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W Gaebel

Publications and source records attributed to W Gaebel.

At least 73 records · Page 4Linked to original sources
PubMed1997

Facial-affect recognition and visual scanning behaviour in the course of schizophrenia.

The performance of schizophrenic in-patients in facial expression identification was assessed in an acute phase and in a partly remitted phase of the illness. During visual exploration of the face stimuli, the patient's eye movements were recorded using an infrared-corneal-reflection technique. Compared to healthy controls, patients demonstrated a significant deficit in facial-affect recognition. In addition, schizophrenics differed from controls in several eye movement parameters such as length of mean scan path and mean duration of fixation. Both the facial-affect recognition deficit and the eye movement abnormalities remained stable over time. However, performance in facial-affect recognition and eye movement abnormalities were not correlated. Patients with flattened affect showed relatively selective scan pattern characteristics. In contrast, affective flattening was not correlated with performance in facial-affect recognition. Dosage of neuroleptic medication did not affect the results. The main findings of the study suggest that schizophrenia is associated with disturbances in primarily unrelated neurocognitive operations mediating visuomotor processing and facial expression analysis. Given their time stability, the disturbances might have a trait-like character.

Adult↗
PubMed1997

In vivo evidence for the involvement of dopamine-D2 receptors in striatum and anterior cingulate gyrus in major depression.

The dopaminergic system is a candidate neurotransmitter system thought to be involved in the pathogenesis of depression. This study addresses the issue whether the antidepressant efficacy of serotonin reuptake inhibition is related to changes in the cerebral dopaminergic system. Cerebral dopamine-D2 receptors were characterized in 13 patients with major depression using the dopamine-D2 receptor antagonist iodobenzamide and single photon emission tomography. Dopamine receptor binding was assessed twice, before and during serotonin reuptake inhibition. An increase in dopamine-D2 receptor binding during serotonin reuptake inhibition was found in striatum and anterior cingulate gyrus in treatment responders, but not in nonresponders. The increase in dopamine-D2 receptor binding correlated significantly with clinical recovery from depression as assessed with the Hamilton depression scale (r = 0.59 for right and left striatum respectively, P < 0.05; r = 0.79 for the anterior cingulate gyrus, P < 0.05 after Bonferroni correction). Qualitatively similar correlations were observed in the precentral gyrus, the medial frontal gyrus, the inferior frontal gyrus, and the frontal part of the opercular gyrus, but these correlations failed to reach statistical significance after correction for the effects of multiple testing. No such correlations were found in the superior frontal gyrus, the orbitofrontal gyrus, the gyrus rectus, the superior parietal gyrus, or the superior temporal gyrus. The data strengthen the concept that the striatum and the anterior cingulate gyrus are involved in mood regulation. Dopamine-D2 receptors may constitute a central role in this domain.

Adult↗
PubMed1997

Towards the improvement of compliance: the significance of psycho-education and new antipsychotic drugs.

Effective pharmacological, psychosocial and other kinds of treatment are now available for schizophrenia. Often, however, neither acute nor long-term treatment can be properly applied because of insufficient compliance by both patients and doctors. Patient non-compliance is as high as 50% under outpatient conditions; potential reasons may be either illness-related (e.g. lack of insight or idiosyncratic concepts of the illness or its treatment), drug-related (e.g. intolerable side-effects) or related to inadequate treatment management (e.g. insufficient information or lack of environmental support). Non-compliance by doctors is partly due to limited adherence to treatment guidelines. To improve both patient and doctor compliance, the use of educational tools for professional health-care providers, patients and families should be generally enforced. New antipsychotics with a better risk-benefit profile with respect to clinical efficacy and side effects will probably help to overcome drug-related non-compliance.

Antipsychotic Agents↗
PubMed1996

Residual symptoms and P300 in schizophrenic outpatients.

