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Biomedical subjects

Ulrich Hegerl

Publications and source records attributed to Ulrich Hegerl.

At least 55 records · Page 3Linked to original sources
PubMed2003

Serotonergic dysfunction in schizophrenia assessed by the loudness dependence measure of primary auditory cortex evoked activity.

Increased serotonergic activity is discussed as an important pathogenetic factor in schizophrenia. Further support for this hypothesis is difficult to obtain due to the lack of valid indicators of the brain's serotonin system. A great deal of evidence discovered through human and animal studies suggests that a weak loudness dependence of auditory evoked potentials (LDAEP) indicates high serotonergic activity and vice versa. The LDAEP is a measure of auditory cortex activity, reflecting increase or decrease of auditory evoked potential amplitudes with increasing tone loudness, which is probably modulated by the serotonergic innervation there. This is true only for the LDAEP of the primary auditory cortex, since this region is more highly innervated by serotonergic fibers than the secondary auditory cortex. The LDAEP (N1/P2 component) of 25 inpatients with schizophrenia free of medication and 25 healthy controls matched by age and gender, were recorded. Using dipole source analysis, the LDAEP of primary (tangential dipole) and this of secondary auditory cortex (radial dipole) was separately analyzed. Following a 4-week treatment with the 5-HT(2) antagonists clozapine or olanzapine, patients were once again studied. The LDAEP of the primary, but not of the secondary auditory cortex, was significantly weaker in the patients with schizophrenia than in healthy volunteers, indicating enhanced serotonergic neurotransmission. After treatment with the 5-HT(2) antagonists, the LDAEP (of the right hemisphere) tended to be increased, indicating normalization of serotonergic function in the patients with schizophrenia. These results suggest that the loudness dependence of primary auditory cortex evoked activity is well suitable to assess serotonergic dysfunction in schizophrenia.

Adult↗
PubMed2003

Effects of sertraline on kinematic aspects of hand movements in patients with obsessive-compulsive disorder.

RATIONALE: Movement disorders such as disturbances of fine motor co-ordination are a frequent phenomenon in patients with obsessive-compulsive disorder (OCD). OBJECTIVES: Our aim was to investigate changes of hand-motor dysfunction in OCD patients under the influence of 10-week treatment with sertraline and behaviour therapy. METHODS: We examined the performance of 40 patients satisfying DSM-IV criteria for OCD before and under this therapy using a digitising tablet and kinematic analysis of handwriting and drawing movements. Forty healthy controls were also tested (test-retest interval: 10 weeks). RESULTS: The speed of drawing was significantly lower in OCD patients than in controls (mean+/-standard deviation=197.03+/-113.26 mm/s for patients and 182.48+/-189.61 mm/s for controls; P=0.01). After 10 weeks of therapy, this parameter normalised in patients (from 197.03+/-113.26 mm/s to 163.66+/-101.92 mm/s; P=0.001). CONCLUSIONS: Hand-motor dysfunction (especially bradykinesia) improves with a serotonin-enhancing therapy in OCD patients.

Adult↗
PubMed2003

EEG abnormalities associated with antipsychotics: a comparison of quetiapine, olanzapine, haloperidol and healthy subjects.

In this study the effects of the atypical antipsychotics quetiapine and olanzapine, and the typical antipsychotic haloperidol on EEG patterns were retrospectively investigated in 81 patients under stable monotherapy with either drug (quetiapine: n=22, olanzapine: n=37, haloperidol: n=22). These three subgroups were compared with a control group of healthy subjects (n=30) which were matched regarding sex and age. Diagnoses of patients were schizophrenia (DSM-IV 295.xx, n=61), brief psychotic disorder (DSM-IV 298.8, n=9), schizoaffective disorder (DSM-IV 295.70, n=8) and delusional disorder (DSM-IV 297.1, n=3). There were no statistically significant differences regarding demographic characteristics between the groups. Digital EEG recordings were retrieved from a database and visually assessed by two independent investigators, and one blinded regarding medication. One patient from the quetiapine group (5%), 13 olanzapine patients (35%), five of the haloperidol patients (23%) and two subjects of the control group (7%) had an abnormal EEG. Epileptiform activity was observed in four patients (11%) of the olanzapine group, and none in the others. EEG abnormalities were statistically significantly increased with dose in the olanzapine group, in contrast to patients treated with haloperidol, quetiapine or healthy subjects. In conclusion, EEG abnormalities seem to occur rarely in patients treated with quetiapine comparable to the control group, but significantly more often with haloperidol and olanzapine, possibly due to different receptor profiles of these substances. To our knowledge, this is the first electrophysiological investigation comparing the new atypical antipsychotics quetiapine, haloperidol, olanzapine with healthy subjects.

