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Biomedical subjects

M Gastpar

Publications and source records attributed to M Gastpar.

At least 55 records · Page 3Linked to original sources
PubMed1997

The benefit of an insight-oriented and experiential approach on panic and agoraphobia symptoms. Results of a controlled comparison of client-centered therapy alone and in combination with behavioral exposure.

BACKGROUND: It is a common view that psychodynamic treatment does not help much to ameliorate the symptoms of panic and agoraphobia. The effects of an insight-oriented treatment on central anxiety symptoms are the subject of the present controlled study. METHODS: Forty patients with severe panic and agoraphobia were admitted to an inpatient anxiety treatment program. Most of the patients had been treated by pharmacological means unsuccessfully. The patients were randomly assigned to pure client-centered therapy or to additional behavioral exposure treatment. Client-centered and behavioral agoraphobia manuals were used. The patients were examined on admission, at discharge and at 3, 6, and 12 months follow-up for panic (Structured Clinical Interview for DSM III-R--SCID), anxiety (Hamilton Anxiety Scale), agoraphobia (SCID, Fear Survey Schedule), and depressive (Hamilton Depression Scale) symptoms. RESULTS: Both client-centered treatment and a combination with exposure treatment reduced panic, avoidance and depressive symptoms significantly. For a short period the combined treatment was superior in patients' coping actively with anxiety and improving agoraphobic symptoms. However, at 1-year follow-up there was no further difference in the reduction of anxiety and depressive symptoms. CONCLUSIONS: The results are discussed with regard to the combination of these forms of therapy and to widespread skepticism about the efficacy of insight-oriented treatment.

Adult↗
PubMed1997

Depression in the community: the first pan-European study DEPRES (Depression Research in European Society).

DEPRESS (Depression Research in European Society) is the first large pan-European survey of depression in the community. A total of 13359 of the 78463 adults who participated in screening interviews across six countries were identified as suffering from depression, a 6-month prevalence of 17%. Major depression accounted for 6.9% of the cases of depression and minor depression for 1.8%. Depressed subjects in both these categories perceived that their working or social lives were substantially impaired by depressive symptoms. The remaining 8.3% of depressed subjects considered that their functional impairment was not substantial. A significant proportion of sufferers from depression (43%) failed to seek treatment for their depressive symptoms. Of those who did seek help (57%), most consulted a primary care physician, the frequency of consultation increasing with the severity of depression. Sufferers from major depression imposed the greatest demand on healthcare resources, making almost three times as many visits to their GP or family doctor as non-sufferers (4.4 vs 1.5 visits over 6 months). More than two-thirds of depressed subjects (69%) were not prescribed any treatment and when drug therapy was prescribed (31%), only 25% of these subjects were given antidepressant drugs. The number of days of work lost due to illness increased with the severity of depression. Major depression had most impact on productive work, with sufferers losing four times as many working days over 6 months as non-sufferers. The results of the DEPRES survey confirm the high prevalence of depression in the community and the burden imposed on the individual sufferer in terms of impaired quality of life and on society in terms of healthcare utilization and lost productivity.

Adult↗
PubMed1996

Ethacrynic acid: effects on postsynaptic GABA responses and electric activity of CA3 neurones.

Ethacrynic acid (ETA) inhibits somatic Cl(-)-extrusion from hippocampal pyramidal neurones. We analysed the dependence of postsynaptic gamma-aminobutyric acid (GABA) responses on this Cl- extrusion. ETA irreversibly reduced the 'somatic' hyperpolarizing GABAA response (hGABAA) within a few minutes, without altering the following depolarizing GABAA (dGABAA) and hyperpolarizing GABAB responses. GABA-induced changes of the membrane resistance were not affected by ETA, indicating that ETA does not act primarily on receptor-operated channels. In about 50% of the tested CA3 neurones spontaneous activity and caffeine-induced epileptiform discharges increased initially after adding ETA. All neurones lost their activity during prolonged ETA exposure. The early ETA-induced increase of neuronal activity coincided with the decrease of hGABAA (disinhibition). The late suppressive action may be caused by intracellular acidosis.

