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ABSTRACT: Via influencing brain plasticity, aerobic exercise could contribute to the treatment of schizophrenia patients. As previously shown, physical exercise increases hippocampus volume and improves short-term memory. We now investigated gray matter density and brain surface expansion in this sample using MRI-based cortical pattern matching methods. Comparing schizophrenia patients to healthy controls before and after 3 months of aerobic exercise training (cycling) plus patients playing table football yielded gray matter density increases in the right frontal and occipital cortex merely in healthy controls. However, respective exercise effects might be attenuated in chronic schizophrenia, which should be verified in a larger sample.
Archiv f ur Psychiatrie und Nervenkrankheiten 11/2012; · 2.75 Impact Factor
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ABSTRACT: Examined the prevalence rates, method of suicide or attempted suicide, and the problems faced by emergency physicians (EPs) when treating suicidal patients. A retrospective analysis of all EP protocols from 1995 in the city of Hamburg was performed. All protocols were evaluated with respect to suicide, parasuicide and suicidal ideation. Demographic data and information on method of suicide or attempted suicide, severity of illness, and underlying psychiatric disorder were extracted from the protocols. A total of 26,347 emergency protocols were evaluated. Suicide and attempted suicide were considered either certain, probable or possible in 743 cases (2.8%). Suicide was committed in 171 cases (mean age 52.2 yrs) and attempts were made by 572 individuals (mean age 41.4 yrs). More men committed suicide in all age groups. The highest number of suicide attempts were by young men between 18 and 39 yrs of age. Hanging was the most commonly used method of completed suicide (41%), followed by jumping from a height (21%). The methods of intoxication with medication (54%) and illegal drugs (17%) clearly prevailed in suicide attempts. Documentation of suicides and attempted suicides was revealed to be unsatisfactory. Underlying psychiatric disorders were scarcely recorded. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Crisis The Journal of Crisis Intervention and Suicide Prevention 10/2012; 23(2):68-73. · 1.09 Impact Factor
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ABSTRACT: GRUNDLAGEN: Die emotionalen Reaktionen von Rettungsdienstpersonal bei einem Einsatz während eines terroristischen Anschlages GRUNDLAGEN: Die emotionalen Reaktionen von Rettungsdienstpersonal bei einem Einsatz während eines terroristischen Anschlages
sind bislang nur unzureichend im Verlauf betrachtet worden. Untersucht wurde, wie die Retter emotional auf die Attentate reagieren sind bislang nur unzureichend im Verlauf betrachtet worden. Untersucht wurde, wie die Retter emotional auf die Attentate reagieren
und ob und wie sich diese emotionalen Reaktionen sechs Monate nach dem Einsatz verändern. Zudem wurde der Einfluss dieser und ob und wie sich diese emotionalen Reaktionen sechs Monate nach dem Einsatz verändern. Zudem wurde der Einfluss dieser
Reaktionen auf ihre Lebensqualität, die körperlichen Beschwerden und Depressivität untersucht. METHODIK: 14 Notärzte und 5 Reaktionen auf ihre Lebensqualität, die körperlichen Beschwerden und Depressivität untersucht. METHODIK: 14 Notärzte und 5
Rettungsassistenten wurden im Durchschnitt 14 Tage und ein zweites Mal sechs Monate nach den Londoner Terroranschlägen vom Rettungsassistenten wurden im Durchschnitt 14 Tage und ein zweites Mal sechs Monate nach den Londoner Terroranschlägen vom
7. Juli 2005 interviewt. Die Interviews wurden mittels Gottschalk-Gleser-Sprachinhaltsanalyse zur Messung von Affekten ausgewertet. 7. Juli 2005 interviewt. Die Interviews wurden mittels Gottschalk-Gleser-Sprachinhaltsanalyse zur Messung von Affekten ausgewertet.
ERGEBNISSE: Über die Hälfte der Rettungsdienstmitarbeiter berichteten über hohe Angstlevel, fast alle über hohe Todesangstlevel. ERGEBNISSE: Über die Hälfte der Rettungsdienstmitarbeiter berichteten über hohe Angstlevel, fast alle über hohe Todesangstlevel.
