Search PubMed⌕ Search

Biomedical subjects

E Klieser

Publications and source records attributed to E Klieser.

At least 37 records · Page 2Linked to original sources
PubMed1995

Fluoxetine in patients with major depressive disorder--a responder analysis.

Fluoxetine is a selective serotonin re-uptake inhibitor and thus being a specific antidepressant has its specific responder. In order to attempt a differential description of fluoxetine responders we collected data of 219 patients with major depressive disorder (MDD; DSM-III R) in an open multicenter (phase IV) study, which were further subclassified. According to the treatment plan, these patients were to be treated with 20 mg fluoxetine daily for a period of five weeks. CGI, HAMD, SDS, undesired side effects, laboratory and physiological variables were recorded at weekly intervals. Predictors for response were searched for by means of discriminatory analysis. The stability of the relations found was verified in two randomized halves of the data. It was found that those patients are probably good responders who at base-line have a high Covi anxiety score, but who according to Raskin score, self-assessment of depression (SDS), and CGI are not particularly severely depressed and show a relatively favorable therapeutic response in the first week of treatment.

Adolescent↗
PubMed1995

[Interaction of therapeutic effects and side effects in drug therapy of generalized anxiety disorders with low dosage fluspirilene].

The present study was designed to investigate the interaction between therapeutic effects and side-effects in fluspirilene treatment of generalised anxiety disorders (GAD). 205 outpatients received in an open trial 1.5 mg fluspirilene per week for 6 weeks. Confirming previous reports of our study group fluspirilene demonstrated marked efficacy and was generally well tolerated. However, the main finding of our study is that side effects, although rare in fluspirilene treatment, predict an unfavourable clinical outcome. This phenomenon is integrated in a psychological model implying that when GAD patients are aware of side-effects this induces anxiety. Again anxiety gives rise to somatic symptoms, both interacting in a forward loop. In conclusion, our data suggest that in the sense of Heinrich (1988) fluspirilene treatment of GAD should be guided by paying attention to possible side effects.

Adolescent↗
PubMed1995

[The atypical neuroleptic clozapine (Leponex)--current knowledge and recent clinical aspects].

The dibenzoepine derivative clozapine is seen as a prototype of an atypical neuroleptic, because clozapine has good antipsychotic efficacy but only minimal dopamine antagonistic properties in common animal paradigms. The latter is reflected by the observation that extrapyramidal symptoms during clozapine are a rare phenomenon. Furthermore, recent studies in the USA demonstrated a superior efficacy of clozapine in schizophrenic patients who are nonresponsive to classic neuroleptics. Therefore, the introduction of clozapine in the USA was performed in 1990 despite the well-known risk of agranulocytosis (1-2% during the first year of treatment); however, under restricted conditions regarding the mandatory weekly control of the white blood cell count. For the use of clozapine in Europe, it should be underlined that in 1992 the indication was restricted to "acute and chronic forms of schizophrenia" whereas formerly it was permitted to treat several other neuroleptic resistant syndromes with clozapine, e.g. severe psychotic excitement, aggressive behavior or manic or atypical psychosis. The usage of clozapine in these indications is now only permitted under the restricted legal conditions of a "therapeutic trial" in selected patients. However, several indications for which clozapine has been used successfully in Europe are currently re-investigated in the USA, hopefully leading to a redefinition and extension of the indication spectrum. On the other hand, the American multicenter trials lead to the conclusion that the treatment with clozapine is not furthermore the treatment of last choice but a serious therapeutic alternative which should be available for all schizophrenic patient in case of neuroleptic resistance or of severe side effects of standard neuroleptics. Clozapine treatment leads to an improvement of the quality of life in one third of these schizophrenics and, moreover, results in a marked reduction of costs mainly by reducing the rehospitalisation rates. On the other hand, the list of well-known side effects of clozapine (e.g. agranulocytosis, increased risk of seizures, initial sedation) has to be extended (e.g. transient leucocytosis or eosinophilia, rare but severe complications like cardiorespiratory arrest and "sudden death" during combination with benzodiazepines, case reports of pericarditis, pancreatitis or polyserositis). On the background of possible cardiorespiratory complications we recommend to start the first treatment with clozapine in high risk patients (e.g. those in older age or in case of organic brain impairment) only in restricted indications and only in centers with sufficient clozapine experience.

Clozapine↗
PubMed1995

[Differential pharmacologic therapy of generalized anxiety disorders--results of a study with 30 individual case experiments].

