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T Bschor

Publications and source records attributed to T Bschor.

15 recordsLinked to original sources
PubMed2006

Do antidepressants influence mood patterns? A naturalistic study in bipolar disorder.

This prospective, longitudinal study compared the frequency and pattern of mood changes between outpatients receiving usual care for bipolar disorder who were either taking or not taking antidepressants. One hundred and eighty-two patients with bipolar disorder self-reported mood and psychiatric medications for 4 months using a computerized system (ChronoRecord) and returned 22,626 days of data. One hundred and four patients took antidepressants, 78 did not. Of the antidepressants taken, 95% were selective serotonin or norepinephrine reuptake inhibitors, or second-generation antidepressants. Of the patients taking an antidepressant, 91.3% were concurrently taking a mood stabilizer. The use of antidepressants did not influence the daily rate of switching from depression to mania or the rate of rapid cycling, independent of diagnosis of bipolar I or II. The primary difference in mood pattern was the time spent normal or depressed. Patients taking antidepressants frequently remained in a subsyndromal depression. In this naturalistic study using self-reported data, patients with bipolar disorder who were taking antidepressants--overwhelmingly not tricyclics and with a concurrent mood stabilizer--did not experience an increase in the rate of switches to mania or rapid cycling compared to those not taking antidepressants. Antidepressants had little impact on the mood patterns of bipolar patients taking mood stabilizers.

Adult↗
PubMed2004

Time experience and time judgment in major depression, mania and healthy subjects. A controlled study of 93 subjects.

OBJECTIVE: Studies on the time sense of depressed patients have revealed inconsistent results. Manic patients have been almost neglected. METHOD: Patients with a major depressive episode (n = 32), or a manic episode (n = 30) (both Diagnostic and Statistical Manual of Mental Disorders-IV, Mini-International Neuropsychiatric Interview-confirmed), and 31 healthy controls were included. The subjective time experience was assessed by a visual analog scale (VAS), the objectively measurable time judgment abilities by the Chronotest, a computer program developed for this study, consisting of time estimation and time production tasks. RESULTS: Controls reported a balanced, manic patients an enhanced, and depressive patients a slowed experience of time flow in the VAS (P < 0.001). In the time judgment tasks, however, both depressed and manic patients showed time overestimation for the longer time spans (P < 0.008). CONCLUSION: This largest study on time sense in manic patients confirmed results of a divergent alteration of time experience in depressive and in manic patients but revealed an uniform time overestimation by both patient groups in time judgment tasks.

Analysis of Variance↗
PubMed2003

Lithium augmentation in treatment-resistant depression: clinical evidence, serotonergic and endocrine mechanisms.

For now more than 50 years, lithium has been the gold standard for the pharmacologic treatment of bipolar disorder. However, its utility is not restricted to acute mania and prophylactic treatment of bipolar disorder. A relatively new indication for its use is the addition to an antidepressant in the acute treatment phase of unipolar major depression. To date, this treatment approach called lithium augmentation is the best-documented approach in the treatment of refractory depression. In international treatment guidelines and algorithms, lithium augmentation is considered a first-line treatment strategy for patients with a major depressive episode who do not adequately respond to standard antidepressant treatment. In a recent double-blind, placebo-controlled trial, lithium augmentation has demonstrated to also be effective in the continuation treatment phase to prevent early relapses. From animal studies there is robust evidence that lithium augmentation increases serotonin (5-HT) neurotransmission, possibly by a synergistic action of lithium and the antidepressant on brain 5-HT pathways. In contrast to the established decline of HPA system activity during treatment with tricyclic antidepressants, neuroendocrine studies on the effects of lithium augmentation on the HPA system showed an unexpected and marked increase in the ACTH and cortisol response in the combined DEX/CRH test. Here we review new data on the efficacy and mechanism of action of lithium augmentation.

Adrenocorticotropic Hormone↗
PubMed2001

[Loperamide abuse in anxiety disorder].

Anxiety disorders often accompany somatic correlates of anxiety such as abdominal trouble and diarrhoea. Nevertheless, misuse of antidiarrhoeals has been described only once. We report on a 34-year-old woman who abused loperamide for over 10 years, taking up to 16 mg per day. Loperamide is an opioid that stimulates opioid receptors in the gastrointestinal tract, thereby inhibiting intestinal secretion and propulsive peristalsis, probably without affecting the central nervous system. As our patient's digestive trouble was a consequence of her states of anxiety, diazepam application helped against her diarrhoea as well. This second strategy of self-medication gained particular importance for her, when even high doses of loperamide stopped having an effect. So she developed a benzodiazepine dependence. As soon as she began treatment as an inpatient, her feelings of anxiety became less and the diarrhoea disappeared.

