Biomedical subjects

Tilman Wetterling

Publications and source records attributed to Tilman Wetterling.

17 recordsLinked to original sources

PubMed2006

[Blood glucose in chronic schizophrenic patients treated with antipsychotics].

OBJECTIVE: There is some evidence that the treatment with new ("atypical") antipsychotics is associated with a higher frequency of type 2-diabetes mellitus. AIM: In this study the blood glucose levels of consecutively admitted inpatients with chronic schizophrenia were investigated. METHODS: The base blood glucose levels of 177 consecutively admitted chronic schizophrenic patients were evaluated. RESULTS: After long-term treatment (mean duration: 17.8 +/- 8.7 years [range 5 - 44 years]) 24.3 % of the investigated patients showed elevated base blood glucose levels (> or = 126 mg/dl). The proportion of patients with elevated blood glucose levels among the schizophrenic patients treated with antipsychotics was significantly higher than the proportion of diabetics in the corresponding age groups in the general population. The comparison of different groups of antipsychotics revealed that those patients treated with conventional neuroleptics and non-dibenzodiazepine derivates (i. e. risperidone) had a lower risk of developing diabetes mellitus than those also receiving dibenzodiazepine derivates (like clozapine, olanzapine). CONCLUSION: Our data showed that schizophrenic patients treated with antipsychotics 5 years or longer had elevated blood glucose levels more frequently than the general population.

Adult↗

PubMed2006

[Dyslipidemia and schizophrenia].

OBJECTIVE: There is some evidence that the treatment with new ("atypical") neuroleptics is associated with a higher frequency of hyperlipidemia. AIM: In this study the serum lipid levels of patients with chronic schizophrenia were investigated. METHODS: The serum lipid levels of 177 consecutively admitted schizophrenic patients treated at least 5 years were evaluated. RESULTS: No gender differences of lipid concentrations could be detected. A considerable rate of the patients (35.6 %) showed elevated triglycerides (> 150 mg/dl) or elevated cholesterol levels (> 200 mg/dl; 43.9 %). The rate of patients with elevated cholesterol or triglyceride concentrations is associated with the duration of treatment. The comparison of different groups of neuroleptics yielded at best a trend to higher triglyceride levels in the patients treated with dibenzodiazepines compared to those receiving only classical neuroleptics. The triglyceride concentrations correlated with the body mass index (rho = 0.25, p < 0.01). CONCLUSIONS: This study revealed evidence for an association of the rate of patients with elevated lipid levels and duration of neuroleptic treatment in schizophrenia patients.

Adult↗

PubMed2006

Development of a rating scale to predict the severity of alcohol withdrawal syndrome.

AIM: Various factors that may influence the severity of the alcohol withdrawal syndrome (AWS) have been identified. We tested the predictive value of these factors compiled in a newly developed scale, LARS (Luebeck alcohol withdrawal risk scale). METHOD: A total of 100 individuals (81 males, 19 females, mean age: 47.6 +/- 9.9 years) consecutively transferred to inpatient detoxification were included in this prospective study. All fulfilled the ICD-10 criteria for alcohol dependence. The LARS was applied at the time of admission. The course of the AWS was assessed by AWS-scale at least every 4 h. The maximum AWS-score was taken as indicator of the severity of AWS. RESULTS: The mean AWS-score(max) was 6.5 +/- 3.3. In all 20% of the patients developed a severe AWS (AWS-score(max) > or =10). The maximum score usually occurred within 36 h after the last drink. A short version, the LARS11, was developed by statistically grounded item reduction. The optimal cut-off of the LARS11 was calculated as 10. The positive predictive value for severe AWS was 76%, while the negative predictive value was 98.7%. The sensitivity and specificity were high (95 or 92.5%, respectively). CONCLUSION: LARS11 assessed immediately before detoxification appears to provide a useful estimate of mild/moderate versus severe AWS, and is now ready to be validated in an independent sample.

Alcoholism↗

PubMed2006

[Risk factors for suicide in substance-related disorders].

