[Psychological and psychiatric aspects of pregnancy].
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Biomedical subjects
Publications and source records attributed to W Pöldinger.
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The relationships between depression and art are many and varied. Examples of poets, novelists, and musicians spring to mind who have vividly portrayed depression, usually from personal experience of it. These portrayals often had a psychohygienic significance for the artists concerned--as in the case of Goethe, who, in writing 'The sorrows of young Werther', exorcised his own suicidal impulses and thoughts, thus probably saving his own life. Artists have also depicted the physiognomy of depressives, e.g. Hans Baldung Grien in his picture 'Saturn' showing the pronounced nasolabial folds described by Veraguth as indicative of melancholia. Relationships between depression and art also play a role in certain theories of creativity, such as that of Silverman, who postulates that in the depressive phase new impressions arise which then find their expression in a manic phase. Finally, there are the various creative therapies designed in cases of depression (e.g. by encouraging the patient to paint or draw) to reactivate the nondominant hemisphere of the brain. Particularly in chronic or recurrent depressions this reactivation also serves to open up to the patient new perspectives for the solution of the problems that drive him into depression.
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Following a discussion of the diagnostic preconditions that are essential to any treatment of depression, this paper deals with the biologically-based therapies that recommend themselves in psychotherapy. Of chief interest here are the pharmacotherapeutic possibilities and above all the indications of the various antidepressants - many of them new - which are listed together with their German, Austrian and Swiss brand names in Table 8. Some new drugs that are not first and foremost antidepressants are also discussed here, as well as adjunctive medication and treatment of therapy-resistant depression. The main types of chronobiological therapy discussed are sleep deprivation and the use of light in the treatment of depression. Finally, there is a brief outline of shock therapy; for non-medical reasons, this no longer plays an important role today, but is nevertheless an extremely effective method of treating depression.
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In an open multicenter trial 46 schizophrenic patients were treated with fluperlapine for 20 days. A mean daily dosage of 300-400 mg appeared to be an effective antipsychotic treatment in most cases. The marked antipsychotic effect was accompanied by a good improvement of depressive symptoms. Extrapyramidal side effects were extremely rare.
In a double-blind study on 40 outpatients (20 per group) suffering from endogenous and psychogenic depression of the anxious-agitated or inhibited form, trazodone was compared with doxepin to determine their efficacy and safety, and whether a single daily administration was adequate. Increasing doses of trazodone 50-200 mg and doxepin 25-100 mg were given once a day in the evening for a period of 5 weeks. Both drugs were found to be approximately equivalent as far as their antidepressive and anxiolytic effects and safety are concerned. Treatment with trazodone promises less risks according to the clinical experience described in the international literature. Administration once a day provides sufficient efficacy and safety.
In an open multicenter trial (7 hospitals) 85 schizophrenic patients were treated with 3-fluoro-6-(4-methyl-piperazinyl)- 11H -dibenz[b,e]azepine ( fluperlapine , NB 106-689) during 20 days. Symptomatology was documented with the AMDP system on days 0, 1, 5, 10, 15 and 20. A mean daily dosage of about 400 mg caused a significant antipsychotic effect and pronounced improvement of depressive symptoms. Fluperlapine was well tolerated. Extra-pyramidal side-effects were very rare.
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Due to the increasing pressure to investigate new drugs under conditions met with in practice, Lormetazepam (0.5 mg) was investigated in nine general practices under the direction and collaboration of a psychiatrist used to investigations with psychopharmaceuticals. The results of a double-blind study, carried out in comparison to triazolam (0.5 mg), in a total of 94 ambulatory patients are presented.
The antidepressive and anxiolytic efficacy of flupenthixol has been investigated in numerous controlled and open trials involving patients with endogenous, reactive as well as senile depressions. When administered at a mean daily single or multiple dose of 1-2 mg, flupenthixol proved to be a very effective and well-tolerated antidepressant. As opposed to some of the currently available antidepressants, flupenthixol has a rapid onset of action which is often displayed within the first 2-3 days following its application. Flupenthixol decanoate has also a pronounced antidepressive and anxiolytic effect which appears to be adequate enough for treating mild to moderately severe syndromes of depression. This depot neuroleptic has been given at a fortnightly dosage ranging between 2.5 and 30 mg. However, if the aspect of efficacy in relation to tolerance has to be taken in to consideration, then 5 mg are apt to be an appropriate dose. Patients with an agitated depression and/or suicide ideation should, however, be excluded from therapy with this drug. Extrapyramidal movement disorders which may appear during treatment are a disadvantage of this medication. Apparently such disorders are rarely encountered if the dose is kept below 10 mg. Other untoward effects are very seldom indeed. A final and conclusive judgement on the possible application of flupenthixol decanoate in the prophylaxis of phases in patients with bipolar and periodical depressions is as yet not feasible. Further clinical trials are necessary before flupenthixol decanoate can be classified as a possible 'depot antidepressant'.
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Psychoreactive crises can lead to a presuicidal evolution under certain conditions. This is dependent on the susceptibility for crises of the individual but also on the cause of the crises. Certain groups of people are specially at risk for suicide. We also know certain events that very frequently lead to serious crises. The individual crisis susceptibility is very much determined by the previous history of the involved person. The course of the crisis is very much determined by the reaction of the environment. The evolutions of suicide show corresponding courses. These are presented in detail. Furthermore the question of judging suicidality and the risk for suicide are presented in detail.