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Biomedical subjects

Dieter Naber

Publications and source records attributed to Dieter Naber.

At least 19 recordsLinked to original sources
PubMed2007

Psychopathological characteristics and treatment response of first episode compared with multiple episode schizophrenic disorders.

OBJECTIVE: The aim was to investigate the hypothesis that patients with first episode schizophrenic disorders have a more favorable treatment response than those with multiple episodes. METHOD: A total of 400 inpatients from an ongoing multi-centre, follow-up program who fulfilled ICD-10 criteria for schizophrenic disorders (F2) were assessed at admission to and discharge from hospital using the Positive and Negative Syndrome Scale (PANSS). RESULTS: At admission, first episode patients (n = 121) showed higher levels of positive symptoms (PANSS positive subscore) and lower ones of negative symptoms (PANSS negative subscore) than multiple episode patients (n = 279), whereas the global disease severity (PANSS total score) was comparable. Analyses of covariance revealed that treatment response (adjusted symptom levels at discharge) was more favorable in first-episode patients, with respect to both positive and negative symptoms. CONCLUSION: The results are compatible with the hypothesis that treatment response becomes less favorable during the course of schizophrenic illness. This finding might be associated with progressive neurobiological alterations.

Adult↗
PubMed2006

Three-year antipsychotic effectiveness in the outpatient care of schizophrenia: observational versus randomized studies results.

Antipsychotic discontinuation rates are a powerful indicator of medication effectiveness in schizophrenia. We examined antipsychotic discontinuation in the Schizophrenia Outpatient Health Outcomes (SOHO) study, a 3-year prospective, observational study in outpatients with schizophrenia in 10 European countries. Patients (n=7728) who started antipsychotic monotherapy were analyzed. Medication discontinuation for any cause ranged from 34% and 36% for clozapine and olanzapine, respectively, to 66% for quetiapine. Compared to olanzapine, the risk of treatment discontinuation before 36 months was significantly higher for quetiapine, risperidone, amisulpride, and typical antipsychotics (oral and depot), but similar for clozapine. Longer medication maintenance was associated with being socially active and having a longer time since first treatment contact for schizophrenia, whereas higher symptom severity, treatment with mood stabilizers, substance abuse, having hostile behaviour were associated with lower medication maintenance. Antipsychotic maintenance in SOHO was higher than the results of previous randomized studies.

Adult↗
PubMed2006

Effectiveness, tolerability, and safety of ziprasidone in patients with schizophrenia or schizoaffective disorder: results of a multi-centre observational trial.

PURPOSE: The ZEISIG study (Ziprasidone Experience in Schizophrenia in Germany/Austria) investigated the effectiveness of ziprasidone as measured by discontinuation rates and mean changes of the BPRS total. Secondary objectives included quality of life, subjective well-being, tolerability, and safety. SUBJECTS AND METHODS: Two hundred and seventy-six subjects with schizophrenia and schizoaffective disorder were treated within an open-label, 12-week, prospective, flexible-dose observational trial of ziprasidone (40-160 mg/day). Baseline and outcome assessments mainly included Brief Psychiatric Rating Scale (BPRS), Clinical Global Impressions Scale (CGI), Short-Form 12 (SF-12), and Subjective Well-being under Neuroleptic treatment (SWN-K). RESULTS: Study discontinuation due to any cause was evident in 58% of subjects, most of them within the first 4 weeks after study initiation. In study completers, ziprasidone was associated with improvements in BPRS total (44.8 to 33.6; p<0.001), CGI, SF-12, and SWN-K total scores (80.5 to 89.5). Ziprasidone was related to reduction of weight, fasting glucose, and serum lipids. No cardiovascular adverse event or significant increase of the QTc interval was observed. DISCUSSION AND CONCLUSION: Approximately 60% of subjects discontinued ziprasidone prematurely, probably related to an initial and overall underdose. The present study confirmed previous tolerability and safety data of ziprasidone as well as results of its effectiveness. Independent from reason to switch, previous antipsychotic class, and severity of illness at baseline, the recommended starting dose of 80 mg/day as well as the maximum treatment dose of 160 mg/day may not be sufficient for a selected subgroup of patients.

Adolescent↗
PubMed2006

Constructing an Index for the Subjective Well-being Under Neuroleptics scale (SWN), short form: applying structural equation modeling for testing reliability and validity of the index.

