Marius Nickel

Medical University of Graz, Gratz, Styria, Austria

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Publications (92)232.75 Total impact

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    ABSTRACT: Hyponatremia, defined as serum sodium below 135 mmol/l, is a potentially life-threatening condition and was shown to be more frequent in elderly and psychiatric patients. In the last years numerous case reports on SSRI- and venlafaxine-induced hyponatremia were published indicating a higher incidence than previously thought. Only few studies have been performed and the incidence reported varies widely from 4.6/1000 people to 25%. It is still unclear if any single SSRI shows a higher incidence of hyponatremia than the others. Some data suggest that venlafaxine may have a stronger association to hyponatremia than SSRIs. Risk factors include age, female sex, low body mass index, severe physical illness, history of former hyponatremia and co-medications known to induce hyponatremia, especially thiazide diuretics. Symptoms of hyponatremia are usually neuropsychiatric (e.g. restlessness, lethargy, cognitive impairment), and any worsening in psychiatric symptoms in patients with a corresponding risk-profile receiving SSRIs or venlafaxine should give cause to check serum electrolytes. Usually SSRI-induced hyponatremia occurs within approximately 30 days and is reported to improve after withdrawal of the drug. Further controlled studies to confirm the true incidence of hyponatremia due to SSRI or venlafaxine and to define predictors more precisely are needed.
    No preview · Article · Jul 2009 · International Journal of Psychiatry in Clinical Practice
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    ABSTRACT: Asthma is a frequently disabling and almost invariably distressing disease that has a high overall prevalence. Although relaxation techniques and hypnotherapeutic interventions have proven their effectiveness in numerous trials, relaxation therapies are still not recommended in treatment guidelines due to a lack of methodological quality in many of the trials. Therefore, this study aims to investigate the efficacy of the brief relaxation technique of functional relaxation (FR) and guided imagery (GI) in adult asthmatics in a randomized controlled trial. 64 patients with extrinsic bronchial asthma were treated over a 4-week period and assessed at baseline, after treatment and after 4 months, for follow-up. 16 patients completed FR, 14 GI, 15 both FR and GI (FR/GI) and 13 received a placebo relaxation technique as the control intervention (CI). The forced expiratory volume in the first second (FEV(1)) as well as the specific airway resistance (sR(aw)) were employed as primary outcome measures. Participation in FR, GI and FR/GI led to increases in FEV(1) (% predicted) of 7.6 +/- 13.2, 3.3 +/- 9.8, and 8.3 +/- 21.0, respectively, as compared to -1.8 +/- 11.1 in the CI group at the end of the therapy. After follow-up, the increases in FEV(1) were 6.9 +/- 10.3 in the FR group, 4.4 +/- 7.3 in the GI and 4.5 +/- 8.1 in the FR/GI, compared to -2.8 +/- 9.2 in the CI. Improvements in sR(aw) (% predicted) were in keeping with the changes in FEV(1) in all groups. Our study confirms a positive effect of FR on respiratory parameters and suggests a clinically relevant long-term benefit from FR as a nonpharmacological and complementary therapy treatment option.
    Full-text · Article · May 2009 · Psychotherapy and Psychosomatics