A reduced P300 amplitude has often been found to be related to schizophrenic psychopathology. It is still unclear, however, whether this relationship is trait- or state-dependent. We investigated 88 stabilized schizophrenic outpatients during a 2-year follow-up period. Multivariate analyses revealed that patients who had reduced P300 amplitudes showed pronounced residual symptoms, especially thought disorder (Brief Psychiatric Rating Scale). Intraindividual changes in that psychopathology were not correlated to corresponding changes of the P300 amplitude, so the relationship between schizophrenic psychopathology and P300 amplitude appears to be, at least in part, trait-dependent. A reduced P300 amplitude may characterize a subgroup of schizophrenic patients with a disposition to cognitive disturbances and incomplete remissions.

Adult↗
PubMed1996

Facial affect recognition in the course of schizophrenia.

Deficits in facial affect recognition have been shown repeatedly in schizophrenia. However, the stability of this deficit over time remains to be clarified. A total of 36 remitted, 32 acutely ill schizophrenic patients and 21 healthy volunteers participated in a cross-sectional and longitudinal study. All subjects were assessed twice within 4 weeks (acute schizophrenics and normal controls), or 12 weeks, respectively (remitted schizophrenics). Subjects had to identify six basic emotions from corresponding facial expressions shown as photographs on a video screen. Both acute and remitted schizophrenics demonstrated a stable deficit over time in facial affect recognition unrelated to psychopathology and medication. This suggests that deficits in facial affect recognition in schizophrenia reflect a trait-like, rather than a state-dependent, characteristic.

Acute Disease↗
PubMed1996

Prediction of response to acute neuroleptic treatment in schizophrenia.

Predicting the outcome of treatment with neuroleptics and understanding the factors that contribute to variability in the response to these drugs have preoccupied researchers and clinicians since the class was developed. Clinicians need empirically based prospective criteria in order to choose a treatment strategy that will lead to the best response from the patient while minimizing side effects. Thus the optimal strategy will match patient, illness and drug characteristics. Before a response can be predicted, the researcher needs explicit concepts and definitions on the course of the illness, drug responses, treatment outcome and predictive criteria. Whereas outcome refers to an arbitrary endpoint of an illness, whether spontaneous or modified by treatment, response is a treatment-related concept. Response refers to a change in the course of the illness which is defined either by pre- or post-treatment criteria and is caused by treatment. Apart from treatment, the spontaneous course of the illness is shaped and modified by various factors, which are referred to as potential outcome/response predictors sampled from a wide area of patient, illness and environmental characteristics. A superordinate concept of prediction must show how these potential determinants of (treatment) course and outcome relate to each other in biopsychosocial terms. Valid predictions of response can only be expected if recognizable rules are operative in the illness course and the treatment outcome. With increasing knowledge about the pathophysiology of the illness, its course and potential determinants, the development of valid predictive algorithms will be promoted. The application of vigorous research strategies in future pharmacological treatment studies will also be required to reach this goal.

Algorithms↗
PubMed1996

Conclusions and treatment recommendations for the acute episode in schizophrenia.

Interventions which reduce symptoms, vulnerability and stress on the one hand and improve psychosocial competence and quality of life on the other are essential components of a comprehensive treatment program in schizophrenia. Drug treatment of acute exacerbations which is adequate with respect to drug type, dose and treatment duration and takes risk/benefit measures into account is at the heart of these interventions and should be applied as early as possible. Subsequent neuroleptic treatment to prevent a relapse should be administered in accordance with established treatment guidelines. Drug treatment must be combined with psychosocial interventions, which should be properly adapted to the particular phase and stage of the illness. Implementation and coordination of various interventions require cooperation between therapists, institutions, the patient and the patient's family.

Acute Disease↗
PubMed1995

Is intermittent, early intervention medication an alternative for neuroleptic maintenance treatment?