Structural equation modeling (SEM) has been widely used in psychology and sociology for testing validity of measurement instruments. However, this statistical technique has so far played minor role in quality-of-life research. The main objective of this paper is to demonstrate the potential of SEM for constructing and testing the validity of a Subjective Well-being under Neuroleptics (SWN) index for patients with schizophrenia. For these purposes, data from the GEO study (Gesundheitsökonomische Evaluation von Olanzapin in Deutschland; Health economics study of olanzapine in the treatment of schizophrenia in Germany) were used. The GEO is a prospective, comparative, noninterventional, observational study. A total of 646 participants treated with either olanzapine (n = 416) or haloperidol (n = 230) were enrolled in the study; 360 patients were available for factor analyses. The short (20-item) form of the SWN scale was administered to assess patients' perspectives on their quality of life. The structural equation models (SEMs) were then applied to construct 5- and 10-item indexes based on SWN. The data indicate that the 5-item index is the most time-saving approach for evaluating perceptions of well-being (and thus, quality of life) among patients with schizophrenia. The application of SEM showed no appreciable loss of validity of this index.

Adult↗
PubMed2006

Hypothalamic-pituitary-adrenocortical axis activity: a target of pharmacological anticraving treatment?

BACKGROUND: An association between the activity of the hypothalamic-pituitary-adrenocortical (HPA) axis and alcohol intake behavior is currently discussed. We examined the relationship between efficacy of pharmacological anticraving treatment and HPA axis activity in the relapse prevention treatment of alcoholism. METHODS: In 160 patients suffering from alcoholism, we measured plasma adrenocorticotropic hormone (ACTH) and cortisol during placebo-controlled relapse prevention treatment with naltrexone and/or acamprosate. RESULTS: In the placebo group, ACTH and cortisol decreased during early abstinence. Treatment with naltrexone and acamprosate prevented this course. Increased ACTH and cortisol during treatment was associated with a reduced risk of relapse. CONCLUSIONS: These findings suggest that heightened HPA responsiveness might contribute to relapse-preventing effects of anticraving compounds in alcoholism.

Acamprosate↗
PubMed2006

Everyday memory functioning in obsessive- compulsive disorder.

Memory performance in obsessive-compulsive disorder (OCD) is discussed as a pathogenetic risk factor for the emergence of OCD, particularly checking compulsions. At present, however, findings are mixed and little is known about memory performance in tasks relevant to everyday functioning in patients with OCD. For the present study, memory performance was assessed in 31 patients diagnosed with OCD and 33 healthy controls with the Rivermead Behavioural Memory Test (RBMT), which covers a wide range of verbal and nonverbal memory components as well as prospective memory. OCD patients performed comparably to healthy controls on the memory task for verbal, nonverbal, and prospective memory (p > .1). According to norm values, memory performance was unimpaired in most OCD patients. The present findings further challenge a broad account of the "memory deficit" hypothesis of OCD and compulsive checking, respectively.

Activities of Daily Living↗
PubMed2006

[Treatment resistant schizophrenia, residual subtype: symptom improvement after additional treatment with amisulpride].

BACKGROUND: Therapy resistant, severe residual schizophrenia poses major challenges for the psychiatric pharmacological treatment. METHOD: We report about a 44-year old schizophrenic male who has been detained in a closed forensic ward for 10 years, following a conviction in one manslaughter case. Despite various pharmacological treatment efforts severe residual schizophrenia remained. RESULT: Adding Amisulpride to the ongoing treatment with Olanzapine achieved a noticeable improvement of symptoms, resulting in the possibility of relaxing imprisonment conditions. CONCLUSION: A combination of Amisulpride and Olanzapine seems to be effective in treating severe residual schizophrenia.

Adult↗
PubMed2006

Is quality of life among minimally symptomatic patients with schizophrenia better following withdrawal or continuation of antipsychotic treatment?

This secondary report from our 52-week, double-blind, relapse prevention trial tested whether stable patients with schizophrenia who were taken off active drug treatment would experience greater improvements in long-term quality of life than those who were continued on antipsychotic treatment. On average, Heinrichs-Carpenter Quality-of-Life Scale total scores improved by 4.3 +/- 10.6 points during treatment with olanzapine (10-20 mg/d; n = 212), but decreased by 7.1 +/- 14.6 points during treatment with placebo (n = 92; P < 0.001). Mean Quality-of-Life Scale total scores worsened in both treatment groups for the relapsing patient subgroup, whereas for nonrelapsing patients, those treated with olanzapine had significantly improved mean Quality-of-Life Scale total scores compared with those given placebo. For a subset of nonrelapsing patients who were considered "nonexacerbating" on the basis of minimal non-clinically relevant increases in psychopathology, Quality-of-Life Scale total mean change was no better (P = 0.066) for those given placebo (2.7 +/- 11.0; n = 40) than those treated with olanzapine (5.7 +/- 8.9; n = 174). Path analysis indicated a direct effect of treatment (approximately 29%) on quality of life that was not accounted for by differential changes in psychopathology. In conclusion, stable patients with schizophrenia who were taken off active drug treatment experienced no greater improvements in long-term quality of life than those who were continued on antipsychotic treatment, even in the absence of psychotic symptoms.

