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Biomedical subjects

M Linden

Publications and source records attributed to M Linden.

At least 37 records · Page 2Linked to original sources
PubMed2003

Is interval medication a successful treatment regimen for schizophrenic patients with critical attitudes towards treatment?

In neuroleptic long-term medication, only part of the patients accept regular intake of neuroleptic drugs. The question is whether an interval medication regimen as opposed to continuous medication can help to reduce drop outs in patients with critical attitudes towards long-term medication. In a 2-year prospective study, 122 patients were randomised to an interval and 164 to a continuous neuroleptic medication regimen. The drop out rates were 62.5% in the interval and 53.7% in the continuous medication group. Drop outs generally show more negative attitudes towards treatment. Patients with negative attitudes do not do better under interval medication. Moreover, this regimen even requires more cooperation and trust in terms of the necessity of medication on the part of the patient compared to the continuous medication regimen. Interval medication therefore is a strategy which can only be successful in highly cooperative, but not in treatment-reluctant patients.

Antipsychotic Agents↗
PubMed2003

Dosage finding and outcome of venlafaxine treatment in psychiatric outpatients and inpatients: results of a drug utilization observation study.

BACKGROUND: Venlafaxine is an antidepressive drug with the special characteristic of inhibiting both synaptic serotonin and norepinephrine reuptake. This double action is dosage dependent, with the relatively weaker inhibition of norepinephrine becoming clinically relevant only at higher dosages. This allows treatment to be tailored towards the needs of individual patients through differential dosing. It is unknown, however, how physicians use this unique feature in prescribing venlafaxine in routine treatment. METHOD: Data from a drug utilization observation (DUO) study, including 6706 patients, are used to investigate which patient and setting variables predict dosage of venlafaxine as prescribed by psychiatrists in inpatient and outpatient settings. Treatment outcome and adverse drug reactions (ADR) were analyzed for different dosage groups. RESULTS: Treatment setting is the most important factor in predicting high (> 75 mg/day) or low (up to 75 mg/day) dosage of venlafaxine, with inpatients receiving higher dosages. Severity of illness and a history of previous treatment with major antidepressives are also related to higher dosages. Although the total rate of ADR did not increase with increased dosage, the profile of drug reactions changed. Response to therapy was better in cases of non-chronic, major depression with no treatment history of antidepressives. Additionally, increased dosage increased the likelihood of response in outpatients. In both settings, very high dosages predicted better response to venlafaxine among severely ill patients. CONCLUSION: Venlafaxine at a dosage of 75 mg/day is sufficient for the majority of cases. In extremely ill patients, higher dosages are associated with additional benefits. Therefore, a stepwise dosage regimen is suggested, with an increase of dosage to upper limits in cases of non-response before discontinuation of treatment with venlafaxine.

Adolescent↗
PubMed2002

[ICD-10 primary health care. WHO support for family practice psychotherapy].

In the year 2001, The World Health Organization (WHO) published a special edition of the International Classification of Mental Disorders (ICD-10, Chapter F) for use by general practitioners (ICD-10 PHC-Primary Health Care). In this GP version of the ICD-10, diagnostic categorizations and algorithms serving treatment requirements are summarized in simplified form. Unlike the general ICD-10 guidelines, this version also contains management guidelines for each disease category. These include information for the patient and family, advice on counseling, description of treatment methods, and indications for specialist referral. The treatment guidelines are differentiated, concrete and suitable for use in the doctor's office, and concise (in each case not more than a single page). The WHO also offers an education program to enable the interested GP to deepen his knowledge of the treatment guidelines and their theoretical basis. A particular feature of this program are patient information leaflets that guide the physician on what the patient needs to be told. The physician can use these as a basis for his talks with the patient, or give them to the patient for home study.

Family Practice↗
PubMed2002

Cognitive impairment in depressed outpatients as measured with the Dementia Checklist: a simple method for primary care and in field research.

The Dementia Checklist is a 12-item dementia rating scale for physicians who, for whatever reason, cannot be specifically trained. It addresses symptoms of cognitive decline that can easily be identified, and that are typical for different stages of cognitive impairment. This allows an easy classification of the severity of dementia. In a first study, the dementia checklist was used in 937 geriatric outpatients who were treated by neuropsychiatrists for depression. All items contribute to the accuracy of measurement (Cronbach's alpha = 0.84). Differences in cognitive impairment depending on age (chi 2 = 51.7; p < or = 0.001) and depression (chi 2 = 47.6; p < or = 0.001) indicate external validity of the dementia checklist and 5.7% of the outpatients were rated as demented. The Dementia Checklist provides a very economical and easy-to-use assessment of cognitive decline.