  • No preview · Conference Paper · Feb 2009
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    ABSTRACT: The primary aim of this study was to investigate facial emotion recognition in patients with somatoform disorders (SFD). Also of interest was the extent to which concurrent alexithymia contributed to any changes in emotion recognition accuracy. Twenty patients with SFD and twenty healthy, age, sex and education matched, controls were assessed with the Facially Expressed Emotion Labelling Test of facial emotion recognition and the 26-item Toronto Alexithymia Scale (TAS-26). Patients with SFD exhibited elevated alexithymia symptoms relative to healthy controls. Patients with SFD also recognized significantly fewer emotional expressions than did the healthy controls. However, the group difference in emotion recognition accuracy became nonsignificant once the influence of alexithymia was controlled for statistically. This suggests that the deficit in facial emotion recognition observed in the patients with SFD was most likely a consequence of concurrent alexithymia. Impaired facial emotion recognition observed in the patients with SFD could plausibly have a negative influence on these individuals' social functioning.
    Full-text · Article · Jan 2009 · Depression and Anxiety
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    ABSTRACT: Hintergrund: Obwohl die Wirksamkeit körperpsychotherapeutischer Ansätze und hypnotherapeutischer Interventionen bei Asthma bronchiale in mehreren Studien belegt werden konnte, sind diese Ansätze noch nicht Bestandteil aktueller Therapieempfehlungen. In der vorliegenden Behandlungsstudie wurde die Wirksamkeit von Funktioneller Entspannung (FE) und Geleiteter Imagination (GI) bei erwachsenen Patienten mit allergischem Asthma bronchiale untersucht. Methodik: 64 Patienten mit allergischem Asthma bronchiale wurden über einen Zeitraum von 4 Wochen mit FE, GI, einer Kombination aus FE und GI (FE/GI) oder einem Placebo-Entspannungsverfahren (PE) behandelt. Der Behandlungseffekt wurde mittels Lungenfunktionsprüfung (FEV 1 und sRaw) gemessen. Ergebnisse: Die Behandlung mit FE, GI bzw. FE/GI führte zu einer Zunahme des FEV 1 (% vorhergesagt) von 7,6 ± 13,2; 3,3 ± 9,8 und 8,3 ± 21,0 bzw. einer Abnahme von –1.8 ± 11.1 in der PE-Gruppe am Ende der Therapiephase. Nach 4 Monaten lagen die Veränderungen bei 6,9 ± 10,3 in der FE-Gruppe; 4,4 ± 7,3 in der GI-Gruppe und 4,5 ± 8,1 in the FE/GI-Gruppe, während sich in der PE-Gruppe eine Abnahme von –2,8 ± 9,2 ergab. Die Veränderungen des Atemwegswiderstands (sRaw) entsprachen in ihrer Ausrichtung in allen Gruppen denen des FEV 1. Schlussfolgerung: Die Studie konnte die bereits aus früheren Studien bekannte Wirksamkeit der FE bei Asthma replizieren und die zeitliche Stabilität der Erfolge über die Zeit der Katamnese belegen.
    Full-text · Conference Paper · Jan 2009
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    ABSTRACT: The purpose of this study was to investigate cortisol levels as a function of the hypothalamic-pituitary-adrenal axis (HPA) in relation to alexithymia in patients with somatoform disorders (SFD). Diurnal salivary cortisol was sampled in 32 patients with SFD who also underwent a psychiatric examination and filled in questionnaires (Toronto Alexithymia Scale, TAS scale; Screening for Somatoform Symptoms, SOMS scale; Hamilton Depression Scale, HAMD). The mean TAS total score in the sample was 55.6+/-9.6, 32% of patients being classified as alexithymic on the basis of their TAS scores. Depression scores were moderate (HAMD=13.2, Beck Depression Inventory, BDI=16.5). The patients' alexithymia scores (TAS scale "Difficulty identifying feelings") correlated significantly positively with their somatization scale scores (Symptom Checklist-90 Revised, SCL-90-R); r=0.3438 (P<0.05) and their scores on the Global Severity Index (GSI) on the SCL-90-R; r=0.781 (P<0.01). Regression analysis was performed with cortisol variables as the dependent variables. Cortisol levels [measured by the area under the curve-ground (AUC-G), area under the curve-increase (AUC-I) and morning cortisol (MCS)] were best predicted in a multiple linear regression model by lower depressive scores (HAMD) and more psychopathological symptoms (SCL-90-R). No significant correlations were found between the patients' alexithymia scores (TAS) and cortisol levels. The healthy control group (n=25) demonstrated significantly higher cortisol levels than did the patients with SFD; in both tests P<0.001 for AUC-G and AUC-I. However, the two groups did not differ in terms of their mean morning cortisol levels (P>0.05). The results suggest that pre-existing hypocortisolism might possibly be associated with SFD.
    No preview · Article · Sep 2008 · Nordic journal of psychiatry
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    Claas Lahmann · Thomas H Loew · Karin Tritt · Marius Nickel
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    ABSTRACT: Recurrent heart problems and, especially, chest pain in the absence of somatic heart disease is a common finding, although challenging to treat. The authors assessed a body-oriented approach to the somatic fixation frequently seen in these patients. They conducted a controlled study to assess the effect of functional relaxation in 22 patients with non-specific chest pain. The primary outcome measures were self-reported changes on the subscales Somatization and Anxiety of the Symptom Checklist of Derogatis, as well as the subscale Cardiovascular Complaints of the Giessen Inventory of Complaints. Significant improvements of the primary outcome measures were observed in patients treated with functional relaxation, whereas no significant improvements could be seen in the control group. Functional relaxation appears to be a safe and effective, non-pharmacological approach in the treatment of non-specific chest pain.
    Full-text · Article · Sep 2008 · Psychosomatics
  • Thomas H Loew · Marius K Nickel

