May 2010
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34 Reads
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3 Citations
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Publications (151)
March 2010
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29 Reads
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9 Citations
Clozapine is still the gold standard in treatment-resistant schizophrenia. However, a substantial amount of patients do not fully recover on clozapine monotherapy. Though there is still a lack of randomised controlled studies of combination strategies in treatment-resistant schizophrenia, they are widely used. Aripiprazole is a relatively new therapeutic option due to its partial D2 agonism. Both clozapine and aripiprazole, though having a generally favourable side-effect profile, may lead to insufficient response and might provoke side effects in monotherapy. We report the case of four patients in whom we observed a distinct clinical improvement with respect to positive and negative symptoms without major side effects under a combination of clozapine and aripiprazole. The combination of clozapine action and aripiprazole-mediated D(2) receptor regulation could be responsible for the described favourable effects and for the increase of D(2) receptor blockade after adding aripiprazole to clozapine observed in one patient. A combination of clozapine and aripiprazole may be an effective therapeutic strategy for some schizophrenic patients, leading to a good response with respect to positive and negative symptoms without the occurrence of major side effects.
June 2009
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37 Reads
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40 Citations
International Journal of Geriatric Psychiatry
To measure the prevalence of benzodiazepine (BZD) use and to explore associated demographic and clinical variables of BZD use within a cohort of 75-year- old inhabitants of an urban district of Vienna. This is a prospective, interdisciplinary cohort study on aging. Our investigation is based on the first consecutive 500 subjects that completed the study protocol. Demographic and clinical characteristics, benzodiazepine and antidepressant use were documented using a standardized questionnaire. Affective status was assessed using the Hamilton Depression Rating Scale (HAMD), the Geriatric Depression Scale (GDS), and the Spielberger State-and Trait Anxiety Inventory subscales (STAI). Prevalence of BZD use was 13.8%. Compared to non-users, BZD users had significantly higher mean scores at the HAMD (p = 0.001), the GDS (p = 0.026), and the Spielberger State-and Trait Anxiety Inventory subscales (p = 0.003; p = 0.001). Depression was found in 12.0% (HAMD) and 17.8% when using a self-rating instrument (GDS). Less than one-third of depressed subjects were receiving antidepressants. Statistically equal numbers were using benzodiazepines. Inappropriate prescription of BZD is frequent in old age, probably indicating untreated depression in many cases. The implications of maltreated geriatric depression and the risks associated with benzodiazepine use highlight the medical and socioeconomic consequences of inappropriate BZD prescription.
January 2008
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3 Reads
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8 Citations
October 2007
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47 Reads
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5 Citations
The Journal of Clinical Psychiatry
October 2003
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5 Reads
European Neuropsychopharmacology
October 2003
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4 Reads
European Neuropsychopharmacology
April 2003
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491 Reads
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41 Citations
European Neuropsychopharmacology
The value of a long-term treatment with clonazepam in the prophylaxis of affective disorder is discussed controversially in the scientific literature. Altogether there are only a few reports on the use of this compound as a mood stabilizer, most of them describing patients suffering from bipolar affective disorder. The aim of this investigation was to evaluate clonazepam as a phase prophylactic medication in affective disorder. We conducted a retrospective chart review in 34 out-patients of our lithium clinic (15 suffering from unipolar depression, 15 from bipolar disorder, four from schizoaffective disorder), who had been treated with clonazepam as a long-term medication. Clonazepam was either given as monotherapy, or as in the case of lithium non-responders, as adjunctive therapy. Patients with unipolar depression had significantly (P=0.026) less depressive episodes after initiation of treatment with clonazepam. Patients with bipolar disorder did not benefit from this therapy. Neither manic/hypomanic phases nor depressive episodes were reduced in this group of patients. Interestingly, clonazepam also reduced affective phases in our four schizoaffective patients on a trend level. Our results indicate that patients with unipolar depression may benefit from a maintenance treatment with clonazepam. Due to methodological limitations our results need to be replicated in controlled double-blind randomized clinical trials.
March 2003
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587 Reads
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8 Citations
Journal of the American Geriatrics Society
February 2003
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33 Reads
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48 Citations
Affective dysregulation, impulsivity and cognitive-perceptual difficulties are the psychopathological nuclear dimensions of Borderline Personality Disorder (BPD). Psychopharmacological treatment may become necessary during episodes of acute decompensation in which suicidal or self-destructive behaviour erupts. Some classes of psychotropic drugs have demonstrated efficacy in diminishing symptom severity and optimising functioning, such as antidepressants, mood stabilizers, benzodiazepines, opiate antagonists and antipsychotics. Conventional antipsychotics are the best-studied psychotropic medications for BPD, but nonadherence is often due to their severe side effects. Preliminary data reveal efficacy of atypical antipsychotics in BPD. We describe the impact of the novel antipsychotic drug quetiapine on severe self-mutilation in two female patients with the diagnoses of BPD. In both cases, monotherapeutic treatment with quetiapine was well tolerated and resulted in a marked improvement of impulsive behaviour and, over time, overall level of function. Though promising, our findings have to be regarded as preliminary. Due to the overall paucity of data there still is insufficient evidence to make a strong recommendation concerning continuation and maintenance therapy with atypical antipsychotics in BPD. Thus, there is a clear need for further controlled studies to evaluate pharmacological treatment options for this disorder.
Citations (47)
... Yet another attempt was adding aripiprazole and sodium valproate to the existing clozapine treatment taking into account studies which suggest an improvement in efficacy. (7,8,9,10) This choice of treatment combined with the addition of sodium valproate to clozapine proved to be somewhat successful in relieving the patient's psychotic anxiety and diminishing, although faintly, the intensity of his positive symptoms. The second prominent feature of the case is the differential diagnosis of the patient's chronic psychosis. ...