OBJECTIVE: To assess the contribution of sociodemographic and psychopathologic predictors for suicide in alcohol-related disorders and in substance-related disorders in general and to examine the constellations of risk factors for suicide. METHODS: Out of 163 suicides (using psychological autopsy method) and 396 population-based control persons, 67 suicides and 67 controls with substance-related disorders (DSM-IV; alcohol-related disorders: suicides: n = 36, controls: n = 27) were assessed. RESULTS: Affective disorders, suffering from substance dependence, and low education independently predicted increased suicide risk in alcohol-related disorders as well as in substance-related disorders in general, severe nicotine consumption only in alcohol-related disorders. CONCLUSIONS: There are common risk factors for suicide in alcoholism and substance-related disorders in general. Effective suicide prevention strategies must include a focus on substance dependence as well as on affective disorders.

Adult↗

PubMed2005

Axis I disorders and personality disorders as risk factors for suicide.

There is a lack of psychological autopsy studies assessing the influence of axis I disorders on axis II disorders as risk factors for suicide. Therefore, we investigated the association between personality disorders, axis I disorders, and suicide. Psychiatric disorders were evaluated by a semi-structured interview including the Structured Clinical Interview for DSM-IV Axis I (SCID-I) and Personality Disorders (SCID-II) in 163 completed suicides (mean age 49.6 +/- 19.3 years; 64.4% men) and by personal interview in 396 population-based control persons (mean age 51.6 +/- 17.0 years; 55.8% men). In both genders, suicides significantly more often had personality disorders of all clusters than controls, also after adjustment for axis I disorders (p < 0.001, each). In addition, alcohol-related disorders, major depression, and co-occurrence of personality disorders of more than one cluster (men: OR = 16.13; women: OR = 20.43) remained independent predictors for suicide in both genders, "pure" cluster B personality disorders only in women and "pure" cluster C personality disorders only in men. In both genders, co-occurrence of personality disorders of more than one cluster contributed to risk of completed suicide after control for axis I psychiatric disorders and has to be considered as an independent risk factor for suicide.

Adult↗

PubMed2005

Proposal of a comprehensive clinical typology of alcohol withdrawal--a cluster analysis approach.

AIMS: To characterize the various courses of alcohol withdrawal. METHODS: The Alcohol Withdrawal Scale (AWS) was applied to 217 alcohol-dependent patients every 4 h till the symptoms of withdrawal had passed (until each of four consecutive scores were <3). Patients were medicated by a standardized treatment scheme according to AWS-scores. Hierarchical cluster analysis and discriminant analysis were applied. RESULTS: We found five clusters representing increasing severity of alcohol withdrawal. Each cluster is characterized by a combination of the two maximum subscores (vegetative and psychopathological subscore) and three additional psychopathological symptoms (anxiety, disorientation, and hallucination). In 18.4% of the patients, relevant symptoms were not observed (cluster 1), 18.9% developed mild or moderate vegetative symptoms only (cluster 2), and 40.6% additional anxiety (cluster 3). In cluster 4 (11.1%) the most frequent psychopathological symptoms were disorientation and anxiety but no hallucinations, which could be observed only in cluster 5 (11.1%). Discriminant analysis using the maximum subscores at the first day of treatment as independent variables correctly predicted 89.9% of the five clusters. CONCLUSIONS: Our findings support a model of alcohol withdrawal clustering along the two dimensions of vegetative and psychopathological severity. Furthermore, the AWS may be useful to predict the course of alcohol withdrawal already at the first day of treatment.

Adult↗

PubMed2005

Nicotine use in suicides: a case-control study.

PURPOSE: Despite of higher rates of substance-related disorders in psychiatric patients and suicides than in the general population, there is no clear specificity to the relationship between nicotine use and other psychiatric disorders for suicide risk. METHODS: One hundred and sixty-three suicides (mean age 49.8 +/- 19.3 years; 64.4% males; using psychological autopsy method) and 396 control persons (mean age 51.6 +/- 17.0 years; 55.8% males) were assessed with a standardised semi-structured interview including SCID-I and SCID-II (for DSM-IV). Suicides and controls were compared in terms of nicotine consumption and psychiatric disorders. Logistic regression was used to evaluate the interactions of tobacco consumption with psychiatric disorders. RESULTS: Suicides were significantly more often current smokers and heavy users of cigarettes (> 20 cigarettes per day; P < 0.001, each). Alcohol dependence, other axis I disorders than substance-related disorders, and cluster B personality disorder(s) remained independent predictors for suicide in both genders, current nicotine consumption only in men (OR = 2.6, 95% CI 1.3-5.2). DISCUSSION AND CONCLUSIONS: In males, but not in females, nicotine consumption contributed to risk of completed suicide after control for psychiatric disorders and has to be considered as independent risk factor for suicide.