Adult↗
PubMed2001

Predictors of response to lithium augmentation in tricyclic antidepressant-resistant depression.

BACKGROUND: The efficacy of lithium augmentation in therapy-resistant depression has been shown in a series of well-designed, placebo-controlled studies. However, little is known about the predictors of a good response to this treatment strategy. METHODS: We retrospectively examined the predictive value of 20 demographic, clinical, biochemical and endocrinological variables using a two-step logistic regression. Seventy-one in-patients with depression refractory to tricyclic antidepressants had received lithium augmentation as part of a standardised treatment protocol. RESULTS: Within 4 weeks 37 patients (52%) responded to lithium augmentation. Five variables with predictive value were found. Responders were more severely depressed according to the Bech-Rafaelsen Melancholia Scale. The duration of their index episode was shorter. Triiodothyronine serum levels were lower and neuroleptic co-medication and co-diagnosis of personality disorder were less frequent. LIMITATIONS: This was an open, retrospective study. CONCLUSIONS: Severity of depression is a predictor of response to lithium augmentation. This result conflicts with recent studies but is similar to results found in studies of other pharmacological antidepressant strategies.

Adult↗
PubMed2001

Subjective response to and tolerability of long-term supraphysiological doses of levothyroxine in refractory mood disorders.

BACKGROUND: Although supplementation with supraphysiological doses of levothyroxine (T4) has been an effective treatment for refractory affective disorders in open studies, questions remain as to the tolerability of this treatment. This is the first study to investigate subjective patient response and tolerability to long-term treatment with adjunctive T4. METHODS: Of 24 patients with refractory affective disorders or schizoaffective disorder who were consecutively included into an open trial with supraphysiological T4, 16 were eligible for this study. Four measures were used to rate tolerability to T4 treatment. Subjective response was graded on a scale ranging from -33 (maximal negative response) to +33 (maximal positive response). Positive and negative effects were assessed on a structured questionnaire. Clinical tolerance was assessed with the clinician-rated Thyroid Symptom List and the self-rated Von Zerssen Complaint Lists. Outcome was assessed with the CGI for prophylactic ratings (CGI-BP). RESULTS: At the time of assessment, patients had been treated with supraphysiological T4 (mean dose 368 microg/d) for a mean of 54 months. The total subjective response score was +25.2. Positive subjective response and observer-rated treatment success were moderately correlated. Ratings on the Thyroid Symptom List indicated an overall favorable side effect profile. General physical and mental symptoms were only slightly higher than in the general population. LIMITATIONS: This was an open, cross-sectional study that only included responders and partial responders to T4 treatment. CONCLUSIONS: Subjective response and side-effect tolerability of long-term supraphysiological doses of T4 is favorable in patients with refractory mood and schizoaffective disorders who respond to the intervention.

Adult↗
PubMed2001

Spontaneous speech of patients with dementia of the Alzheimer type and mild cognitive impairment.

This article discusses the potential of three assessments of language function in the diagnosis of Alzheimer-type dementia (DAT). A total of 115 patients (mean age 65.9 years) attending a memory clinic were assessed using three language tests: a picture description task (Boston Cookie-Theft picture), the Boston Naming Test, and a semantic and phonemic word fluency measure. Results of these assessments were compared with those of clinical diagnosis including the Global Deterioration Scale (GDS). The patients were classified by ICD-10 diagnosis and GDS stage as without cognitive impairment (n = 40), mild cognitive impairment (n = 34), mild DAT (n = 21), and moderate to severe DAT (n = 20). Hypotheses were (a) that the complex task of a picture description could more readily identify language disturbances than specific language tests and that (b) examination of spontaneous speech could help to identify patients with even mild forms of DAT. In the picture description task, all diagnostic groups produced an equal number of words. However, patients with mild or moderate to severe DAT described significantly fewer objects and persons, actions, features, and localizations than patients without or with mild cognitive impairment. Persons with mild cognitive impairment had results similar to those without cognitive impairment. The Boston Naming Test and both fluency measures were superior to the picture description task in differentiating the diagnostic groups. In sum, both hypotheses had to be rejected. Our results confirm that DAT patients have distinct semantic speech disturbances whereas they are not impaired in the amount of produced speech.

Aged↗
PubMed2001

Decreased level of EEG-vigilance in acute mania as a possible predictor for a rapid effect of methylphenidate: a case study.