Bei etwa der Hälfte zeigte sich eine erhöhte psychische Beanspruchung durch Angst und Aggressivität (im Amerikanischen Original: Bei etwa der Hälfte zeigte sich eine erhöhte psychische Beanspruchung durch Angst und Aggressivität (im Amerikanischen Original:
Feindseligkeit nach innen gerichtet), eine beeinträchtigte Lebensqualität und eingeschränkte Sozialbeziehungen. Die Ängste Feindseligkeit nach innen gerichtet), eine beeinträchtigte Lebensqualität und eingeschränkte Sozialbeziehungen. Die Ängste
verminderten sich in den folgenden sechs Monaten. Eine Veränderung der Aggressivität trat nicht ein. Dagegen erhöhte sich verminderten sich in den folgenden sechs Monaten. Eine Veränderung der Aggressivität trat nicht ein. Dagegen erhöhte sich
die Hoffnung und verminderte sich die Depressivität. Tendenziell verbesserte sich die Lebensqualität über diesen Zeitraum. die Hoffnung und verminderte sich die Depressivität. Tendenziell verbesserte sich die Lebensqualität über diesen Zeitraum.
SCHLUSSFOLGERUNGEN: Einsätze bei Terroranschlägen sind für Rettungsdienstpersonal in Bezug auf Angst, Aggressivität, Lebensqualität SCHLUSSFOLGERUNGEN: Einsätze bei Terroranschlägen sind für Rettungsdienstpersonal in Bezug auf Angst, Aggressivität, Lebensqualität
und Sozialbeziehungen herausfordernd. Wir fanden überwiegend günstige Verläufe dieser Affekte nach sechs Monaten. Es scheint und Sozialbeziehungen herausfordernd. Wir fanden überwiegend günstige Verläufe dieser Affekte nach sechs Monaten. Es scheint
so, dass diese positive Verarbeitung durch die Ermutigung von informell organisierten Copingprozessen in der Gruppe des Rettungsdienstpersonals so, dass diese positive Verarbeitung durch die Ermutigung von informell organisierten Copingprozessen in der Gruppe des Rettungsdienstpersonals
unterstützt wird. unterstützt wird.
BACKGROUND: Psychological responses in emergency personnel deployed in terroristic events have rarely been looked at in a BACKGROUND: Psychological responses in emergency personnel deployed in terroristic events have rarely been looked at in a
follow-up approach. We studied psychological responses in emergency personnel deployed to the London bombings of 7th July follow-up approach. We studied psychological responses in emergency personnel deployed to the London bombings of 7th July
immediately after the incident and after 6 months. We further measured life quality, somatic concerns and depression. METHODS: immediately after the incident and after 6 months. We further measured life quality, somatic concerns and depression. METHODS:
A total of 14 emergency physicians and 5 paramedics were interviewed on an average of 14 days after the London bombings of A total of 14 emergency physicians and 5 paramedics were interviewed on an average of 14 days after the London bombings of
7th July 2005. The interviews were repeated after a period of 6 months and were analysed using the Gottschalk-Gleser content 7th July 2005. The interviews were repeated after a period of 6 months and were analysed using the Gottschalk-Gleser content
analysis of speech for the assessment of affects. RESULTS: More than half of the participants reported high levels of anxiety, analysis of speech for the assessment of affects. RESULTS: More than half of the participants reported high levels of anxiety,
almost all of them complained of high levels of death anxiety. Half of them showed high levels of distress caused by anxiety almost all of them complained of high levels of death anxiety. Half of them showed high levels of distress caused by anxiety
and aggression (hostility inward). Levels of anxiety had declined after six months, aggression was unchanged. Hope had improved, and aggression (hostility inward). Levels of anxiety had declined after six months, aggression was unchanged. Hope had improved,
depression decreased after six months. Further there was tendency towards an improvement of quality of life. CONCLUSIONS: depression decreased after six months. Further there was tendency towards an improvement of quality of life. CONCLUSIONS:
Coping strategies after terrorist attacks are a challenge to emergency medical personnel's anxiety, aggression, quality of Coping strategies after terrorist attacks are a challenge to emergency medical personnel's anxiety, aggression, quality of
life and social relations. After six months we found an improvement of most of the affects studied. This seems to be due to life and social relations. After six months we found an improvement of most of the affects studied. This seems to be due to
informal coping strategies utilised by the group of emergency medical personnel. informal coping strategies utilised by the group of emergency medical personnel.
