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Biomedical subjects

G Hajak

Publications and source records attributed to G Hajak.

At least 19 recordsLinked to original sources
PubMed2006

[Depressive patients in primary care].

The study aimed at investigating out-patient treatment of patients with depressive disorders referred to a psychiatric hospital by general practitioners (GP) and psychiatrists in private practice (PP). Data of the German psychiatric basic documentation system (DGPPN-BADO) of all depressive inpatients admitted to a psychiatric hospital in 2003 were analysed (n = 360). GP-patients had significantly less often a psychopharmalogical treatment before admission than PP-patients (59.4% vs. 89.7%). GP give significantly less often antidepressive drugs than PP do (53.1% vs. 87.9%). 4,7% of GP-patients and 17.9% of PP-patients received supportive psychotherapy, special psychotherapeutic treatment regimes were seldom in use during outpatient care (4,7% vs. 5,4%).

Antidepressive Agents↗
PubMed2006

Structural brain alterations following 5 days of intervention: dynamic aspects of neuroplasticity.

Activation-dependent brain plasticity in humans on a structural level has been demonstrated in adults after 3 months of training a visio-motor skill. The exact timescale of usage-dependent structural changes, whether days, months, or years, is, however, still debated. A better understanding of the temporal parameters may help elucidate to what extent this type of cortical plasticity contributes to fast adapting cortical processes that may be relevant to learning and effects of treatments. Using voxel-based morphometry, we are able to show that repetitive transcranial magnetic stimulation delivered to the superior temporal cortex causes macroscopic cortical changes in gray matter (GM) in the auditory cortex as early as within 5 days of continuous intervention. These structural alterations are mirrored by changes in cortical evoked potentials attributed to the GM changes and demonstrate the rapid dynamics of these processes, which occur within a time range characteristic for the onset of behavioral effects induced by a variety of treatment methods for neuropsychiatric diseases. Our finding suggests that cortical plasticity on a structural level in adult humans is already detectable after 1 week, which provides support for fast adjusting neuronal systems, such as spine and synapse turnover, and contradicts slow evolving mechanisms, such as neuronal or glial cell genesis.

Adult↗
PubMed2006

[Depression, a widespread disease. Epidemiology, care situation, diagnosis, therapy and prevention].

According to a WHO study depressive disorders are the worldwide leading cause for life years lived with disability. Beside the direct costs of care, enormous indirect costs are caused by disablement and permanent incapacity to work. Furthermore, depressive disorders are often accompanied by suicidal behaviour, and they increase the mortality rate due to cardiovascular disorders. Despite their outstanding importance, there is a huge need to optimize diagnostic and therapeutic procedures in primary care, because depression is often masked by somatic symptoms. To achieve a correct diagnosis, the medical practitioner must actively explore the core criteria of depressed mood, diminished interest and pleasure, as well as fatigue and loss of energy. Improvement of early recognition and treatment of depressive patients is thus the main objective of modern awareness programs such as the "German Alliance against Depression", which was established in the framework of the German Research Network on Depression and Suicidality.

Cardiovascular Diseases↗
PubMed2006

[Stability of the "amok runner syndrome"].

BACKGROUND: Running amok is considered a rare but dangerous act of violence which has been investigated predominantly on a case by case basis. German-wide data on amok cases covering the decades 1980 - 1989 and 1991 - 2000 were used to perform the first epidemiological study world-wide on the stability of socio-demographic, criminological and psychiatric variables of amok behaviour. METHODS: A content analysis study on nation-wide press reports of amok cases included a total of 104 subjects who were identified by combined homicidal-suicidal acts of violence and fulfilled structured criteria originally defined according to former Malayan amok events. RESULTS: Amok cases in both decades were comparable except for the significant increase of weapon use, especially of firearms. Total prevalence showed a tendency to decline from 1 : 5.5 million to 1 : 8.5 million men per year, females were involved in rare single cases only. The male offenders showed a bimodal age distribution with a mean of 35 years. They were professionally well qualified, but had a 5 - 7fold higher risk of unemployment than the normal population. Motives and reasons for running amok were serious but not unusual, they varied widely and addressed all areas of daily life. Most offenders were characterized by abnormal personality patterns such as passive, aggressive, impulsive and paranoid and were in possession of firearms and previously convicted. Psychiatric diseases such as psychosis, paranoia, depression or personality disorders were present in more than 50 % of cases; further 20 % were intoxicated. The presence of psychiatric disorders influenced patterns of violent behaviour in individual subjects. Victims were predominantly unknown to the offenders. Close to one third of the amok runners committed suicide or were killed by legal authorities. CONCLUSION: Amok represents a temporarily stable syndrome of extreme violent behaviour even in modern industrialized societies. Subjects exhibit a complex combination of serious causative motives, social burden and psychiatric diseases which do not explain common causes of amok rather than the origin of amok behaviour in individual cases. Amok joins the wide spectrum of human homicidal-suicidal acts which show similarities in many aspects.