Age Factors↗
PubMed2002

[Chronic course and psychosocial disability caused by depressive illnesses in general practice patients during a one year period. Results of a study by the World Health Organization].

As part of an international WHO study on psychological disorders in primary health care, patients were examined for mental disorders and especially depression and social disability in the course of 1 year. Depression is common in primary care (8.6%) and frequently associated with recurring or chronic courses (33.3%). Depression at baseline leads to a 100% increase of lost working days (3.2 per month) 1 year later as compared to patients without depression (1.7). The diagnosis of depression at baseline poses a greater risk for a relevant and lasting psychosocial disability (28.2%) than e.g. chronic somatic illnesses (8.6%). Even the diagnosis of a subthreshold depression leads comparatively to a higher degree of psychosocial disability (15.6% of patients) and days of absenteeism at work during the last month (2.9 days).

Absenteeism↗
PubMed2002

Effects of rhinovirus-induced common colds on granulocyte activity in allergic rhinitis.

OBJECTIVE: To explore the activities of mast cells, eosinophils, and neutrophils in patients with allergic rhinitis developing common colds and increased responsiveness to allergen following nasal rhinovirus inoculation. METHODS: We have revisited a nasal lavage material obtained from 17 patients who were successfully inoculated with rhinovirus outside the pollen season and received nasal allergen challenges before and after inoculation. We have examined indices of mast cell activity (tryptase), eosinophil degranulation (eosinophil peroxidase; EPO), and neutrophil activation (myeloperoxidase; MPO). RESULTS: Allergen challenges performed before rhinovirus inoculation increased the nasal output of EPO. Notably, this response was significantly greater after rhinovirus inoculation (cf. before inoculation). The output of MPO was also increased following allergen challenge after, but not before, rhinovirus inoculation. Nasal lavage fluid levels of tryptase were increased following allergen challenge similarly before and after rhinovirus inoculation. Also, the viral infection did not affect the baseline levels of tryptase. CONCLUSIONS: The present data demonstrate that rhinovirus infections activate both eosinophils and neutrophils, but that they may not affect mast cell activity. We suggest that common colds in part through stimulation of granulocyte activity potentiate the airway inflammation in allergic diseases.

Administration, Intranasal↗
PubMed2002

[Psychosocial Risk Factors of the Wish to be Dead in the Elderly].

BACKGROUND: Suicidal ideation is a common phenomenon in the elderly. The purpose of this report is to reveal the influence of psychosocial risk factors and psychiatric disorders on the wish to die in the elderly. METHOD: We compared the data of 54 persons (age 70+) who said that they wished to die with 462 persons without death wishes according to several psychosocial risk factors, physical health and psychiatric diagnoses. The data come from the Berlin Aging Study, an interdisciplinary assessment of an epidemiological random sample of 516 citizens in Germany. RESULTS: Using a MANOVA and logistic regression analysis the data indicated that the wish to be dead, even in these very old persons, was mostly associated with the occurrence of a major depression, self rated higher depressivity, higher age, female gender, and negative life conditions such as living in a nursing home. CONCLUSION: The results of this study support that the wish to be dead in the very old is very likely to be associated with the occurrence of a psychiatric disorder, especially major depression and the higher probability of negative life conditions. Thus, we emphasize the requirement of psychiatric assessment as well as treatment of those older people who want to die.

Age Factors↗
PubMed2002

[Vagus nerve stimulation. A potential therapy for chronic/recurrent depression?].

Vagus Nerve Stimulation (VNS) is since the 1990 a clinically useful anticonvulsant therapy for treatment-resistant epilepsy. Open acute and longer term data suggest the potential clinical utility of VNS as an antidepressant therapy especially in treatment refractory depression. The vagus nerve has connections to the limbic system and other brain structures which modulate affect. PET studies showed functional changes under VNS in such critical areas, which can explain the mechanisms of action of VMS. Ongoing studies will have to better establish its acute and longer-term efficacy, and specific indications in the treatment of depression.

Depressive Disorder↗
PubMed2001

In vitro bioactivity of aerosol-gel deposited TiO(2) thin coatings.