Wiener Medizinische Wochenschrift 04/2012; 159(11):288-295.
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ABSTRACT: Disturbed copper (Cu) homeostasis may be associated with the pathological processes in Alzheimer’s disease (AD). In the present
report, we evaluated the efficacy of oral Cu supplementation in the treatment of AD in a prospective, randomized, double-blind,
placebo-controlled phase 2 clinical trial in patients with mild AD for 12months. Sixty-eight subjects were randomized. The
treatment was well-tolerated. There were however no significant differences in primary outcome measures (Alzheimer’s Disease
Assessment Scale, Cognitive subscale, Mini Mental Status Examination) between the verum [Cu-(II)-orotate-dihydrate; 8mg Cu
daily] and the placebo group. Despite a number of findings supporting the hypothesis of environmental Cu modulating AD, our
results demonstrate that oral Cu intake has neither a detrimental nor a promoting effect on the progression of AD.
Acta Neurovegetativa 04/2012; 115(8):1181-1187. · 2.73 Impact Factor
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ABSTRACT: Personality influences behaviour and decision-making. This may play a particular role in emergency medical personnel (EMP) dealing with critical situations. So far very little is known about personality traits that distinguish paramedics (PM) and emergency physicians (EP) from other medical staff.
A questionnaire including the ultra-short version of the Hamburg Personality Inventory (HPA) was distributed to EP, PM, medical doctors not practicing emergency medicine (MD) and medical students (MS).
274 EPs, 245 PMs, 48 MDs and 60 MSs returned the questionnaire. Four personality clusters in EPs and PMs were identified and to be found largely independent from demographic and job-related variables. For both groups one cluster revealed personality characteristics that seem particularly suitable for EMP ('resilient crisis manager'). 'Anxious' and 'insecure' personality traits were found in two clusters in PMs and in one cluster in EPs. Mental health problems in the participants or their relatives or the experience of loss increased scores in the dimensions neuroticism and openness.
The personality characteristics of EPs and PMs are not homogenous and do not differ substantially from those of MDs and MSs. 50-70% of EMP can be characterised as 'resilient and stable', up to 30-40% as 'anxious and insecure'. The presence of mental health problems in participants or their relatives or the experience of loss may lead to openness for new experiences and alternative behaviour or--on the other hand--may trigger feelings of insecurity and/or anxiety in emergency situations.
Emergency Medicine Journal 02/2011; 28(2):141-6. · 1.44 Impact Factor
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ABSTRACT: Patient inclusion in antipsychotic drug decisions is recommended by international treatment guidelines. For N=300 in patients with schizophrenia, we analysed patients' preferences for inclusion in decisions and physicians' estimates which patients actually participated in drug choice. Path analysis was used to examine the relationships between patients' preferences/actual participation and clinical variables measured. Forty percent of the patients expressed a wish to participate in clinical decisions. Those patients wishing to participate in medical decisions had less insight into the necessity of treatment. Psychiatrists gave better ratings of the doctor-patient relationship to those patients whom they rated as having participated in their drug choice. These patients had more positive attitudes towards antipsychotic medication. There was no relationship between the desire to participate and actual participation in the drug choice. When working with patients exhibiting poor insight and negative drug attitudes, psychiatrists use authoritative decision-making styles despite the patient's desire to participate.
Psychiatry Research 05/2010; 178(1):63-7. · 2.52 Impact Factor
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Frank-Gerald Pajonk,
Thomas Wobrock,
Oliver Gruber,
Harald Scherk,
Dorothea Berner,
Inge Kaizl,
Astrid Kierer,
Stephanie Müller,
Martin Oest,
Tim Meyer,
Martin Backens,
Thomas Schneider-Axmann,
Allen E Thornton,
William G Honer,
Peter Falkai
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ABSTRACT: Hippocampal volume is lower than expected in patients with schizophrenia; however, whether this represents a fixed deficit is uncertain. Exercise is a stimulus to hippocampal plasticity.
