Publications (17)75.41 Total impact
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Article: Algorithm-guided treatment of depression reduces treatment costs--results from the randomized controlled German Algorithm Project (GAPII).
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ABSTRACT: The German Algorithm Project, Phase 2 (GAP2) revealed that a standardized stepwise treatment regimen (SSTR) results in better treatment outcomes than treatment as usual (TAU) in depressed inpatients. The objective of this study was a health economic evaluation of SSTR based on a cost effectiveness analysis (CEA). GAP2 was a randomized controlled study with 148 patients. In an intention to treat (ITT) analysis direct treatment costs for study duration (SD) and total time in hospital (TTH; enrolment to discharge) were calculated based on daily hospital charges followed by a CEA to calculate cost expenditure per remitted patient. Treatment costs in SSTR compared to TAU were significantly lower for SD (SSTR: 10 830 € ± 8 632 €, TAU: 15 202 € ± 12 483 €; p = 0.026) and did not differ significantly for TTH (SSTR: 21 561 € ± 16 162 €; TAU: 18 248 € ± 13 454; p = 0.208). CEA revealed that the costs per remission in SSTR were significantly lower for SD (SSTR: 20 035 € ± 15 970 €; SSTR: 38 793 € ± 31 853 €; p<0.0001) and TTH (SSTR: 31 285 € ± 23 451 €; TAU: 38 581 € ± 28 449 €, p = 0.041). Indirect costs were not assessed. Different dropout rates in TAU and SSTR complicated interpretation of data. An SSTR-based algorithm results in a superior cost effectiveness at no significant extra costs. Implementation of treatment algorithms in inpatient-care may help reduce treatment costs.Journal of affective disorders 07/2011; 134(1-3):249-56. · 3.76 Impact Factor -
Article: Cerebrovascular reactivity over time-course - from major depressive episode to remission.
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ABSTRACT: Depression is a prospective risk factor for stroke. Little is known, however, about the pathophysiologic links leading to this association. Cerebrovascular reactivity (CVR) reflects the compensatory dilatory capacity of cerebral arterioles to a dilatory stimulus and is an important mechanism to provide constant cerebral blood flow. In the absence of major arterial stenosis, an impaired CVR has been associated with a higher risk of stroke. We hypothesized that CVR might be continuously reduced in patients with major depression even after successful remission thus contributing to the association between depression and stroke. We investigated CVR in a group of patients (N=29) in the acute episode of depressive illness and after 21months under euthymic condition. A healthy control group (N=33) was investigated at comparable time intervals. All patients and controls were otherwise healthy. CVR was investigated by calculating the increase in cerebral blood flow velocity after stimulation with acetazolamide. Blood flow velocities were measured by transcranial doppler ultrasound. A group of acutely depressed patients presented a significantly reduced CVR compared to controls. On follow-up 21months later after treatment and remission, CVR in the patient group had significantly improved, whereas CVR in the control group remained unchanged. Confounding factors had no significant influence. CVR is impaired during major depression. Since CVR seems to improve after treatment of depression, the contribution to an increased stroke risk among depressive patients may be true for a subgroup only and needs to be further investigated.Journal of psychiatric research 09/2009; 44(3):132-6. · 3.72 Impact Factor -
Article: Efficacy of an algorithm-guided treatment compared with treatment as usual: a randomized, controlled study of inpatients with depression.
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ABSTRACT: Medication algorithms have been proposed as effective means to offer optimal treatment and improved outcome for patients with severe mental illness. This single-center prospective study compared the efficacy and effects on treatment prescriptions of an algorithm-guided treatment regimen with treatment as usual (TAU) in depressed inpatients. Depressed inpatient participants were randomized to an algorithm-guided standardized stepwise drug treatment regimen (SSTR, n = 74) or TAU (n = 74). The SSTR regimen included sleep deprivation, antidepressant monotherapy, lithium augmentation, monoamine oxidase inhibitor therapy, or electroconvulsive therapy guided by scores on the clinician-rated Bech-Rafaelsen Melancholia Scale. The primary outcome was time to remission (defined as a Bech-Rafaelsen Melancholia Scale score of < or =7). Secondary outcomes were remission rates, number of changes in treatment strategies (types), and the number of different prescribed medications over the treatment period. Patients receiving SSTR had a significantly shorter time to remission (7.0 +/- 0.9 weeks vs 12.3 +/- 1.8 weeks for TAU). Compared with that in remitters in SSTR, the number of strategy changes was significantly higher in TAU remitters (3.0 +/- 2.7 and 1.0 +/- 1.5) and had more psychotropic medications (fix agents: 3.0 +/- 1.5 and 1.9 +/- 1.1; optional agents: 1.5 +/- 1.0 and 0.9 +/- 0.7). Although more patients dropped out of the SSTR group (33 of SSTR, 12 of TAU), the probability of remission tended to be higher in SSTR. Algorithm-guided treatment produces better outcomes and less frequent medication changes than TAU. A systematic, stepwise, measurement-based approach to the treatment of depressed inpatients is warranted.Journal of clinical psychopharmacology 08/2009; 29(4):327-33. · 5.09 Impact Factor -
Article: Motor cortex excitability after vagus nerve stimulation in major depression.