Autopsy↗

PubMed2005

The consumption of cigarettes, coffee and sweets in detoxified alcoholics and its association with relapse and a family history of alcoholism.

Thirty male alcohol dependent inpatients without concurrent depressive disorder, 13 of them with a positive family history of alcohol dependence in a first degree relative (PFH), were questioned about their desire and consumption habits with respect to cigarettes, coffee, and sweets while on a three-week inpatient treatment after detoxification from alcohol. Six weeks after discharge from hospital, the patients were reassessed for relapse. Eleven patients (36.6%) had relapsed at follow-up. Relapsers were younger than abstainers. The days until relapse correlated negatively with intensity of desire to drink alcohol, desire to smoke cigarettes, and with a higher consumption of cigarettes. PFH patients did not relapse earlier but they had a stronger desire to drink coffee and eat sweets and had a higher coffee consumption.

Adult↗

PubMed2004

Detection of alcohol consumption in suicides.

Screening instruments for detection of alcohol consumption, abuse, and dependence for use in psychological autopsy studies with case control design are not validated. Therefore, interrater and test-retest reliability of the Luebeck Alcohol Dependence and Abuse Screening Test (LAST) and the usability of this test for the psychological autopsy method were investigated. Alcohol consumption was evaluated by a semi-structured interview including the Structured Clinical Interview for DSM-IV Axis I (SCID-I) and the LAST in 163 completed suicides (mean age 49.6 +/- 19.3 years; 64.4% men) and by personal interview in 396 population-based controls (mean age 51.6 +/- 17.0 years; 55.8% men). Of the controls, 35 were additionally assessed by interviewing informants; these results were compared with those generated by personal interview. Comparison of LAST scores by personal and informant's interview of controls generated a Spearman correlation coefficient of 0.74 (P < 0.0001). The LAST (7 item-version, cut-off of 2) revealed high sensitivity and specificity for alcohol abuse and dependence, in both controls and suicides. LAST scores were significantly associated with high, frequent, and hazardous alcohol consumption (P < 0.001) in suicides. Our findings provide support for reliability and validity of identifying individuals with alcohol dependence and abuse obtained through the best-estimate method using the LAST. This 7-item questionnaire can be recommended as a useful tool for the psychological autopsy procedure in postmortem research.

Adult↗

PubMed2004

Affective disorders in older inpatients.

BACKGROUND: After dementia the group of depressive disorders is considered to be the second most common psychiatric disorder in the elderly. There is dispute regarding whether depression in the elderly differs from depression in the younger age groups by a longer duration of inpatient treatment, a more frequent occurrence of delusions, more cognitive impairment or by a more frequent co-occurrence of physical disease. This study aimed to compare younger with older inpatients with respect to these aspects. METHODS: Retrospective chart review of all admissions to the psychiatric department of a General University Hospital (n=9400) and review of the documentation of 15 348 psychiatric consultations in the years 1990-1998. The clinical diagnoses were made according to the ICD-10 criteria. RESULTS: 15.5% of the psychiatric inpatients in this period suffered from depressive episodes (ICD-10 F31.3-31.5,32,33). The proportion of depressive episodes increased with age, making up 5.4% in the age group below 30 years and 37.4% in the age group of 70-79 years. On the basis of the ICD-10 criteria for the severity of depressive episodes no significant differences could be demonstrated between the younger (< 65 years) and the older inpatients (>/= 65 years). In particular, no higher frequency of psychotic symptoms with increasing age could be found. The length of inpatient treatment did not significantly differ between both age groups. The elder patients showed less suicidal attempts prior to admission and less psychiatric comorbidity, but a significantly higher rate of concurrent physical illness. In 923 inpatients a psychiatrist was consulted by the other medical departments because of a co-occurrence of physical with affective disorders, making up 8.6% of the total seen by the psychiatric consultation service. Here again, the proportion of depressive episodes increased with age. The pattern of the depressive episodes in these patients did not differ from that seen in the psychiatric inpatients. LIMITATIONS: Only clinical diagnoses made by experienced psychiatrists were evaluated. CONCLUSIONS: According to our results older depressive inpatients differ from younger ones only with regard to concurrent comorbidity but not with respect to the duration of inpatient treatment or the pattern or severity of depressive symptoms. They more frequently suffered from physical illness but less often showed concurrent psychiatric comorbidity.