In pharmacotherapy of generalized anxiety disorders (GAD) different psychopharmacological agents (neuroleptics, diazepines, antidepressants) proved to be effective. However, there is a lack of predictors of therapeutic response. The present study was designed to address this question in 30 patients with treatment refractory GAD (12 male, 18 female). Amitriptyline 30 mg/d, flupentixol 1.5 mg/d, clotiazepam 15 mg/d, and placebo were administered double-blind and randomly. Each agent was given 4 times for one week. To avoid carry-over effects, all treatment weeks were interrupted by one week's wash-out periods. Thus each single-case experiment comprised 31 weeks. Primary efficacy criterion was Hamilton total score at the end of each treatment week. Statistical analysis (U-test) showed that in 19 patients one agent was significantly (p < 0.05) superior to the other substances (clotiazepam n = 11, flupentixol n = 3, amitriptyline n = 5). Placebo was not superior in any of these 30 patients. There was no significant difference between the drugs in 11 patients. However, metaanalysis showed that in chronic GAD, by means of single-case experiments, differences in efficacy between different drugs can be found (p < 0.01). ANOVA showed no drug x time interaction.

Adult↗
PubMed1995

Randomized, double-blind, controlled trial of risperidone versus clozapine in patients with chronic schizophrenia.

This study compares the antipsychotic efficacy and the tolerability of risperidone and clozapine in patients with schizophrenia. Patients were randomized to double-blind treatment with risperidone, 4 mg (N = 20), risperidone, 8 mg (N = 19), or clozapine, 400 mg (N = 20), daily for 28 days. Efficacy was assessed by improvement of psychotic symptoms, measured on the Brief Psychiatric Rating Scale, and Clinical Global Impression. The tolerability was assessed by the Simpson and Angus scale for extrapyramidal side effects (EPS), the Association for Methodology and Documentation in Psychiatry (AMDP) scale for somatic side effects, spontaneous reports of adverse events, clinical laboratory assessments, and vital signs. All treatments reduced psychotic symptoms. The global tolerability was significantly better in the risperidone than in the clozapine-treated patients (p < 0.01). There were no differences between treatments on the AMDP scale. The most frequent spontaneously reported adverse effects were dizziness, fatigue, accommodation disturbance, and EPS in all treatment groups and increased salivation, mainly in the clozapine-treated patients. Although there were no changes in vital signs during risperidone treatment, clozapine was associated with a mean reduction in heart rate of 10 beats/minute. Risperidone tolerability at endpoint was classified as "very good" by 60 and 47% of patients treated with risperidone, 4 and 8 mg daily, respectively; the corresponding figure in clozapine-treated patients was 30%. The results suggest that risperidone is at least as effective as an antipsychotic as clozapine, providing a valuable new approach for the treatment of schizophrenia.

Adult↗
PubMed1994

[Therapy of depression].

Somatic treatment and psychotherapy are available for the treatment of depressive episodes. Regarding the side-effect profile, tetrazyclic antidepressants, selective serotonin reuptake inhibitors and selective MAO inhibitors are recommended as therapy of first choice. In less severe cases phytopharmaca and major tranquilizers in low dosage are possible alternatives. In case of resistance to therapy with high subjective strain electroconvulsive therapy may be indicated. Psychotherapy can also be applied as treatment of first choice. The cognitive behavioural therapy intends a normalization of activity rate, cognitive attitude and social competence, which are characteristically changed in depressives. The combination of drug therapy with psychotherapy has no clear advantage over monotherapy, but it possibly reduces the relapse rate.

Antidepressive Agents↗
PubMed1994

Risperidone versus clozapine in the treatment of schizophrenic patients with acute symptoms: a double blind, randomized trial.

1. In order to verify the hypothesis that risperidone is a useful therapeutic alternative to clozapine the authors carried out a randomized double blind trial in 59 patients with paranoid hallucinatory psychoses. 2. In a treatment lasting 28 days three groups of patients received either 4 mg risperidone (N = 20), 8 mg risperidone (N = 19), or 400 mg clozapine (N = 20) daily. 3. The tolerance of 4 mg risperidone was globally assessed as being better than that of 400 mg clozapine. Drop-outs under clozapine were mostly caused by side effects, whereas under risperidone they tended to occur for therapeutic inefficacy. 4. The antipsychotic effect was highly significant and clinically relevant under both risperidone and clozapine.