Animals↗
PubMed1996

Oligosymptomatic neurosyphilis with false negative CSF-VDRL in HIV-infected individuals?

The true prevalence of neurosyphilis in HIV-infection is unknown, since a sufficiently sensitive and specific test is lacking. In a prospective study we found reactive serum TPHA and FTA-ABS IgG tests in 95 (31%) of 307 HIV-infected patients. Three of 11 patients with latent syphilis revealed reactive CSF-VDRL tests, six others only demonstrated CSF abnormalities. Resolution of CSF abnormalities during a six month follow up after high dose antibiotic therapy led to the diagnosis of oligosymptomatic or asymptomatic neurosyphilis in all nine patients. Thus, the specificity of the CSF-VDRL was 100%, but the sensitivity was only 33%. The overall prevalence of neurosyphilis was 2.9%, increasing to 9.5% in patients with a reactive serum TPHA. Our study emphasizes the importance of antibiotic therapy for presumptive neurosyphilis in HIV-infected patients with latent syphilis and CSF abnormalities but nonreactive CSF-VDRL tests, even if they are neurologically asymptomatic or present with complaints inconclusive of neurosyphilis.

Adult↗
PubMed1996

Trimipramine: a challenge to current concepts on antidepressives.

Although it is chemically a classical tricyclic antidepressant agent, trimipramine shows atypical pharmacological properties. Its well-documented antidepressant action cannot be explained by noradrenaline or serotonin reuptake inhibition or by a down-regulation of beta-adrenoceptors. Furthermore, its receptor affinity profile resembles more that of clozapine, a neuroleptic drug, than that of tricyclic antidepressants. Trimipramine does not reduce, but rather increases, rapid eye movement sleep. It stimulates nocturnal prolactin secretion and inhibits nocturnal cortisol secretion and may act at the level of the hypothalamus on corticotropin-releasing hormone secretion. Trimipramine is of particular value in depressed patients with insomnia, and it has been shown to be effective in the therapy of primary insomnia. As the pharmacological profile indicates, and an open clinical study has shown, trimipramine might also be active as an antipsychotic. The drug is both a tool for increasing our understanding of depression and a potential therapy for several psychiatric disorders.

Antidepressive Agents, Tricyclic↗
PubMed1996

Replacement of (R)-methadone by a double dose of (R,S)-methadone in addicts: interindividual variability of the (R)/(S) ratios and evidence of adaptive changes in methadone pharmacokinetics.

METHODS: Twenty-two patients receiving (R)-methadone maintenance treatment were switched to a double dose of (R,S)-methadone: blood samples were collected before and after the change, and the concentrations of the enantiomers were measured. In the second period, during racemic methadone treatment, important interindividual variability in the stereoselective disposition of the enantiomers of methadone was measured, with (R)/(S) ratios ranging from 0.63 to 2.40. This point should be taken into account particularly with respect to therapeutic drug monitoring of racemic methadone. RESULTS: A significant decrease P < 0.005 in the mean serum concentration/dose ratios of the active (R)-enantiomer before and after the change was measured (mean 3.97 and 3.33). CONCLUSION: Although of small amplitude (16%), this decrease confirms previously described adaptive changes in methadone pharmacokinetics during racemic methadone maintenance treatment and may necessitate, in some patients, a dose adjustment.

Adult↗
PubMed1996

Pain perception of intravenous heroin users on maintenance therapy with levomethadone.

