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Biomedical subjects

R Tölle

Publications and source records attributed to R Tölle.

At least 19 recordsLinked to original sources
PubMed2006

[Science and clinical practice. 1865 psychiatric convention in Hannover].

Psychiatric conventions in Germany have taken place since the 1840s. Concerning content and influence, outstanding was one in 1865 for scientists and physicians in Hannover, Germany. Practical and scientific problems of current psychiatric interest were discussed, particularly the question of monomania in the context of Unitarian theory, and further new, extramural ways of psychiatric care which already had received notice abroad (family care, agricultural colonies). The Hannover congress reveals the progressive influence of German institutional psychiatry.

Congresses as Topic↗
PubMed2002

[Wilhelm Griesingers "Magna Charta" of psychiatry. Its reception and impact on modern psychiatry].

The work of Wilhelm Griesinger, really a magna charta of psychiatry, is usually reduced to just one sentence: "Geisteskrankheiten sind Gehirnkrankheiten", roughly: "mental illnesses are brain disorders". However, this is neither explicitly stated in Griesingers work nor does it adequately summarise his conception. This misinterpretation will be questioned by a careful analysis of the literature, and, in addition to that, the dimensions of Griesingers psychiatry including its delayed impact on the development of modern psychiatry will be described.

Germany↗
PubMed1999

[Persecution in Nazi everyday life. The pathological aspects of extreme stress].

The extensive literature on persecution during the Third Reich lacks a first person account of the psychological distress induced by public Nazi harassments in everyday life--with the only exception of Victor Klemperer's diary. His records are outstanding in their unusual authenticity. They have gained widespread publicity and have been extensively reviewed, but almost exclusively from historical or political perspectives. The following is focused on his personal view. Taking his diaries as a starting point three subjects are treated: It is first discussed what kind of persecutional measures had to be faced by a Jewish person who was neither imprisoned nor had gone underground, but seemed to lead a normal life. Klemperer's records reveal an extreme kind of distress with permanent fear of death very close to that described by psychiatrists as victims of the Nazi persecution. It is then discussed how Klemperer experienced himself under these circumstances. Severe depression, distorted perception of time, stupefaction, egoism, and retreat from his compassion for fellow-sufferers may be understood from a psychodynamic point of view but were of course perceived as demoralization by Klemperer himself. Finally the present paper pursues the potentials of coming through and coping with persecution. Klemperer describes various ways and means of compensating and coping which were subsequently taken away from him with growing persecution. His non-Jewish wife was his only personal supporter. Writing was a constantly effective coping measure to him, initially as an essayist. After he had been banned from the academic community his diary remained his only opportunity for writing. In spite of being under constant fear for his life, he kept on writing. The subjective experiences of this situation are discussed. His recording of everyday life under persecution enabled him to survive it. Hence his diaries had a life-preserving function.

Germany↗
PubMed1998

[Delusion in depression].

The present article endeavours an outline of depressive delusions, their symptomatology and their various topics. Their relations to depressive feelings of guilt and anxiety are discussed and differentiated. Delusions of guilt, poverty or disease including their preliminary states are by no means rare but regularly occurring symptoms which substantiate the diagnosis of major depressive disorder/endogenous depression/melancholia. Preliminary states like hypochondriatic fears of guilt and poverty are likewise characteristic clinical signs which may be differentiated with high validity from the kind of anxiety associated to neurotic depression/dysthmia. Delusional depression did not prove to be a nosological entity but as a concept may bear considerable heuristic value concerning therapeutic considerations. This particularly serious form of depression requires specific therapeutic procedures.

Delusions↗
PubMed1998

Repeated sleep deprivation once versus twice a week in combination with amitriptyline.

