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Biomedical subjects

H Hippius

Publications and source records attributed to H Hippius.

At least 19 recordsLinked to original sources
PubMed1992

Double-blind cross-over study of phosphatidylserine vs. placebo in patients with early dementia of the Alzheimer type.

Thirty-three patients with mild primary degenerative dementia according to DSM-III (MMS between 15 and 27) took part in a double-blind cross-over study of phosphatidylserine (Fidia, 300 mg/d) versus placebo. Both treatment phases lasted for 8 weeks with an 8 week washout phase in between and a 4 week washout phase before treatment phase one. Clinical global improvement ratings showed significantly more patients improving under BC-PS than under placebo during treatment phase one. The improvement carried over to the following wash-out and treatment phases. There were no significant improvements in GBS dementia rating scale, psychometric tests or P300-latency. 16-channel EEG mapping findings indicated that the patients initially showed higher power values in all frequency bands (except alpha), when compared to a younger, healthy control group. BC-PS reduced the higher power values compared to placebo, shifting EEG power more towards the normal level.

Aged↗
PubMed1992

Inadequate treatment response to des-enkephalin-gamma-endorphin compared with thioridazine and placebo in schizophrenia.

The possibility of an involvement of peptidergic systems in schizophrenia has been under investigation for a number of years. Studies of the efficacy of des-tyr-gamma-endorphin were equivocal; more recent studies with des-enkephalin-gamma-endorphin have reported some activity but the peptide has only been investigated as an adjunct to neuroleptic medication, apart from one very small active reference comparator study. In the multicentre study reported here, 96 patients suffering from schizophrenia (DSM-III with a current exacerbation if chronic) were allocated randomly to double-blind treatment with either des-enkephalin-gamma-endorphin (DE-gamma-E) (Org 5878) 10 mg given as a once daily intramuscular injection for 4 weeks, thioridazine 400 mg orally in 2 divided doses or placebo using a double-dummy technique to preserve blindness. There was a significant advantage for thioridazine compared with placebo registered on all measures at weeks 3 and 4. There was no difference between DE-gamma-E and placebo. There was a significant difference between thioridazine and DE-gamma-E at weeks 3 and 4 registered on the MSS and at week 3 registered on the BPRS. The lack of efficacy of DE-gamma-E suggests that the theories that the endorphins have an important role in schizophrenia have to be revised. The need for well designed placebo controlled studies for assessing efficacy in schizophrenia is emphasized.

Adult↗
PubMed1992

Clinical management of clozapine patients in relation to efficacy and side-effects.

Medical charts of 480 schizophrenic in-patients (581 treatments) were analysed to evaluate the efficacy and side-effects of clozapine. Clozapine treatment lasted for mean 49 (s.d. 38) days. Of the sample, 11.0% showed worsening or no change, 31.5% slight improvement, 53.0% marked improvement and 4.5% almost total reduction of symptoms. At least one major side-effect occurred in 68.0% of patients. A combination of clozapine with classical neuroleptics, antidepressants, benzodiazepines or lithium is tolerated by most patients, but increases the incidence of some side-effects. Clozapine treatment had to be discontinued because of severe side-effects in 8.6% of patients. In 81 schizophrenic out-patients, clozapine significantly reduced the days of in-patient treatment and number of hospital readmissions. Two patients developed leucopenia but had no complications after clozapine withdrawal. This study indicates a satisfactory benefit/risk ratio and compliance in most of the patients.

Adolescent↗
PubMed1991

Benzodiazepine dependence: detoxification under standardized conditions.

In an analysis of the withdrawal syndrome of 12 patients dependent on benzodiazepines (BZD), important factors such as underlying psychiatric disease, precipitating life events, complaints leading to BZD use, and also positive and negative psychological and social consequences, duration of intake, dose and type of BZD dependence are discussed. Withdrawal was completed under standardized inpatient conditions reducing the BZD dose to 50% of the previous dose once every 5 days and maintaining control through regular measurements of the BZD urine concentrations. The course of the somatic, psychological and perceptual withdrawal phenomena was documented according to Lader's BZD withdrawal symptom checklist (Lader, M. (1983) J. Clin. Psychiatry 44, 121-127). The reduction scheme proved to be safe and efficient; no major withdrawal syndromes developed. Abstinence phenomena largely disappeared within 10 days of discontinuation.

Adult↗
PubMed1991

Brain dysfunction during motor activation and corpus callosum alterations in schizophrenia measured by cerebral blood flow and magnetic resonance imaging.

