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Biomedical subjects

G Stoppe

Publications and source records attributed to G Stoppe.

At least 19 recordsLinked to original sources
PubMed2006

[Changeover to risperidone after treatment with conventional low potency neuroleptics in dementia patients. An observation study during usage].

BACKGROUND AND OBJECTIVE: Up to 90% of the patients with dementia develop behavioral and psychological symptoms during the course of their illness. Since 1999 the atypical neuroleptic risperidone is the only drug approved by the German authorities for the treatment of aggressive behavior or psychotic symptoms of dementia, which was defined in March 2004 with respect to severe chronic aggressive behavior, endangering themselves or others, or impoverishing psychotic symptoms. This prospective investigation was aimed at detecting therapeutic efficacy and the tolerability of risperidone after changing from low-potency neuroleptics in patients, for whom the broader indications before March 2004 were still valid. PATIENTS AND METHODS: Symptoms, activities of daily living and caregivers" burden were documented for 6 weeks in 111 demented patients with chronic aggressive behavior and psychotic symptoms. RESULTS: Marked improvements of psychotic symptoms, aggressiveness, other behavioral disorders and activities of daily living were observed. Furthermore, a substantial reduction of caregivers' burden was noted. The treatment with risperidone was well tolerated. No patient died and no cerebrovascular events were observed. CONCLUSION: Changing the treatment of demented patients from low-potency neuroleptics to risperidone led to marked improvement of symptoms and to a substantial decrease of caregivers' burden.

Aged↗
PubMed2006

[The role of psychoeducation in the treatment of psychiatric inpatients].

Psychoeducation has proved to be a highly effective therapeutic method to reduce relapse and rehospitalization rates of schizophrenic patients. Education about their disease has good results on clinical course and especially on compliance. Despite evidence of effectiveness and the recommendations of evidence-based guidelines, psychoeducational programs are underutilized in clinical practice. Based on a review of the literature, we summarize the development and current state of research on psychoeducation. With regard to its broader use in psychiatric inpatient treatment, we examine potential barriers and possible improvements. Characteristics of a psychoeducational concept that meets the demands of the modern structure of psychiatric institutions are discussed. Essential issues are specificity in the traditional diagnosis of schizophrenia and applying integrative concepts to the mainly didactic method used today.

Humans↗
PubMed2006

[Agitation and gamma-hydroxybutyrate].

Agitation is a symptom in various disorders. Gamma-hydroxybutyrate (GHB) is often abused because of its stimulating effects. Side effects comprise loss of consciousness, coma, and agitated states. We present a 50-year-old patient with repeated GHB intoxications and abstinent alcohol dependency and a video document showing an agitated state. Diagnostic workup is discussed considering the relevant literature on this topic. Intoxication and dependence on GHB are important entities in the contexts of neurology and psychiatry.

Akathisia, Drug-Induced↗
PubMed2006

Filial maturity as a predictor for the burden of demented parents' caregivers.

In this study, we administered the Louvain Filial Maturity Scale [Marcoen 1993] to 61 adult children of demented elderly. The scores of the seven factors of this scale were compared to the scores of an unselected group of adult children examined by Marcoen. The results were taken into the context with caregiver's burden, and the effect of filial maturity on parents' institutionalisation was investigated. Marcoen's results were confirmed. Only the means of "filial help" and "parental consideration" differed slightly from the means of the unselected group. Overall, filial maturity had no influence on the caregiver's feeling of burden, but higher "parental consideration" resulted in lower caregiver burden. In addition, adult children with more "filial obligation" continued to care for their parents in the community more often, even when experiencing great burden and stress. However, institutionalisation was caused mainly by parents' growing needs and increasing behavioural problems. We conclude that "filial maturity" seems to be a very stable concept. Further investigations should focus on the relevance of the Louvain Filial Maturity Scale for caregiving relationship and also on the arrangement of the scale in order to exclude a "pseudo"-stability with regard to burdensome life events and situations.

Adult↗
PubMed2005

[Treatment of Alzheimer's disease utilising the best available evidence-based medicine -- utopia?].