    No preview · Article · Jul 2008 · Journal of Clinical Psychopharmacology
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    ABSTRACT: Dental anxiety is a significant cause of poor dental health. Because patients often prefer nonpharmacological interventions, the clinical effectiveness of clearly structured approaches is of particular interest. This prospective randomized controlled study compares a brief relaxation method (BR) with music distraction (MD) and with a control group (C). The authors randomly assigned 90 patients with dental anxiety to BR, MD or C groups. They assessed the outcomes by means of the state anxiety subscale of the State-Trait Anxiety Inventory. Both BR and MD reduced dental anxiety significantly. In contrast, patients in the C group did not exhibit a significant change in their anxiety level. BR was significantly superior to MD. Stratification according to the patient's general level of dental anxiety revealed that BR also was particularly effective in highly anxious subjects, whereas MD did not have a clinically relevant effect on these subjects. BR appears to be a safe, economically sound and effective nonpharmacological approach to the short-term reduction of dental anxiety. Additional investigations are needed to validate these findings in a larger clinical trial and to determine the long-term effects of this intervention. Relaxation techniques are a pragmatic, effective and cost-saving method of facilitating dental treatment in anxious patients.
    Full-text · Article · Apr 2008 · Journal of the American Dental Association (1939)
  • Marius K Nickel · Thomas H Loew
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    ABSTRACT: We previously tested topiramate, an anticonvulsant, in the treatment of aggression in men with borderline personality disorder (BPD) (Nickel M, Nickel C, Kaplan P, Lahmann C, Mühlbacher M, Tritt K, et al. Treatment of aggression with topiramate in male borderline patients: a double-blind, placebo-controlled study. Biol Psychiatry 2005;57:495-9), and found significant changes on most scales of the state-trait anger expression inventory (STAXI) and significant weight loss eight weeks later. The aim of this trial was to assess topiramate's efficacy in the long-term therapy for aggression in men with BPD. This 18-month follow-up observation, in which the previous patients (topiramate group: n=22; former placebo group: n=22) were examined bianually, was carried out. According to the intent-to-treat principle, significant changes on all scales of the STAXI were observed in the subjects treated with topiramate. Additional significant weight loss was observed. All subjects tolerated topiramate relatively well. Topiramate appears to be an effective, relatively safe agent in the long-term treatment of patients with BPD. Mild, non-transient weight loss can be expected.
    No preview · Article · Apr 2008 · European Psychiatry