Sixteen unmedicated (14 never-medicated, 2 with washout periods of 1-2 weeks) schizophrenic patients displaying positive symptoms (e.g., formal thought disorder, hallucinations, delusions) without negative symptoms (e.g., flattening of affect, loss of energy, anhedonia--type I patients), 15 unmedicated (with washout periods from 1 week to 2 years) patients with marked negative symptomatology [type II patients; criterion score below 15/above 35 on the Munich version of the Scale of Assessment of Negative Symptoms (SANS), respectively], and 31 matched normal controls were investigated using regional cerebral blood flow [rCBF; dynamic single-photon emission computerized tomography (SPECT) with Xenon-133 as tracer] and magnetic resonance imaging (MRI; spin-echo technique, T1 weighted, midsagittal cuts). rCBF measurements were performed during both resting conditions and simple motor activation. Separately, on the same day, we performed a planimetric evaluation of the callosal-brain ratio in all subjects using MRI. In accordance with previous results on a smaller sample, we found signs of diffuse bilateral rCBF hyperactivation in type I patients, as compared with signs of nonreactivity in type II schizophrenics. Both activation patterns were different from a strictly contralateral sensorimotor rCBF activation seen in normal persons (only 8 studied with SPECT). The planimetry of relative callosal area did not reveal differences compared to normal persons, when type I/II patients were taken together. However, the threefold increased variance as compared with that found in normal persons suggested biological heterogeneity in patients. We found an increase of relative callosal size in type I as compared with type II patients. In the light of some recent findings linking lack of laterality of several brain functions to increased callosal size, we propose lack of laterality/diffuse hyperactivation and increased callosal size to be connected with positive symptomatology/good prognosis schizophrenia, and vice versa.

Activities of Daily Living↗
PubMed1991

[HIV and nervous system manifestations: a review].

Since 1986 the notation Human Immunodeficiency Virus (HIV) is used for the retroviral agent of the Acquired Immunodeficiency Syndrome (AIDS). At the beginning of the therapeutical interest in the immunodeficiency syndrome have been primarily focussed in the internal complications. 1982 one reported for the first time about nervous system manifestations (NS-M) in HIV-patients; according to the latest reports NS-M are diagnosed in 39-63% of these patients. In this review all important aspects of the pathogenesis, clinic and therapy for the HIV-associated peripheric- and central-neurological (like e.g. acute and chronic meningitis/meningoencephalitis, dementia, opportunistic infections, polyneuropathies and myopathies) and psychiatric diseases are described.

AIDS Dementia Complex↗
PubMed1990

Effects of single doses of alpidem, lorazepam, and placebo on memory and attention in healthy young and elderly volunteers.

The aim of the present study was to compare the effects of alpidem, a new imidazopyridine derivative with benzodiazepine-like anxiolytic effects, with those of lorazepam and placebo on memory and attention in two age groups of healthy volunteers. The study design was that of a randomized double-blind crossover trial with 12 young (18-30 years old) and 12 elderly (65-80) subjects. At weekly intervals, each subject was administered single oral doses of 25 mg alpidem, 50 mg alpidem, 1 mg lorazepam, and placebo in a randomized sequence. Computerized memory and attention tests were performed 90 minutes before and 320 minutes after drug administration. Lorazepam and alpidem 50 mg produced memory impairments: for verbal memory tests the difference against placebo was highly significant for both drugs, while for visual memory this impairment was significant for lorazepam only. No memory effects were seen with 25 mg alpidem. There were no significant drug effects on attention, suggesting a specific amnestic effect not explained by general sedation. Performance of the elderly subjects was much lower than that of the younger ones in both memory and attention tasks. It was not possible to observe any interaction effects between drug and age.

Adolescent↗
PubMed1990

Drug treatment of panic disorder: early response to treatment as a predictor of final outcome.

One of the core problems in clinical research is the detection of early changes in target symptoms that predict future therapeutic outcome. To analyze potential predictors of outcome, data of a multicenter study on patients with panic disorder were used. A total of 1010 patients were randomly allocated either to alprazolam, imipramine or placebo treatment. Early improvement in the number of spontaneous panic attacks within the first week of treatment predicted outcome exclusively in the alprazolam group. In contrast, placebo responders and nonresponders were differentiated by early changes in anticipatory anxiety intensity. For tricyclic antidepressants such as imipramine an evaluation period of more than one week is required to allow conclusions about outcome.

Adult↗
PubMed1990

The European experience with use of clozapine.

The efficacy and adverse effects of clozapine for patients who cannot be treated with conventional neuroleptics were evaluated by means of a retrospective chart review. The review showed that 85 percent of 503 inpatients experienced slight to nearly complete reduction in symptoms. Adverse effects occurred in 59 percent of patients, although only 7 percent had side effects severe enough to warrant discontinuation of the drug. Data for 70 outpatients treated with clozapine showed that the rate of rehospitalization was significantly lower than before treatment with the drug. These findings agree with those of other European studies and suggest that when hematological and other variables are carefully controlled, the benefits of clozapine therapy outweigh the risks.

Adult↗
PubMed1989

Efficacy and adverse effects of clozapine in the treatment of schizophrenia and tardive dyskinesia--a retrospective study of 387 patients.

