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Biomedical subjects

W Gaebel

Publications and source records attributed to W Gaebel.

At least 19 recordsLinked to original sources
PubMed1999

Subcortical correlates of differential classical conditioning of aversive emotional reactions in social phobia.

BACKGROUND: Conditioning processes have been proposed to play a role in the development of anxiety disorders. As yet, the neurobiologic correlates of emotional learning have not been fully understood in these patients. Accordingly, brain activity was studied in subcortical and cortical regions involved in the processing of negative affect during differential aversive classical conditioning. METHODS: Twelve patients with social phobia and 12 healthy control subjects were presented with paired conditioned (CS; neutral facial expressions) and unconditioned stimuli (US; negative odor vs unmanipulated air). Functional magnetic resonance imaging (fMRI) was utilized to examine regional cerebral activity during habituation, acquisition,a nd extinction trials. Activity was measured with echo-planar-imaging (EPI), and signal intensity in individually defined anatomic regions were analyzed. RESULTS: Subjective ratings of emotional valence to the CS indicated that behavioral conditioning occurred in both groups. The presentation of CS associated with negative odor led to signal decreases in the amygdala and hippocampus of normal subjects, whereas an opposite increased activation in both regions was observed in patients. Regional differences were not found during habituation and extinction. CONCLUSIONS: Results suggest that conditioned aversive stimuli are processed in subcortical regions, with phobic patients differing from control subjects.

Adult↗
PubMed1999

Neurophysiological correlates of the recognition of facial expressions of emotion as revealed by magnetoencephalography.

MEG correlates of the recognition of facial expressions of emotion were studied in four healthy volunteers. Subjects performed a facial emotion recognition task and a control task involving recognition of complex objects including faces. Facial emotion recognition activated inferior frontal cortex, amygdala and different parts of temporal cortex in a relatively consistent time sequence. The characteristics of these activations were clearly different from those recorded during the control task. Most interesting was the fact that faces evoked different MEG responses as a function of task demands, i.e., the activations recorded during facial emotion recognition were different from those recorded during simple face recognition in the control task. These findings support the assumption that MEG is able to specifically identify the activation pattern of the brain when recognition of the emotional expression of a face is performed.

Adult↗
PubMed1998

Imaging dopamine D4 receptors in the living primate brain: a positron emission tomography study using the novel D1/D4 antagonist [11C]SDZ GLC 756.

The dopamine D4 receptor has lately attracted interest since it has been hypothesized to be involved in the pathogenesis and pharmacotherapy of neuropsychiatric diseases. The present study provides first in vivo evidence of dopamine D4 receptors in primate brain using a [11C]benzo[g]quinoline, the novel radioligand [11C]SDZ GLC 756 ([11C]GLC: in vitro dissociation constants at human receptor clones [nM]: 1.10 at D1; 0.40 at D2; 25 at D3; 0.18 at D4.2; 6.03 at D5). Dynamic positron emission tomography scans were performed on healthy baboons (Papio hamadryas, n = 3). Specific receptor binding (SB) was calculated for striatum and neocortex (frontal, temporal, parietal, and occipital) based on the differences between the regional and the cerebellar concentration of [11C]. Blockade of D1 and D5 receptors by SCH23390 (1.7 pmol/kg) diminished SB in the striatum by 55 +/- 4% (mean +/- standard deviation, P < 0.05) and in the frontal cortex by 13 +/- 8% (P < 0.05) when compared to SB in the unblocked state (SB(D1-D5)). In the presence of the dopamine antagonists SCH23390 (1.7 micromol/kg) and raclopride (5.7 pmol/kg)--which mask the D1, D2, D3, and D5 subtypes--SB of [11C]GLC to D4 receptors (SB(D4)) was demonstrated in the striatum and all cortical regions of interest. In the striatum, the ratio of SB(D4)/SB(D1-D5) was 0.13 +/- 0.07. In the neocortex, SB(D4)/SB(D1-D5) was notably higher (0.77 +/- 0.29; mean of all cortical regions of interest). The widespread distribution of dopamine D4 receptors suggests a basic functional role of this receptor subtype in the modulation of cortical and subcortical neuronal activity.

Animals↗
PubMed1998

[Electroconvulsive therapy in psychiatric clinics in Germany in 1995].