Adolescent↗
PubMed2003

The evaluation of suicide prevention activities: state of the art.

One million people commit suicide world-wide every year. The need for suicide prevention is obvious, and very different approaches have been investigated to reduce the number of suicides. Some interventions aim at identified high-risk groups (e.g. support for people after suicide attempt), some at the population as a whole (e.g. restricting the access to means for suicide). There is, however, but little evidence for the efficacy of suicide prevention activities. This can mostly be attributed to methodological problems such as the lack of randomised controlled studies and the fact that the sample size is too small to show an effect. Despite these problems, some interventions showed promising results (e.g. long-term lithium treatment). A main problem, however, is that many people at risk do not get in contact with health care institutions. Moreover, no single approach by itself seems to contribute to a substantial decline in the suicide rate. The authors therefore argue that a combination of different strategies in a multi-level approach might prove to be the most effective.

Crisis Intervention↗
PubMed2003

[Clinical practice guidelines for the diagnosis and therapy of depressive disorders in primary care].

The guidelines for diagnosis and treatment of depressive disorders are practice-oriented and evidence-based recommendations for primary care of depressive patients. They were developed in the context of subproject 3.1 "Comprehensive Quality Management in Outpatient Care" within the German Research Network on Depression and Suicidality. The guidelines were developed by research groups from study centres in Freiburg, Duesseldorf and Munich and an external expert group. In addition, a close co-operation was established with the Guideline Clearing Commission of the Agency for Quality in Medicine (AQuMed) and the Drug Commission of the German Medical Profession (AkdA) and are intended as an orientational aid in terms of a "pathway of care". The guidelines particularly address physicians in primary care. The development process followed the methodological recommendations of the Association of the Scientific Medical Societies in Germany (AWMF) and the requirements of evidence-based medicine. National and international guidelines for depressive disorders as well as Cochrane reviews (CR) and quality-assessed reviews (CRD) were taken into account. The present formulation of the treatment guidelines and the evidence was agreed upon in a consensus process that included all participants.

Depressive Disorder↗
PubMed2003

[Agreement in physicians' and patients' assessment of depressive disorders].

Depression is one of the most frequently encountered mental health disorders in primary care. The health and financial burden caused by this disorder emphasise the clinical importance of depressive disorders. Research shows that these conditions often remain unrecognised and untreated. The aim of this study is to analyse if and how primary care physicians identify this condition in comparison to the patients' self-evaluation. A total of 1,233 cases in 32 primary care physicians' offices were examined to see if symptoms of depression were recognised. The assessment procedures were evaluated, too. In this study, the prevalence of depressive disorders was 10%, and the recognition rate of primary care physicians 45%. These results underscore the importance of improving physicians' recognition of depression and use of ICD-10 criteria for differential diagnosis. Conclusions must be drawn for a specific training of primary care physicians that focuses on the improvement of diagnosis and treatment of depressed patients.

Depressive Disorder↗
PubMed2003

[Subjectively-perceived inappropriate treatment of depressed patients in general and psychiatric practice].

In the present study, process quality in outpatient depression care was documented by general practitioners and specialists in psychiatry. Opportunities to improve inpatient treatment were identified by comparing current physicians' treatment procedures with guideline recommendations and, furthermore, by evaluating treatment outcomes from the patients' perspective. Data of 350 depressed outpatients were collected by 43 GPs and 23 specialists in psychiatry in three study regions (Rhineland, South Baden and Munich). Data reflected psychopathology, diagnostic assessment, investigation of suicidal intentions as well as somatic and psychotherapeutic measures at the first visit. Additionally, change in depression symptoms after six to eight weeks by means of self-rating (n = 165) and expert rating (n = 70) was measured. The study shows that the GPs and, to a lesser extent, the specialists, still fail to orient themselves towards guideline recommendations regarding assessment, therapy and referral in depression care. These findings seem to be reflected in insufficient self rated treatment outcome: one half of the patients reported a reduction in depression symptoms, the other half of patients reported stagnation or even progression. Expert ratings of treatment courses were more positive. The results indicate a considerable need for guideline training and improvement of networking and co-operation between GPs and specialists as well as between inpatient and outpatient settings.