About one third of manic patients show a decreased Electroencephalographic Vigilance Level (EVL). In two patients with recurrent manias the hypothesis was tested that the EEG may be used to predict the therapeutic response to methylphenidate. Patient A (with a decreased EVL) responded rapidly to methylphenidate with a considerable reduction of symptoms and a clear increase of EVL, whereas patient B (normal EVL) did not show any change, neither clinically nor in the EEG.

Bipolar Disorder↗
PubMed2000

[When the mind affects the body. Unmasking "masked" depression].

The term masked depression means a depressive condition in which physical symptoms predominate while the depressive symptoms are concealed. The physical complaints are frequently unspecific and difficult to identify. The leading symptom is usually pain--the predilection sites being the head and chest. For the general practitioner, orientation to a check list of questions aimed at identifying depressive symptoms in patients with physical complaints that are difficult to diagnose, makes good sense. The concept of masked depression has been abandoned in favor of other diagnoses that can be operationalized.

Depressive Disorder↗
PubMed2000

Double-blind, placebo-controlled trial of the use of lithium to augment antidepressant medication in continuation treatment of unipolar major depression.

OBJECTIVE: Use of lithium to augment antidepressant medication has been shown to be beneficial in the acute treatment of depression. The authors examined the efficacy of lithium augmentation in the continuation treatment of unipolar major depressive disorder. METHOD: Thirty patients with a refractory major depressive episode who had responded to acute lithium augmentation during an open 6-week study participated in a randomized, parallel-group, double-blind, placebo-controlled trial of lithium augmentation during continuation treatment. After a 2-4-week stabilization period following remission, patients were randomly assigned to receive either lithium or placebo for a 4-month period. Antidepressant medication was continued throughout the study. RESULTS: Relapses (including one suicide) occurred in seven (47%) of the 15 patients who received placebo in addition to antidepressants. None (0%) of the 14 patients who received lithium augmentation with antidepressants suffered a relapse during the double-blind phase of the study. Five of the seven relapsing patients in the placebo group developed a depressive episode, and the other two experienced a manic episode. CONCLUSIONS: Lithium augmentation in the continuation phase of treatment of unipolar major depressive disorder effectively protects patients against a relapse. Patients who respond to lithium augmentation should be maintained on lithium augmentation for a minimum of 6 months or even longer.

Adolescent↗
PubMed1998

[Thyroid gland function in lithium treatment].

Lithium is widely used in the acute and prophylactic treatment of affective disorders. Lithium affects thyroid hormone metabolism via different mechanisms. In patients this leads to a compensatory increase in pituitary thyroid stimulating hormone (TSH) which usually maintains the euthyroid status. This is probably the reason for the relatively high prevalence of goitre in lithium-treated patients; however, the enlargement of the gland is only moderate in most cases. Due to its immunostimulating effects lithium may support the appearance of thyroid auto-antibodies and the development of thyroiditis, which may be the reason for a higher prevalence of hypothyroidism in patients receiving lithium. However, also cases of hyperthyroidism in such patients have been reported repeatedly. Therapeutic recommendations for the treatment of disturbances of thyroid function during lithium treatment are given.

Affective Disorders, Psychotic↗
PubMed1998

[Lithium in the treatment of acute depression].

In contrast to its widespread use in the prophylaxis of affective illness and in the acute treatment of mania lithium has not well been established in the treatment of acute depressive disorders. However, recent results from placebo controlled trials on lithium augmentation have shown its efficacy in the treatment of depressive disorders. Three different modes of application of lithium have been investigated since the 1960s and are reviewed in this article: 1. Although not a first line antidepressant lithium can be applied in monotherapy in the treatment of mild depressive episodes particularly in bipolar patients. 2. The successful additional use of lithium in patients not responding to conventional antidepressive treatment (lithium augmentation) has repeatedly been shown in controlled clinical trials since the 1980s. Therefore, lithium augmentation therapy has been established as treatment option of first choice in refractory depression. 3. Up to now there is little data concerning the initial combination of lithium with a conventional antidepressive drug: this indication of lithium seems to be useful in the treatment of depressive episodes in bipolar patients with a history of switching into mania during administration of tricyclics and leading to faster symptom relief.

Acute Disease↗
PubMed1995

[Organic origin of maniform psychosis. A case example of progressive paralysis].

A 36-year-old patient with a highly developed manic-type psychosis is presented. The precise, thorough psychopathological examination indicated organic illness. The diagnosis of neurosyphilis was established when specific CNS-derived immunoglobulin was detected. The existence of increased general inflammatory parameters in the CSF indicated that the condition was active. Treatment with penicillin resulted in clear improvement of laboratory findings, but clinical recovery was only partial.

Adult↗