STUDY OBJECTIVES: To practice evidence-based medicine is considered to improve health care, particularly of chronically ill patients. Taking Alzheimer's as an example the objective of this study is to explore as to how far ambulatory Alzheimer's patients receive the medical treatment with the best evidence available. METHOD: In 2000 and 2002 the health care situation of Alzheimer's disease patients was assessed by conducting telephone interviews with one hundred randomly selected general practitioners and specialists listed in the panel of the Institut fur Medizinische Statistik (IMS -- Institute for Medical Statistics). By means of a standardised questionnaire the interviewees' prescriptions were assessed as well as their knowledge of the medical therapy for Alzheimer's and the use of non-medical therapeutic measures. Besides, the interviewees' prescriptions were checked on the basis of quantitative data taken from the IMS panel. Cholinesterase inhibitors (ChE-I), which are accorded the best evidence presently available in the medical treatment of Alzheimer's, were seen as a marker for the improvement of health care in the course of the study. RESULTS AND CONCLUSIONS: The interviewed physicians considered the evidence of medical Alzheimer's disease therapy with cholinesterase inhibitors high. 67 % of the interviewees would use ChE-I as the drug of first choice if a near relative fell ill with Alzheimer's. However, the ChE-I prescriptions were limited to 13 % in the base year 2000 and to 24 % in the base year 2002. Obviously, the implementation of this medical therapy is hampered by budgetary regulations. The interviewees find it particularly disadvantageous that the prescription of ChE-I may overstrain the budgets allocated to their practices. As a consequence, the effort to improve the quality of health care by implementing evidence-based medicine is thwarted by the increasing pressure on German physicians to prescribe drugs according to economic viability.

Adult↗
PubMed2004

[Outpatient treatment of patients suffering from Alzheimer dementia. Two exploratory studies on the characteristics of therapy in medical practice].

In two exploratory studies on the outpatient treatment of patients suffering from Alzheimer dementia research was done into the characteristics of therapy in medical practice on the basis of exemplary interviews of 100 doctors in 2000 and 2002. The interviewers discern the burden of the disease for the patients and their relatives. However, medical treatment is still too scarce and inappropriate as the prescribing of antidementia drugs shows, among which especially acetylcholinesterase inhibitors as drugs of first choice. The spectrum of non-pharmacological interventions is applied but psychosocial measures are under-represented. To maintain the Alzheimer patient's functional level and to thus relieve the caring relatives a multimodal therapy should be intensified preferably by comprehensive co-operations.

Alzheimer Disease↗
PubMed2003

Association of late-onset Alzheimer disease with a genotype of PLAU, the gene encoding urokinase-type plasminogen activator on chromosome 10q22.2.

Urokinase-type plasminogen activator (uPA) converts plasminogen to plasmin. Plasmin is involved in processing of amyloid precursor protein and degrades secreted and aggregated amyloid-beta, a hallmark of Alzheimer disease (AD). PLAU, the gene encoding uPA, maps to chromosome 10q22.2 between two regions showing linkage to late-onset AD (LOAD). We genotyped a frequent C/T single nucleotide polymorphism in codon 141 of PLAU (P141L) in 347 patients with LOAD and 291 control subjects. LOAD was associated with homozygous C/C PLAU genotype in the whole sample (chi2=15.7, P=0.00039, df 2), as well as in all sub-samples stratified by gender or APOE epsilon4 carrier status (chi2> or = 6.84, P< or =0.033, df 2). Odds ratio for LOAD due to homozygosity C/C was 1.89 (95% confidence interval 1.37-2.61). PLAU is a promising new candidate gene for LOAD, with allele C (P141) being a recessive risk allele or allele T (L141) conferring protection.

Age of Onset↗
PubMed2003

[German-speaking memory clinics: state of the art and practical recommendations].

The 7th annual meeting of the memory clinics of Germany, Switzerland and Austria in March 2002 in Göttingen, Germany was an optimal opportunity to make an inventory about the state of the art in diagnostic and therapy of dementia and mild cognitive impairment in German-speaking memory clinics. Several problems were discussed including difficulties in 1) diagnosis of patients with aphasia or foreign patients, 2) handling of demented patients without a caregiver, 3) psychological support for patients, who have been diagnosed in a very early stage, 4) misunderstandings between general practitioners, neurologists and psychiatrists in private practice on the one hand and the memory clinics on the other hand, 5) recommendations for prevention of dementia, 6) recommendations concerning dementia and car driving and 7) questions of genetic counselling. The following paper is a summary of the results of a workshop in Göttingen and gives practical recommendations based on the experiences of the memory clinics.

Aged↗
PubMed2002

Critical appraisal of effects of estrogen replacement therapy on symptoms of depressed mood.

That estrogen plays a role in the regulation of mood has been postulated since extracts of animal ovarian tissue were administered to oophorectomized women at the end of the last century to alleviate psychological symptoms thought to be related to the removal of the ovaries. The occurrence of depressive symptoms in the perimenopause is associated with a variety of factors. A previous history of either depression and/or premenstrual syndrome as well as cognitive factors explain most of the variance. There are no consistent findings of a correlation between any serum hormone level and severity or presence of mood symptoms. Neurobiological studies show, with regard to an antidepressant effect, promising effects of estradiol on serotonergic, noradrenergic, cholinergic, dopaminergic and GABAergic functions. Progestogens seem to oppose some of these effects. The role of adrenergic hormones and DHEA(S) is less clear. Most clinical trials showed a modest effect on symptoms of depression. However, the predominantly poor methodological quality does not allow generalisation and recommendations. A "tonic" effect on well-being in non- or mild depressed women should not be regarded as true antidepressant effect. Results yielded in studies of surgically menopausal women may not be applicable to women with natural menopause. There is a great potential for exploring various types, doses, and routes of administration of both antidepressants and sex hormones. With regard to the domino theory, future studies should also focus on the mediation of treatment effects through alleviation of vasomotor symptoms or sleep quality.