To determine whether hippocampal volume would increase with exercise in humans and whether this effect would be related to improved aerobic fitness.
Randomized controlled study.
Patients attending a day hospital program or an outpatient clinic.
Male patients with chronic schizophrenia and matched healthy subjects.
Aerobic exercise training (cycling) and playing table football (control group) for a period of 3 months.
Magnetic resonance imaging of the hippocampus. Secondary outcome measures were magnetic resonance spectroscopy, neuropsychological (Rey Auditory Verbal Learning Test, Corsi block-tapping test), and clinical (Positive and Negative Syndrome Scale) features.
Following exercise training, relative hippocampal volume increased significantly in patients (12%) and healthy subjects (16%), with no change in the nonexercise group of patients (-1%). Changes in hippocampal volume in the exercise group were correlated with improvements in aerobic fitness measured by change in maximum oxygen consumption (r = 0.71; P = .003). In the schizophrenia exercise group (but not the controls), change in hippocampal volume was associated with a 35% increase in the N-acetylaspartate to creatine ratio in the hippocampus. Finally, improvement in test scores for short-term memory in the combined exercise and nonexercise schizophrenia group was correlated with change in hippocampal volume (r = 0.51; P < .05).
These results indicate that in both healthy subjects and patients with schizophrenia hippocampal volume is plastic in response to aerobic exercise.
Archives of general psychiatry 02/2010; 67(2):133-43. · 12.26 Impact Factor
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Holger Kessler, Frank-Gerald Pajonk,
Daniela Bach,
Thomas Schneider-Axmann,
Peter Falkai,
Wolfgang Herrmann,
Gerd Multhaup,
Jens Wiltfang,
Stephanie Schäfer,
Oliver Wirths,
Thomas A Bayer
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ABSTRACT: A plethora of reports suggest that copper (Cu) homeostasis is disturbed in Alzheimer's disease (AD). In the present report we evaluated the efficacy of oral Cu supplementation on CSF biomarkers for AD. In a prospective, randomized, double-blind, placebo-controlled phase 2 clinical trial (12 months long) patients with mild AD received either Cu-(II)-orotate-dihydrate (verum group; 8 mg Cu daily) or placebo (placebo group). The primary outcome measures in CSF were Abeta42, Tau and Phospho-Tau. The clinical trial demonstrates that long-term oral intake of 8 mg Cu can be excluded as a risk factor for AD based on CSF biomarker analysis. Cu intake had no effect on the progression of Tau and Phospho-Tau levels in CSF. While Abeta42 levels declined by 30% in the placebo group (P = 0.001), they decreased only by 10% (P = 0.04) in the verum group. Since decreased CSF Abeta42 is a diagnostic marker for AD, this observation may indicate that Cu treatment had a positive effect on a relevant AD biomarker. Using mini-mental state examination (MMSE) and Alzheimer disease assessment scale-cognitive subscale (ADAS-cog) we have previously demonstrated that there are no Cu treatment effects on cognitive performance, however. Finally, CSF Abeta42 levels declined significantly in both groups within 12 months supporting the notion that CSF Abeta42 may be valid not only for diagnostic but also for prognostic purposes in AD.
Acta Neurovegetativa 11/2008; 115(12):1651-9. · 2.73 Impact Factor
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ABSTRACT: The prescription rate of antipsychotic depots for patients suffering from schizophrenia is currently low. Among these patients the assumable acceptance rate of depot as treatment of choice is markedly higher, but psychiatrists do report that patients frequently reject the offer of depot treatment. In a first step to highlight this contradiction we aimed at identifying attributes of patients that indicate their qualification for depot treatment in the eyes of the psychiatrists.
We surveyed 201 psychiatrists about their evaluation of patients' attributes potentially influencing their qualification for depot treatment. Multidimensional and cluster analyses were applied to detect associated attributes. A second sample of further 248 psychiatrists was asked about their proposal of depot treatment to patients depending on the number of relapses in the past.