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ABSTRACT: Recent data suggest that inhibitory pathways may be involved in the pathophysiology of depression and in the mode of action of some antidepressant interventions. The aim of the present study was to test whether vagus nerve stimulation (VNS) can affect motor cortex excitability. Measures of motor cortical excitability were probed by using single-pulse and paired-pulse transcranial magnetic stimulation at baseline, after 10 weeks of left VNS, and additionally, in an on-off paradigm in 10 patients with treatment-resistant unipolar depression. Ten weeks of VNS was associated with a selective and pronounced increase in intracortical inhibition, whereas no changes occurred in the on-off paradigm. These results suggest that VNS is capable of changing motor cortical excitability in patients with depression.Journal of Clinical Psychopharmacology 05/2007; 27(2):156-9. · 4.10 Impact Factor -
Article: Nerve growth factor serum concentrations rise after successful cognitive-behavioural therapy of generalized anxiety disorder.
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ABSTRACT: Generalized anxiety disorder (GAD) is a chronic stress disease with permanent physical tension and cognitive strain. Raised nerve growth factor (NGF) serum levels were reported as an acute stress reaction in soldiers before their first parachute jump even before the rise in cortisol. Taking GAD as a clinical model of chronic stress, we measured NGF in the serum of 22 patients with GAD before and after cognitive-behavioural therapy (CBT) and compared them to those of healthy normal controls. Treatment response was tested by the values of the State and Trait of Anxiety Inventory (STAI) and the Hamilton Anxiety Scale (HAM-A) as treatment outcome variables. The NGF values of patients and controls were similar at baseline (p=0.8941); however, with successful treatment, corresponding to a mean reduction in the HAM-A by more than 50% and a reduction in the clinical global impression scale (CGI) median from 4 to 1, the patients' NGF serum concentrations rose significantly (p=0.0006) which might correspond to an altered stress reaction, possibly contributing to good therapeutic response with CBT. There were 3 patients with a HAM-A decrease of less than 15%. In those patients NGF rose only marginally. Hence, the increase in serum NGF seems to indicate good treatment response.Progress in Neuro-Psychopharmacology and Biological Psychiatry 02/2007; 31(1):200-4. · 3.25 Impact Factor -
Article: Cerebrovascular reactivity following administration of mirtazapine in healthy probands--a randomized, placebo controlled double-blind clinical study.
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ABSTRACT: Cerebrovascular reactivity (CVR) reflects the compensatory dilatory capacity of cerebral arterioles to a dilatory stimulus and is important for maintaining constant cerebral blood flow. A reduced CVR increases the risk of stroke. We recently found that CVR was reduced in patients with depression. This might contribute to the higher risk of stroke that has been found in subjects suffering from depression. The characterization of pathophysiological conditions in the cerebral circulation requires the knowledge of influencing factors on CVR. We therefore investigated the influence that antidepressant administration might have on CVR in humans. We investigated CVR in 48 healthy men before and after a 10-day application of either mirtazapine or placebo. CVR was determined by calculating the increase in cerebral blood flow velocity after stimulation with acetazolamide. Blood flow velocities were measured by transcranial Doppler ultrasound. There was no significant group-difference of CVR after the treatment trial compared to baseline. Mirtazapine does not seem to have an influence on CVR, or any impact on CVR might have been quickly limited by a cerebral autoregulatory response.Journal of Psychiatric Research 07/2006; 40(4):349-52. · 4.66 Impact Factor -
Article: Effects of right unilateral electroconvulsive therapy on motor cortical excitability in depressive patients.
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ABSTRACT: Electroconvulsive therapy (ECT) is a widely acknowledged effective treatment for severe major depression. ECT produces considerable anticonvulsant effects that may be related to an increased GABA-ergic neurotransmission. We aimed to explore whether motor cortical excitability as assessed with single and paired pulse transcranial magnetic stimulation (TMS) could be used to investigate these anticonvulsant effects. Therefore, parameters of motor cortical excitability were investigated in 10 patients before and after 10 sessions of right unilateral ECT. After 10 sessions of right unilateral ECT, an enhanced activity of inhibitory circuits in human motor cortex had been observed, as measured by both increased intracortical inhibition and cortical silent period duration, whereas intracortical facilitation and resting motor threshold remained unchanged. The reduction of seizure duration in the course of ECT was associated with clinical improvement and an increase in intracortical inhibition. We interpret this finding as further indirect evidence for changes in inhibitory circuits in the course of ECT in patients with major depression.Journal of Psychiatric Research 07/2006; 40(4):322-7. · 4.66 Impact Factor -
Article: Evidence for impaired cortical inhibition in patients with unipolar major depression.