Acute Disease↗
PubMed1994

The tolerability and efficacy of the atypical neuroleptic remoxipride compared with clozapine and haloperidol in acute schizophrenia.

Remoxipride and clozapine are new neuroleptics that are thought to be superior to the substances in use by their efficacy and tolerance. At the University Clinic of Psychiatry in Düsseldorf a double-blind study with 54 patients diagnosed as schizophrenic in accordance with DSM-III was conducted to record the influence of the neuroleptics remoxipride, clozapine and haloperidol on schizophrenic psychosis. The schizophrenic symptoms were rated by the AMDP-system (Arbeitsgemeinschaft für Methodik und Dokumentation in der Psychiatrie), Brief Psychiatric Rating Scale and the Clinical Global Impression on days 0, 7, 14, 21 and 28 of treatment to evaluate the degree of change in psychopathology. The tolerance of the neuroleptic treatment was checked by the doctor's overall impression and the somatic findings of the AMDP-system. All 3 neuroleptics reduced the schizophrenic symptoms to a similar degree but showed differentiation as to their side effects.

Adult↗
PubMed1993

Initial improvement as a criterion for drug choice in acute schizophrenia.

Several investigators have found that the initial improvement of acute schizophrenia after some days of neuroleptic treatment is correlated in a statistically significant way to the outcome after four weeks. In all these studies the question arises as to whether the correlation between early response and subsequent outcome is due to a specific response to a certain neuroleptic, or whether patients who respond early simply have a better prognosis. In order to isolate the specific drug effect from prognostic influences we performed a controlled double-blind study in 50 newly admitted schizophrenic inpatients. All patients were treated over three days with 15 mg haloperidol i.v., following which they were classified as 'early responders (ER)' (markedly improved or improved) or as 'early nonresponders (EN)' and then randomly assigned to group 1 (3 x 5 mg haloperidol p.o./d) or to group 2 (3 x 100 mg perazin p.o./d). If there was a specific drug effect on the correlation between early response and subsequent outcome a therapeutic superiority of perazin in EN and no superiority in ER was expected. Independently of the treatment condition the mean BPRS score had decreased from 61.2 (Sx = 12.1) to 38.1 (Sx = 13.9) at the end of the study. ER and EN were evenly distributed in the haloperidol and perazin group. The analysis of variance revealed no significant interactions of the factors 'treatment condition' x 'duration' x 'early response' (p = 0.27) and 'treatment condition' x 'early response' (p = 0.88) on the outcome (BPRS, CGI). This means that the initial hypothesis of this study has to be rejected.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

[Possibilities in therapy of anxiety disorders in DSM-III-R].

Between 2% and 5% of the population are affected by anxiety disorders. Several studies have shown that imipramine possesses anti-panic and anti-phobic properties. Its response rate is at least 70%. In panic disorder with agoraphobia it is therefore the medication of first choice. Agoraphobia, simple and social phobias are highly responsive to behavioural therapy (desensitization, flooding, social skills training, cognitive restructuring). Drugs have not been found useful in controlled studies. In conjunction with the tricyclic antidepressant clomipramine, behavioural therapy is superior to other psychotherapeutic strategies in the treatment of obsessive-compulsive disorders. Patients suffering from posttraumatic stress disorders require first of all supportive psychotherapy. Pharmacological treatment is of limited value. Neuroleptics, benzodiazepines, sedating antidepressants and beta-blockers are the most appropriate agents for the treatment of generalised anxiety disorders. In addition to that, intense psychotherapy and relaxation techniques should be applied. Further research should address the question of relapse rates after termination of therapy and the elaboration of therapeutic strategies that take individual psychopathology into consideration.

Anxiety Disorders↗
PubMed1992

[Disagreement in standardized haloperidol treatment in comparison with "adequate individual dosage" of acutely schizophrenic patients].