Two clusters of attributes were identified characterizing patients' qualification for depot treatment. In cluster I episodes of non-compliance and relapses in the past were considered as favoring the qualification. cluster II included a high level of insight, openness to drug treatment and profound knowledge about the disease representing attributes that increase patients' qualification. Patients were significantly more likely to be offered depot treatment after their fourth reexacerbation compared to their first relapse.
Attributes comprised in cluster I highly qualify a patient for depot treatment which is in line with the current prescription stereotype. This conservative notion of depot use is supplemented by an alternative cluster II patient profile. Patients fitting this cluster also potentially qualify for depot treatment according to the surveyed psychiatrists and should be offered depot in clinical routine considering the advantages of this form of administration.
Progress in Neuro-Psychopharmacology and Biological Psychiatry 11/2008; 32(8):1987-93. · 3.25 Impact Factor
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ABSTRACT: In spite of their well known advantages, depot antipsychotics are seldom prescribed in the treatment of schizophrenia. A frequently stated reason is the patient's objection to depot treatment. We questioned 300 patients in nine psychiatric hospitals shortly before their discharge about their preferences in the mode of administration of antipsychotic treatment, taking earlier depot experience into account. 145 patients were naive to depot treatment, 95 had experienced a depot earlier and 60 were currently on a depot medication. Acceptance of depot treatment in relapse prevention was 73% in patients currently being treated with a depot and 45% in depot-experienced patients, compared with 23% in depot-naive participants. Participants, depending on their experience with the formulation, acknowledged suggested potential advantages of depot treatment. Preference of depots as favorable antipsychotic treatment depends on the patient's experience with the formulation. A considerable number of patients would accept a depot drug as a long-term treatment option. The gap between patients' acceptance and the low prescription rates can be narrowed by offering antipsychotic depots to more patients.
International Clinical Psychopharmacology 10/2007; 22(5):275-82. · 2.92 Impact Factor
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ABSTRACT: There is mounting evidence that the amyloid precursor protein (APP), the key protein in Alzheimer's disease (AD) is involved in the copper (Cu) homeostasis in the brain. Conflicting results about the potential use of dietary Cu and clioquinol (CQ), a known Cu chelator, have been reported using APP transgenic mice. Previously, in vitro studies have demonstrated that CQ can act as a Cu transporter. To analyze the potential function of CQ as a Cu transporter in vivo, the nutritional effect of Cu and CQ was analyzed in young APP transgenic mice and nontransgenics with food pellets containing either Cu, CQ, Cu plus CQ (Cu + CQ), or without addition of supplements (control). The offspring were fed with corresponding food pellets until the age of 14 weeks. We observed an increased lethality of APP transgenics upon CQ treatment, which could be rescued by a co-treatment with Cu. The exposure of Cu + CQ led to a modest but significant increase in cerebral Cu levels, most likely due to an enhanced transport of CQ-Cu complexes. In CQ or Cu + CQ treatment groups, the plasma levels of Cu, zinc, and iron were reduced in all animals; moreover, Cu treatment alone reduced only plasma iron levels. We conclude not only that CQ has certain toxicity but also that the chelating effect, perhaps, plays a secondary role with respect to its properties as an intracellular Cu transporter, thus, counteracting the supposed therapeutic effects of CQ as an agent for chelating therapy in AD.
Journal of Molecular Medicine 05/2007; 85(4):405-13. · 4.67 Impact Factor
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ABSTRACT: Recommendations of treatment guidelines concerning the use of second-generation antipsychotic (SGA) agents for acute mania vary substantially across committees or working groups. Meta-analyses addressing the use of SGAs in the treatment of acute mania are lacking.
To conduct a meta-analysis of the efficacy and safety of SGAs in the treatment of acute mania.
Randomized controlled trials comparing SGAs with placebo, first-generation antipsychotic drugs, or mood stabilizers (MSs) in the treatment of acute mania were searched for in the PsiTri and MEDLINE databases (last search: May 2006).