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ABSTRACT: Several lines of evidence suggest that central cortical inhibitory mechanisms, especially associated with gamma-aminobutyric acid (GABA) neurotransmission, may play a role in the pathophysiology of major depression. Transcranial magnetic stimulation is a useful tool for investigating central cortical inhibitory mechanisms associated with GABAergic neurotransmission in psychiatric and neurological disorders. By means of transcranial magnetic stimulation, different parameters of cortical excitability, including motor threshold, the cortical silent period, and intracortical inhibition/facilitation, were investigated in 20 medication-free depressed patients and 20 age- and gender-matched healthy volunteers. Silent period and intracortical inhibition were reduced in depressed patients, consistent with a reduced GABAergic tone. Moreover, patients showed a significant hemispheric asymmetry in motor threshold. This study provides evidence of reduced GABAergic tone and motor threshold asymmetry in patients with major depression.Biological Psychiatry 04/2006; 59(5):395-400. · 8.28 Impact Factor -
Article: Repetitive transcranial magnetic stimulation of the dorsolateral prefrontal cortex and cortical excitability in patients with major depressive disorder.
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ABSTRACT: Repetitive transcranial magnetic stimulation (rTMS) of the dorsolateral prefrontal cortex is a relatively non-invasive technique with putative therapeutic effects in major depression. However, the exact neurophysiological basis of these effects needs further clarification. Therefore, we studied the impact of ten daily sessions of left, dorsolateral prefrontal rTMS on motor cortical excitability, as revealed by transcranial magnetic stimulation-elicited motor-evoked potentials in 30 patients. As compared to the non-responders, responders (33%) showed changes in parameters pointing towards a reduced cortical excitability. These results suggest that repetitive transcranial magnetic stimulation of the dorsolateral, prefrontal cortex may have inhibitory effects on motor cortical neuronal excitability in patients with major depressive disorder. Furthermore, measurement of motor cortical excitability may be a useful tool for investigating and monitoring inhibitory brain effects of antidepressant stimulation techniques like rTMS.Experimental Neurology 01/2006; 196(2):332-8. · 4.70 Impact Factor -
Article: Therapeutic brain stimulation and cortical excitability in depressed patients.
American Journal of Psychiatry 12/2005; 162(11):2192-3. · 12.54 Impact Factor -
Article: Cognitive function over the treatment course of depression in middle-aged patients: correlation with brain MRI signal hyperintensities.
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ABSTRACT: It has been proposed that the often found hyperintensities on MRI representing vascular changes might be correlated with a worse outcome of cognitive malfunction in depression. The purpose of this study was to evaluate neuropsychological status in the acute depressed state and following remission and to investigate the potential relationship between MRI hyperintensities and neuropsychological functioning through the treatment course in a group of middle-aged depressed patients. Twenty-seven depressed patients were assessed by a series of neuropsychological tests at the beginning of the depressive episode and again after an euthymic phase of 6 months following treatment. Thirty healthy controls were tested at comparable intervals. In all patients and controls a MRI was performed to identify hyperintensities representing a possible correlation with test performance during treatment course. At the onset of a depressive episode patients performed significantly worse than the controls in all tests. After sustained remission the patient group still performed significantly worse in verbal memory and verbal fluency compared to controls. There were no significant correlations between number of presence of vascular risk factors, or presence of hyperintensities on MRI, and cognitive abilities at either time point. These findings favor the hypothesis that some neuropsychological deficits might persist following treatment for depression, even in middle-aged patients. We found, however, that any residual cognitive deficit is not associated with MRI-hyperintensities in this age-group.Journal of Psychiatric Research 04/2005; 39(2):129-35. · 4.66 Impact Factor -
Article: Cerebral blood flow during vagus nerve stimulation--a transcranial Doppler study.
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ABSTRACT: Vagus nerve stimulation (VNS) is an approved treatment of partial onset seizures and has recently shown antidepressant effects in patients with treatment-resistant depression. This study was conducted to investigate whether acute VNS has an influence on cerebral blood flow (CBF) in humans. This investigation was designed as an add-on study. In 10 patients with an implanted stimulator who participated in a multicenter clinical trial to evaluate the efficacy of VNS in depression, CBF was investigated by functional transcranial Doppler at baseline (before the stimulator was turned on for the first time) and during stimulation with three different stimulation intensities in a randomized order. Immediately after every increase of the current, CBF velocity showed a nonsignificant increase. Otherwise, no change of CBF above standard deviation could be registered. Acute VNS does not have an influence on CBF velocity in depressive patients.Neuropsychobiology 02/2005; 51(4):265-8. · 2.67 Impact Factor -
Article: A prospective study on the course of anxiety after vestibular neuronitis.