Experimental double-blind trials were performed to establish whether individual neuroleptic treatment of acute schizophrenic disorders is more effective and has fewer side effects than standard therapy. For this purpose, a group of 30 patients was treated with 10 mg haloperidol/day for 14 days, while a further group of 30 patients receined 20 mg haloperidol/day for the same period. Thirty patients in a third group were treated for 14 days with an individual haloperidol dose that was matched to the psychopathological findings. Allocation of the patients to the treatment groups was done on a random basis. In the individually treated group the dosage was determined by a senior psychiatrist at the hospital who was not involved in collecting the data of the investigation; neither the nursing staff nor the physicians involved in thus study were informed of the dosages. The psychological findings were recorded by means of the BPRS and the global assessment of the physician (CGI) on days 0, 7, and 14. The extrapyramidal side effects were established with the aid of the Simpson scale on days 0, 7, and 14. No superiority of the individually matched treatment over standardized treatment was demonstrated, either for the therapeutic target parameters or for the side effects. On the contrary, the groups treated with fixed doses were found to exhibit somewhat better results. These findings are discussed with respect to their significance for treatment.

Acute Disease↗
PubMed1991

Psychotropic effects of ritanserin, a selective S2 antagonist: an open study.

The efficacy of the S2-antagonist ritanserin has not yet been clarified satisfactorily. In an open indication finding study to generate new hypotheses concerning its possible therapeutic application carried out in the psychiatric university clinic 25 patients (10 patients with vitalized neurotic depression (ICD No. 296.1), 7 with florid depressively tinged schizophrenia (ICD No. 295.3)) were treated with an average of 15.5 mg/day of ritanserin for a period of 4 weeks. Alterations in the psychopathological findings were documented by means of the Brief Psychiatric Rating Scale (BPRS), the Hamilton Depression Scale (HAMD), the Hamilton Anxiety Scale (HAMA), and the psychopathological findings (page 4) of the AMDP system. The results suggest that ritanserin improves depressive rather than schizophrenic symptomatology. In 4 of the 7 schizophrenic patients of our study an intensification of the psychotic symptomatology could even be observed. On the basis of our open study findings ritanserin could be classified as a substance with antidepressive effects, with a low incidence of side-effects and a rapid onset of action. In placebo controlled clinical studies this indication should be examined in different patient groups.

Adult↗
PubMed1991

[Effectiveness of neuro-electric therapy in drug resistant endogenous psychoses].

A retrospective chart review of 50 pharmacotherapeutically resistant patients was performed after treatment with NET in 1986-1988. 28 patients suffered from schizophrenia and 22 from affective psychosis. In contrast to literature where NET as therapy of first choice has favourable results in depression in this study 60.7% of the treatment resistant acute schizophrenics responded well to NET. 3 months after discharge from hospital 9 schizophrenics (32.1%) but only 3 patients with affective psychosis (13.6%) presented a 'good' outcome (full remission). A longer duration of schizophrenia (more than 5 years since first manifestation) and a good response to neuroleptics in history was predictive for a good actual NET response (14 of 17 patients), whereas 7 of 11 patients suffering from schizophrenia less than 3 years without any period of full remission on neuroleptics were also non-responders to NET.

Adult↗
PubMed1991

[Kleine-Levin syndrome].

The Kleine-Levin syndrome is generally considered to be a benign functional disorder of hypothalamic structures. Its onset is usually in adolescence. The most characteristic symptoms are periodic hypersomnia, excessive eating, hypersexuality, irritability and apathy. Associated features are depressive and schizophrenic symptoms. A biological relationship between the Klein-Levin syndrome and endogenous psychoses is discussed.

Adolescent↗
PubMed1991

[Kleine-Levin syndrome].

The Kleine-Levin syndrome is generally considered to be a benign functional disorder of hypothalamic structures. Its onset is usually in adolescence. The most characteristic symptoms are periodic hypersomnia, excessive eating, hypersexuality, irritability and apathy. Associated features are depressive and schizophrenic symptoms. A biological relationship between the Kleine-Levin syndrome and endogenous psychoses is discussed.

Disorders of Excessive Somnolence↗
PubMed1991

[Double-blind comparison of 3 x 75 mg zotepine und 3 x 4 mg haloperidol in acute schizophrenic patients].

To assess the efficiency/risk ratio, fixed doses of zotepine and haloperidol were compared by means of a double-blind study in acute schizophrenics over a 4-week period. The assessment tools were BPRS, CGI, and the Simpson-Angus scale for the extrapyramidal disturbances, and a free report on side effects. No differences between the groups were found in respect of efficacy. According to the Simpson-Angus scale, the patients who had been treated with zotepine achieved better values, this being a general trend. There were significant differences according to the free report on side effects. Especially at onset of treatment, the patients treated with zotepine complained of tiredness. Partly marked extrapyramidal disturbances were seen in the patients who had been treated with haloperidol.

Acute Disease↗