The abstracts, titles, and index terms of studies were searched using the following key words: aripiprazole, amisulpride, clozapine, olanzapine, quetiapine, risperidone, ziprasidone, and zotepine in conjunction with mania, manic, and bipolar.
Data on efficacy, global dropout, dropout due to adverse events, dropout due to inefficacy, weight gain, rate of somnolence, and extrapyramidal symptoms were extracted and combined in a meta-analysis.
A total of 24 studies with 6187 patients were included. The SGAs were significantly more efficacious than placebo. The analysis demonstrated that adding antipsychotic agents to MS treatment was significantly more effective than treatment with MSs alone. The SGAs displayed efficacy comparable with that of MSs. Some SGAs seemed to induce more extrapyramidal symptoms than placebo. The SGAs were also associated with higher rates of somnolence than placebo.
Currently available data suggest that combining SGAs and MSs is the most efficacious treatment of acute mania.
Archives of General Psychiatry 04/2007; 64(4):442-55. · 12.02 Impact Factor
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Frank-Gerald Pajonk
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ABSTRACT: Results from clinical trials do not necessarily provide information for decisions in clinical practice. This review aims to present strengths and limitations of different methodological types of clinical trials and to offer an overview of how knowledge from clinical trails can be distilled for clinical practice. Selected key questions in the treatment of schizophrenia are presented, with a focus on the possibilities and restrictions of translating trial results into real-world practice.
Randomized controlled trials are the gold standard for proving efficacy of a diagnostic or therapeutic procedure. They have a high degree of internal validity and a clear-cut message when conducted to good-quality standards but suffer from a lack of generalizability (external validity). Effectiveness studies evaluate effects of treatments under conditions approximating usual care. They may include patient-centred outcomes or health economic evaluations. According to the type of trial, specific problems arise in the interpretation of results. Typical examples are given for the treatment of acute exacerbations of schizophrenia, for relapse prevention and for the treatment of cognitive impairment.
Clinical decisions have to be made upon the best knowledge. Therefore, well conducted studies addressing all major issues from all relevant perspectives are needed. The assessment of a treatment regimen for clinical utility requires both efficacy and effectiveness studies. An understanding of the design, analysis and conventions of both study types is essential for the interpretation of results and their translation to the clinical decision-making process.
Current Opinion in Psychiatry 12/2005; 18(6):692-9. · 3.05 Impact Factor
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Frank-Gerald Pajonk,
Holger Kessler,
Tillmann Supprian,
Pegah Hamzei,
Daniela Bach,
Janina Schweickhardt,
Wolfgang Herrmann,
Rima Obeid,
Andreas Simons,
Peter Falkai,
Gerd Multhaup,
Thomas A Bayer
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ABSTRACT: Alzheimer's disease (AD) is a devastating brain disorder clinically characterised by progressive loss of characteristic cognitive abilities. Increasing evidence suggests a disturbed copper (Cu) homeostasis to be associated with the pathological processes. In the present study we analysed the plasma Cu levels and cognitive abilities using the Alzheimer's disease Assessment Scale-cognitive subscale (ADAS-cog) in 32 patients with mild to moderate AD. Statistical analysis revealed a negative correlation between plasma Cu levels and cognitive decline (r=-0.49; P<0.01). Patients with low plasma Cu (mean 82 +/- SD 9) had significant higher ADAS-cog values (mean 23 +/- SD 7), than patients with medium plasma Cu (mean 110 +/- SD 7), who exhibited lower ADAS-cog scores (mean 16 +/- SD 4; ANOVA, P<0.0001). Despite the fact that all patients had plasma Cu levels within the physiological range between 65 microg and 165 microg/dL, 87.5% of the patients revealed a significant negative correlation between plasma Cu and ADAS-cog. This finding supports the hypothesis of a mild Cu deficiency in most AD patients.
Journal of Alzheimer's disease: JAD 10/2005; 8(1):23-7. · 3.74 Impact Factor
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ABSTRACT: Efficacy of atypical antipsychotic in acute schizophrenic episodes is still in debate. This study evaluated treatment practices over 7 years of initial treatment with oral risperidone in acutely exacerbated patients with schizophrenia and in a subgroup of highly agitated, tense, and aggressive patients. Additionally, the study investigated the efficacy and tolerability of risperidone in routine clinical practice.
