Biomedical subjects

T Wetterling

Publications and source records attributed to T Wetterling.

At least 19 recordsLinked to original sources

PubMed2004

[Legal decisions of german supreme courts about prescription of drugs for not registered indications ("off-label-use")].

In the medical treatment of patients drugs not registered for this specific indication are often prescribed. This so-called "off-label-use" is an increasing point of discussion and in the past years had to be settled in court more than once. The debate covers some questions, i. e. whether the health insurance funds have to pay for the prescribed "off-label-use" drugs, and who is responsible in case of side-effects. In this article the most relevant court decisions of German Supreme Courts are reviewed. The decisions show some changes. According to a recent sentence of the German Supreme Court for Social Law an "off-label" medication to be paid by health insurance funds is only allowed under strong conditions: presence of a life-threatening disease or a disease causing a long term severe impairment of the quality of life, no other medication available, and sufficient data from scientific literature supporting an clinical efficacy of the drug. However, in case of an "off-label" medication the physician is fully responsible for all legal consequences.

Drug Approval↗

PubMed2004

[Prescription of drugs without registered indication].

In the medical treatment of psychiatric patients drugs not registered for this specific indication are often prescribed. This so-called "off-label-use" is an increasing matter of discussion in the last years. In the article several aspects concerning "off-label-use" of psychotropic drugs debated in Germany are reviewed. According to a sentence of the German Supreme Court for Social Law an "off-label-use" is only allowed under strong conditions. Furthermore, controlled randomized studies are judged to be the basis of an evaluation of the permission to prescribe an "off-label" medication. Since in clinical practice a comprehensive research of suitable controlled studies is time consuming, in this article controlled randomized studies concerning the main problematic fields of psychopharmacotherapy: treatment of single psychopathological symptoms, therapy resistance, contraindications or severe side-effects, absence of well-established medical treatment strategies and "add-on"-therapy are reviewed. The problems and legal aspects of an "off-label-use" in psychiatry are discussed.

Drug Approval↗

PubMed2003

[Diabetes mellitus type II--induced by "atypical" neuroleptics?].

After the introduction of the so-called "atypical antipsychotics" in the clinical practice hyperglycemia as well as increased triglyceride and cholesterol serum levels were reported in patients treated with some of these agents. The studies and case reports available up to now were reviewed. Some epidemiologic studies show that diabetes mellitus occurs more often in patients treated with atypical antipsychotics if compared to conventional antipsychotics. The available data show that hyperglycemia and diabetes mellitus type II were particularly observed in patients receiving clozapine and olanzapine. Also diabetic ketoacidosis was most frequently reported in patients treated with these drugs. The underlying pathomechanism still remains widely unclear. There is some evidence for an important role of insulin and also leptin. Their secretion seems to be influenced by some atypical antipsychotics. Since overweight is a known risk-factor for diabetes mellitus type II, the weight inducing effect of atypical antipsychotics may also play an important role. Since diabetes mellitus type II often lead to severe diseases, the serum glucose levels should be paid more attention in the treatment with atypical neuroleptics.

Antipsychotic Agents↗

PubMed2003

[Hyperlipidemia - side-effect of "Atypical" neuroleptics?].

After the introduction of the so-called 'atypical antipsychotics' some reports concerning hyperlipidemia observed in patients treated with these drugs have been published. The studies and case reports available up to now were reviewed. The available data show that hyperlipidemia particularly occurred in patients receiving clozapine, olanzapine and also quetiapine. Predominately elevated serum levels of triglycerides have been reported. The underlying pathomechanism still remains widely unclear. Since hyperlipidemia is an important symptom of the so called 'metabolic syndrome' which is often associated with severe complications like cardial and vascular diseases, more attention should be paid to hyperlipidemia as a potential side effect of antipsychotics.

Antipsychotic Agents↗

PubMed2002

[Alcohol and stroke. Is moderate alcohol consumption protective?].