Depressive Disorder↗
PubMed2002

Handedness and corpus callosum morphology.

Investigations of a relationship between callosal size and functional behavioral lateralization lead to the hypothesis that, as the size of the corpus callosum (CC) increases, interhemispheric information transfer is facilitated and behavioral laterality effects become smaller. The aim of our in vivo study was to investigate the relationship between functional asymmetry of handedness and CC size in healthy subjects. Magnetic resonance images of the CC and five CC subregions were obtained with a 1.5-T Magnetom using a three-dimensional T1 sequence in 46 healthy men. Handedness was determined using the 'handedness dominance test' (HDT). According to the HDT values, 32 consistent and 14 non-consistent right-handers were identified. No significant difference between handedness subgroups in CC regions and no significant correlations between HDT values and CC areas were detected.

Adolescent↗
PubMed2002

Investigation of a possible diencephalic pathology in schizophrenia.

Absence of the adhesio interthalamica (AI) in schizophrenic first episode patients is suggestive for another marker of early developmental neuropathologic changes. Moreover, findings suggest that schizophrenic patients without AI are characterised by more severe negative symptoms. The study aims to investigate the presence vs. absence of AI in relation to brain measurements and clinical features. Presence or absence of AI and volumetric brain measurements were assessed in 50 patients with schizophrenia and 50 matched controls. No differences in the incidence of AI were found between the groups. Patients without AI revealed a strong trend towards a larger third ventricle and significantly higher scores for negative symptoms. Interestingly, the subgroup of healthy controls without AI also had larger third ventricles. The absence of AI may represent another early developmental marker of cerebral malformation in a clinical subgroup of schizophrenic patients.

Adolescent↗
PubMed2002

Allelic variants of the functional promoter polymorphism of the human serotonin transporter gene is associated with auditory cortical stimulus processing.

The loudness dependence (LD) of the auditory-evoked N1/P2 component has been shown to be related to the central serotonergic neurotransmission. Allelic variants in the promoter region of the 5-hydroxytryptamine transporter (5-HTT) gene were shown to modulate serotonergic activity. It was hypothesized that the three genotypes (l/l, s/l, s/s) differ with respect to LD. Allelic variants of the 5-HTT promoter region and LD at the Cz electrode were determined in 185 healthy subjects prospectively. A significant association was found between LD and genotype (ANOVA: F=4.172, p=0.017). Individuals homozygous for the l allele exhibited a weaker LD compared to heterozygous subjects. The results are consistent with the reported association between 5-HTT genotype and serotonin transport capacity in lymphoblasts, and indicate that auditory stimulus processing is associated with genetic variants of the brain serotonergic system. The LD may serve as endophenotype in human serotonin research.

Adult↗
PubMed2002

P300 subcomponents and clinical symptoms in schizophrenia.

A small P300 component of the auditory event-related potential has been found to predict poor clinical outcome with a higher amount of thought disorders in schizophrenia and has been proposed as a marker for an underlying neurodevelopmental disorder with prominent thought disorders, early age of onset, prominent negative symptoms and positive family history. The present study was designed to confirm our previous findings with subcomponent analysis. Using dipole source analysis a temporo-basal (TB) P300 as well as a temporo-superior (TS) P300 and LP potential were separated. Fifty patients with schizophrenia (DSM-IV) were included in the study. Late auditory event-related P300 potentials were recorded to infrequent auditory stimuli after treatment psychopathology and family history were assessed. The TB-P300 amplitudes were significantly negatively correlated with thought disorders remaining after treatment and were positively correlated with age of onset. Illness duration was significantly correlated to TB-P300 and TS-P300 amplitudes in the group of patients with late onset. No significant correlations were found with negative symptoms. Family history did not show significant effects on P300. A smaller P300 in patients with more thought disorder remaining after stabilization on medication and an earlier age of onset support the hypothesis that P300 characterizes schizophrenic patients with an underlying neurodevelopmental disorder with specific clinical symptom clusters. On the other hand, diminished P300 with illness duration in the group of patients with later age of onset supports an underlying neurodegenerative progressive process in this subgroup of patients.

Adolescent↗
PubMed2002

Identification of a naturally occurring polymorphism in the promoter region of the norepinephrine transporter and analysis in major depression.