Methadone is a very potent analgesic drug. Accordingly, maintenance therapy of heroin addicts with methadone may conceal pain producing processes. Here we report on the pain perception of 42 patients on a levomethadone maintenance treatment for intravenous heroin users. Pain perception was measured by single-blind, non-invasive pressure stimulation of the nociceptors located in the dorsal extension aponeurosis and the underlying periosteum of the middle phalanx of a digit before and respectively 1,2, and 4 hours after oral routine drug administration. Measures were related to the individual levomethadone plasma levels. Under steady-state conditions, the pain perception of the patients did not differ from a drug-free placebo control group and was not related to individual levomethadone plasma levels, although an analgesic effect in the reabsorption phase was observed. It is concluded that the individual pain perception of maintained patients is adapted to a normal response range and that even prolonged opioid consumption does not diminish dynamic analgesic responsiveness to levomethadone.

Adult↗
PubMed1996

The efficacy of L-methadone and racemic methadone in substitution treatment for opiate addicts--a double-blind comparison.

In a two-week double-blind trial l-methadone and racemic methadone were compared for efficacy in substitution treatment for opiate addicts. Before the trial the twenty-six participants had been on stable doses of l-methadone. Patients with evidence of current serious psychological problems were excluded. Patients were evaluated twice a week using a modified FSUCL, physician's withdrawal checklist, self-rating withdrawal scale, and the Beschwerden-Liste (complaint list) according to von Zerssen. Between addicts continuing on l-methadone (n = 13) and those now receiving racemic methadone (n = 13) there were no statistically significant differences. In particular, patients receiving racemic methadone did not complain more frequently of withdrawal symptoms. In a follow-up period of nine weeks after replacement of l-methadone with racemic methadone, there was also no significant increase in complaints about withdrawal symptoms, although six patients needed an elevation of their daily dosage by at least 20 mg racemic methadone.

Adult↗
PubMed1996

Pharmacokinetic and pharmacodynamic interactions in an outpatient maintenance therapy of intravenous heroin users with levomethadone.

The plasma levels of 42 patients on a levomethadone maintenance treatment programme for intravenous heroin users were measured before and, respectively, 1, 2 or 4 hours after oral routine administration and related to the individual additional drug usage (detected by urine drug screening), liver function, side-effects and withdrawal symptoms. In general, accelerated levomethadone metabolism induced by additional misuse of benzodiazepines, barbiturates and opiates resulted in significantly lower plasma levels of the substitute. In particular, high gamma-glutamyltransferase activity was related to benzodiazepine consumption. On the other hand, an impaired liver function reflected by increased beta-globulins resulted in an insufficient body clearance and drug accumulation. Major side effects, such as sweating, were not related to plasma levels whereas withdrawal symptoms like diarrhoea or "feeling cold" correlate with lower plasma concentrations. It is concluded that polydrug misuse in the methadone maintenance therapy creates a vicious circle of enzyme induction, thus increasing "instrumental drug utilization". However, underestimated maintenance dosage may lead to additional drug consumption resulting, finally, in therapeutic failure.

Journal Article↗
PubMed1995

Different patterns of sexual dysfunctions associated with psychiatric disorders and psychopharmacological treatment. Results of an investigation by semistructured interview of schizophrenic and neurotic patients and methadone-substituted opiate addicts.

Little is known about sexual dysfunctions associated with psychiatric disorders and psychopharmacological treatment. In the present study schizophrenic patients (n = 45, mostly under neuroleptic treatment), neurotic patients (n = 50, mostly treated without medication), methadone-substituted opiate addicts (n = 37), and normal controls (n = 41) were included. They were interviewed with the aid of a sex-differentiated semistructured questionnaire on sexual function. All the methadone-substituted opiate addicts and nearly all the schizophrenic patients suffered from dysfunctions in at least one criterion. The three clinical groups differed significantly from the controls in sexual interest, emotional arousal, physiological arousal (erectile function/vaginal lubrication), performance (ejaculatory function/vaginism, dyspareunia), and orgasm satisfaction. Characteristic patterns of dysfunction were found in the male patients. The schizophrenic patients had significantly more dysfunctions of interest, physiological arousal, performance, and orgasm than the controls. Emotional arousal, erectile and ejaculatory functions, and orgasm satisfaction were impaired more frequently in the male schizophrenics than in the neurotic patients. Reduced sexual interest, emotional arousal, and orgasm satisfaction were reported more frequently by the methadone-substituted opiate addicts than by the neurotic men. Emotional arousal was even more frequently reduced than in the schizophrenic men. There was no correlation between sexual dysfunction and particular neuroleptics or neuroleptic or methadone dosage. The results are compared with the literature and suggestions made for further investigations.