Adult↗
PubMed2006

[Treatment of chronic tinnitus with neuronavigated repetitive Transcranial Magnetic Stimulation (rTMS)].

BACKGROUND AND OBJECTIVE: Idiopathic tinnitus is a frequent and debilitating disorder of largely unknown pathophysiology. Focal brain activation in the auditory cortex has recently been demonstrated in chronic tinnitus. Low-frequency rTMS can reduce cortical hyperexcitability. PATIENTS AND METHODS: In 12 patients with chronic tinnitus, fusion of [18F]deoxyglucose-PET and structural MRI (T1, MPRAGE) scans allowed the area of increased metabolic activity in the auditory cortex to be exactly identified; this area was selected as the target for rTMS. A neuronavigational system adapted for TMS positioning enabled the relative positions of the figure-8 coil and the target area to be monitored. Repetitive TMS (110% motor threshold; 1 Hz; 2000 stimuli per day over 5 days) was performed using a placebo-controlled crossover design. A sham coil system was used for the placebo stimulation. Treatment outcome was assessed with a specific tinnitus questionnaire (Goebel and Hiller). RESULTS: In all 12 patients an asymmetrically increased metabolic activation of the gyrus of Heschl was detected. The tinnitus score was significantly improved after 5 days of active rTMS, an effect not seen after placebo stimulation. CONCLUSION: These preliminary results show that neuronavigated rTMS may improve our understanding and treatment of chronic tinnitus.

Adult↗
PubMed2006

[How does recruit successfully recruit staff? An investigation of recruitment in the medical service].

In Germany, an increasing shortage of medical doctors has developed in recent years. Today, many clinics must compete to attract qualified MDs. In this study, 60 medical students, 60 doctors working in psychiatry, and 60 doctors working in somatic fields of clinical medicine were interviewed in order to analyse the importance that potential applicants place on the information and offers contained in advertisements seeking medical doctors. In this regard, good working atmosphere in the ward, excellent opportunities for further education, and assistance from nonmedical personnel in documentation and administration got the highest ratings. There were significant differences between psychiatrists and other doctors rating the items "own office" and "permission to take additional nonhospital jobs" such as providing medical opinions. The study shows how advertisements can be improved.

Advertising↗
PubMed2006

[The work of medical doctors on psychiatric wards: an analysis of everyday activities].

In Germany, the economic situation of psychiatric hospitals has markedly changed during the last years. Whilst the number of patients has steadily increased, many clinics considerably reduced the number of therapeutic staff due to an increasing lack of financial support. The German psychiatry personnel regulations act defines the number of therapeutic staff required for an adequate psychiatric treatment, but the requirements of this regulations act nowadays are widely missed in most of the German psychiatric hospitals. This severely affects the therapeutic work on psychiatric wards. This study analyses tasks and activities of medical doctors on psychiatric wards and compares the hours spent with various types of activities with the amount of time that should be spent according to the personnel regulations act. Results show that doctors spend much more time with documentation and administrative work than originally intended by the personnel regulations act. They compensate this mainly by a reduction of time spent in direct contact with the patients. In this context, the number of psychotherapy sessions as well as sessions with the patients' relatives has been considerably reduced, whereas the time spent for emergency intervention and basic treatment still corresponds to the calculations according to the personnel regulations act. All in all, the results show that a reduction of therapeutic staff in psychiatric hospitals directly leads to a change in treatment settings with a focus on less individual treatment options.

Documentation↗
PubMed2006

[Dual acting reuptake inhibitors in the treatment of depression and pain].

Pain is a common symptom in many somatic illnesses. Chronic pain can trigger affective disorders and anxiety states. But they can also be symptoms of mental disease, e.g. depression, without somatic cause. For this reason diagnosis of the underlying cause of pain can be very difficult in daily practice. Two neurotransmitters, serotonin and noradrenaline, play an important role not only in the pathophysiology of depression but importantly also as mediators in pain regulation. Thus antidepressants have for a long time been used in the treatment of chronic pain and depression. The newly available duloxetine is a drug with properties of both serotonin and noradrenaline re-uptake inhibition. This drug acts not only as an antidepressant but also reduces pain. It has been approved for the treatment of pain in diabetic neuropathy.