A total of 451 German psychiatric hospitals were asked in 1995 about their use of electroconvulsive therapy (ECT). As ECT nowadays is well accepted as a therapeutic tool, we wanted to compare our data with data collected in former inquiries in 1977 and 1985 and to acquire information from the new German States. Since 1977, the use of ECT has evidently increased. The psychiatric hospitals that often use ECT are for scattered throughout the whole country. ECT is mainly indicated for febrile catatonia/febrile stupor and depressive stupor, not for schizophrenia. ECT is applied especially when depressive patients are resistant or intolerant of psychopharmacotherapy. The preparation and application correspond to the standards. One focus in the present study was the attitudes of the managing directors towards ECT. Data were collected by open questionnaires. When these data were compared with data from a standardized inquiry of 1985, a similar trend was found regarding positive statements about ECT. Statements are emphasized even more when using open questionnaires. If there is a strong indication for ECT, the basic attitudes of the managing directors toward ECT are very positive. However, its application is in fact much more influenced by social factors than by indication because of negative attitudes by colleagues and nursing staff and political and stereotypic thinking of the general population.

Attitude of Health Personnel↗
PubMed1998

Guidelines for depot antipsychotic treatment in schizophrenia. European Neuropsychopharmacology Consensus Conference in Siena, Italy.

These guidelines for depot antipsychotic treatment in schizophrenia were developed during a two-day consensus conference held on July 29 and 30, 1995 in Siena, Italy. Depot antipsychotic medications were developed in the 1960s as an attempt to improve the long-term treatment of schizophrenia (and potentially other disorders benefiting from long-term antipsychotic medication). Depot drugs as distinguishable from shorter acting intramuscularly administered agents can provide a therapeutic concentration of at least a seven day duration in one parenteral dose. The prevention of relapse in schizophrenia remains an enormous public health challenge worldwide and improvements in this area can have tremendous impact on morbidity, mortality and quality of life, as well as direct and indirect health care costs. Though there has been debate as to what extent depot (long-acting injectable) antipsychotics are associated with significantly fewer relapses and rehospitalizations, in our view when all of the data from individual trials and metaanalyses are taken together, the findings are extremely compelling in favor of depot drugs. However in many countries throughout the world fewer than 20% of individuals with schizophrenia receive these medications. The major advantage of depot antipsychotics over oral medication is facilitation of compliance in medication taking. Non-compliance is very common among patients with schizophrenia and is a frequent cause of relapse. In terms of adverse effects, there are not convincing data that depot drugs are associated with a significantly higher incidence of adverse effects than oral drugs. Therefore in our opinion any patient for whom long-term antipsychotic treatment is indicated should be considered for depot drugs. In choosing which drug the clinician should consider previous experience, personal patient preference, patients history of response (both therapeutic and adverse effects) and pharmacokinetic properties. In conclusion the use of depot antipsychotics has important advantages in facilitating relapse prevention. Certainly pharmacotherapy must be combined with other treatment modalities as needed, but the consistent administration of the former is often what enables the latter.

Antipsychotic Agents↗
PubMed1998

Predictors of relapse and rehospitalization in schizophrenia and schizoaffective disorder.

In a German multicenter treatment study, 354 patients with schizophrenia and schizoaffective disorder were followed for 2 years. The data collected were taken as a basis for the present predictor study. For the first time, the technique of classification and regression tree (CART) analysis has been employed for this purpose. CART yielded informative data and appeared to be a useful instrument in predictor research. On the outcome variables "relapse" and "rehospitalization," significant predictor variables were found in several areas: neuroleptic treatment, onset and previous course (precipitating factors, first manifestation, hospitalization in the preceding year, suicide attempts), psychopathology (residual type, schizoaffective disorder), social adjustment (marital status, employment, intensity of life, Phillips score), previous life experiences (traumatic experiences and psychiatric or developmental disturbances in childhood), and biology (gender, age). Our investigation confirmed the generally prevalent views regarding the value of neuroleptic treatment, the multifactorial etiology, and the vulnerability stress model of schizophrenia.

Adult↗
PubMed1998

Critical issues in the treatment of schizophrenia.

Treatments that effectively control schizophrenia are now available. The full benefits of these treatments, however, are not being realized, as a result of insufficient compliance by patients and doctors. Patient noncompliance has been largely the result of the shortcomings of conventional antipsychotics (e.g. subjectively distressing side effects), their inappropriate application (e.g. excessively high dosages) and the lack of patient insight into or information about schizophrenia and its treatment. The development of guidelines for drug treatment, the introduction of novel antipsychotics with a better risk-benefit ratio and the implementation of psychosocial interventions all help to improve compliance and treatment outcome. Continued effort needs to be directed towards the educational programmes that have been developed, to ensure that they are used to their maximum potential. Critical treatment issues in the different phases of schizophrenia have been outlined.

Antipsychotic Agents↗
PubMed1998

[The social status of schizophrenic patients].