It is now increasingly recognized that mild to moderate consumption of alcohol is associated with reduced mortality and coronary heart disease. Alcohol consumption and mortality follows a J-shaped association, with increasing mortality in heavy drinkers. There is some evidence from epidemiological studies that mild to moderate alcohol consumption may also reduce the risk of ischemic stroke and overall stroke in persons over 40 years of age. However, these studies have been criticized for not adequately considering possible confounding factors. Moreover, alcohol consumption is associated with an increased risk of intracerebral and sub-arachnoid hemorrhage, and binge drinking is a strong risk factor for both ischemic and hemorrhagic stroke. Alcohol consumption probably has no beneficial effects in young subjects. On the basis of the current evidence, it is not justified to advise an otherwise healthy, mild to moderate consumer of alcoholic beverages to quit drinking. However, it seems premature to advise alcohol consumption generally for prevention of stroke.

Adult↗

PubMed2002

[Addiction in the elderly - an underestimated diagnosis in clinical practice?].

According to several studies in the USA, alcohol abuse is common among elder people, particularly among those admitted to hospital. Corresponding data for Germany are lacking as yet. In this study, the frequency of addiction problems in the elderly admitted to hospital was investigated using the data from 1990 to 1998 of the psychiatric department at the General University Hospital of Lübeck, Germany. Furthermore, the documentations of all consultations in that period were reevaluated. The psychiatric consultation service covers two general hospitals providing inpatient treatment for about 200,000 inhabitants. Diagnoses were made according to the ICD-10 criteria. In 17.7% of the males older than 64 years and in 4.2% of the elderly females admitted to the psychiatric department, alcohol dependency was diagnosed, while 5.8% of the elderly patients showed substance abuse, most often of benzodiazepine. Among the patients visited in the psychiatric consultation service, 10.8% of the elderly males and 3.2% of the elderly females were alcohol addicts and 3.9% substance abusers. The frequency of alcohol-induced neuropsychiatric complications, particularly withdrawal delirium and amnestic syndrome, increased with age. Also, benzodiazepine withdrawal delirium most frequently occurred in older patients. These results underscore that, although the prevalence rate seems to be lower than among the younger population, in the elderly population substance abuse still is a relevant medical problem, since the rate of neuropsychiatric complications increased with age.

Aged↗

PubMed2001

Acceptance of pharmacotherapy for relapse prevention by chronic alcoholics.

The willingness to take medication is a major prerequisite for compliance with biological treatment approaches in psychiatric disorders. The aim of this study was to investigate the willingness of alcoholics to improve relapse prevention using drug therapy, since there has been little information about the acceptance of such a medication as yet. 261 chronic alcoholics consecutively referred for detoxification completed a newly developed questionnaire containing items on drinking history, recent treatments, and beliefs about drug therapy for relapse prevention. In order to draw comparisons, 67 self-help group attendees and 29 alcoholics consulting an outpatient advice service were also recruited. 67.8% of the recently detoxified alcoholics were prepared to take medication for relapse prevention, if prescribed, while 60% the self-help group attendees refused drug therapy. There was no correlation between the acceptance of drug treatment and duration of dependence. Subjects willing to take a medication more often believed their alcoholism to be curable, and they reported a higher craving frequency. 55% of those willing to take a medication were willing to pay for the drugs, but in most cases, at a level lower than the equivalent of 5 beers. As drug therapy acceptance is a crucial part of compliance with, and success of medical relapse prevention, our results underscore the necessity of a thorough exploration into the health beliefs of the patient and joint development of a treatment rationale prior to prescription.

Adult↗

PubMed2001

[Medical treatment of psychiatric disorders in alcoholics].

PURPOSE: Epidemiological studies show that alcoholics have a high life-time prevalence of psychiatric illnesses, particularly of anxiety, depressive and schizophrenic disorders. But the complex relationships between elevated alcohol consumption and psychiatric symptomatology frequently Iead to problems in finding diagnosis and thereafter in planning therapeutic strategies. METHODS: In this article the results of the studies concerning the medical treatment of psychiatric comorbidity of alcoholics are critically reviewed. RESULTS: According to the available results a therapy with antidepressive drugs indicated in alcoholics with depression lasting over 14 days. Anxiety disorders seem to have little influence on the course of alcoholism. Thus, an anxiolytic medication has to be considered carefully in view of the addiction potency of tranquilizers. There is a paucity of data concerning drug treatment of schizophrenics with alcohol abuse. Thus far only a few studies have shown an effect of a drug treatment of the psychiatric comorbidity on the drinking behavior. CONCLUSION: There is a lack of studies on specific treatment strategies of psychiatric comorbid alcoholics, particularly of schizophrenics with alcohol abuse.

