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Biomedical subjects

M Wolfersdorf

Publications and source records attributed to M Wolfersdorf.

At least 19 recordsLinked to original sources
PubMed2000

Schizophrenic psychosis: a contraindication for treatment of hepatitis C with interferon alpha?

Depressive or psychotic symptoms are a well known side-effect of interferon alpha (INF-alpha). Therefore, the questions arises whether a chronic psychosis should be considered a contraindication for the treatment of active hepatitis C with INF-alpha. We report on a 38-year-old woman with a chronic schizophrenic psychosis, who acquired chronic aggressive hepatitis C. Considering the young age of the woman, the potential risk of developing a hepatocellular carcinoma and the result of the liver biopsy, treatment with interferon alpha 2 b (3x5 million IU/week) was started. The patient was seen three times a week, her psychiatric condition was monitored using the positive and negative symptoms score (PANSS). No signs of psychotic or depressive symptoms appeared during INF-alpha therapy. During the first 6 months the liver enzymes dropped slowly but the virus load was increasing. After adding ribavirin to the therapy, the liver enzymes dropped again, and the PCR carried out 9 months after initiation and 6 months after the end of the 12 months INF-alpha treatment did not detect any virus RNA. This positive result should encourage prospective studies including patients with these two diagnoses on whether patients benefit from INF-alpha.

Adult↗
PubMed2000

[Substance dependence and suicide in hospitalized patients. A description].

OBJECTIVE: The research group "Suicide and Psychiatric Hospital" has studied inpatient suicides in psychiatric hospitals in Baden-Württemberg and Bavaria (Germany) from 1970-1996. Whereas suicides in depression and schizophrenia are described very well, a description of addicted inpatients who committed suicide is still missing. PATIENTS AND METHODS: We studied the data of substance dependent patients of the collective of 726 inpatient suicides. RESULTS AND CONCLUSIONS: Among the generally rare suicides of addicted inpatiens--33 of 726--about 81% were alcohol dependent. The frequency of suicide in this group of patients decreased from 6.7% in the years 1970-1984 to 1.4% between 1990 and 1996. Whereas the age remained more or less stable in the middle of the fifth decade, the time from hospitalisation until suicide shortened from 192 days (mean) to 52 days. Suicide of alcohol dependent and poly-drug-abusing patients today almost exclusively takes place during treatment on an open station and among patients being in treatment on a voluntary basis. Suicide attempts in the anamnesis are extraordinarily rare in alcohol dependent suiciders.

Adult↗
PubMed1998

[Inpatient treatment of depressed patents. Conceptual considerations and results of a pilot project for quality assurance in Baden-Württemberg].

Quality-assurance activities will become more important in psychiatry during the next few years. In relation to other medical disciplines, some special aspects concerning structure, process and outcome quality as well as practical realization and methodologic aspects must be considered. These specific issues were the focus of a study dealing with the treatment of depressed inpatients. The experiences and results as well as considerations concerning future quality-assurance projects are discussed.

Adult↗
PubMed1998

Thyroid parameters during therapy with zotepine in delusional depression. Preliminary results.

There are only few data on the effects of atpyical neuroleptics on thyroid function. In an open pilot study of 12 inpatients with delusional depression, thyroid hormone levels and TRH-TSH test were determined during neuroleptic treatment with zotepine. No significant changes in triiodothyronine (T3), thyroxine (T4) and delta-TSH levels were found in this observation period (28 days).

Adult↗
PubMed1998

[Suicide in depression, lost years of life and gross social consequences. What is the outcome of suicide prevention?].

In recent years there has been a tendency in research and clinical treatment to discuss also economic aspects of mental illness in the context of outcome and consequences of treatment for the individual and society. In our study on economic consequences of suicide prevention we could show that a reduction of suicide mortality of depressed patients could save money to the tune of thousands of million Deutschmark.

Cost Savings↗
PubMed1998

[Depression and aggression. A control group study on the aggression hypothesis in depressive disorders based on the Buss-Durkee Questionnaire].