Neuroleptic maintenance medication is clearly effective for relapse prevention in schizophrenia. However, besides benefits for the majority of patients, there are also failures and/or risks for some patients (e.g. tardive dyskinesia). Since the risk-benefit ratio is often difficult to predict in the individual case, this has stimulated the search for modifications and alternatives to maintenance treatment. In particular, neuroleptic low-dose treatment strategies compare favorably with standard-dose treatment concerning relapse prevention and side effects. Alternatively, based on prodromal symptoms preceding a relapse, early intervention, intermittent neuroleptic treatment strategies have been developed. However, all recently completed controlled 2 year studies have not confirmed this strategy to be as effective as maintenance treatment in preventing relapse. Therefore, for the majority of patients intermittent treatment cannot be recommended.

Antipsychotic Agents↗
PubMed1995

Schizophrenics with small P300: a subgroup with a neurodevelopmental disturbance and a high risk for tardive dyskinesia?

Schizophrenics with a neurodevelopmental disturbance resulting in micro- and macroanatomical cortical abnormalities are supposed to form a subgroup clinically characterized by low premorbid adjustment, early onset, incomplete remission, poor outcome, male predominance and high risk for tardive dyskinesia. A small amplitude of the event-related P3 (P300) potential could be a marker of this subgroup, because the cortical neurons and their orderly laminar arrangement are crucial for the electrogenesis of P3. In a 2-year follow-up study, auditory evoked P3 was recorded in 89 stabilized schizophrenic outpatients. Patients who developed tardive dyskinesia during the follow-up had smaller P3 than matched controls. Furthermore, a small P3 was associated with low premorbid adjustment, pronounced residual symptoms, low relapse rate, and male predominance. These findings indicate that schizophrenic patients with a reduced P3 have a higher risk of developing tardive dyskinesia and correspond clinically to a schizophrenic subgroup with a supposedly neurodevelopmental disturbance.

Adult↗
PubMed1995

[Quality assurance in psychiatry. Concept--methodology--implementation].

Quality assurance is the corrective action applied to any observed discrepancy between optimal and actual level of medical care requiring continuous quality control. According to the German health act "Gesundheitsreformgesetz" introduced in 1989 [46], involvement in quality assurance is mandatory for all health professionals. Obviously, quality assurance is of utmost importance in psychiatric practice. Quality care as defined by the degree of adherence to standards and guidelines can be measured in terms of structural, process and outcome characteristics referring to inpatient, outpatient and complementary services. To promote the implementation of practice guidelines into psychiatric care conceptual, methodological, political, financial, and organizational requirements must be taken into account.

Cost-Benefit Analysis↗
PubMed1994

Ventricle size and P300 in schizophrenia.

Both ventricular enlargement and reduced P3 amplitudes are consistent findings in schizophrenic patients, suggesting that the two measures reflect a common underlying pathophysiological process in schizophrenia. Investigating 14 stabilized schizophrenic outpatients, a relationship between the size of the lateral ventricles as well as of the third ventricle on CT scans and the auditory event-related P3 amplitude was, however, not found. This negative result suggests that ventricular enlargement and reduced P3 amplitudes in schizophrenics reflect different pathophysiological processes. It is assumed that the P3 amplitude is related rather to abnormalities in the temporal lobe of schizophrenic patients.

Adult↗
PubMed1994

Intermittent medication--an alternative?

Neuroleptic maintenance medication is clearly effective for relapse prevention in schizophrenia. However, besides benefits for the majority of patients, there are also failures and/or serious risks for some patients (e.g., tardive dyskinesia). Since the risk-benefit ratio is often difficult to predict in the individual case, this has stimulated the search for modifications and alternatives to maintenance treatment. In particular, neuroleptic low-dose treatment strategies obviously compare quite favourably with standard-dose treatment concerning relapse prevention and side effects. Alternatively, on the basis of reports on prodromal symptoms preceding a relapse, early intervention, intermittent neuroleptic treatment strategies have been developed. However, all recently completed controlled 2-year studies have not confirmed this strategy to be as effective as maintenance treatment in preventing relapse, although total drug exposure is significantly reduced and social adjustment seems to be unaffected. Therefore, for the majority of patients, intermittent treatment cannot be recommended.

Antipsychotic Agents↗