Adolescent↗
PubMed2006

Childhood trauma and dissociation in female patients with schizophrenia spectrum disorders: an exploratory study.

The few studies that have investigated the relationship between trauma and dissociative symptoms in patients with schizophrenia have not assessed the role of the severity of psychotic symptoms. The current study examined correlations among five domains of childhood trauma and dissociative symptoms in 30 female patients with schizophrenia spectrum disorders, using the Dissociative Experiences Scale and the Childhood Trauma Questionnaire. Psychotic symptoms were measured by the Positive and Negative Syndrome Scale. Consistent with previous studies, high levels of childhood traumatic experiences were found (Childhood Trauma Questionnaire total score M = 48.5, SD = 18.3). Physical neglect and emotional abuse showed significant correlations with dissociative symptoms at admission. When patients were stabilized, about a month after admission, emotional abuse still showed a significant correlation with dissociative symptoms. However, in contrast to previous findings, Dissociative Experiences Scale findings were not stable over time. Our results confirm the relevance of childhood trauma in schizophrenic patients but also demonstrate the need to develop appropriate methodologies for measuring dissociation in this population.

Adolescent↗
PubMed2006

Characterization of the facial expression of emotions in schizophrenia patients: preliminary findings with a new electromyography method.

OBJECTIVE: We investigated facial expression of emotions (FEE) in schizophrenia patients, using an improved and highly selective facial electromyography (EMG) method, and we examined the correlation between FEE and psychopathology. METHOD: We compared unmedicated patients with schizophrenia (n = 32) with healthy subjects (n = 21) with regard to the activity of 3 joy-relevant facial muscles (the M.zygomaticus, the M. orbicularis oculi, and the M.levator labii). Emotions were induced by pictures from the International Affective Picture System. We measured previsible muscle activity with a new, highly selective facial EMG. We used the Positive and Negative Syndrome Scale to evaluate psychopathology. RESULTS: Patients with schizophrenia showed fewer joy or smile reactions than did control subjects and displayed decreased activity of the M.orbicularis oculi and M.zygomaticus under presentation of positive pictures. Reduced activity of these muscles can be caused by depression. Increased activity of the M. levator labii correlates with positive symptoms. CONCLUSIONS: Our findings indicate that psychopathological syndromes correlate with schizophrenic mimic disturbances. These results can be used to compare various antipsychotics with regard to their influence on mimic disturbances.

Adult↗
PubMed2006

The relationship between quality of life and clinical efficacy from a randomized trial comparing olanzapine and ziprasidone.

OBJECTIVE: To examine treatment-specific changes in health-related quality of life (QOL) among patients with schizophrenia and to assess the association between clinical and QOL improvement. METHOD: This post hoc analysis used the findings of a 28-week, randomized, multicenter trial of patients with schizophrenia (DSM-IV) treated with olanzapine (10-20 mg/day) or ziprasidone (80-160 mg/day). Data were collected from August 2001 to December 2002. Efficacy was measured using the Positive and Negative Syndrome Scale (PANSS). Quality of life was assessed with the generic health self-administered Medical Outcomes Study Short-Form 36-Item Health Survey (SF-36) and the disease-specific expert-administered Heinrichs-Carpenter Quality of Life Scale (QLS). Mixed-effects-repeated-measures and last-observation-carried-forward approaches were used to assess the effects of treatment on QOL and the association of clinical outcomes to QOL outcomes. RESULTS: Olanzapine- and ziprasidone-treated patients demonstrated similar improvement from baseline to endpoint on the SF-36 and QLS. All correlations between changes in PANSS scores and the SF-36 were significant (p < .001), ranging from -0.159 to -0.400. All correlations between changes in PANSS scores and the QLS were significant (p < .0001), ranging from -0.286 to -0.603. The correlations between the 2 QOL measures were generally significant but small to moderate in magnitude. CONCLUSIONS: The results of this study indicate that, in patients with schizophrenia, olanzapine and ziprasidone treatment are associated with significant QOL and clinical improvements. Further, the significant correlation between change scores on the PANSS and QOL measures suggests that treatment-related clinical improvements are associated with improved health-related and disease-specific QOL. CLINICAL TRIALS REGISTRATION: ClinicalStudyResults.org identifier 2347.

Antipsychotic Agents↗
PubMed2006

Prediction of remission as a combination of symptomatic and functional remission and adequate subjective well-being in 2960 patients with schizophrenia.

