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D Naber

Publications and source records attributed to D Naber.

At least 37 records · Page 2Linked to original sources
PubMed2002

[Atypical neuroleptics in the treatment of aggression and hostility in schizophrenic patients].

The treatment of aggressive symptoms in schizophrenic patients is a relevant clinical problem. We systematically review the efficacy of the different atypical neuroleptics on acute or persistent aggressive symptoms also regarding methodological problems. Currently typical neuroleptics are still first choice in treating acute aggressive symptoms, while risperidone and olanzapine could be alternatives. In persistent aggression clozapin shows the best specific results. Typical depot neuroleptics should be considered in cases when medication compliance is a problem.

Aggression↗
PubMed2002

Psychopharmacological treatment of aggression in schizophrenic patients.

Aggressive behavior is frequently observed in schizophrenic patients. More than 50 % of all psychiatric patients and 10 % of schizophrenic patients show aggressive symptoms varying from threatening behavior and agitation to assault. The pharmacological treatment of acute, persisting and repetitive aggression is a serious problem for other patients and staff members. Not only is violent behavior from mentally ill patients the most detrimental factor in their stigmatization, aggression is also a considerable direct source of danger for the patients themselves. Based on rather limited evidence, a wide variety of medications for the pharmacological treatment of aggression has been recommended: typical and atypical antipsychotics, benzodiazepines, mood stabilizers, beta-blockers and selective serotonin reuptake inhibitors (SSRIs). Most clinical information on treating aggression has been collected for atypical neuroleptics, particularly for clozapine. Several retrospective and open studies indicate its efficacy. Treatment duration of 6 months is recommended to induce a stable reduction of physical and verbal aggression. Severe side effects have very rarely been seen. At the moment, clozapine seems to be the first choice in aggression treatment. Within the last few years, about 10 articles were published showing that this is the most effective antiaggressive agent in the treatment of aggression and agitation in psychiatric patients, independent of psychiatric diagnosis. However, clozapine, like all the other substances used, does not have an established indication for the treatment of aggressive symptoms. Noncompliance with medication makes it difficult to choose the right preparation for the medication: tablets, liquids, intramuscular injections and readily soluble "FDDFs" are available. Ethical, juridical and methodological problems prevent controlled studies from establishing a reference in the treatment of aggression in mentally ill patients. This review summarizes the current discussion and publications on the pharmacological treatment of aggression in schizophrenic patients of the last 20 years. In addition, we will briefly present studies and case reports concerning the treatment of aggression in other psychiatric patients.

Adrenergic beta-Antagonists↗
PubMed2002

Relationship between neuroleptic dosage and subjective cognitive dysfunction in schizophrenic patients treated with either conventional or atypical neuroleptic medication.

Previous research has suggested that high doses of conventional neuroleptics may induce neurocognitive deficits when assessed with standard tasks. However, little is known about the effects of high doses of neuroleptics (conventional or atypical) on subjective cognitive dysfunction. Recent research stresses the putative importance of self-reported cognitive deficits for both symptomatic outcome and medication compliance. The aim of the present study was to investigate the impact of neuroleptic medication on subjective cognition in patients treated with either conventional or atypical agents (clozapine, risperidone, olanzapine). Patients were asked to endorse the items of a questionnaire entitled 'Subjective Well-Being under Neuroleptic Treatment' prior to discharge. Subjective impairment, as assessed with the subscale 'mental functioning', was significantly correlated with greater conventional neuroleptic dosage after controlling for psychopathology (P<0.05). The difference between patients medicated with higher doses of conventional neuroleptics and those with lower doses was highly significant (P<0.001). In contrast, higher atypical neuroleptic doses were not associated with impairment.

Adult↗
PubMed2001

Improvement of schizophrenic patients' subjective well-being under atypical antipsychotic drugs.