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ABSTRACT: Critical life events trigger intense emotions. Anxiety is one of the most frequent of these emotions. It is unclear which factors determine the intensity and course of anxiety after a critical life event. Anxiety levels of 92 patients in the 6 weeks after experiencing an acute vestibular disorder were examined. The influence of cognitive, personality and illness variables on the course of their anxiety was analyzed. Acute vestibular disorder is accompanied by intensive anxiety. In most patients, anxiety decreased as vertigo regressed. Catastrophizing and dysfunctional cognitions and different personality styles predicted 17.6% of the anxiety 6 weeks after the functional loss of vestibular equilibrium. Acute vestibular disorder is a critical life event. Most individuals cope successfully with acute vestibular disorder. However, dysfunctional cognitions are risk factors for the persistence of anxiety.Journal of Psychosomatic Research 04/2004; 56(3):351-4. · 3.30 Impact Factor -
Article: Motorcortical excitability after electroconvulsive therapy in patients with major depressive disorder.
Supplements to Clinical neurophysiology 02/2003; 56:433-40. -
Article: Neuroleptic malignant syndrome in a patient with succinic semialdehyde dehydrogenase deficiency.
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ABSTRACT: A patient suffering from a rare enzyme deficiency developed a malignant neuroleptic syndrome after having been treated with one single dose of haloperidol. We investigated the patient's serum for all frequent polymorphisms in cytochrome P450 2D6, assuming him to be a poor neuroleptic metabolizer. We will also discuss other potential mechanisms inducing this disturbance and its differential diagnoses.Pharmacopsychiatry 02/2002; 35(1):26-8. · 2.07 Impact Factor -
Article: Cerebrovascular reactivity in major depression: a pilot study.
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ABSTRACT: There are a growing number of reports that depression may increase the risk of stroke. Little is known, however, about the pathophysiologic mechanisms underlying this association. Cerebrovascular reactivity (CVR) reflects the compensatory dilatory capacity of cerebral arterioles to a dilatory stimulus and is an important mechanism to provide constant cerebral blood flow. We hypothesized that CVR is reduced in patients with major depression, thus contributing to the association between depression and stroke. We assessed CVR in 33 patients with unipolar depression and 26 healthy controls by calculating the increase in cerebral blood flow velocity after stimulation with acetazolamide. Blood flow velocities were measured by transcranial Doppler ultrasound. Cerebrovascular reactivity was significantly reduced in depressed patients. Smoking was also associated with a significant reduction in CVR, whereas age and gender had no significant influence. Cerebrovascular reactivity appears to be impaired in major depression. Further studies should clarify the mechanisms leading to this reduced CVR.Psychosomatic Medicine 66(1):6-8. · 3.97 Impact Factor -
Article: Why does vertigo become chronic after neuropathia vestibularis?
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ABSTRACT: Vertigo is one of the most frequent complaints in general medical practice and is often linked to psychiatric disorders. A longitudinal study of 67 patients with an acute vestibular disorder was undertaken to clarify if, after experiencing acute vestibular vertigo, certain patients have a higher likelihood of developing chronic, debilitating dizziness despite no evidence of a damaged peripheral vestibular system. The severity of dizziness was determined in 67 patients with vestibular neuronitis, 6 months after their release from hospital, using the Vertigo Symptom Scale from Yardley et al. The intensity of anxiety directly after vertigo was experienced, body-related cognitions, illness coping, personality structure, and the recovery of the organ of equilibrium were recorded in order to explain the severity of vertigo that occurred after 6 months. The function of the organ of equilibrium was assessed by using a caloric test. Over a period of 6 months, 13 of the 67 patients (19.4%) reported continuing dizziness after neuropathia vestibularis. Eleven of the 13 patients showed high scores on a scale for measuring vertigo-related symptoms, which can be interpreted as being equivalent to anxiety. The variables of gender, catastrophic thoughts and a dependent personality accounted for 35% of why vertigo became chronic. Neuropathia vestibularis represents a risk factor for the development of chronic vertigo. Chronic vertigo after neuropathia vestibularis appears to be equivalent to anxiety and is partly conditional on catastrophic thoughts at the beginning.Psychosomatic Medicine 66(5):783-7. · 3.97 Impact Factor
Top co-authors
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Institutions
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2005–2007
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Charité Universitätsmedizin Berlin
- Department of Psychiatry
Berlin, Land Berlin, Germany
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2002
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Freie Universität Berlin
- Department of Psychiatry
Berlin, Land Berlin, Germany
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