Disturbances in the noradrenergic neurotransmission system have been implicated in the etiology of mood disorders. The norepinephrine transporter (NET) is a main target of antidepressant action and was shown to be dysregulated in major depression. Despite the clinical and physiological significance of NET gene regulation, little is known about the transcriptional control mechanisms governing its expression. Since it is well established that affective disorders have a genetic component with many genes of small effect contributing to the genetic susceptibility of depression, the NET gene is an interesting candidate gene for affective disorders. In a search for polymorphisms or mutations in the 5' flanging region of the NET gene we sequenced approximately 1000 bp upstream of the first codon in the NET gene promoter in 100 patients with major depression and 100 healthy controls. We identified a so far unknown T --> C polymorphism 182 bp upstream of the start codon in a transcriptional relevant region. In a case control association study we investigated the newly identified T-182C polymorphism and an already known G1287A polymorphism in exon 9 of the NET gene in a sample of 193 patients with major depression and 136 healthy, non-related controls. No statistical significant differences between patients and controls were found for any of the analyzed polymorphisms, either in the genotype distribution or in the allele frequencies. Our results suggest that the investigated polymorphisms are not major susceptibility factors in the etiology of major depression.

Adult↗
PubMed2002

Value of event-related P300 subcomponents in the clinical diagnosis of mild cognitive impairment and Alzheimer's Disease.

Accurate and early diagnosis of Alzheimer's Disease (AD) with reliable and noninvasive methods is of great importance for clinical practice as effective and specific antidementive therapies become available. The aim of the study was to evaluate the clinical relevance of event-related P300 in the early diagnosis of AD. Thirty patients with AD, 26 patients with mild cognitive impairment (MCI) from our Memory Clinic and 26 age-matched healthy controls (HC) were studied with event-related P300 potentials. Amplitudes of temporo-basal dipoles (TB-P300) were significantly diminished in AD compared to HC and MCI. Furthermore, latencies of temporo-superior dipoles (TS-P300) were significantly prolonged in AD compared with HC. Sensitivity was 90.0% for the differentiation of patients with AD from HC (specificity 79.1%) using reduced TB-P300 amplitudes and prolonged TS-P300 latencies. Similar results were found using Pz amplitudes as well as Fz latencies. Our data suggest that TB-P300 amplitudes and TS-P300 latencies may be an accurate clinically available, nonexpensive, noninvasive, and reliable marker for AD.

Aged↗
PubMed2002

Screening for depression in adult acne vulgaris patients: tools for the dermatologist.

BACKGROUND: Adult dermatological out patients have a 40% prevalence of psychiatric co-morbidity. If psychiatric co-morbidity is unrecognized, undetected and untreated, the consequences may be fatal. Acne is the most common skin disorder of the second and third decades of life. Acne and its treatments may cause depression. AIMS: To identify a screening tool to identify depression in adult acne patients. METHODS: The literature was reviewed to identify validated screening instruments for depressive disorders. Questionnaires studied included the Hospital Anxiety and Depression Scale (HAD), the Brief Patient Health Questionnaire (B-PHQ), the General Health Questionnaire-12 item version (GHQ-12), and the World Health Organization-5 Well Being Index (WHO-5). RESULTS: WHO-5 performed best in terms of sensitivity (0.93 for a cut-off score of 13) as well as taking least time to complete (2-5 min) and evaluate (0.5-2 min). CONCLUSIONS: WHO-5 can be recommended as part of a two-step screening process for depression in acne patients. Step 1 is the WHO-5. In the case of a positive score, step 2 is a detailed psychosocial assessment.

Acne Vulgaris↗
PubMedDate not supplied

Use of brief depression screening tools in primary care: consideration of heterogeneity in performance in different patient groups.

Heterogeneity of performance of screening tools in different patient groups has rarely been considered in the literature on depression screening in primary care. The objectives of the present study were to assess and to compare diagnostic accuracy of three screening questionnaires (Brief Patient Health Questionnaire, General Health Questionnaire-12, WHO-5) in identifying depression across various patient subpopulations and to assess the accuracy of the unaided clinical assessment of primary care physicians in the same subgroups. We conducted a cross-sectional validation study in 448 primary care patients. Two-by-two tables as well as receiver operating characteristics were applied. Results indicated that diagnostic accuracy (sensitivity, specificity) of the three screening instruments as well as of the clinical diagnoses differed in the various patient groups. Superiority of one screening tool over the other depends on the subgroup considered. Gender, age, form (subtype), and severity of depression influence the test characteristics of a screening tool. This should be considered if routine depression screening should be widely introduced. Of course, the benefit of routine screening also depends on efforts made for treatment and monitoring of patients in whom depression was diagnosed.

Adult↗