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W Pöldinger

Publications and source records attributed to W Pöldinger.

At least 19 recordsLinked to original sources

[Ethics in psychiatry].

In psychiatry there are two major problem areas where ethical questions are of greatest importance. On one hand these are problems arising from commitment to an institution, e.g. forced hospitalisation and forced treatment. Swiss civil law requires in articles 397a to f that such patients may appeal to a judicial court. When this court is a commission comprised of an attorney and of psychiatric and psychotherapeutic specialists, it is of greatest importance that the patient himself be heard by the attorney and not just by a member of the commission and that this attorney also takes into account statements of relatives, as an incompetent patient may say things that are inconsistent with actual facts. As existing or planned hospitalization laws apply mainly to acutely ill patients who are dangerous to themselves or to others, the treatment of chronically ill psychiatric patients cannot be guaranteed. Thus conflicts of conscience arise, since physicians are required to provide medical aid; therefore if such aid is not given or if it is refused, a physician can be sued for inflicting heavy injury. Hence there is an urgent need for judicial measures that guarantee also the treatment of the chronically ill who, like all patients, have a right to be treated. A second problem area is represented by the ethical commissions that decide which scientific investigations may be performed on psychiatric patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Commitment of Persons with Psychiatric Disorders

Diurnal variation of symptoms in seasonal affective disorder.

The classic melancholic pattern of depressive symptoms being worse in the morning was present in 3/4 of a sample of 47 seasonal affective disorder patients (SAD), as assessed by global ratings and self-ratings of diurnal variation (DV). The type of DV did not predict response to light, but it did predict relapse within a week: Only those SAD patients with symptoms worse in the evening or no DV did so.

Adult

The long-term treatment of periodical and cyclic depressions with flupenthixol decanoate.

In a 2- to 3-year open study 30 patients were treated with flupenthixol decanoate (depot form). These periodic and cyclic depressive patients had side effects during treatment with lithium salts. In comparison with the depressive and manic phases before the treatment, the prophylactic effect of flupenthixol decanoate on periodic and cyclic forms of depression was similar to the effect of lithium salts.

Adult

[Problems with hypnotic drug abuse and its therapy (author's transl)].

Barbiturate dependence leads to serious withdrawel symptoms requiring first hospitalisation and later intensive outpatient treatment. This treatment can be supported with neuroleptic and anti depressant drug therapy. Adequate supportive aftercare is essential for a successful treatment of drugdependence.

Ambulatory Care

[Position of behavior therapy among the psychiatric therapies].

In the fourth table, we have classified the most important measures of behaviour therapy: desensitivization, operating conditioning, aversive therapy and negative learning. These courses of action can play an important role in psychiatry and can enrich the therapeutic repertory through their rational use, placed in a general plan of treatment. Moreover, these methods are usually excluded from the tought theories and they do not see in the neurotic troubles a consequence of unconscious conflicts; these conflicts must become conscious again, but they must appear, then, as the result of the learning of bad behaviour.

Aversive Therapy

Differences in effect between nomifensine and nortriptyline.

A double-blind study comparing the effects of nomifensine and nortriptyline, which was carried out exclusively on outpatients with retarded depressions, showed nomifensine to have a distinctive antidepressive and activating effect. 40 patients (17 male and 23 female) with either endogenous, endogenous/psychogenic or psychogenic depression were divided into two treatment groups (20 patients to each group). During the 21-day study, all patients were given three 50 mg capsules of nomifensine or nortriptyline per day. With the aid of a depression scale, a significant improvement in the psychic symptoms was noted both in the nomifensine and the nortriptyline group. There was no evidence of a significant difference in the two drugs. The data obtained from the dropouts suggest that nomifensine had a better effect. From the results of the study, it can be concluded that nomifensine is suitable for the treatment of patients with retarded depressions.

Adult

Therapy of extrapyramidal side effects, with particular reference to persistent dyskinesia and lithium tremor.

In 13 of 27 cases of persistent dyskinesia, treatment with amantadine, in an average dose of 300 mg, brought good to moderate improvement. In 14 patients who showed no response whatever, further treatment, with bromocriptine in doses raised gradually to a final daily dosage of 15 mg, was effective in four cases, though the improvement was generally only moderate. In more than 50 percent of the cases of initial tremor induced by lithium therapy, oxprenolol in daily doses of 160--240 mg produced good effects and moderate improvement was noted in a few further cases. In a series of 20 patients with initial tremor due to neuroleptic therapy, on the other hand, the same treatment proved unsuccessful in the majority of cases. This is the converse of the experience gained with the classical antiparkinson agents, which have proved more effective against tremor induced by neuroleptics than against lithium-induced tremor.

Adolescent

[Closing word].

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Antipsychotic Agents

[Introduction].

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Haloperidol

[Frequent cases of agranulocytosis due to clozapin (leponex) in eastern Switzerland].

Two personally observed cases of severe agranulocytosis within 3 months, one of them fatal, could be attributed to the new dibenzodiazepine derivative Clozapine (Leponex). Clozapine, a very effective neuroleptic for the treatment of acute and chronic schizophrenia, has been found before to induce agranulocytosis of the metabolic type, as phenothiazines are known to do. An inquiry in al Swiss medical departments and mental hospitals revealed a total of 20 cases of Clozapine induced agranulocytosis in some 50% of institutions responding. 9 of these were observed in Eastern Switzerland. This time-space clustering recalls the "finnish epidemic" of 1975 in Southern Finland. Possible explanations for this phenomenon are discussed. Calculations of the incidence suggest a higher rate of agranulocytosis induced by Clozapine than has been assumed for the phenothiazines. Clozapine should therefore be restricted to schizophrenic patients and initially (6 weeks) be given only on a stationary basis under regular blood controls.

Adult

Clinical study with bromperidol, a new butyrophenone derivative.

20 psychotic - predominantly schizophrenic - patients underwent treatment with the new butyrophenone derivative bromperidol for a period of 4 weeks; the drug was administered in the form of 1 mg tablets. The daily dose (initial dose: 1 mg; mean dose at the end of the trial: 4.47 mg) was always administered in one single dose. 19 patients finished the trial, and in 18 cases the therapeutic result was considered very good to good. These results were confirmed by statistical analysis. Nine patients exhibited mild to moderate extrapyramidal concomitant symptoms; no other side effects were observed. The results of detailed laboratory tests and evaluations of various quantitative and qualitative tolerability parameters were not indicative of toxic effects. The therapeutic value of this new substance will be demonstrated by a double-blind study.

Adult

Double-blind study with two butyrophenone derivatives: bromperidol vs. haloperidol.

The present report deals with a double-blind study comparing the new butyrophenone derivative, bromperidol, with haloperidol as the reference substance. Both substances were found to be highly effective in the treatment of psychotic syndromes belonging predominantly to the schizophrenia group. Certain clues, including the onset of action, seem to be indicative of the superiority of bromperidol. No differences between the two substances were observed with respect to side effects and general tolerability.

Butyrophenones

[Double-blind comparison of the effects of a new tricyclic antidepressant (Lofepramine) and a tetracyclic antidepressant (maprotiline)].

Two random groups of depressed out-patients were treated with either Maprotiline or the new antidepressant Lofepramine. The depressive state was assessed by using the Hamilton Depression Scale (HAM-D) before and after 1, 3 and 6 weeks of treatment. Both drugs produced remarkable improvement globally in total HAM-D score as well as in the symptom clusters. The differences in both groups are not significant, but compiling the results of adverse reactions and the therapeutic effect, the treatment outcome in the Lofepramine group was slightly superior.

Adolescent