In the German multicenter ANI study comparing continuous prophylactic treatment with intermittent medication, the social situation of a large sample of 364 schizophrenic patients was investigated and followed up over a 2-year period of outpatient aftercare. Effective therapy and prophylaxis substantially reduced relapses and rehospitalization. On the other hand, the psychosocial situation still showed considerable disadvantages. Of the patients (35 years old on average), 60% were still unmarried. Almost one-half of the patients still lived alone or with their parents, and one-third lived a very solitary life. At the end of the 2-year aftercare period, one-third was able to earn their own living. Almost one-half retired early from their occupations. Predictors and intervening variables are presented in order to stimulate early rehabilitation approaches. Schizophrenics are particularly placed at a disadvantage by tighter competition in the employment market, even though the course of illness can be improve. Social psychiatry must to be involved in helping to improve social contacts, accommodation and employment in order to prevent major distress.

Adult↗
PubMed1998

[Quality indicators of patient treatment of schizophrenic patients. Results of a pilot study for external quality assurance using tracer diagnosis].

PURPOSE: In Germany, measures for assuring the quality of inpatient treatment are regulated by legislation. Treatment quality must be presented in comparison with other hospitals. Tracer diagnosis is an established method for external quality assurance in the sphere of somatic medicine. METHOD: To evaluate this method of external quality assurance in psychiatry, the German Society for Psychiatry, Psychotherapy and Nervous Diseases (DGPPN) defined and operationalised quality indicators for the treatment of schizophrenic inpatients. RESULTS: of a multicentre project supported by the German Federal Ministry of Health (BMG) using this inventory in 96 schizophrenic inpatients (ICD-10) from 4 hospitals are presented. The qualification of these indicators of structure, process and outcome while comparing the treatment quality of different hospitals as well as their applicability for internal quality management are discussed.

Adult↗
PubMed1997

Facial-affect recognition and visual scanning behaviour in the course of schizophrenia.

The performance of schizophrenic in-patients in facial expression identification was assessed in an acute phase and in a partly remitted phase of the illness. During visual exploration of the face stimuli, the patient's eye movements were recorded using an infrared-corneal-reflection technique. Compared to healthy controls, patients demonstrated a significant deficit in facial-affect recognition. In addition, schizophrenics differed from controls in several eye movement parameters such as length of mean scan path and mean duration of fixation. Both the facial-affect recognition deficit and the eye movement abnormalities remained stable over time. However, performance in facial-affect recognition and eye movement abnormalities were not correlated. Patients with flattened affect showed relatively selective scan pattern characteristics. In contrast, affective flattening was not correlated with performance in facial-affect recognition. Dosage of neuroleptic medication did not affect the results. The main findings of the study suggest that schizophrenia is associated with disturbances in primarily unrelated neurocognitive operations mediating visuomotor processing and facial expression analysis. Given their time stability, the disturbances might have a trait-like character.

Adult↗
PubMed1997

In vivo evidence for the involvement of dopamine-D2 receptors in striatum and anterior cingulate gyrus in major depression.

The dopaminergic system is a candidate neurotransmitter system thought to be involved in the pathogenesis of depression. This study addresses the issue whether the antidepressant efficacy of serotonin reuptake inhibition is related to changes in the cerebral dopaminergic system. Cerebral dopamine-D2 receptors were characterized in 13 patients with major depression using the dopamine-D2 receptor antagonist iodobenzamide and single photon emission tomography. Dopamine receptor binding was assessed twice, before and during serotonin reuptake inhibition. An increase in dopamine-D2 receptor binding during serotonin reuptake inhibition was found in striatum and anterior cingulate gyrus in treatment responders, but not in nonresponders. The increase in dopamine-D2 receptor binding correlated significantly with clinical recovery from depression as assessed with the Hamilton depression scale (r = 0.59 for right and left striatum respectively, P < 0.05; r = 0.79 for the anterior cingulate gyrus, P < 0.05 after Bonferroni correction). Qualitatively similar correlations were observed in the precentral gyrus, the medial frontal gyrus, the inferior frontal gyrus, and the frontal part of the opercular gyrus, but these correlations failed to reach statistical significance after correction for the effects of multiple testing. No such correlations were found in the superior frontal gyrus, the orbitofrontal gyrus, the gyrus rectus, the superior parietal gyrus, or the superior temporal gyrus. The data strengthen the concept that the striatum and the anterior cingulate gyrus are involved in mood regulation. Dopamine-D2 receptors may constitute a central role in this domain.

Adult↗
PubMed1997

Towards the improvement of compliance: the significance of psycho-education and new antipsychotic drugs.

