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Biomedical subjects

M Soyka

Publications and source records attributed to M Soyka.

At least 127 records · Page 7Linked to original sources
PubMed1995

Pharmacotherapy and psychotherapy for the treatment of alcoholism in Germany.

Although past alcoholism treatment in Germany has primarily focused on psychotherapy, new advances in pharmacotherapy are expanding therapeutic options. Recent biomedical studies have produced new theories about how alcohol affects neurotransmitters in the brain. These studies have led to new pharmacologic strategies for the treatment of alcoholism using dopamine agonists and antagonists, serotoninergic agents, glutamate antagonists, and opiate antagonists. While preliminary studies of these agents offer encouraging results, it remains to be demonstrated which agent(s) will provide effective pharmacotherapy for this disease.

Alcohol Deterrents↗
PubMed1995

Successful treatment with flupenthixol decanoate of a patient with both schizophrenia and alcoholism.

There is growing evidence that substance abuse is a major problem in patients with schizophrenia. With respect to alcohol, alledegly the most frequently abused drug among schizophrenics, clinical and epidemiological studies would suggest that the risk of alcoholism is approximately four times greater (Cuffel, 1992; Mueser et al., 1990; Soyka et al., 1993; Soyka, 1994). A variety of hypotheses have been proposed to explain this phenomenon, including the so-called "self-medication hypothesis". Some authors feel that substance abuse in schizophrenics might be due to extrapyramidal and other side-effects caused by neuroleptic treatment or inadequate remission of psychotic symptoms. There remains, at present, an obvious lack of both psychosocial and psychopharmacological studies of treatment in "dual diagnosis" schizophrenics (Mueser et al., 1992). Changes in dopaminergic neurotransmission and dopamine-receptor dysfunction have been linked both to the development of psychotic symptoms and to alcoholism/substance abuse, and thus give rise to the question as to whether some dual diagnosis patients might benefit from neuroleptic treatment in both domains. A number of dopamine receptor subtypes in different regions of the brain seems to be involved in the development of schizophrenia and substance abuse. Modifications of D2-receptor subtype function have been implicated in psychotic symptoms, and changes in the D1- and D2-receptor function in substance abuse such as cocaine abuse and alcoholism (Spealman et al., 1990; 1991; 1992), especially in the mesolimbic dopaminergic reward system. Accordingly, the "ideal" neuroleptic drug for dual diagnosis schizophrenics should be effective in both receptor subtypes.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

[Othello syndrome--jealousy and jealous delusions as symptoms of psychiatric disorders].

Jealousy as a psychopathological symptom has long been neglected by psychiatric research. Despite the obvious difficulty to prove or exclude the infidelity of a spouse, delusional jealousy can clearly be considered as pathological, but the evaluation and classification of non-psychotic jealousy remains a challenge. Typical psychopathological symptoms which usually accompany pathological jealousy and the prevalence of delusional jealousy in different psychiatric disorders are described. In delusional jealousy neuroleptic treatment is necessary. Positive results have been reported especially with pimozide. For non-psychotic jealousy various forms of psychotherapy have been advocated to improve self-esteem or to treat other psychological disorders. Other possible interventions are alcohol therapy or family counselling. Many studies show that jealousy is a frequent motive in homicide with the spouse being nearly exclusively the victim. Finally some forensic aspects of jealousy are discussed.

Antipsychotic Agents↗
PubMed1995

Prevalence of delusional jealousy in schizophrenia.

Prevalence rates for delusional jealousy were found, respectively, to be 2.2 and 1.1% in two samples of 183 and 447 schizophrenic inpatients and therefore being lower than the prevalence rates reported in a recent sample studied by Tateyama and coworkers. Five of the 8 patients with delusional jealousy were found to have an additional alcohol abuse or dependence problem. Various other factors such as present age and age at onset of psychosis, gender, and transcultural factors might contribute to the development of the syndrome in schizophrenia.

Adult↗
PubMed1995

[Forensic psychiatric expert evaluation of so-called drug-induced psychoses].

A considerable number of schizophrenic persons also abuse illegal drugs. This comorbidity raises problems of diagnosis which become particularly important when concerning forensic questions. The hypothesis of a distinct psychopathological syndrome of drug induced psychosis is widely criticized in the literature. A case report is presented to demonstrate the problems of differential diagnoses and the difficulties for psychiatric expertizing arising from these problems.

Adult↗
PubMed1995

[Munchausen syndrome by proxy].

The term "Munchausen by proxy" denotes a special form of factitious disorder and a rare kind of child abuse. We present the case of a 12-year-old boy, whose mother's manipulations culminated in his immobilization in a wheelchair and the implantation of a pacemaker. Problems of diagnosis and clinical management of Munchausen by proxy are discussed.

Adult↗
PubMed1995

[Mefloquine-induced psychoses--problems in etiologic classification based on 2 case reports].

Psychiatric disorders following treatment with Mefloquine were described several times since the introduction of this antimalarial drug in Germany in 1985. On the basis of two case reports problems of the diagnosis and of the correlation of psychiatric disorders with the medication are discussed. Particularly are an analysis of the development of the ADR and a comparison of the psychiatric symptoms with known ADR-cases and with other psychiatric diseases important. This seems to be significant for an optimal treatment as well as for the assessment of the prognosis.

Adolescent↗
PubMed1994

Substance abuse and dependency as a risk factor for delinquency and violent behaviour in schizophrenic patients--how strong is the evidence?