  • No preview · Article · Apr 2008 · Psychiatry Research
  • P Leiberich · M K Nickel · K Tritt · F. Pedrosa Gil
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    ABSTRACT: Borderline patients often display pathological aggression. We previously tested lamotrigine, an anti-convulsant, in therapy for aggression in women with borderline personality disorder (BPD) (J Psychopharmacol 2005; 19: 287-291), and found significant changes on most scales of the State-Trait Anger Expression Inventory (STAXI) after eight weeks. To assess the longer-term efficacy of lamotrigine in therapy for aggression in women with BPD, this 18-month follow-up observation was carried out, in which patients (treated with lamotrigine: n = 18; former placebo group: n = 9) were tested every six months. According to the intent-to-treat principle, significant changes on all scales of the STAXI were observed in the lamotrigine-treated subjects. All subjects tolerated lamotrigine relatively well. Lamotrigine appears to be an effective and relatively safe agent in the longer-term treatment of aggression in women with BPD.
    No preview · Article · Mar 2008 · Journal of Psychopharmacology
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    ABSTRACT: This study examines the relationship between parental bonding, adult attachment, and alexithymia in patients with Somatoform Disorders (SFD). There are few empirical studies to support the clinical hypothesis that alexithymia may be due to disturbances in the early parent-child relationship. In a cross-sectional study, data from 76 patients with SFD were obtained, consisting of questionnaire measures of alexithymia (TAS scale), attachment style (BFKE), and also the German version of the MOPS (Measure of Parental Style), the FDEB scale for measuring perceived parental attitude. A higher than average prevalence of insecure attachment (n = 67, 88.2%) was found in our sample with SFD and a T-value of 54.3 (9.5) in the TAS total score, 22% reaching clinically significant alexithymia. Regression analyses demonstrated the relationship between the "ambivalent clinging" and "ambivalent withdrawing" attachment style and more marked alexithymia features. Furthermore, alexithymia was positively predicted by "indifference" in the relationship to the father, BDI, and Global severity index (SCL-90-R). The results of this study support the hypothesis that alexithymia is associated with perceived parental bonding and attachment style.
    No preview · Article · Feb 2008 · The International Journal of Psychiatry in Medicine
  • Johanna Seeliger · Torsten Lenz · Marius Nickel
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    ABSTRACT: A unipolar depressive disorder had been phasically present in a 46-year-old female patient for many years, and had first manifested itself following completion of her studies approx. 10 years ago. She was admitted into a psychiatric unit shortly thereafter with the diagnosis of a moderate depressive episode. Treatment resulted in complete remission. After a long episode-free period, a severe depressive episode recurred three years ago, directly after her brother's suicide. Treatment did not result in complete remission. Since then four episodes have recurred, but none remitted completely. Between the episodes a dysthymia was continuously present. The current relapse was triggered by a difficult, stressful, occupational situation and an additional domestic conflict. The patient was admitted to the psychosomatic hospital Bad Aussee. Based on the bio-psychosocial model, a multi-methodological and multi-modal psychotherapeutic concept with a disorder-specific treatment focus was carried out. Under continuous psychopharmacological and psychotherapeutic treatment with the addition of individual creative arts therapy as a nonverbal medium, the patient could achieve psychophysical stability with clear improvement in self-worth, recovery of employability and a clear reduction of the depressive symptoms.
    No preview · Article · Dec 2007 · Psychiatrie und Psychotherapie
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    ABSTRACT: Propofol is often used as an anesthetic agent for electroconvulsive therapy (ECT). Whether the relatively short seizure duration, resulting from the medication, deteriorates the seizure quality and therapeutic outcomes, or whether propofol might be associated with small but significant post-ECT cognitive impairments, is still a subject of controversy. The purpose of our study was to test these hypotheses in comparison with methohexital. In a double-blind, controlled study, 50 patients with severe major depression who were to be treated with ECT were randomly assigned to anesthesia with propofol (120.9 +/- 50.0 mg) or methohexital (83 +/- 26.3 mg) and were observed for 2 months. The 2 drugs were compared on the basis of electroencephalography-registered seizure duration, mean blood pressure, as well as pulse frequency, seizure efficacy index, and postictal suppression. Systolic and diastolic blood pressure, and seizure duration and quality were recorded consecutively during ECT treatments. Changes in depressive symptoms and cognitive functions were measured at 5 time points, pre-ECT, after the third to fifth ECT, post-ECT treatment, and at a follow-up examination 2 and 8 weeks after the last ECT treatment. Patients on propofol showed a significantly lower increase in blood pressure post-ECT (P < 0.001), their seizure duration was comparable to patients on methohexital (P = 0.072), and seizure quality was significantly superior, as was measured by the Postictal Suppression Index (P = 0.020), and comparable to the methohexital group as measured by the Seizure Efficacy Index (P = 0.160). The improvement of depressive symptoms and the improvement in cognitive functions were similar in both groups (with the exception of the results from 2 cognition tests). Propofol, as compared with methohexital, results in a more moderate increase in blood pressure and shorter seizure duration. The seizure quality did not differ significantly between the 2 groups. We detected a tendency toward improved cognitive performance after anesthesia with propofol as compared with methohexital, but with statistical significance in only 2 cognition trials. Therefore, propofol is a safe and efficacious anesthetic for ECT treatment.
    No preview · Article · Dec 2007 · Journal of Ect
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    ABSTRACT: This study examined whether the promotion of mindfulness in psychotherapists in training can influence the treatment results of their patients. The therapeutic course and treatment results of 196 inpatients, who were treated during a nine week period by nine psychotherapists in training, were compared: in the first phase of the study, the treatment group without (CG, historical control group, n=55), and in the second phase the treatment group with, (MFG, n=58) therapists who were currently practicing Zen meditation. The results of treatment were examined (according to the intent-to-treat principle) with the Session Questionnaire for General and Differential Individual Psychotherapy (STEP), the Questionnaire of Changes in Experience and Behaviour (VEV) and the Symptom Checklist (SCL-90-R), and showed significantly better results in the MFG.
    Full-text · Article · Dec 2007 · European Psychiatry
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    Marius K Nickel