Alcoholism↗

PubMed2001

[Attitudes of alcoholics to addiction-related topics].

PURPOSE: In Germany the attitudes towards alcohol consumption and smoking are rather heterogeneous. Although it is well accepted that both behaviours are harmful and often lead to addiction, thus far the attitudes of alcoholics to addiction-related topics have not been evaluated. METHODS: In this investigation 228 alcoholics were asked to complete a questionnaire of addiction-related topics. RESULTS: The attitudes were rather realistic, concerning the harmful effects of alcohol. The beliefs were only slightly influenced by personal involvement (e.g. divorce). Different opinions were given as to the riskiness of illegal drugs. The attitude towards the reasons of alcoholism are most important for therapeutical decisions. Only a third of the patients believed that they themselves were responsible for their addictive behaviour while nearly half accused socioeconomical factors. The curability of their alcoholism as well as their own competence to overcome alcoholism was estimated rather realistically by the patients. The results could not be generalized since the sample mainly consisted of alcoholics who themselves sought an alcohol-specific treatment service. Furthermore the data analysis shows that about 90 % of them regarded themselves as alcoholics. CONCLUSION: Future studies have to show whether these attitudes differ from those of the general population and from alcoholics not seeking-help.

Adult↗

PubMed2001

Bodyweight gain with atypical antipsychotics. A comparative review.

The atypical antipsychotics have been shown to have superior efficacy compared with typical antipsychotics such as haloperidol, particularly in the treatment of negative symptoms of schizophrenia. Furthermore, they induce less extrapyramidal effects. However, following clinical use, marked bodyweight gain has been frequently observed with some of the atypical antipsychotic drugs. In order to examine and compare the frequency, amount and conditions of bodyweight gain during treatment with atypical antipsychotics, studies concerning bodyweight gain with these agents were identified through a MEDLINE search from 1966 to March 2000. Although comparison is limited by the different designs and recruitment procedures of the reviewed studies, the available data support the notion that the frequency as well as the amount of bodyweight gain is high in patients treated with olanzapine (average bodyweight gain 2.3 kg/month), clozapine (1.7 kg/month), quetiapine (1.8 kg/month), and possibly also zotepine (2.3 kg/month). Moderate changes in bodyweight have been observed in the treatment with risperidone (average bodyweight gain 1.0 kg/month). Ziprasidone seems to induce only slight bodyweight changes (0.8 kg/month). Bodyweight gain most frequently occurs in the first 12 weeks of treatment. Patients who were underweight at the beginning of treatment are at highest risk of gaining bodyweight. The underlying pathomechanism still remains largely unclear. The relative receptor affinities of the atypical antipsychotics for histamine H1 receptors as well as the ratio of their affinity for serotonin 5-HT2 and dopamine D2 receptors appear to be the most robust correlate of bodyweight gain. Furthermore, the induction of leptin secretion may have an important impact on bodyweight gain in patients treated with atypical antipsychotics. Although many questions concerning the pathogenesis of bodyweight gain remain unresolved, this adverse effect has to be taken into consideration when prescribing the atypical antipsychotics, particularly in view its affect on compliance during long term treatment and the long term effects of obesity on mortality and morbidity.

Antipsychotic Agents↗

PubMed2000

[Psychiatric consultation services for the elderly. Changes in utilization due to the new German legislation concerning guardianship and restructuring of health care providers].

In the discussion of increasing costs of health care in Germany, the frequent and long hospital stays of elderly patients are often pointed out. Since these patients very frequently suffer from psychiatric disorders, psychiatric consultation is often required. This study was aimed at investigating whether new German laws concerning guardianship and the structure of health care providers change conditions for psychiatric consultation services. For this purpose, the documentation of all consultations in the years 1991 to 1995 was retrospectively evaluated. In about 3% of all patients aged over 65 referred to the General University Hospital of Lübeck, psychiatric consultation was ordered. The most frequent diagnosis was senile dementia. Comparison of the requests and psychiatric recommendations show a significant increase in wishes and recommendations for guardianship. Moreover, there is evidence of the increasing need of consultation in elderly patients. Possibly due to the new law concerning the structure of health care providers and the number of requests and recommendations to transfer patients to psychiatric wards, these results show that the new laws do affect psychiatric consultation.