Recent research indicates that subjective well-being is a major determinant of medication compliance in schizophrenia. However, it is yet unresolved whether atypical neuroleptics differ regarding subjective side-effects. A self-report instrument has been constructed to evaluate 'subjective well-being under neuroleptics' (SWN). The primary aims of the present study were to develop a short form of the SWN and to investigate the extent to which the atypical antipsychotic improves the patient's subjective well-being. The short form of the SWN was constructed following an item analysis based on data from 212 schizophrenic patients medicated with either typical or atypical antipsychotics. The short form of the SWN showed sufficient internal consistency and good construct validity. The SWN was only moderately correlated with positive and negative syndrome scale (PANSS) scores or changes in psychopathology (r=-0.20 to -0.37). SWN-ratings in patients receiving olanzapine were superior compared to those of patients medicated with either clozapine or risperidone on three of five domains of well-being. Clozapine reduced global psychiatric symptoms significantly more than risperidone. It is concluded that the assessment of subjective well-being under antipsychotic treatment provides an independent outcome measure which is relevant to compliance.

Adult↗
PubMed2001

Leptin: a modulator of alcohol craving?

BACKGROUND: Leptin has been shown to regulate food intake and energy expenditure. Because leptin acts via regulation of appetite, we studied the hypothesis that suggests leptin modulates craving for alcohol as well. METHODS: We studied leptin plasma concentrations (RIA) both in alcoholic subjects during inpatient detoxification (day 1: n = 78, day 14: n = 60) and in healthy control subjects (n = 30). To rule out interference with the activation of the HPA axis during alcohol withdrawal, we also evaluated cortisol plasma levels (RIA). RESULTS: We found plasma leptin and cortisol elevated at onset of withdrawal, decreasing significantly up to day 14. Leptin (and the body-mass corrected ratio leptin/BMI) was highly correlated with self-rated craving. No correlations of craving with cortisol and BMI were observed. CONCLUSIONS: We suggest that leptin may modulate withdrawal-induced craving in alcoholic subjects.

Adult↗
PubMed2001

Negative priming in schizophrenia: effects of masking and prime presentation time.

Beech et al. [Br. J. Clin. Psychol. 28 (1989) 109--116] previously reported attenuated negative priming in schizophrenic patients that was interpreted as a sign of dysfunctional cognitive inhibition. However, subsequent research has provided mixed results. In the present study, it was investigated whether reduced negative priming in schizophrenics may be an experimental artifact. Based on evidence from backward masking studies in schizophrenia, it was hypothesized that brief prime presentation times and pattern masking as used by Beech et al. and others may have impaired the visual perception of the prime display in schizophrenics. 20 schizophrenic patients and 20 matched healthy controls participated in the study. Subjects completed four negative priming experiments varying in prime presentation time (100 or 250 ms) and masking (a mask or a blank screen followed prime presentation). In line with prediction, reduced negative priming in schizophrenics only occurred for trials with 100 ms prime presentation time followed by a mask. Neither psychopathology nor any sociodemographic variable correlated substantially with negative priming. Results strongly suggest that reduced negative priming in schizophrenics may not be due to reduced cognitive inhibition but mirrors perceptual deficits.

Adult↗
PubMed2001

Enhanced semantic priming in thought-disordered schizophrenic patients using a word pronunciation task.

Previous research on semantic priming in schizophrenia has produced contradictory findings. For the present study, it was intended to resolve some of the ambiguities in the literature. Using a semantic priming task with word pronunciation, evidence is provided that thought-disordered schizophrenic (TD) patients exhibit significantly increased semantic priming as compared to healthy and psychiatric controls. Results suggest that enhanced semantic priming is not confined to tasks that require lexical decision. Moreover, results indicate that TD schizophrenic patients suffer from a decay of hierarchical thinking, i.e. TD schizophrenics reveal a tendency to process the less meaningful rather than the dominant aspects of external information. Priming effects for the inferior meaning of homograph words (for example, 'dance' is an inferior, and 'game' is a superior associate of the word 'ball') were significantly greater compared to healthy controls and non-TD schizophrenics. Results were not moderated by sociodemographic background variables, psychomotor slowing and psychopathological symptoms other than thought disorder.