Bioactive, pure, and Ca- or P-doped TiO(2) thin coatings on Ti metal and Si wafers were prepared by the aerosol-gel technique. The coatings were characterized by X-ray photoelectron spectroscopy, atomic force microscopy, Fourier transform infrared spectroscopy, and scanning electron microscopy. Bioactivity was determined in vitro in a simulated body fluid and was shown to be fully comparable to sol gel-derived TiO(2) coatings prepared by dip-coating. However, the formation rate of carbonate containing apatite decreased with increasing dopant concentration, which was related to changes in chemical composition and topology of the coatings.

Aerosols↗
PubMed2001

[Depressive disorders and antidepressive therapy. A comparison of neurology practice and psychiatric clinic].

It is a question of great importance when psychiatric patients should be treated as inpatients or as outpatients. This decision depends on therapeutic as well as economic considerations. However in depression, as in other mental illnesses, many cases could reasonably be treated as in- or outpatients alike. Despite the importance of this question, there is to our knowledge no epidemiological study which compares patients in inpatient and outpatient settings within the current German medical system. 1300 inpatients and 5376 outpatients were investigated using identical methodologies within a drug utilization study of the antidepressant venlafaxine. Inpatients were found to be more severely ill and have a recurrent course of illness and higher rates of comorbidity. Outpatients more often had a chronic course. Inpatients were treated more often and with a wider variety of medication than outpatients, with the exception of phytopharmaceuticals. Venlafaxine was given in higher doses in the inpatient setting and combined more often with other psychotropic medications. Complaints of adverse drug reactions were comparable in both groups. Nausea was the most frequent, reported by 9.7% of inpatients and 15.2% of outpatients. The data show that the distribution of patients in outpatient and inpatient settings corresponds to the stepwise structure of the German health care system.

Adult↗
PubMed2001

Psychiatrists' diagnoses of subthreshold depression in old age: frequency and correlates.

BACKGROUND: Depressive syndromes not fulfilling the criteria for specified disorders (subthreshold depression, SD) may be clinically important. We aimed to study SD in old and very old age, in comparison with subjects with no depressive symptoms (NDS) and subjects with major depression (MD). METHODS: A community-based random sample of 516 subjects, age 70 to 100 years and over, stratified by age and sex, was examined. All participants were investigated by psychiatrists and by geriatricians independently. RESULTS: In 16.5% (N = 85) of the study subjects SD was identified. Study subjects with SD had, similarly to the subjects with MD, significantly more somatic diagnoses and used more somatic as well as psychotropic medications than the subjects with NDS. Self-ratings and observer ratings of depression indicated that SD was a milder depressive state than MD. CONCLUSIONS: Compared with MD, SD is probably a milder form of depression. The increased use of psychotropic medications indicates that at least a portion of these individuals have a disorder requiring treatment. One of the characteristics of SD is co-morbidity with somatic illnesses and physical disability.

Aged↗
PubMed2001

The development of a quantitative electroencephalographic scanning process for attention deficit-hyperactivity disorder: reliability and validity studies.

The development of a quantitative electroencephalographic (QEEG)-based procedure for use in the assessment of attention deficit-hyperactivity disorder (ADHD) was examined through a series of studies investigating test reliability and validation issues. This process, involving a spectral analysis of the electrophysiological power output from a single, midline, central location (the vertex), was conducted in 469 participants, 6 to 20 years of age, classified as ADHD, inattentive type; ADHD, combined type; or control. The results indicated that the QEEG scanning procedure was reliable (r = .96), was consistent with the Attention Deficit Disorders Evaluation Scale (S. B. McCarney, 1995) and the Test of Variables of Attention (L. M. Greenberg, 1994; chi-square, p < .01), and differentiated participants with ADHD from a nonclinical control group (p < .001). The sensitivity of the QEEG-derived attentional index was 90%; the specificity was 94%.

Adolescent↗
PubMed2001

Mucosal output of eotaxin in allergic rhinitis and its attenuation by topical glucocorticosteroid treatment.