Aged↗

PubMed2000

Psychopathology of alcoholics during withdrawal and early abstinence.

Epidemiologic surveys show a high lifetime co-morbidity with psychiatric disorders (e.g., depression and anxiety) in alcoholics. However, alcoholics frequently complained about psychopathologic symptoms, particularly during alcohol withdrawal. There is some evidence that symptomatology decreases spontaneously with prolonged abstinence. Thus, the question arises whether high levels of psychopathology could be accounted for by withdrawal effects. This study was aimed at examining the impact of the alcohol withdrawal severity (assessed by the AWS scale) on psychopathologic symptoms. The psychopathologic profile of 110 alcoholics as measured by the Symptom Checklist-90 revised (SCL-90-R) was compared to that of 253 patients with adjustment, anxiety or depressive disorders (according to ICD-10 criteria). No relationship between the severity of alcohol withdrawal and psychopathology could be found which might hint at two different neurobiological processes underlying these phenomena. The comparison with patients suffering from depression or anxiety disorders revealed that the global symptom severity of alcoholics undergoing withdrawal was similar, but recovery was achieved more rapidly than in the other groups. On the other hand, the self-rated psychopathologic symptom profile of alcoholics was rather similar to that of patients with adjustment disorders. While about one-quarter of the alcoholics reported severe psychopathology on admission, only about 10% showed symptomatology at discharge about three weeks later, predominantly depression or anxiety. These results underline the notion that much of the psychopathology described by alcoholics decreases within 2-3 weeks after withdrawal without specific treatment.

Acute Disease↗

PubMed2000

[Weight gain from atypical neuroleptics--an underreported adverse effect?].

After the introduction of the so-called "atypical neuroleptics" in the clinical experience a marked weight gain was frequently observed in patients treated with some of these agents. In this review the frequency, amount and conditions of weight gain during the medication with 'atypical' neuroleptics were evaluated. A comparison is limited by the different designs and recruitment procedures of the reviewed studies. The available data show that the frequency as well as the amount of weight gain is particularly high in patients treated with clozapine, olanzapine, and likely also quetiapine and zotepine. Moderate changes of weight have been observed in the treatment with risperidone and probably also with amisulpride, while ziprasidone seems to induce only clinically irrelevant weight changes. Weight gain most frequently occurs in the first weeks of treatment. Underweighted patients are at highest risk to gain weight. The underlying pathomechanism still remains widely unclear. The relative receptor affinities of the atypical antipsychotics for histamine H1 as well as their quotient of 5-HT2/D2 receptor affinity appear to be a correlate of weight gain. Furthermore, the induction of leptin secretion may have an important impact on weight gain in subjects treated with atypical neuroleptics. Although many questions concerning the conditions of weight gain remain unsolved, this side-effect has to be considered in the medication with many atypical neuroleptics, particularly in view of compliance in long-term treatment and possible medical complications.

Antipsychotic Agents↗

PubMed2000

Craving shift in chronic alcoholics.

In order to investigate changes in the consumption of substances that stimulate the reward system, 222 recently detoxified alcoholics were asked about their consumptional habits before as compared to after detoxification (mixed prospective and retrospective design). Seventy-eight point two percent reported an increase in consumption of coffee, cigarettes, chocolate and other sweets, while 34.9% managed to reduce at least one of these substances. The increase was significant for coffee, chocolate and other sweets. The desire for consumption of these substances was correlated with the maximum ever experienced desire for alcohol (0.232 for coffee, 0.213 for cigarettes, 0.193 for chocolate and 0.176 for other sweets), and the actual consumption of coffee, cigarettes and sweets was correlated with the actual desire for alcohol (0.172, 0.157 and 0.245, respectively). The results lend some support to the hypothesis that psychotropic substances might serve as a kind of self-regulation against craving in this group. A possible link to biochemical theories is discussed.

Adult↗

PubMed2000

[Patient education regarding the diagnosis. Results of a survey of psychiatric patients].