    Preview · Article · Dec 2007 · The Journal of Clinical Psychiatry
  • Marius Nickel

    No preview · Article · Nov 2007 · European Archives of Psychiatry and Clinical Neuroscience
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    ABSTRACT: In a randomized controlled trial, we compared the efficacy of topiramate versus placebo in women undergoing olanzapine therapy and found that topiramate effectively contributed to weight loss in short-term treatment and had a positive effect on health-related quality of life, the patients' actual state of health, and psychological impairments. The aim of this observational study was to assess whether topiramate has a sustained benefit in long-term treatment of olanzapine-associated weight gain in subjects who had participated in the previous randomized controlled trial comparing topiramate with placebo. The subjects (topiramate group, n = 25; former placebo group, n = 18) were observed in an 18-month open-label study. After unblinding, subjects from the former topiramate group continued treatment with topiramate, whereas subjects from the former placebo group received neither placebo nor topiramate. The subjects were seen every 6 months, weighed, and tested with the SF-36 Health Survey, Scale of Well-Being, and the Adjective Checklist. According to the intent-to-treat principle, the repeated-measures analysis showed a significant interaction for the group-by-time effect for change of weight (P < 0.01) on the Scale of Well-Being (P < 0.01), all scales of the Adjective Checkist (all P < 0.01), and 5 scales (physical functioning, role limitations due to physical health, social functioning, mental health, and vitality) of the SF-36 Health Survey (all P < 0.01). Topiramate was well tolerated and seems to be effective and safe in the long-term treatment of olanzapine-related adiposity in women. Furthermore, positive changes in the patients' state of health, psychological impairments, and health-related quality of life could be also observed.
    No preview · Article · Oct 2007 · Journal of Clinical Psychopharmacology
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    ABSTRACT: Overworking is one of the most frequent stressors. The purpose of this study was to determine the effectiveness of behavioural/psycho-educational group training in men who are chronically stressed from overworking. Of 72 male subjects, 36 were randomly assigned to training for 8 weeks and another 36 formed the control group, which received a placebo intervention. Primary outcome measures were systolic blood pressure, salivary cortisol concentration upon awakening, and self-reported changes on the scales of the Trier Inventory for the Assessment of Chronic Stress (TICS), the State-Trait Anger Expression Inventory (STAXI) and the 36-item Short Form Health Survey (SF-36). A significant reduction in mean values was observed in daily systolic blood pressure and salivary cortisol concentration on all the TICS and most of the STAXI and SF-36 scales. Behavioural/psycho-educational group training appears to be effective in the treatment of men suffering from chronic stress due to overworking.
    Full-text · Article · Sep 2007 · Psychological Medicine

Publication Stats

2k Citations
232.75 Total Impact Points


  • 2006-2009
    • Medical University of Graz
      Gratz, Styria, Austria
  • 2005-2009
    • Paracelsus Medical University Salzburg
      • University Clinic of Psychiatry and Psychotherapy I
      Salzburg, Salzburg, Austria
  • 2005-2008
    • University of Salzburg
      Salzburg, Salzburg, Austria
  • 2007
    • Karl-Franzens-Universität Graz
      Gratz, Styria, Austria
  • 2005-2006
    • Universität Regensburg
      Ratisbon, Bavaria, Germany