- Citing Article
January 2008
... Understanding the effects of magnetic fields on the brain is especially important since magnetic stimulations are already a well-known and well-used method for non-invasive brain stimulation used as both diagnostic and therapeutic tools [20][21][22] . Since magnetic stimulations can modulate various brain functions, they also have the potential to be used as a treatment for numerous neuropsychiatric diseases 23,24 . ...
- Citing Article
March 2002
Wiener klinische Wochenschrift
... Patients were excluded if they reported a current or past substance use disorder except for alcohol and nicotine, other major psychiatric disorders or neurological disorders. At the time of the study, patients were free of any psychotropic medication or drug known to interact with the central nervous system for at least four half-lives post last intake (including illegal drugs and detoxification treatment) as tested by drug urine tests and displayed no relevant alcohol withdrawal symptoms (CIWA-Ar score < 4 27 ). For relapse assessment, patients with AD were continuously followed up for 12 months (48 weeks) after the MRI measurement using the Timeline-Follow-Back (TLFB 28 ), a reliable method to retrospectively assess alcohol use. ...
- Citing Article
January 1995
... Pramipexole is a D 2 -D 3 dopamine agonist antiparkinsonian with a selective tropism for the mesolimbic system (9), which has been suggested to be effective in different psychiatric conditions including depression (10), residual positive and negative symptoms of schizophrenia (11), anhedonia (12) and craving in substance abuse disorder (13). An 8-week double-blind randomized study of pramipexole, fluoxetine and placebo in major depression showed that both antidepressants were significantly more effective than placebo in terms of Montgomery-Asberg Depressive Rating Scale (MADRS) total score and CGI-S score decrease (14). ...
- Citing Article
September 1996
European Neuropsychopharmacology
... Sertindole has also been studied by SPECT (Kasper et al 1997Kasper et al , 1998a) as well as PET techniques (Nyberg 1998). The study performed by our group (Kasper et al 1998a) included 10 patients treated with sertindole and compared the data to haloperidol, clozapine, risperidone and untreated healthy controls. ...
- Citing Article
July 1997
Biological Psychiatry
... IV/85 Fig. 2 Striatal D 2 receptor occupancy rates for different typical and atypical antipsychotics (data from: Küfferle et al. 1995;Küfferle et al. 1996;Barnas et al. 1997;Kasper et al. 1998;Tauscher et al. 1999) ...
- Citing Article
September 1997
European Neuropsychopharmacology
... [2] Sertindole continued to be available under a Named Patient Use programme [6] and was subsequently given European market approval in 2006. [7] In contrast, while approval of the second-generation antipsychotic ziprasidone was initially delayed in the US due to reported QTc prolongation, the extent of QTc prolongation was found to be less than that observed with sertindole, in terms of both the mean increase in QTc at the highest recommended dose and the proportion of patients with a measured QTc >500 ms, [2,[8][9][10] and the drug was approved for acute treatment of schizophrenia in 2001. Oral ziprasidone was subsequently approved as monotherapy for acute treatment of bipolar manic or mixed episodes, and as an adjunct to lithium or valproate for bipolar disorder; an injectable preparation of ziprasidone, used to treat acute agitation in psychotic patients via the intramuscular (IM) route, was approved in 2002. ...
- Citing Article
November 1998
European Neuropsychopharmacology
... However, this has not been replicated for second-generation AP (Pilowsky et al., 1992(Pilowsky et al., , 1996Nordstrom et al., 1995;Busatto et al., 1995;Knable et al., 1997;Gefvert et al., 1998Gefvert et al., , 2001Tauscher et al., 1999;Bernardo et al., 2001). Moreover, despite good clinical efficacy, a high variability in D 2 RO has been reported for both clozapine (16-75%) (Scherer et al., 1994;Pilowsky et al., 1996;Pickar et al., 1996;Tauscher et al., 1997;Kapur et al., 1999) and quetiapine (0-76%) (Gefvert et al., 1998;. Thus, the D 2 RO required for therapeutic response for the second-generation AP remains undefined. ...
- Citing Article
July 1997
Biological Psychiatry
... Der Einsatz von Phasenprophylaktika ist darauf zurückzuführen, dass in der Akuttherapie dieses Krankheitsbildes polypharmakotherapeutische Strategien vonnöten sind. Untersuchungen belegen, dass bei mehr als 70% der bipolaren Patienten adjuvant zu einer phasenprophylaktischen Therapie mit Lithium und/oder Antikonvulsiva der Einsatz weiterer Psychopharmaka notwendig ist und zumindest 50% dieser Patienten Antipsychotika erhalten (Gitlin 1995,Hilger 2002). Insgesamt kommt bei der Diagnosegruppe F3 nach ICD 10 unterschiedlicher Nosologie , die von psychotischen Symptomen begleitet sein können aufgrund der polypragmatischen Therapieansätze und der dafür einsetzbaren Antipsychotika der Medikation in Hinsicht auf die Verweildauer eine tragende Rolle zu. ...
- Citing Article
May 2002
Fortschritte der Neurologie · Psychiatrie
... These, and many other smaller studies, confirm what we see in the clinicthat sertindole is as effective as haloperidol and risperidone in the treatment of positive symptoms, but is more effective than these agents in the treatment of negative symptoms. These results need to be qualified by further study, but suggest that the specific pharmacodynamic profile of sertindole is linked to superior efficacy regarding the treatment of the negative symptoms of schizophrenia (Kasper, 1996;Kasper et al., 2000). ...
- Citing Chapter
January 2000