Age Distribution↗

PubMed2004

[Bodyweight in inpatients with schizophrenia].

OBJECTIVE: Epidemiological studies show overweight to be a major health problem in Germany. There is some evidence that psychiatric patients often are overweight. In view of the high frequency of weight gain during the treatment with neuroleptics, particularly atypicals, in this study the bodyweight of schizophrenics should be examined. METHODS: The body-mass-index (BMI) of two samples of schizophrenic inpatients was compared to BMI-data of the German general population. RESULTS: 90 inpatients with the first episode of schizophrenic psychoses showed an average BMI of 22.2 +/- 3.3. The BMI in all age groups were lower compared to the general population, but in a follow-up these patients showed a higher weight gain. 238 chronic schizophrenic inpatients with at least 5 years duration of illness (mean 15.3 +/- 8.3 years) showed BMI-values in the range of the general population. Only the age group 30 - 35 years showed a significantly higher BMI. However, in many age groups of schizophrenic inpatients the proportion of obesity (BMI > 30) was higher compared to the general population. CONCLUSIONS: The bodyweight of first episode schizophrenics is lower compared to the general population. In contrast, chronic schizophrenic patients frequently are overweight or show obesity. However, thus far the causes of pronounced weight gain in schizophrenic patients remain to be elucidated.

Adolescent↗

PubMed2003

Late onset alcoholism.

Rather high prevalence rates of alcohol abuse in the elderly have been reported in the literature. However, there is some evidence that many elderly persons with alcohol problems are not identified, probably due to the nonspecificity of alcohol-related presentations in old individuals. Thus, there is an ongoing discussion on appropriate diagnostic criteria for alcohol dependence in elder people who frequently begin to abuse alcohol in late life. This study was aimed to explore whether alcoholics with late onset (beginning after the age of 45) differ from those with an early onset (prior the age of 25). Two hundred and sixty eight subjects consecutively referred to a ward of a general hospital specialized for alcohol detoxification were divided into three groups by the age at onset of harmful alcohol consumption. The duration of harmful drinking was rather similar in all groups. However, alcohol dependence according to the ICD-10 criteria (three or more have to be fulfilled) was diagnosed in 94.1% of the alcoholics with an early onset (</= 25 years), but only in 62.2% of those with late onset (P < 0.0001). Significant differences between these groups were found for the following criteria: preoccupation with drinking (P < 0.0001), impaired capacity to control drinking (P < 0.01), strong desire to drink alcohol (P < 0.01), and a trend towards a lower rate of lifetime psychiatric comorbidity. The alcoholics with late onset reported fewer previous detoxifications and a lower actual alcohol consumption. Moreover, they showed a higher rate of abstinence in the 12 month follow-up. Regarding the difficulties in comparing groups of different ages at onset of harmful alcohol use our results suggest that the alcoholics with late onset differ in many ways from those with early onset.

Adult↗

PubMed2002

[Informing psychiatric patients about medication - results of a query].

PURPOSE: Physicians are obliged to inform all patients about the purpose and risks of therapeutic procedures, also drug treatment. However, although there may be some severe difficulties in informing psychiatric patients only very few data concerning this topic are available as yet. Thus, the aim of this query was to evaluate the patients' opinion of the information about medication. METHODS: In this investigation 255 psychiatric inpatients were asked to complete a questionnaire. RESULTS: 42 % of the patients complained about no or insufficient information of the expected effects of the prescribed medication and 62 % about no or insufficient information of side-effects. An association was found between the willingness to take the medication for a long time and insight in their psychic condition, but not with satisfying informing. CONCLUSION: This query showed the need of a more precise and satisfying information on medication and the need to develop strategies for a better information about side-effects.

Adult↗

PubMed2002

[Gerontopsychiatric consultation service].