PURPOSE: The aim of this study was to prove the hypothesis that covert or inhibited aggression/hostility as described in psychoanalytic literature is part of the psychogenetic development of depression. METHOD: We compared 50 consecutively admitted depressed inpatients to 50 healthy people of the regionally living general population, matched by sex and age, using the Buss-Durkee Hostility Inventory. RESULTS: Depressed patients have significantly higher values in the BDHI subscales "total aggression", especially in irritability, negativism, resentment, suspicion and guilt, also in "attitudional component", "inhibited aggression" and "covert hostility". No differences were found in "assault" and "indirect aggression", controls got significantly higher values in "verbal aggression". A comparison of depressed patients with suicide attempts versus depressed patients without such behaviour showed no significant differences. CONCLUSION: The psychoanalytic hypothesis seems to be useful for depression but not for the suicidal behaviour of depressive patients.

Adult↗
PubMed1997

[Suicide prevention--recognizing and treating acute suicidal behavior].

Over the years, numerous models and working hypotheses have been developed in attempts to understand the underlying causes of suicide, and data on the frequency of certain risk factors are now available. Although a large number of institutions ranging from emergency telephone advice services to departments for crisis intervention are in place, the suicide rate remains distressingly high-in particular in certain high--risk groups such as patients suffering from chronic depression or an addiction. While physicians need to be aware that their influence too may be limited, they would do well always to keep in mind the particular risk factors and high-risk groups.

Antidepressive Agents↗
PubMed1997

Combination therapy using moclobemide with tricyclic and tetracyclic antidepressants to treat therapy-resistant depression.

In an open trial, a combination therapy with 300 mg moclobemide was instituted after adjustment to a classical tricyclic or tetracyclic antidepressant in a group of 23 previously therapy-resistant depressive inpatients (pretreatment with two biochemically different antidepressants over a period of at least 5 weeks with sufficient doses). In 13 patients (53.9%) a significant improvement on the Hamilton Depression Scale (24-item version) of at least 50% was achieved. The improvement in the BPRS was also significant. On the basis of the present findings, a combination therapy with the reversible MAO-inhibitor moclobemide represents an efficacious regimen for therapy-resistant depressions, with low side-effects. After this pilot study, further controlled studies are necessary.

Analysis of Variance↗
PubMed1997

Trimipramine and maprotiline plasma levels during combined treatment with moclobemide in therapy-resistant depression.

In an open pilot study of 21 therapy-resistant depressive inpatients, plasma levels of antidepressants were determined during treatment with a combination of moclobemide/ trimipramine (n = 15) and moclobemide/maprotiline (n = 6). After combined administration of trimipramine and moclobemide (MCB), a significant increase in the plasma level of trimipramine (39%) was observed. After combination of maprotiline with moclobemide, maprotiline levels were increased (25%, n.s.). The results show that moclobemide, as an inhibitor of isoenzymes of the cytochrome P 450 oxidase, can cause increases in the plasma levels of tricyclic and tetracyclic antidepressants. No correlation between the serum level of the antidepressants and treatment outcome was found in this open study.

Adult↗
PubMed1997

[Quality assurance in inpatient treatment of depression. Aspects of quality monitoring and external quality assurance exemplified by a pilot project of inpatient treatment of depression].

Aspects of a Pilot Study on Depression Treatment According to Quality Monitoring and External Quality Assurance: Experiences and results of a pilot study on quality of the treatment of depressed inpatients in 4 different psychiatric hospitals (2 state mental hospitals, 1 university clinic, 1 psychiatric clinic at a city general hospital) according to so-called process and outcome quality, are reported. Outcome data (self-ratings, observer rating, clinical global impression admission versus discharge, patient satisfaction with treatment, duration of inpatient stay/and patient data are reported while comparing the 4 hospitals. Difficulties and problems of data collection, assessments and comparison of 4 different hospitals are discussed.

Adult↗
PubMed1997

[The expanded suicide attempt in depressive patients and its sequelae. The forensic and therapeutic considerations in 3 case reports].

Despite of the frequency of depressive disorders among the population, forensic aspects of depression are rare and usually focussed on suicidal behaviour, especially the so-called homicide-suicide (homicide followed by suicide). Today therapeutic strategies are seen in the first stage of dealing with depressed homicide-suicide attempters. Apart from the question of guilt with regard to the homicidal act, the question of recurrence of depression and the danger of a possibly repeated homicidal-suicidal behaviour are discussed in the light of three clinical cases.

Adult↗
PubMed1996

Electrodermal activity (EDA) and suicidal behavior.