Adult↗
PubMed2001

Non-replication of association between cathepsin D genotype and late onset Alzheimer disease.

In two recent studies from Germany, a strong association was found between the allelic variant T of the amino acid substitution encoding polymorphism 224 C/T (A38V) in exon 2 of the cathepsin D gene (CTSD) and late onset Alzheimer disease (AD). Other studies from Europe and the USA revealed ambiguous results. Therefore, we performed an independent association study on CTSD and AD in a sample of 324 Caucasian patients from Germany, Switzerland, and Italy with late onset AD, and 302 non-demented controls. We could not confirm an association between CTSD genotype and AD, although there was a slight but not significant increase in frequency of the T allele and T carrier status in AD. Post hoc data analyses suggested that there might be a stronger effect of CTSD genotype on AD risk in males, and an interaction between CTSD and APOE genotypes in males but not females.

Age Factors↗
PubMed2001

[Evolution and function of sleep].

This paper presents a brief historical review of the beginning of scientific studies on sleep research and evaluation of the electrophysiological basics. Subsequently, hypotheses are presented and discussed on phylogenesis and function of NONREM- and REM-sleep as well as aspects of the regulation of energy conservation and temperature. Sleep may have first evolved out of rest/activity cycles. Later on, with the evolution of complex brains, sleep may also assume importance in development and maintenance of these structures. Hence, special emphasis is placed on the influence of NONREM and REM sleep on the reorganisation of neuronal networks.

Animals↗
PubMed2000

Genetic association of a cystatin C gene polymorphism with late-onset Alzheimer disease.

OBJECTIVE: To determine whether the cystatin C gene (CST3) is genetically associated with late-onset Alzheimer disease (AD). DESIGN: A case-control study with 2 independent study populations of patients with AD and age-matched, cognitively normal control subjects. SETTING: The Alzheimer's Disease Research Unit at the University Hospital Hamburg-Eppendorf, Hamburg, Germany, for the initial study (n = 260). For the independent multicenter study (n = 647), an international consortium that included the Massachusetts Alzheimer's Disease Research Center at the Massachusetts General Hospital, Boston; the Scientific Institute for Research and Patient Care, Brescia, Italy; and Alzheimer's research units at the Universities of Basel and Zurich, Switzerland, and Bonn, Goettingen, and Hamburg, Germany. PARTICIPANTS: Five hundred seventeen patients with AD and 390 control subjects. MEASURES: Molecular testing of the KspI polymorphisms in the 5' flanking region and exon 1 of CST3 and the apolipoprotein E (APOE) genotype. Mini-Mental State Examination scores for both patients with AD and control subjects. RESULTS: Homozygosity for haplotype B of CST3 was significantly associated with late-onset AD in both study populations, with an odds ratio of 3.8 (95% confidence interval, 1.56-9.25) in the combined data set; heterozygosity was not associated with an increased risk. The odds ratios for CST3 B/B increased from 2.6 in those younger than 75 years to 8.8 for those aged 75 years and older. The association of CST3 B/B with AD was independent of APOE epsilon4; both genotypes independently reduced disease-free survival. CONCLUSIONS: CST3 is a susceptibility gene for late-onset AD, especially in patients aged 75 years and older. To our knowledge, CST3 B is the first autosomal recessive risk allele in late-onset AD.

Age of Onset↗
PubMed2000

Can chronic neuroleptic treatment promote sleep disturbances in elderly schizophrenic patients?

It has been proposed that sleep disturbances, especially reduced delta sleep, are related to a poor outcome in schizophrenia. To determine whether long-term treatment with neuroleptics can promote sleep disturbances by increasing the risk of a nocturnal myoclonus syndrome (NMS) (=periodic movements in sleep) related insomnia, we performed all-night polysomnography in 10 chronically ill schizophrenic patients who had been under neuroleptic therapy for a mean of 27 years. NMS-related insomnia was detected in all 10 patients. Potential pathophysiological relationships between long-term neuroleptic therapy and NMS occurrence are discussed. Our findings suggest that long-term administration of neuroleptics favours the appearance of insomnia.

Aged↗