Adult↗
PubMed1995

[Psychotherapy in the psychiatric clinic--an empirical study of the expectations of patients].

Before admission to in-patient psychotherapeutic treatment 202 patients with schizophrenic or neurotic orders, partly with secondary alcohol or substance addiction, were investigated with a questionnaire concerning patients' expectations of psychotherapy: targets, expectations of therapeutic attitude and technique as well as therapeutic procedure (individuals or group therapy). The results are correlated with sociodemographic data and psychiatric disorders and compared with the patients who were not admitted to therapy and the results after discharge. Conclusions are made with regard to indication and adaptive patient-centered therapeutic proceeding.

Adult↗
PubMed1995

[Cost-effectiveness of syphilis screening in a clinical for general psychiatry].

The most important clinical picture of syphilis for psychiatry is that of progressive paralysis. It is an organic psychosis with varying psychopathology. Therefore, nearly all patients in psychiatric departments undergo lues screening (TPHA) on admission. A cost-benefit analysis is presented. In the examination period from 1 January 1983 to 30 September 1988, in all 8915 patients were newly admitted to the department of general psychiatry at the University Hospital of Essen: 98 of these patients were TPHA-positive, and 6 patients had to be treated with antibiotics. One patient had neurolues. It seems therefore, that lues screening in a department of general psychiatry is performed for traditional reasons at high cost but with minimal benefit. The 6 patients who underwent a specific therapy were analysed; a catalogue of indication criteria for TPHA screening was elaborated and is presented.

Adult↗
PubMed1995

[How can acceptance by psychiatric patients of group psychotherapy be improved? An empirical study of the effect of combined individual and group psychotherapy on attitude to group psychotherapy].

This study investigates whether the sceptic attitude of many psychiatric patients to group therapy can be improved by a combined individual and group therapy program. The investigation was made on 50 patients, most of them with neurotic disorders, partly with secondary alcohol or substance abuse as well as some schizophrenic patients. Before admittance to the psychotherapy program enquiries were made by means of a questionnaire, about what subject they would like to speak in the individual or group therapy sessions. The results differ significantly dependent on sociodemographic and illness related factors. A second examination after discharge reveals an ameliorated attitude concerning group therapy in nearly all central themes. Thus, one of the important goals of in-patient psychotherapy has been achieved to improve patients ability to receive out-patient group therapy.

Adult↗
PubMed1994

[Change in causal attributions and coping caused by inpatient client-centered psychotherapy].

During 3-month client-centered hospital treatment 108 patients with neurotic depression, anxiety disorders and other neuroses (DSM-III-R) recovered from depressivity (Giessen-Test, MES), negative attributional styles and regressive coping (KCF). Gains were maintained over follow-up one and two years after therapy. Not only cognitive, but also rogerian psychotherapy leads to significant increment in cognitive coping efforts, even when grade of depressivity is regarded. Attributional style and coping strategies depended on grade of depressivity and status of patient (admission or follow-up); cognitions did not discriminate dysthymic (depressive) patients from other neurotic disorders.

Adaptation, Psychological↗
PubMed1994

[Demands and reality in the rehabilitation of psychiatric patients. Results of a follow-up study in established need for rehabilitation with reference to the housing and/or vocational sphere].

At an index day all 166 patients of the Department of General Psychiatry were asked whether changes of working or housing condition were considered necessary and which definite steps had to be done. In 85 (51.2%) of 166 patients changes were considered necessary. What measures had been initiated or carried out? Concerning the housing situation age and disease (psychiatric diagnosis) proved to be important factors; concerning the working situation age, sex, socioeconomic status and length of unemployment were important.

Adult↗