In the discussion of the increasing costs of health care in Germany the frequent and often times long inpatient treatments of elderly patients are pointed out. Since these patients also suffer from psychiatric disorders very frequently, a psychiatric consultation is required rather often. This study was aimed to evaluate the requirements of a consultation service for elder inpatients. For this purpose all 9363 consultation reports from 1994 to 1998 were evaluated retrospectively. 2152 (31.4 %) of the patients visited by the psychiatric consultation service were over 64 years old. The most frequent diagnoses were organic brain syndrome (ICD-10: F0), particularly senile dementia (ICD-10: F00 - 03), adjustment disorder (ICD-10: F43) and affective disorders, particularly depressive disorders (ICD-10: F3). In 139 patients (6,5 %) a consultation was requested because of a suicidal attempt prior to admission. Our results suggest that in a gerontopsychiatric consultation service predominantly old patients with internal diseases and with the need of psychosocial help are visited and that the specific knowledge of psychopharmacological treatment in multimorbid patients as well as the psychosocial help and legal advice is requested. These aspects should therefore be a special focus in educational programs for a gerontopsychiatric consultation service.

Adjustment Disorders↗

PubMed2002

[Hyperlipidemia--side-effect of the treatment with an atypical antipsychotic (zotepine)?].

In the last few years some studies and case reports has been published that suggest a frequent occurrence of metabolic disorders like hyperglycemia and hyperlipidemia during the treatment with atypical antipsychotics. However, regarding the high prevalence rates of these disorders in the general population, a possible causative relationship should be substantiated, i.e. occurrence of elevated blood levels within a short time interval after the starting of the medication. In the presented case a hyperlipidemia (triglycerides up to 1247 mg/dl) was observed soon after the beginning of zotepine medication. After the reduction of zotepine lipid levels in serum decreased and normalised after switching to classical antipsychotics. Therefore a causative relationship between the occurrence of the hyperlipidemia and the zotepine medication is very likely.

Adult↗

PubMed2002

Lack of efficacy of naltrexone in the prevention of alcohol relapse: results from a German multicenter study.

In a placebo-controlled, double-blind German multicenter study (seven sites) the efficacy of naltrexone as an adjunctive treatment in alcoholism to maintain abstinence was assessed for 12 weeks. A total of 171 detoxified patients (97.7% met the DSM-III-R criteria for alcohol dependence) were included. Patients had been abstinent for a mean of 19.5 +/- 9.4 days at study entry. Eighty-four and 87 patients were randomized to receive naltrexone (50 mg/day) and placebo, respectively. Each site was instructed to provide its usual psychosocial alcohol treatment program. The primary effectiveness measure was the time to first heavy drinking as derived from self-reports of drinking (timeline-follow-back method). Secondary effectiveness measures included time to first drink, amount of alcohol consumption, intensity of craving, severity of alcoholism problems, and liver enzymes. Thirty-three (38%) placebo patients and 28 (33%) naltrexone patients discontinued the study. At endpoint, 62% of the patients in each group did not have an episode of heavy drinking. Also, there were no significant differences between the study groups concerning secondary effectiveness measures as well as compliance and adverse clinical events--with the exception of the gamma-GT, which was significantly greater reduced in the naltrexone group throughout the study. Based upon an intention-to-treat population, this study confirms the safety but not the efficacy of naltrexone in prevention of alcohol relapse. Nevertheless, the question arises whether self-reports of drinking are more reliable than gamma-GT as a measure of recent alcohol consumption.

Adult↗

PubMedDate not supplied

Mildly disturbed hepatic and pancreatic function during early abstention from alcohol is associated with brain atrophy and with disturbed psychometric performance.

AIMS: To investigate the relation of liver status and pancreatic function to disorders of the central nervous system during early abstention from alcohol. METHODS: Sixty-seven alcohol-dependent patients (47 male) with a mean age of 42.3 +/- 12.5 years, were assessed by clinical history, abdominal sonography, computerized tomography of the brain and with neuropsychological and serum enzyme tests. Patients with sonographically diagnosed cirrhosis were excluded. RESULTS: Patients with fatty liver had more previous complicated detoxifications, but not more current signs of brain atrophy or impairment on neuropsychological tests. However, elevations in alpha amylase (AA), and gamma glutamyl transpeptidase (GGT) were associated with signs of cerebral atrophy. Higher serum GGT was related to impaired score on a number sequencing task (NST), and high AA with impairment on NST and on two tests of speed and perception. GGT and AA levels tended to be higher in older subjects. CONCLUSIONS: After detoxification from alcohol even mildly disturbed liver and pancreatic parameters, but not fatty liver itself, are associated with signs of brain atrophy and impaired psychometric performance. Age may be a confounding or contributing factor.

Adult↗