Adrenergic Uptake Inhibitors↗
PubMed2005

Correlation of subjective well-being in schizophrenic patients with gait parameters, expert-rated motor disturbances, and psychopathological status.

INTRODUCTION: Subjective well-being of schizophrenic patients can be impaired by symptoms of the disease and by adverse effects of antipsychotic medication. We assessed the correlations of subjective well-being with objectively measured gait parameters, expert-rated motor disturbances, and psychopathological status in 25 conventionally treated, 25 atypically treated, and 16 drug-naive patients. METHODS: Main variables were the SWN scores (Subjective Well-being under Neuroleptic Treatment Scale), the ESRS scores (Extrapyramidal Symptoms Rating Scale), and the PANSS scores (Positive and Negative Syndrome Scale). Gait parameters were determined by using an ultrasonic system for gait analysis. RESULTS: In conventionally treated patients, the SWN total score significantly correlated with stride length ( R(2) = 0.39; P < 0.01), whereas in atypically treated and drug-naive patients, it significantly correlated with the PANSS score (atypically treated: R(2) = 0.25, P < 0.05; drug-naive: R(2) = 0.64, P < 0.01), mainly due to the correlations with the "negative symptoms" and the "general psychopathology" sub-scores. Correlations with stride length were significant not only in the "physical functioning" sub-score of the SWN but also in all other sub-scores. Correlations of the SWN scores with ESRS scores were weak. CONCLUSION: Under conventional antipsychotic treatment, subjective well-being particularly depends on major side effects, whereas in atypically treated and drug-naive schizophrenic patients, it is mainly influenced by psychopathological status. Motor adverse effects of conventional antipsychotic treatment cannot be considered as isolated physical side effects but have severe implications for other aspects of the patients' well-being.

Adult↗
PubMed2005

Clioquinol treatment in familiar early onset of Alzheimer's disease: a case report.

Recently the metal chelator clioquinol (CQ) has been suggested as a possible option for treatment of Alzheimer's disease (AD). We report two patients with early onset of AD [one with a mutant amyloid-precursor-protein (APP) gene] who received long-term treatment with CQ. In both cases focally augmented cerebral glucose metabolism and stabilization but no amelioration of the clinical impression were observed without signs of neurotoxicity. In one case CSF-tau and beta-Amyloid (42/40) concentrations changed during CQ treatment.

Alzheimer Disease↗
PubMed2004

[Adult attention deficit/hyperactivity disorder].

ADHD (attention deficit/hyperactivity disorder) in adults is a more complex pathological condition than ADHD seen in children and adolescents. The number of reports of impaired self-regulation are on the increase. Psychiatric comorbities are being found ever more frequently, and negative life experiences are coloring the clinical presentation to an ever greater extent. Therapeutic strategies involving the use of stimulants and antidepressants are often needed to pave the way for individual and group psychotherapy. Despite the fact that it is currently considered to be "fashionable", the diagnosis of ADHD is a clinically relevant and persisting psychological disorder.

Adult↗
PubMed2004

Contrasting metabolic impairment in frontotemporal degeneration and early onset Alzheimer's disease.

[18F]FDG positron emission tomography (PET) scans of 14 patients comprising the clinical prototypes of dementias that are considered to be associated with frontotemporal lobar degeneration (FTLD) were compared to a population of 15 patients with early onset Alzheimer's disease (EOAD). The FTLD group included patients with frontotemporal dementia (FTD), semantic dementia (SD), and primary progressive aphasia (PPA). A voxel to voxel group comparison identified metabolic impairment in the bilateral ventromedial frontal area, the left anterior insula, and inferior frontal cortex, and indicated the right middle temporal gyrus to exhibit increased activity in FTLD compared to EOAD patients. All identified cortical structures are considered to be critically involved in neuropsychological features associated with FTLD (altered social behavior, aphasia) and EOAD (impaired linguistic and visuo-constructive abilities). In conjunction with recent insights from neuropathologic investigations, these results implicate that the a priori heterogeneous prototypes of FTLD (FTD, SD, PPA) may share more common ground than previously assumed, and therefore would become distinguishable as an entire group from EOAD.