PURPOSE: Physicians are obliged to inform all patients about the diagnosis and course of their illness. Often difficulties occur in informing patients with psychiatric disorders. Psychiatrists often fear complications (worsening of the symptomatology) by the disclosure of the diagnosis, which facilitate the informed consent on the treatment. Up to now only a few data concerning this topic are available. METHODS: 255 psychiatric inpatients were given a short questionnaire about their illness, its course, and the wish for being informed about their psychiatric diagnosis and the prognosis of their psychiatric disorder. RESULTS: Most patients want to get informations about their diagnosis (88.6%) and the prognosis of their psychiatric disorder (80.4%). Only 27.8% of the patients described a fear of the disclosure of diagnosis, and some more (35.3%) were afraid to hear the prognosis of their psychiatric disorder. However, this fear did not reduce their wish to become fully informed. 60% of the patients reported a satisfactory information of their diagnosis and were able to give the correct medical diagnosis. Furthermore, our results revealed that those patients not willing to be treated were informed about their diagnosis insufficiently. CONCLUSION: The informing about their diagnosis should play a more important role in the treatment of psychiatric patients.

Adolescent↗

PubMed1999

[Diagnostic and treatment strategies for depressive disorders in alcohol dependence].

Alcohol dependence is one of most common chronic diseases in Germany. Many alcoholics attribute mental disorders as causative for their elevated alcohol consumption intending to cope with these disorders. Epidemiological studies show that alcoholics have a high lifetime prevalence of psychiatric illnesses, particularly of depressive disorders. The complex relationships between elevated alcohol consumption and depressive symptoms frequently lead to problems in finding the diagnosis and thereafter in planning therapeutic strategies. The indication for drug treatment should be based on the psychopathological findings about 14 days after cessation of drinking, since in many subjects depressive symptomatology abates within the first weeks of abstinence without any treatment. Up to now no specific recommendations can be given because the results of the few published controlled studies showed some discrepancies. Summing up, thus far the efficacy of psychopharmacological drugs in treating alcoholics with depressive disorders have not been investigated sufficiently.

Alcoholism↗

PubMed1999

[Vascular depression--a new concise concept?].

Many studies pointed out that in the elderly depression is underdiagnosed, probably due to the uncharacteristic psychopathologic symptoms. Often elder people complain about somatic disorders and cognitive impairment, sometimes covering the psychopathologic symptoms and hampering diagnostic classification. Cerebrovascular disorders has been considered to be one major cause for depressive mood in the elderly. In a recent paper Alexopoulos et al. (1997) proposed the concept of vascular depression (VD) which is different from that of post-stroke depression established by the group of Robinson and Starkstein. The new concept is critically reviewed with regard of its clinical feasibility. In contrast to the ICD-10 guidelines the vascular depression concept requires no connection between the occurrence of psychopathology and of cerebrovascular disorder. Therefore it appears to be more feasible in clinical practice. However, a differentiation of vascular depression into two subtypes according to the CT/MRI findings seems to be more promising: type I (macroangiopathy) is similar to post-stroke-depression, while type II is characterized by microangiopathy and its clinical description resembles that for vascular depression of Alexopoulos et al. Up to now possible therapeutic consequences have not been investigated. Moreover, the concept of vascular depression basing only on two clinical studies needs further confirmation.

Cerebrovascular Disorders↗

PubMed1999

Weight gain: side effect of atypical neuroleptics?

During clinical experience with the "atypical" neuroleptic drugs clozapine, risperidone, and zotepine, some patients have shown a marked weight gain. To prove whether weight gain is a relevant side effect of atypical neuroleptics, the charts of all patients admitted with DSM-III-R diagnoses of schizophrenia, schizoaffective disorder, or delusional disorder in the years 1991 to 1995 were evaluated. A retrospective chart review was performed, which included all patients who were treated longer than 2 weeks with a single neuroleptic. The data analysis showed that weight gain must be considered as a common side effect of atypical neuroleptics (clozapine, risperidone, sulpiride, or zotepine). The mean weight gain (3.1, 1.5, 1.9, or 4.3 kg, respectively) was significantly higher than that of patients treated with "classic" neuroleptics (mean, 0.0-0.5 kg) (Kruskal-Wallis, p = 0.01). Young and not obese patients show the highest weight increase. Because weight gain occurs in the first weeks of treatment, particularly in previously untreated subjects, this side effect has to be considered in view of compliance with long-term neuroleptic medication.

Adolescent↗