Adult↗
PubMed2001

Neuropsychological correlates of schizophrenic syndromes in patients treated with atypical neuroleptics.

There is widespread evidence that schizophrenic symptomatology is best represented by three syndromes (positive, negative, disorganized). Both the disorganized and negative syndrome have been found to correlate with several neurocognitive dysfunctions. However, previous studies investigated samples predominantly treated with typical neuroleptics, which frequently induce parkinsonian symptoms that are hard to disentangle from primary negative symptoms and may have inflated correlations with neurocognition. A newly developed psychopathological instrument called the Positive and Negative and Disorganized Symptoms Scale (PANADSS) was evaluated in 60 schizophrenic patients. Forty-seven participants treated with atypical neuroleptics performed several neurocognitive tasks.A three-factor solution of schizophrenic symptomatology emerged. Negative symptomatology was associated with diminished creative verbal fluency and digit span backward, whereas disorganization was significantly correlated with impaired Stroop, WCST and Trail-Making Test B performance.Data suggest that disorganization is associated with tasks that demand executive functioning. Previous findings reporting correlations between negative symptomatology and neurocognition may have been confounded by the adverse consequences of typical neuroleptics.

Acute Disease↗
PubMed2001

Good tolerability equals good results: the patient's perspective.

Although conventional antipsychotics are useful for the treatment of schizophrenia, many patients discontinue taking them within a few months. As well as the positive influence of a good doctor-patient relationship, evidence suggests that the patient's initial subjective experience during antipsychotic therapy is a major predictor of compliance. In addition to motor symptoms, conventional antipsychotics can cause significant adverse effects on drive, emotion and cognition, which are reflected in patients complaining of a reduced quality of life, although may not be detected by objective examination. This syndrome, which is similar to the negative symptoms of schizophrenia, is known by numerous terms including 'pharmacogenic depression' and 'pharmacogenic anhedonia'. The introduction of atypical antipsychotics broadened the criteria for effective antipsychotic treatment to include the subjective assessment of improvement in patients' quality of life. The previous lack of interest in this domain may have been due to the inability to improve it with conventional agents and the misconception that schizophrenic patients were unable to subjectively evaluate their quality of life. However, numerous studies have shown that 63-95% of patients in remission are able to self-rate their affective state of well being or quality of life. Atypical antipsychotics are superior to conventional antipsychotics in improving quality of life and reducing the stigma of schizophrenia, particularly from the patient's perspective and are strong reasons for the widespread use of these drugs.

Antipsychotic Agents↗
PubMed2001

'Hyper-priming' in thought-disordered schizophrenic patients.

BACKGROUND: A number of studies have suggested that indirect semantic priming is enhanced in thought-disordered schizophrenics. However, research on direct semantic priming has produced conflicting results. The aim of the present study was to resolve some of the ambiguities of previous findings. METHODS: For the present study, 44 schizophrenic patients were split according to the presence of associative loosening into a positive thought-disordered (TD) and non-positive thought-disordered (NTD) group. Thirty healthy subjects and 36 psychiatric patients served as controls. RESULTS: Schizophrenics displayed increased indirect semantic priming compared with psychiatric controls. When subtyping the sample, TD-patients exhibited significantly enhanced indirect semantic priming compared with healthy and psychiatric controls as well as NTD-patients. Overall slowing was found to be independent of priming effects. Medication, age and chronicity of the schizophrenic illness did not modulate priming. CONCLUSIONS: In line with Spitzer and Maher it is inferred that disinhibited semantic networks underlie formal thought disorder in schizophrenia. For future research, it would be appropriate to: employ indirect semantic priming rather than direct semantic priming conditions; and, pay more attention to potential moderators of the priming effect, most importantly, the prime display duration and the length of the stimulus onset asynchrony.

Adult↗
PubMed2000

[Conversion from typical to atypical neuroleptics. Guidelines for ambulatory and inpatient treatment].