BACKGROUND: Eotaxin is a chemokine that attracts and activates eosinophils. The present study examines the occurrence of eotaxin in nasal mucosal surface liquids in patients with seasonal allergic rhinitis without allergen exposure and during repeat allergen challenge with and without topical glucocorticosteroid treatment. The number of subepithelial eosinophils and mucosal outputs of bulk plasma (alpha2-macroglobulin) and eosinophil cationic protein (ECP) are also examined. METHODS: Twelve patients underwent daily allergen challenges for 6 days. Separately, 14 patients, who were receiving budesonide and placebo in a parallel group design, also underwent allergen challenge for 6 days. Nasal biopsies were obtained before and 24 h after the allergen challenge series, and lavages were carried out before and 15 min after selected allergen challenges. RESULTS: At baseline nasal lavage fluid levels of eotaxin correlated to levels of alpha2-macroglobulin and ECP. After the first allergen challenge there was a correlation between nasal lavage fluid levels of eotaxin and ECP. Repeat allergen exposure increased the mucosal output of eotaxin (P <0.05) and ECP (P <0.01) as well as eosinophil numbers (P <0.01), but no correlation was found between increased eosinophil numbers and eotaxin. Budesonide reduced eotaxin levels during repeat allergen challenge (P <0.05). CONCLUSIONS: Repeat allergen exposure in allergic rhinitis is associated with increased mucosal output of eotaxin. Topical budesonide attenuates this effect, suggesting the possibility that inhibitory effects on mucosal eotaxin may contribute to anti-eosinophilic actions of topical glucocorticosteroids.

Administration, Intranasal↗
PubMed2001

Epidemiology of prescriptions for neuroleptic drugs: tranquilizers rather than antipsychotics.

BACKGROUND: The pharmacology of neuroleptics as well as epidemiological and clinical observations of prescriptions of these drugs give the impression that they are and can be used for indications other than schizophrenia to a considerable degree. METHOD: We analyzed pharmacoepidemiological data on neuroleptic prescriptions in Germany. We used the following criteria: numbers of defined daily doses (DDDs) per annum, diagnoses for which they were prescribed, patient age, specialist medical training of the prescribing physician, and indicators that neuroleptics were used instead of other psychotropic drugs such as minor tranquilizers. RESULTS: Only 14% of the prescriptions for neuroleptic drugs were for schizophrenic psychoses, 18% for other paranoid psychoses and 5% for affective disorders. 63% were prescribed for neurotic disorders, sleep disorders, or dementia. Almost half of the neuroleptic prescriptions were given for patients aged 65 years or over. Only 40% were prescribed by psychiatrists or neurologists. Throughout the period from 1986 to 1995, neuroleptic prescriptions increased steadily, which was paralleled by a decrease in the prescription rates for benzodiazepines. CONCLUSIONS: Evaluation is urgently needed for those uses of neuroleptic drugs that, from a pharmacoepidemiological perspective, must be seen as their primary indication.

Adult↗
PubMed2001

A prospective study of factors influencing adherence to a continuous neuroleptic treatment program in schizophrenia patients during 2 years.

Dropout from prophylactic neuroleptic treatment is one major reason for relapse in schizophrenia patients. There is a lack of prospective studies on factors that predict medication adherence. We investigated factors suspected to predict dropout from continuous neuroleptic treatment in a 2-year prospective study involving 122 outpatients with a DSM-III-R diagnosis of schizophrenia. Forty-two (34.4%) were classified as patient-related dropouts. No significant difference between compliant patients and dropouts was found with regard to sociodemographic variables, except that compliant patients were significantly older. Also, no differences in psychopathology were seen at the beginning of treatment, but compliant patients had a longer duration of illness. Compliant patients had higher doses of neuroleptics in the initial stabilization phase and correspondingly showed more extrapyramidal signs. Physicians rated compliant patients from the beginning as more cooperative. These patients also showed significantly higher scores in positive treatment expectations. In a stepwise regression analysis, positive illness concepts, the global assessment of functioning (GAF), and the physicians' view of patients' cooperation predicted 19 percent of the variance. We concluded that the prediction of dropouts is insufficient and remains largely an unsolved problem. Future research should focus more on context factors in the search for clinically meaningful explanations of patient dropout from treatment.

Adult↗
PubMed2001

[Do old persons wish to die? Suicidal tendencies and weariness of life in old age. Results of the Berlin Aging Study (BASE)].

On the basis of the results of the Berlin Aging Study (BASE), some 15% of persons aged 70 years and older confess to being tired of life, 5% express a wish to die, and 0.5-1% entertain thoughts of suicide. Women express a wish to die or have thoughts of suicide approximately 1.5 to 3 times more frequently than men. Depending on the severity of the suicidal tendency, more than 80% of such patients, and all of these entertaining thoughts of suicide, suffer from acute psychiatric disorders. Death wishes and thoughts of suicide must therefore always prompt an intensive psychiatric diagnostic work-up, and initiation of suitable and rigorous treatment, and must not be mistaken for the expression of understandable attitudes towards aging.

Age Factors↗