Age of Onset↗
PubMed2004

High-frequency repetitive transcranial magnetic stimulation in schizophrenia: a combined treatment and neuroimaging study.

BACKGROUND: Repetitive transcranial magnetic stimulation (rTMS) of frontal brain regions is under study as a non-invasive method in the treatment of affective disorders. Recent publications provide increasing evidence that rTMS may be useful in treating schizophrenia. Results are most intriguing, demonstrating a reduction of negative symptoms following high-frequency rTMS. In this context, disentangling of negative and depressive symptoms is of the utmost importance when understanding specific rTMS effects on schizophrenic symptoms. METHOD: Using a sham-controlled parallel design, 20 patients with schizophrenia were included in the study. Patients were treated with high-frequency 10 Hz rTMS over 10 days. Besides clinical ratings, ECD-SPECT (technetium-99 bicisate single photon emission computed tomography) imaging was performed before and after termination of rTMS treatment. RESULTS: High-frequency rTMS leads to a significant reduction of negative symptoms combined with a trend for non-significant improvement of depressive symptoms in the active stimulated group as compared with the sham stimulated group. Additionally, a trend for worsening of positive symptoms was observed in the actively treated schizophrenic patients. In both groups no changes in regional cerebral blood flow could be detected by ECD-SPECT. CONCLUSIONS: Beneficial effects of high-frequency rTMS on negative and depressive symptoms were found, together with a trend for worsening positive symptoms in schizophrenic patients.

Adult↗
PubMed2004

Patterns of referring of patients with frontotemporal lobar degeneration to psychiatric in- and out-patient services. Results from a prospective multicentre study.

Dementia with frontotemporal lobar degeneration (FTLD) is clinically characterized by the occurrence of various psychiatric symptoms. In a recent study, the hospital-based prevalence of FTLD and the circumstances of the patients' admission to German psychiatric state hospitals were estimated. On the basis of further continuous assessment, this original FTLD group (n = 33) has been enlarged to 58 patients. The authors here present demographic and clinical data, and reasons for admission to geriatric psychiatry hospitals in comparison with 17 patients, who primarily attended the Memory Disorders Clinic of the University of Regensburg. The results implicate that both institutions see patients with different clinical syndromes: (1) patients were primarily referred to the Memory Disorders Clinic presenting memory and/or speech difficulties as the leading symptoms; (2) major reasons for hospitalisation of patients with FTLD in geriatric psychiatry hospitals were behavioural disturbances; (3) late-onset FTLD (>65 years) was more common than previously assumed in both institutions, and (4) increasing age at admission increased the likelihood to obtain a limited diagnostic approach of brain imaging (only cranial computer tomography) to evaluate the cause of dementia.

Adult↗
PubMed2003

The sleep-improving effects of doxepin are paralleled by a normalized plasma cortisol secretion in primary insomnia. A placebo-controlled, double-blind, randomized, cross-over study followed by an open treatment over 3 weeks.

RATIONALE: In primary care, sedating antidepressants are often used for treating insomnia, although their underlying sleep-promoting mechanisms are only incompletely understood. Since enhanced evening and nocturnal plasma cortisol levels are supposed to maintain insomniac sleep complaints, a functional link between sleep and cortisol secretion in the mode of action of antidepressants in insomnia might be suspected. OBJECTIVES: We therefore investigated the effects of the tricyclic antidepressant doxepin on nocturnal sleep and plasma cortisol concentration in ten patients (age 41.3+/-9.5 years) with chronic primary insomnia between 1700 hours and 0800 hours. METHODS: Single infusions of placebo and 25 mg doxepin were applied following a double-blind, randomized cross-over design. Afterward, all patients received 25 mg doxepin p.o. for 3 weeks in an open-study design. RESULTS: Both doxepin application forms improved sleep significantly and reduced mean cortisol levels from 9.0+/-1.7 microg/l (single placebo i.v.) to 7.5+/-1.6 microg/l (single doxepin i.v.) or 7.6+/-2.0 microg/l (subchronic doxepin p.o.). The duration of the quiescent period of the cortisol rhythm was significantly prolonged following both doxepin administrations compared with placebo. CONCLUSIONS: The results implicate that the sleep-improving effects of doxepin are mediated at least in part by a normalization of hypothalamic-pituitary-adrenal axis functions. Although in some patients rebound insomnia and specific side effects must be considered, our findings give a further rationale for the use of antidepressants in the treatment of primary insomnia.

Adult↗