Medical charts of 387 in-patients (schizophrenia n = 284, tardive dyskinesia, TD, n = 48), were analyzed to evaluate efficacy and adverse effects of clozapine. These patients were previously treated with between two and four other neuroleptics and were either therapy resistant or had severe side effects. Schizophrenic patients were treated with clozapine for 48 +/- 35 (TD 49 +/- 40) days, dosage was 189 +/- 119 (TD 220 +/- 176) mg. Four per cent showed worsening, 13% no change, 38% slight improvement, 42% marked improvement and 3% nearly total reduction of symptoms. In TD, 44% showed marked improvement, but only in 17% the drug was superior to previous neuroleptics. Adverse effects occurred in 56% of patients. Most frequent were sedation (17%), EEG alterations (16%), increase of liver enzymes (8%), hypotension (7%), hypersalivation (5%), fever (5%), ECG alterations (4%), tachycardia (3%), gastro-intestinal (3%) and delirious states (2%). A gradual increase in dosage seems to considerably reduce the incidence of some side effects. Clozapine treatment had to be discontinued because of severe side effects in 5.9%. In none of these patients did serious complications such as agranulocytosis occur. Only EEG alterations were significantly related to clozapine dosage (P less than 0.0005). At dismissal, most patients continued to receive clozapine; only in 22% (TD 20%) was it replaced by another neuroleptic. Thus, the ratio benefit/risk of clozapine treatment seems to be satisfactory in most of the negatively selected patients. Nevertheless, a gradual increase in dosage and careful control of hematological and other variables is highly recommended.

Adult↗
PubMed1989

Clozapine in the treatment of 121 out-patients.

Retrospectively, effects of long-term therapy with clozapine were evaluated in 121 out-patients. They were treated for 32 +/- 43 months in a daily dosage of 131 +/- 99 mg. Sixty nine patients were schizophrenic and had previously received one or more neuroleptics but with insufficient response or severe side effects. Nine patients suffered from tardive dyskinesia (TD), 44 patients had other diagnoses. Twenty two per cent of the schizophrenic patients improved slightly, 65% markedly and in 13% the symptoms nearly totally disappeared. Fourty per cent of chronic schizophrenics showed improvement of anergia. Eleven per cent of the patients with TD did not improve, 22% showed slight and 67% marked improvement. Clinically relevant side-effects occurred in 64% of patients: Generally sedation/hypotension, EG and ECG alterations, changes of white blood cell count, increase of liver enzymes and weight gain. EEG alteration correlated significantly with dosage of clozapine (P less than 0.01). In 6% of patients, severe side-effects led to discontinuation of clozapine treatment. No case of agranulocytosis occurred. Most patients tolerated the drug well and were compliant. Under careful control of hematological and other variables, the benefit/risk ratio of clozapine long-term treatment appears to be high and acceptable.

Adult↗
PubMed1989

Double-blind study of metaclazepam versus diazepam treatment of outpatients with anxiety syndrome.

The therapeutic efficacy and tolerance of metaclazepam and diazepam were compared in a double-blind study of outpatients suffering from a generalized anxiety syndrome. The investigators were general practitioners. A total of 168 male and female patients aged between 18 and 60 years were included in the study and received either 15 mg metaclazepam or 15 mg diazepam per day. The analysis of tolerance was made for all 168 included patients, the evaluation of efficacy is based on the results of 131 patients (42 males and 89 females) with valid data over four weeks. During the four-week therapy period four examinations were made on days 0, 7, 14, and 28. A significant improvement of the severity of illness after administering the drugs was found for both drugs in the Clinical Global Impressions (CGI), in the Hamilton Anxiety Scale (HAMA), in the List of Complaints (B-L), and in the Adjective Checklist (EWL-K). Metaclazepam showed a statistically significant superiority over diazepam as far as the CGI items "severity of illness" and "global improvement" were concerned. Metaclazepam was slightly superior to diazepam in the two HAMA subscales "psychic anxiety" and "somatic anxiety". In the items of the selfrating scales (B-L and EWL-K) the therapeutic results of the metaclazepam group were, almost without exception, better than those of the diazepam group. A comparison of tolerance showed that metaclazepam was better tolerated. This can be seen in the greater frequency of side effects like tiredness and drowsiness under diazepam. Especially at the beginning of treatment, tiredness and drowsiness were recorded 2 1/2 times more frequently for the patients on diazepam than for those on metaclazepam.

Adolescent↗
PubMed1989

Psychotropic drug use in a representative community sample: the Upper Bavarian study.

A sample of 1979 community residents aged 15 years and above was assessed in a major survey of health status and consumption of psychotropic medication. Interviews were conducted in the subjects' home by a psychiatrically trained physician, who actually inspected the subjects' medical supplies. Of all subjects 6.9% (4.3% of the males and 9.0% of the females) had used a drug containing a benzodiazepine at least once in the 4 weeks preceding the interview. In the same period 3.6% had taken a medication containing a barbiturate, 2.2% a medicine containing an opioid (mainly codeine), 1.8% had taken a neuroleptic drug, 1.5% an antidepressant, 0.8% a carbamine-acid derivative and 0.1% lithium. High use of psychotropic medication was associated with higher age, female sex, higher psychiatric morbidity, higher somatic morbidity, reduced work capacity and higher neuroticism but not with social class and not with the personality factor extra- or introversion.

Adolescent↗