ADP and the phosphopeptide. (FGE)3-pY-(GEF)2GD. The initial velocity pattern was indicative of a sequential mechanism. There was even less binding synergy in the reverse direction as the KiMgADP approximately equal to 1.4KmMgADP. AMP-CP was a competitive inhibitor versus MgADP and a noncompetitive inhibitor versus the phosphopeptide. (FGE)3F(GEF)2GD was a competitive inhibitor versus the phosphopeptide and a noncompetitive inhibitor versus MgADP. These data prove that addition of the substrates in the reverse direction is random. (FGE)3Y(GEF)2GD was a competitive inhibitor against peptide substrate and a noncompetitive inhibitor against MgADP; therefore a dead end complex can form between MgADP, (FGE)3Y(GEF)2GD, and the enzyme. These results indicate that the src TK reaction follows a sequential bi-biequilibrium random mechanism in both directions, with dead end complexes forming when either MgATP and (FGE)3-pY-(GEF)2GD or MgADP and (FGE)3Y(GEF)2GD bind to the enzyme. The kinetic constants determined from the forward and reverse reactions were used in the Haldane equation to determine a K(eq) constant for the forward reaction of 10.1, corresponding to a delta G of -1.4 kcal/mol. This further confirms that the O-P bond of phosphotyrosine is similar in energy to that of the gamma-phosphoryl of MgATP.

Adenosine Diphosphate↗