In a prospective, multicenter, observational trial from 1996 to 2002, patients with schizophrenia experiencing acute symptom exacerbations were treated with risperidone within 24 hours of inpatient admission. Patients with a total score of > or =15 points on the agitation subscale of the Positive and Negative Syndrome Scale (PANSS) were defined as highly agitated. Efficacy measures were carried out with a modified PANSS, the Clinical Global Impression (CGI) and the Brief Psychiatric Rating Scale (BPRS).
A total of 1625 patients were evaluated. Despite prescription of decreasing risperidone dosages over 7 years, efficacy was maintained and tolerability improved significantly. Significant symptom relief occurred in all patients and was more pronounced in the subgroup of highly agitated patients (n = 256; P < 0.001 for PANSS, BPRS, and CGI). At Week 6, the mean daily dosage of risperidone was 4.8 mg in the highly agitated patients and 4.7 mg in the remaining patients, and more than 55% of all patients were receiving risperidone as monotherapy.
Prescribing patterns with risperidone in patients with acutely exacerbated schizophrenia, including highly agitated patients, changed with the experience gained with this compound. In routine clinical practice in this indication, risperidone was found to be effective and well tolerated.
Journal of Clinical Psychopharmacology 09/2005; 25(4):293-300. · 4.10 Impact Factor
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ABSTRACT: After parasuicide there is a high risk of reattempts. However, it seems that patients who survived severe suicidal trauma recover well. Therefore, the outcome of patients with severe multiple blunt trauma as a result of a suicide attempt was investigated with respect to psychiatric and somatic health, quality of life (QOL) and suicide reattempt rates.
Patients who underwent a suicide attempt were isolated from a prospectively collected sample of trauma patients from a level I University Trauma Centre. Follow-up examination was performed 6.1 +/- 3 years after the trauma. A physical and psychiatric examination was performed, using established psychiatric scales.
Twelve percent of severely injured patients were identified as suicide attempters (male/female: 37/28, mean age 38 +/- 18 years, mean Injury Severity Score (ISS) 40 +/- 15 points). A psychiatric diagnosis was present in 90% at the time of the suicide attempt. Twenty-one patients died during the hospital stay (32%) and six subjects died thereafter, none due to suicide. Thirty-five individuals were eligible for examination. None of them had reattempted suicide. Seventeen (48%) had good outcomes reflected by absent or ambulatory psychiatric treatment, employment, normal psychiatric findings and good psychosocial ability. An indeterminate outcome was determined in 24%. Predictive variables for an adverse outcome (10 patients, 28%) were found to be a diagnosis of schizophrenia, continued psychiatric treatment and being without employment.
Despite the seriousness of the suicide attempt, survivors recovered well in about half the cases with no further suicide attempt in any patient. An early psychiatric consultation already on the Intensive Care Unit (ICU) is recommended.
European Psychiatry 04/2005; 20(2):115-20. · 2.77 Impact Factor
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Frank-Gerald Pajonk
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ABSTRACT: Data from a range of well-controlled clinical trials, observational studies, and clinical use support the efficacy of risperidone for both acute and long-term therapy of schizophrenic psychoses. With regard to positive symptoms, the efficacy of risperidone was shown to be at least comparable with that of haloperidol. However, risperidone differs from conventional antipsychotics because it is more effective against the negative symptoms, has beneficial effects on affective and cognitive symptoms, and carries less risk of extrapyramidal side effects (EPS). To date, risperidone is the only atypical antipsychotic to have shown a significantly lower relapse rate compared with haloperidol in a long-term double-blind trial. This review describes comprehensive trial data and therapeutic observations gained with risperidone in the treatment of schizophrenia since its approval.