There may be a connection between suicidal tendencies, electrodermal activity (EDA), disorders of impulse control, and neurobiochemistry (in the sense of a "psychobiology of suicidal tendencies"). The EDA values obtained during a psychobiological habituation experiment involving 11 female patients with personality disorders (PA; ICD-10) and histories of suicide attempts were compared with those of age-paralleled nonsuicidal depressive patients and depressive patients with histories of suicide attempts. They were also compared with EDA values in female schizophrenics with and without histories of suicide attempts. The PA group showed significant differences in all EDA values compared with nonsuicidal depressives, but no significant differences compared with other groups.

Adolescent↗
PubMed1996

The influence of various antidepressants on heart rate and electrodermal activity during psychophysiological examinations of depressive patients.

The aim of our investigation was to examine the effects of different antidepressants on the variables of heart rate and electrodermal activity. Heart rate and parameters of electrodermal activity which are important for psychophysiology were investigated in groups of depressed inpatients with different treatment (no antidepressant, noradrenergic antidepressant [imipramine/ reboxetin], serotonergic antidepressant [paroxetine]). The values of electrodermal parameters were the lowest in the group with noradrenergic antidepressant. There was a reversed pattern for the heart rate. This findings points to a different effect of imipramine/reboxetin versus paroxetine on psychophysiological data.

Adult↗
PubMed1996

[Evaluation of suicidal risk in emergency service].

Identification and assessment of suicide risk in emergency situations depend on special circumstances and are a difficult task in daily routine. Emergency physicians and intensive care physicians usually do not have enough psychiatric experience to deal with psychotic or depressed patients in acute suicidal crisis. In this paper, the authors give an overview on diagnostic procedures which may help to assess suicidal tendencies and acute risk in emergency situations.

Crisis Intervention↗
PubMed1996

[Depression and electrodermal response measures in a habituation experiment. Results from over 400 depressed inpatients].

Depressed inpatients of the Weissenau Depression Treatment Unit take part in an over ten years unchanged psychophysiological habituation experiment with auditive stimuli to study their electrodermal reactivity. An overview on EDA-results of about 400 inpatients (ICD-9: 296.1/300.4/309.1, without delusional depression and without bipolar affective psychosis) is given. Women compared to men and also endogenous (ICD-9: 296.1) compared to psychogenic depression (ICD-9: 300.4/309.1) show significantly more non- and hypo-response.

Adult↗
PubMed1996

[Does long-term hospitalization modify cardiovascular morbidity in schizophrenic patients?].

Cardiovascular risk factors, electrocardiographic findings and preexisting diseases of the cardiovascular system were recorded in 90 schizophrenic patients (mean age 62.6 yrs., mean duration of hospitalisation 28.6 yrs.). The obtained data were compared with a group of depressive inpatients matched for age and sex and with corresponding data of the german population. Although among the schizophrenic patients heavy cigarette-smoking was significantly more frequent, hints for a myocardial infarction in history were found in only 3 of these patients and, in contrast, in 7 depressive patients. Systolic and diastolic blood pressure did not differ among depressive and schizophrenic subjects with mean levels in both groups being lower than in the corresponding age of the general population. Total cholesterol levels were lowest in the schizophrenics; in the depressive patients, however, lower than in the general population. There was a continual increase of cholesterol with progressive age in depressive subjects and in the general population. An adverse tendency was found in the long-term-hospitalized schizophrenics of both genders. In male schizophrenics a significant negative correlation between the duration of hospitalisation and both serum cholesterol and diastolic blood pressure could be observed. This may explain cardiovascular mortality rates in these patients which are not elevated in spite of heavy smoking and lack of movement.

Adult↗
PubMed1996

[Patient suicide in the psychiatric hospital: selected results of the Clinic Suicide Working Group Study I/II 1970-1992 of the "Suicidal Behavior and the Psychiatric Hospital" Study Group].

Data of the Baden-Württemberg and Bavarian inpatient suicide study (1970-1984) and (1985-1989) and (1990-1992) are presented comparing these different observation periods. The total group comprises 59% men and 41% women of 585 suicides, 51% younger than 50 year (main group 21-30 years: 26%). An increase of suicides in the seventies and a plateau in the eighties is observed. 53% of the total group are schizophrenic and 26% depressive inpatients. There is a impressive shortening of the time period from index admission to suicide over the years: (1970-1984) 56% (1985-1989) 85% and (1990-1992) again 83% of the total group committed suicide during the first six month of inpatient treatment. Suicides of psychiatric inpatients seem to be a problem of acute psychiatry.

Adolescent↗