OBJECTIVE: Leptin is produced by fat cells and is presumed to signal the size of the adipose tissue to the brain. The authors investigated whether antipsychotic drugs that often induce weight gain affect circulating levels of leptin. METHOD: Weight, body mass index, and leptin plasma level were measured weekly over 4 weeks in psychiatric inpatients who received clozapine (N = 11), olanzapine (N = 8), haloperidol (N = 13), or no psychopharmacological treatment (N = 12). RESULTS: In patients receiving clozapine or olanzapine, significant increases in weight, body mass index, and leptin level were found, whereas these measures remained stable in patients who received haloperidol or no pharmacological treatment. CONCLUSIONS: Weight gain induced by clozapine or olanzapine appears to be associated with an increase in leptin level that cannot be attributed to dietary changes upon hospitalization.

Adipose Tissue↗

PubMed1998

Growth hormone response to placebo, apomorphine and growth hormone releasing hormone in abstinent alcoholics and control subjects.

Abstinent alcoholics and control subjects were challenged with placebo (saline), growth hormone releasing hormone (GHRH) and apomorphine (APO). While both groups did not differ in their growth hormone response (HGH) to placebo and GHRH, the alcoholics revealed a significant lower HGH response to dopamine receptor stimulation with APO. These findings provide no evidence that in abstinent alcoholics HGH blunting after dopamine receptor stimulation could be related to an alteration at the pituitary level but they give neuroendocrinological support to the hypothesis of a lower dopamine receptor sensitivity in abstinent alcoholics.

Adult↗

PubMed1998

[Managed care--an example for future structural developments in health care. Reflections on a informational visit on direction and administration of medical centers in east USA].

While the different national health systems merge structurally, cost expansion in health care is a global challenge. Structural reforms have been developed during recent years in the USA which can be summarized as "managed care". They are characterized by the evolution of an economically orientated system, in which units of medical therapy are generally handled like conventional economically goods. In managed-care models, patients are deliberately directed to the most economic forms of therapy. The spectrum of medical interventions as well as diagnostic or therapeutic patterns are predefined by a system of contracted guidelines, which lead to a standardization of processes. Financing and medical executive responsibilities fuse. The autonomy of medical decisions is clearly reduced to enforce and integrated and economically oriented steering of the health system. Leadership is no longer primarily confined to doctors or scientists. It is progressively shifting to financing institutions, managing directors or insurance companies. Structural changes currently are expanding rapidly in the U.S. and have meanwhile led to marked regional reductions of medical costs. Nevertheless, the US model is still far more expensive compared to the German system. Historical development, current concepts of US-managed care, its potential influence and general applicability to the German situation are discussed in an overview.

Academic Medical Centers↗

PubMed1998