OBJECTIVE: Although a combination of antidepressive pharmacotherapy with repeated sleep deprivation therapy has proved to be an effective and easily applied treatment strategy, no systematic study investigating the most favourable interval between the sleep deprivation trials is available. METHOD: In a cross-over design, 44 patients with a major depressive episode (ICD-10) were randomly allocated to 4 weeks treatment with amitriptyline (150 mg/d) in combination with either late sleep deprivation (of the second half of the night, LSD) twice weekly during week 1 and 2 followed by LSDs once weekly during week 3 and 4 or vice versa. Two hypotheses were tested: Does LSD twice weekly during week 1 and 2 accelerate the clinical response compared with LSD once weekly? Does LSD twice weekly during week 3 and 4 improve the response rate compared with LSD once weekly? RESULTS: According to both observer rating (Hamilton Rating for Depression, 21-item version) and self-rating (Visual Analogue Mood Scale), no significant differences could be ascertained between the groups compared at any time of the investigation. With respect to drop-outs and immediate LSD effects there is a trend for patients undergoing twice weekly LSDs followed by once weekly LSD trials to have a more favourable treatment course than the control group. CONCLUSION: The hypotheses tested were answered in the negative. "High dose" LSD administration does not prove to be clearly superior to "low dose" LSD. This finding is in line with most of the corresponding data on antidepressive pharmacotherapy.

Adult↗
PubMed1997

Electroconvulsive therapy vs. paroxetine in treatment-resistant depression -- a randomized study.

Failure to respond to adequate pharmacological treatment for major depression is now the most common indication for the use of electroconvulsive therapy (ECT). The advantages of ECT with respect to both speed and quality of response are clinically important issues, but surprisingly few studies have examined the efficacy of ECT in relation to newer antidepressant agents such as selective serotonin reuptake inhibitors (SSRIs). A total of 39 subjects with major depression and with at least two failed antidepressant trials (mean 4.9 trials) were randomized to either paroxetine treatment (n=18) or right unilateral (RUL) ECT (n=21). Up to the end of the study treatment we found a reduction in the HAMD score of 59% for the ECT group and of 29% for the paroxetine group (P<0.001 paired t-test). In the ECT group, 71% of subjects fulfilled the response criteria (at least a 50% decrease in total HAMD score). The present study found ECT to be superior to paroxetine in medication-resistant major depression, in terms of both degree and speed of response.

Adult↗
PubMed1996

Amitriptyline in combination with repeated late sleep deprivation versus amitriptyline alone in major depression. A randomised study.

Only few systematic studies are available on the status of sleep deprivation therapy in the overall treatment regimen of depressive patients. 51 patients suffering from a major depressive episode (ICD-10) were randomly allocated to 4 weeks' treatment with amitriptyline (150 mg/day) or to a combination of amitriptyline with six partial-sleep-deprivation treatments late in the night (at 4-5 day intervals). According to observer rating (Hamilton Rating Scale for Depression, 21- and 10-item version), a highly significant amelioration was recorded in both groups until the 14th day of treatment. A further improvement occurred, however, only in those patients treated with both antidepressants and sleep deprivation. Hence the response rate ( > or = 50% HAMD reduction) after 4 weeks' treatment was distinctly more favourable in this group than in those patients under pharmacotherapy alone. The superiority of the combined therapy cannot be confirmed statistically by self-rating (Befindlichkeitsskala: von Zerssen; Visual Analogue Mood Scale). The immediate antidepressive effect of sleep deprivation diminished in the course of the sleep deprivation series. The response to the first sleep deprivation was a predictor neither for the response to further sleep deprivation treatments nor for the overall treatment outcome.

Adult↗
PubMed1996

[Dyssocial identity disorder (double identity) in psychopathology and poetry].

Identity dissociation signifies: there seem to exist two identities in one personality that take turns-apparently without knowing about each other. Descriptions of this rare state are often spectacular. As scientifically proven they depend on culturally specific conditions and iatrogeneous influences. The disorder is to be analysed in this article for the case of both psychiatry and every-day-life-experiences in a matter-of-fact way. The first description of the phenomenon is not found in psychiatric literature but in poetry. The novellas of E.T.A. Hoffmann contain at least eight descriptions of 'double life'. The 'Fräulein von Scuderi' (1820) seems to be the most interesting of these and is therefore focused on in this article. E.T.A. Hoffmann himself was at the same time well respected jurist and significant artist of great versatility: poet as well as musician, composer, painter. Hoffmann's artistic and his civic life stood in sharp contrast, which gives reason to use of the term 'double life'.

Adult↗
PubMed1995

[Modified insulin treatment of therapy refractory depression].

In the light of progress in psychiatric therapy the problem of treatment-resistance deserves increasing attention. One of the most important challenges in modern psychiatry is to further reduce treatment failure. In so-called treatment-resistant depression various strategies are recommended. In the present paper a regimen is described that only little attention is paid to: Subliminal induced-hypoglycemia (insulin therapy), that coursed amelioration in about 3/4 of the patients.