Progress in Neuro-Psychopharmacology and Biological Psychiatry 02/2004; 28(1):15-23. · 3.25 Impact Factor
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ABSTRACT: Patients with schizophrenia are more likely than the general population to develop diabetes, which contributes to a high risk of cardiovascular complications; individuals with schizophrenia are two to three times more likely to die from cardiovascular disease than the general population. The risk of diabetes, and hence cardiovascular disease, is particularly increased by some of the new atypical antipsychotic drugs. Individuals taking an atypical antipsychotic drug, particularly younger patients under 40 years of age (odds ratio 1.63, 95% CI 1.23-2.16), represent an underrecognized group at high risk of type 2 diabetes. The mechanisms responsible for antipsychotic-induced diabetes remain unclear. Hypotheses include these drugs' potential to cause weight gain, possibly through antagonism at the H(1), 5-HT(2A), or 5-HT(2C) receptors. Other mechanisms independent of weight gain lead to elevation of serum leptin and insulin resistance. Patients with psychoses have difficulties with diet and lifestyle interventions for diabetes and weight management. If hyperglycemia develops, withdrawal from antipsychotic medication will often be inappropriate, and a change to an atypical antipsychotic drug with lower diabetogenic potential should be considered, especially in younger patients. Management of psychoses should routinely include body weight and blood glucose monitoring and steps to promote exercise and minimize weight gain. Careful collaboration between the psychiatric and diabetology teams is essential to minimize the risk of diabetes in patients taking atypical antipsychotic medication and for effective management when it develops. This collaboration will also help minimize the already high risk of cardiovascular disease in individuals with schizophrenia.
Diabetes Care 06/2003; 26(5):1597-605. · 8.09 Impact Factor
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ABSTRACT: Due to methodological reservations, open clinical trials investigating efficacy and tolerability of antipsychotic agents are often regarded with doubt. However, there are nearly no studies comparing findings of controlled double-blind with those of open trials. The aim of this study was to investigate whether results of open and double-blind approaches differ and thereby gain information about the validity of open trials.
After literature research, three atypical antipsychotic agents were identified for which at least three open and double-blind trials existed that met the inclusion criteria and from which either the reduction of the Brief Psychiatric Rating Scale (BPRS)- or Positive and Negative Symptom Scale (PANSS) scores or the response rate could be determined.
There were no differences in the reduction of the BPRS- or PANSS scores or in the response rates for all three antipsychotic agents between open and double-blind trials.
Although double-blind controlled studies are essential in the investigation of new compounds, results of methodologically well-performed open studies are valid and deserve more attention. Preceding open trials may help in the design of double-blind studies.
Psychopharmacologia 07/2002; 162(1):29-36. · 4.08 Impact Factor
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ABSTRACT: In emergency medicine, suicides and attempted suicides represent a major challenge for emergency physicians (EPs) and paramedics, both in terms of psychiatric and somatic treatment. To date no investigations have been performed to determine prevalence rates, method of suicide or attempted suicide, and the problems faced by EPs when treating these patients. This investigation presents a first evaluation of the complete emergency protocols from a major German city focusing on suicide and parasuicide.
A retrospective analysis of all EP protocols from 1995 in the city of Hamburg was performed. All protocols were evaluated with respect to suicide parasuicide and suicidal ideation. Demographic data and information on method of suicide or attempted suicide, severity of illness, and underlying psychiatric disorder were extracted from the protocols.
A total of 26,347 emergency protocols were evaluated. Suicide and attempted suicide were considered either certain, probable, or possible in 743 cases (2.8%). Suicide was committed in 171 cases and attempted were made by 572 individuals. More men committed suicide in all age groups. By far the highest number of suicide attempts were by young men between 18 and 39 years of age. Hanging was the most commonly used method of completed suicide (41%), followed by jumping from a height (21%). The methods of intoxication with medication (54%) and illegal drugs (17%) clearly prevailed in suicide attempts. Documentation of suicides and attempted suicides was revealed to be unsatisfactory. Underlying psychiatric disorders were scarcely recorded.
In emergency medicine, the incidence of suicide or the attempt to commit suicide is small, yet disturbing. The frequency assessed may be too low as result of methodology. There is a need to improve the education of emergency physicians and paramedics in this area, and there is a need for data to be collected in a prospective design.
Crisis The Journal of Crisis Intervention and Suicide Prevention 02/2002; 23(2):68-73. · 1.09 Impact Factor