There is increasing evidence that schizophrenics are at a comparatively high risk for delinquency and violent behaviour. There is a need to define risk factors for aggression and violence in schizophrenics. Apart from an apparently higher rate of violent and assaultive behaviour in male schizophrenics, on the psychopathological level, symptoms such as vivid hallucinations or delusions have been proposed as possible risk factors. It is possible that substance abuse in schizophrenia may be considered as a risk factor for delinquency and violent behaviour. There is evidence from both clinical and epidemiological studies that this is the case. These data are reviewed.

Journal Article↗
PubMed1994

[Addiction and schizophrenia. Nosological, clinical and therapeutic questions. 1. Alcoholism and schizophrenia].

The scientific discussion on the interrelationship of "alcoholism and psychosis" has been dominated by nosological problems for years. Alcohol hallucinosis, a comparatively rare psychosis in chronic alcoholism, can mimic the symptomatology of paranoid schizophrenia. The clinical features (vivid acoustic hallucinations and fear) are often inconclusive, as, unlike other organic psychoses, alcohol hallucinosis does not entail clouding of sensorium and disorientation. On the one hand follow-up studies suggest that alcohol hallucinosis in some cases can take a chronic schizophrenia-like course. Especially in these cases differential diagnosis between both conditions can be difficult. On the other hand a number of recent clinical studies suggest high prevalence rates for substance and esp. alcohol abuse and dependence in schizophrenics. Different approaches account for limitations in comparing the results. In most of the studies prevalence estimates for alcohol abuse and dependence range from 12-43%. In some highly selected clinical populations even higher prevalence estimates have been reported. Epidemiological studies such as the "Epidemiological Catchment Area Study" equally are in support of an appr. 4-fold increased risk for alcoholism in schizophrenics. Schizophrenics with alcohol abuse differ from non-abusing schizophrenics in a variety of clinical symptoms and features. With respect to psychopathological symptomatology schizophrenics with an additional alcohol abuse or dependence show more "positive", psychotic and less "negative" symptoms. Some findings suggest that in comparison with other schizophrenics, dual diagnosis schizophrenics may be superior in terms of a better premorbid functioning. However, during course of illness higher (re-) hospitalization rates and higher rates of suicide attempts have been reported; likewise, aggressivity and delinquency have been encountered. In this review clinical and diagnostic questions concerning the interrelationship between alcoholism and schizophrenic psychosis are discussed and some principles of psychopharmacotherapy in dual diagnosis schizophrenics are outlined.

Alcoholism↗
PubMed1994

[Addiction and schizophrenia. Nosological, clinical and therapeutic questions. 2. Substance dependence and schizophrenia].

While schizophrenia-like psychosis is known to occur with chronic alcoholism the nosological differentiation of schizophrenia-like psychosis in patients with drug abuse remains difficult. An increased risk for the development of such psychoses has been discussed for various substances, e.g. cannabis. On the one hand this is supported by clinical and epidemiological studies but a final agreement has not been reached. On the other hand high prevalence estimates for substance abuse in schizophrenics have been reported in the angloamerican literature. Prevalence estimates for drug abuse and dependence range between 7-65% and a comparatively distinct abuse pattern in schizophrenics has been discerned: Apart from alcohol schizophrenics tend to abuse cannabis and psychostimulants including cocaine and hallucinogenes, whereas narcotics are abused only infrequently. Whether these recent figures for substance abuse and dependence are due to a real increase (32) or to improved diagnostic instruments and differences in the classification of psychiatric disorders or to selected samples (3, 122) is still a matter of controversy. In comparison with other schizophrenics dual diagnosis schizophrenics show more positive (psychotic) and less negative symptoms. In this review some clinical and neuro-biological problems concerning the concept of drug-induced psychosis and basic principles of pharmacotherapy and psychotherapy in schizophrenic patients with substance abuse are discussed.

Combined Modality Therapy↗
PubMed1994

Spiperone binding capacity in lymphocytes of patients with alcohol- and drug-induced psychosis: preliminary results.

An increased spiperone binding capacity in lymphocytes has been proposed as a possible biological marker for schizophrenia while in previous studies patients with alcohol dependence were shown to have a normal binding capacity. In a pilot study the spiperone binding capacity was studied in 8 patients with alcohol hallucinosis, 11 patients with acute drug-induced psychosis and 12 patients with other organic psychosis. An increased binding capacity, defined as > 4 fmol/l E6 cells, was found in only 1 patient with alcohol hallucinosis, 3 patients with drug-induced psychosis and 2 patients with other organic psychosis. Possible implications of these findings for future research are discussed.

Adult↗
PubMed1994

[Exacerbation of an affective psychosis after terminating a decade of benzodiazepine treatment. Which therapeutic procedure is sensible?].

We report the case of a 61-year old patient with an affective disorder who had been treated with benzodiazepines in low dosages over a 16 year period. This treatment had been prescribed by his physician following several depressive episodes. During this time, the patient remained able to work and exhibited little psychopathological symptomatology. Following discontinuation of medication, however, the depressive phases resumed and were particularly intractable. The clinical implications of this case and the therapeutic strategies for approaching patients with long-term benzodiazepine treatment are discussed.

Antidepressive Agents↗
PubMed1994

Alcohol dependence and schizophrenia: what are the interrelationships?

The interrelationship between alcohol dependence and schizophrenia is very complex. On the one hand, chronic alcoholism alone can result in a chronic, schizophrenia-like psychosis (alcoholic hallucinosis) which cannot be distinguished from schizophrenia on the basis of psychopathological or clinical symptoms. On the other hand, recent clinical and epidemiological studies point at a significantly increased prevalence for substance abuse and dependence in schizophrenia, especially of alcohol. Pathophysiological mechanisms possibly involved in the onset of hallucinations in alcoholics and recent studies on the comorbidity of alcohol dependence and schizophrenia are discussed.

Alcoholism↗