Adolescent↗
PubMed1994

[Modified insulin treatment of therapy refractory schizophrenic disorders].

Subliminal hypoglycemia therapy (subcoma therapy, modified insulin therapy) is rarely practised in modern psychiatry. This study reports on the therapy of 105 patients (2619 single treatments) suffering from therapy-resistant schizophrenia. Evaluation was retrospective. Remarkably, 46.7% of the patients responded positively to a 4-6 week course of insulin therapy. In 26.6%, the effect was moderate. Tolerance ist good.

Adult↗
PubMed1993

Somatopsychic aspects of paranoia.

The factors to which the pathogenesis of paranoia is ascribed are predisposition, personality and environment. This paper deals with further etiological preconditions such as psychoorganic impairment, convulsive disorders and physical handicaps together with their psychoreactive processing, based on detailed case reports. Such patients are relatively frequent within the (epidemiologically small) group comprising paranoia. The psychodynamic factors underlying the sensitive processing of physical handicaps are described, with means of prevention being discussed in conclusion.

Adult↗
PubMed1991

Sleep deprivation therapy.

This review reports, with as much detail as possible, on the literature relating to therapeutic sleep deprivation (or induced-wakefulness therapy) since it was first described in 1971. The antidepressive effect of sleep deprivation has been substantiated by numerous studies. A series of clinical predictors of response to sleep deprivation are also described. Partial sleep deprivation late in the night is equivalent to total sleep deprivation in terms of therapeutic value and--because of its simpler application--can be regarded today as the sleep deprivation method of choice. The status of sleep deprivation in the overall treatment schedule for depressive disorders is discussed in detail. Numerous findings, some of them contradictory, have been published on the effect of sleep deprivation on biological variables. To date, no unequivocal explanation has been found for the mechanism of action of sleep deprivation.

Combined Modality Therapy↗
PubMed1991

[Diurnal variations of symptoms of depression].

New symptom-statistical, chronobiological and experimental investigations concerning diurnal variation in endogenous depression (melancholia) are reported and interpreted referring to psychopathological, biological and phenomenological aspects. According to recent studies, the so-called typical diurnal variation of mood (with morning low) is not as frequent, as it was assumed before, and even intraindividually unstable. Although more frequent than other daily rhythmus, the so called typical diurnal variation should not be used for diagnostic purposes, because it is quite frequent in different depressive states as well. During their healthy intervals endogenous depressive patients show not rarely an analogous diurnal variation of mood; this was also found in healthy subjects. Therefore the so called typical variation in mood is not specific, and it is questionable whether it is a marker of endogenous depression at all. Concerning circadian rhythm biological functions were examined more often than the depressive symptomatology itself (especially temperature, heart rate, cortisol and other neuroendocrine parameters). Unexpectedly there were only slight variations of the circadian diurnal curves in melancholic patients compared to healthy subjects. The circadian rhythm in endogenous depression does not seem to be very different from the physiological diurnal course. Comparing the biological circadian curves in endogenous depression to the curves of the depression symptomatology, the similarities outline the differences. Sleep research didn't show any results, supporting the suggestion of a specific rhythm variation either. Therefore the opinion, that the circadian rhythm is altered basically in melancholia, cannot be maintained, neither psychopathologically nor biologically. Experiments of time estimation in the course of the day could'nt explain the diurnal variation in mood either.

Circadian Rhythm↗
PubMed1991

Time estimation and the experience of time in endogenous depression (Melancholia): an experimental investigation.

The importance of disturbances in time experience in endogenous depression (melancholia) has long been under discussion. In the present study alterations of time experience were examined by means of time estimation experiments. 25 endogenous depressive patients (according to ICD-9) underestimated prospectively a 30-second interval by 6 s, whereas 12 healthy controls overestimated this interval by more than 10 s. The results are based on eight successive measurements over a period of 2 days. In the endogenous depressives, a feeling of being unwell was accompanied by a more pronounced time estimation error than a relatively good state of well-being. The influence of various patient data on the results of time estimation is also discussed in detail. The findings show clearly that time estimation provides a satisfactory delineation between depressive patients and healthy controls.

Adaptation, Psychological↗