OBJECTIVE: Recently, the Remission in Schizophrenia Working Group proposed symptomatic remission criteria and pointed to the lack of data regarding functional remission and quality of life in schizophrenia. This post hoc analysis of data from German patients in the Schizophrenia Outpatient Health Outcomes study assessed rates and predictors of symptomatic and functional remission as well as adequate subjective well-being/quality of life in a large cohort of patients with schizophrenia. METHOD: Data were collected in an observational 24-month follow-up study of 2960 patients with DSM-IV-defined schizophrenia recruited between January and December 2001. Complete remission required that patients achieved symptomatic remission mirroring the Remission in Schizophrenia Working Group criteria, functional remission, and a level of adequate subjective well-being over at least 6 months. RESULTS: At endpoint, 47.2% of the patients achieved symptomatic remission, 26.6% achieved functional remission, and 42.2% achieved adequate subjective well-being. At endpoint, 12.8% were in complete remission. In 35.1% of patients, none of the 3 remission criteria were achieved. Only 8.7% of early nonremitted cases achieved remission at endpoint. Each single remission component as well as complete remission was mainly predicted by early remission within the first 3 months. First-line treatment with atypical antipsychotics increased the likelihood of complete remission compared to conventional antipsychotics. CONCLUSIONS: Despite advances in pharmacologic and psychosocial treatments in schizophrenia, close to 90% of the patients in this study did not fulfill the combined remission criteria. This was in part attributable to the low functional remission rate, particularly the low employment rate. The finding that the course of the disorder depends on early outcome not only in previously untreated but also in more chronically ill patients points toward a critical "window of opportunity" in the course of treatment.

Adult↗
PubMed2006

The impact of subjective well-being under neuroleptic treatment on compliance and remission.

The patients' perspective of antipsychotic treatment was largely neglected for a long period. It has only been during the last 10 years, with the development of atypical antipsychotics, that scientific interest in this issue has markedly increased. Numerous studies have shown that the majority of schizophrenic patients are able to fill out a self-rating scale in a meaningful way, and several self-report scales with sufficient internal consistency and good construct validity have been developed. The effects of antipsychotic treatment on psychopathology and on subjective well-being (SW) are not strongly related; the perspectives of the patient and his/her psychiatrist markedly differ. Recent research indicates that SW/quality of life, much more improved by atypical than by typical antipsychotics, has a strong impact on compliance, as well as on the chance of achieving remission. The data strongly suggest that a systematic evaluation of the patient's perspective of antipsychotic treatment is meaningful and necessary to increase compliance, functional outcome, and long-term prognosis.

Antipsychotic Agents↗
PubMed2005

Influence of atypical neuroleptics on executive functioning in patients with schizophrenia: a randomized, double-blind comparison of olanzapine vs. clozapine.

Accepted clinical evidence suggests superior efficacy of novel antipsychotics in the treatment of cognitive symptoms in schizophrenia. Whether this constitutes a primary drug effect or a secondary effect due to easing extrapyramidal side-effects or improving positive symptoms when converting from a first- to a second-generation neuroleptic is still open to debate. Long-term efficacy as well as differential drug effects on cognitive performance are also poorly documented. We therefore compared cognitive performance of olanzapine vs. clozapine treatment in a controlled, randomized, double-blind trial. Fifty-four patients were assessed following a 2- to 9-day washout and again after 4 and 26 wk of neuroleptic treatment. Patients were rated on the PANSS for psychopathological changes, extrapyramidal side-effects were assessed on the Simpson-Angus Scale, and cognitive performance was assessed with the Stroop, Wisconsin Card Sorting and the Tower of London tests. Schizophrenia symptoms, extrapyramidal side-effects and cognitive performance improved significantly in the course of either drug treatment. Stroop test performance and Tower of London planning time improved significantly over 26 wk compared to baseline and 4-wk follow-up assessment while Wisconsin Card Sorting and Tower of London execution time improved significantly after 4 wk with no further improvement after 26 wk. Improved executive function was not related to improving positive symptoms and easing extrapyramidal side-effects, thus indicative of a primary treatment effect of either antipsychotic. However, Stroop reaction time improved with olanzapine while clozapine had a stronger effect on improving negative symptoms, thus suggestive of a differential drug effect.

Adult↗
PubMed2005

The facial pattern of disgust, appetence, excited joy and relaxed joy: an improved facial EMG study.

The purpose of the study was to investigate the facial muscle pattern of disgust in comparison to appetence and joy, using an improved facial EMG method. We analyzed the activity of nine facial muscles in forty healthy subjects. The subject group was randomly divided into two groups (oversaturated vs. hungry) of ten women and ten men each. Four different emotions (disgust, appetence, excited-joy and relaxed-joy) were induced by showing pictures from the IAPS. Pre-visible facial muscle activity was measured with a new facial EMG. A Visual Analog Scale (VAS) was established. Disgust is represented by a specific facial muscle pattern involving M.corrugator and M.orbicularis oculi, clearly distinguishing it from the facial patterns of appetence and joy. The intensity of disgust is stronger in a state of hunger than under oversaturation and is altogether stronger in females than in males. Our findings indicate the possibility to explore the entire emotion system successfully through a state-of-the-art psychophysiological method like our EMG device.

Adult↗