The introduction of atypical antipsychotics has presented new options for the pharmacological treatment of schizophrenic patients. It is assumed that in the near future, neuroleptic medication will shift from conventional to atypical antipsychotics for an increasing number of patients. The present article addresses guidelines for the conversion from conventional to atypical neuroleptics in inpatient and outpatient settings.

Ambulatory Care↗
PubMed2000

[Open studies in comparison to controlled studies in testing of neuroleptics].

OBJECTIVE: Due to methodological reservations, results concerning the efficacy of neuroleptics in open trials are often regarded with doubt. Until now, there are nearly no studies comparing findings of controlled double-blind with those of open trials. Aim of this study was to investigate if results of an open or double-blind approach differ and hereby to gain information about the validity of open trials. METHODS: After a literature research, five neuroleptics were identified for which at least 3 open and 3 double-blind trials exist which met the inclusion criteria and from which either the reduction of the BPRS (Brief Psychiatric Rating Scale)-score or the response rate could be determined. RESULTS: There were no differences in the reduction of the BPRS-score or response rate for all 5 neuroleptics between open and double-blind trials. Furthermore, the efficacy of all 5 neuroleptics was comparable. CONCLUSIONS: Double-blind controlled studies are essential in the investigation of new compounds. But results of methodologically well performed open studies are valid and deserve more attention. Preceding open trials may help in the design of double-blind studies.

Antipsychotic Agents↗
PubMed2000

Dosage of conventional neuroleptic medication and subjective cognitive functioning in schizophrenia.

Subjective cognitive and perceptual disturbances as assessed with the Frankfurt Complaint Questionnaire (FCQ) were correlated with chlorpromazine equivalents in 40 schizophrenic inpatients, who were treated with conventional neuroleptics. In line with previous research using 'objective' neuropsychological tests, both correlations and partial correlations (controlling for the effects of psychopathology, extrapyramidal symptoms and length of illness) confirmed that higher neuroleptic doses significantly worsen several cognitive and perceptual domains (r = 0.44 -0.54; P < or = 0.005 -0.05) with the possible exception of mnestic functions (r = 0.21 -0.24, n.s.) and language (r = 0.37 -0.38, P < 0.1). The clinical importance of self-report scales for evaluating both the risks and benefits of neuroleptic treatment is discussed.

Adult↗
PubMed2000

Treatment with the selective muscarinic agonist talsaclidine decreases cerebrospinal fluid levels of total amyloid beta-peptide in patients with Alzheimer's disease.

Brain amyloid load in Alzheimer's disease (AD) is, at least in genetic forms, associated with overproduction of amyloid beta-peptides (A beta). Thus, lowering A beta production is a central therapeutic target in AD and may be achieved by modulating such key enzymes of amyloid precursor protein (APP) processing as beta-, gamma-, and alpha-secretase activities. Talsaclidine is a selective muscarinic M1 agonist that stimulates the nonamyloidogenic alpha-secretase pathway in model systems. Talsaclidine was administered double-blind, placebo-controlled, and randomized to 24 AD patients and cerebrospinal fluid (CSF) levels of total A beta were quantitated before and after 4 weeks of drug treatment. We observed that talsaclidine decreases CSF levels of A beta significantly over time within the treatment group (n = 20) by a median of 16% as well as compared to placebo (n = 4) by a median of 27%. We conclude that treatment with selective M1 agonists may reduce A beta production and may thus be further evaluated as a potential amyloid-lowering therapy of AD.

Aged↗
PubMed2000

Long-term phase of schizophrenia: impact of atypical agents.

Typical antipsychotic agents are poorly suited to the long-term treatment of schizophrenia, particularly since the introduction of atypical compounds has increased the expectations of both physicians and patients. Well-being and quality of life--now important considerations--have shown significant improvements in patients treated with atypical agents such as amisulpride rather than typical agents such as haloperidol. This is associated with alleviation of negative symptoms and cognitive deficits, benefits which are not seen with traditional agents and which increase the likelihood of successful rehabilitation.

Antipsychotic Agents↗