Effective pharmacological, psychosocial and other kinds of treatment are now available for schizophrenia. Often, however, neither acute nor long-term treatment can be properly applied because of insufficient compliance by both patients and doctors. Patient non-compliance is as high as 50% under outpatient conditions; potential reasons may be either illness-related (e.g. lack of insight or idiosyncratic concepts of the illness or its treatment), drug-related (e.g. intolerable side-effects) or related to inadequate treatment management (e.g. insufficient information or lack of environmental support). Non-compliance by doctors is partly due to limited adherence to treatment guidelines. To improve both patient and doctor compliance, the use of educational tools for professional health-care providers, patients and families should be generally enforced. New antipsychotics with a better risk-benefit profile with respect to clinical efficacy and side effects will probably help to overcome drug-related non-compliance.

Antipsychotic Agents↗
PubMed1996

Residual symptoms and P300 in schizophrenic outpatients.

A reduced P300 amplitude has often been found to be related to schizophrenic psychopathology. It is still unclear, however, whether this relationship is trait- or state-dependent. We investigated 88 stabilized schizophrenic outpatients during a 2-year follow-up period. Multivariate analyses revealed that patients who had reduced P300 amplitudes showed pronounced residual symptoms, especially thought disorder (Brief Psychiatric Rating Scale). Intraindividual changes in that psychopathology were not correlated to corresponding changes of the P300 amplitude, so the relationship between schizophrenic psychopathology and P300 amplitude appears to be, at least in part, trait-dependent. A reduced P300 amplitude may characterize a subgroup of schizophrenic patients with a disposition to cognitive disturbances and incomplete remissions.

Adult↗
PubMed1996

Facial affect recognition in the course of schizophrenia.

Deficits in facial affect recognition have been shown repeatedly in schizophrenia. However, the stability of this deficit over time remains to be clarified. A total of 36 remitted, 32 acutely ill schizophrenic patients and 21 healthy volunteers participated in a cross-sectional and longitudinal study. All subjects were assessed twice within 4 weeks (acute schizophrenics and normal controls), or 12 weeks, respectively (remitted schizophrenics). Subjects had to identify six basic emotions from corresponding facial expressions shown as photographs on a video screen. Both acute and remitted schizophrenics demonstrated a stable deficit over time in facial affect recognition unrelated to psychopathology and medication. This suggests that deficits in facial affect recognition in schizophrenia reflect a trait-like, rather than a state-dependent, characteristic.

Acute Disease↗
PubMed1996

Prediction of response to acute neuroleptic treatment in schizophrenia.

Predicting the outcome of treatment with neuroleptics and understanding the factors that contribute to variability in the response to these drugs have preoccupied researchers and clinicians since the class was developed. Clinicians need empirically based prospective criteria in order to choose a treatment strategy that will lead to the best response from the patient while minimizing side effects. Thus the optimal strategy will match patient, illness and drug characteristics. Before a response can be predicted, the researcher needs explicit concepts and definitions on the course of the illness, drug responses, treatment outcome and predictive criteria. Whereas outcome refers to an arbitrary endpoint of an illness, whether spontaneous or modified by treatment, response is a treatment-related concept. Response refers to a change in the course of the illness which is defined either by pre- or post-treatment criteria and is caused by treatment. Apart from treatment, the spontaneous course of the illness is shaped and modified by various factors, which are referred to as potential outcome/response predictors sampled from a wide area of patient, illness and environmental characteristics. A superordinate concept of prediction must show how these potential determinants of (treatment) course and outcome relate to each other in biopsychosocial terms. Valid predictions of response can only be expected if recognizable rules are operative in the illness course and the treatment outcome. With increasing knowledge about the pathophysiology of the illness, its course and potential determinants, the development of valid predictive algorithms will be promoted. The application of vigorous research strategies in future pharmacological treatment studies will also be required to reach this goal.

Algorithms↗
PubMed1996

Conclusions and treatment recommendations for the acute episode in schizophrenia.

Interventions which reduce symptoms, vulnerability and stress on the one hand and improve psychosocial competence and quality of life on the other are essential components of a comprehensive treatment program in schizophrenia. Drug treatment of acute exacerbations which is adequate with respect to drug type, dose and treatment duration and takes risk/benefit measures into account is at the heart of these interventions and should be applied as early as possible. Subsequent neuroleptic treatment to prevent a relapse should be administered in accordance with established treatment guidelines. Drug treatment must be combined with psychosocial interventions, which should be properly adapted to the particular phase and stage of the illness. Implementation and coordination of various interventions require cooperation between therapists, institutions, the patient and the patient's family.

Acute Disease↗