Maximilian Gahr's research while affiliated with Ulm University and other places

Publications (180)

Article
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Introduction Drug-induced liver injury is one of the leading causes for acute liver failure and drug withdrawal after marketing approval. One important risk factor is the extent of exposure of the hepatocytes to a substance, either by high doses or by long-term medication. In many psychiatric diseases, like schizophrenia long-term use of drugs is c...
Article
Full-text available
Introduction Volume reductions in brain structures of patients with schizophrenia spectrum disorder (SSD) have repeatedly been found in voxel-based morphometry MRI studies. Hence, an underlying neurodegenerative etiological component of SSD is currently being discussed. In recent years, the imaging method of optical coherence tomography (OCT) has s...
Article
Full-text available
Introduction Sexual dysfunction is a frequent adverse drug reaction (ADR) of antidepressants that considerably affects quality of life and adherence to therapy. We previously investigated the potential underlying neurofunctional mechanisms by neuroimaging methods and revealed a dampening of the dopaminergic mesolimbic-mesocortical reward system alo...
Article
Background: Drug-associated liver injury is one of the most common causes for acute liver failure and market withdrawal of approved drugs. In addition, the potential for hepatotoxicity related to specific substances has to be considered in psychopharmacotherapy. However, systematic evaluations of hepatotoxicity related to antipsychotics are limite...
Article
Background The COVID-19 pandemic has imposed enormous psychological discomfort and fear across the globe, including Germany.Objectives To assess the levels of COVID-19 associated psychological distress and fear amongst Southern German population, and to identify their coping strategies.MethodsA cross-sectional survey using an online questionnaire w...
Article
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Purpose In aut-idem or generic substitution, discrepancies between summaries of product characteristics (SmPCs) referring to the same active substance (AS) may cause difficulties regarding informed consent and medical liability. The qualitative and quantitative characteristics of such discrepancies are insufficiently studied, impeding harmonization...
Article
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Background: Quantitative (e.g. increasing recreational cannabinoid use) and qualitative (e.g. increasing availability and use of synthetic cannabinoids and cannabis preparations with increased tetrahydrocannabinol content) changes in cannabinoid use may be associated with changes in the prevalence of cannabinoid-related mental and behavioural diso...
Article
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Introduction: Until now, methods of pharmacovigilance as disproportionality analysis were not capable of proving the otherwise well-established increased bleeding risk related to antidepressants (ADs). As bleeding events with ADs often occur in combination with antithrombotics, they might not be considered causative of, but merely “linked” with, th...
Poster
Abstract: Objectives Most psychiatric drugs, such as antidepressants (AD) and antipsychotics (AP), may cause cardiac adverse events (CAE). We used summaries of product characteristics (SmPC) for assessing the likelihood of AD and AP to cause CAE. Methods We identified all original medicinal products (OMP) of AD and AP approved in Germany. We searc...
Article
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There has recently been a renewal of interest in psychedelic research on the use of psilocybin in psychiatric treatment and, in particular, for the treatment of major depressive disorder (MDD). Several state-of-the-art studies have provided new insight into the mechanisms of action of psilocybin and its therapeutic potential. Nevertheless, many que...
Article
Purpose/background: The alleged primary mechanism underlying bleeding events associated with antidepressants is inhibition of serotonin uptake in platelets resulting in reduced platelet aggregability and activity, and prolonged bleeding time. There is some evidence that a substance's degree of serotonin reuptake inhibition in terms of its binding...
Article
Full-text available
Background To date, disproportionality analysis has been unable to demonstrate the increased bleeding risk associated with antidepressant drugs, especially selective serotonin reuptake inhibitors.Objective We hypothesised that a potential signal for an increased bleeding risk may be mitigated by the effects of agents other than antidepressant drugs...
Article
Background: Interventions for improving reporting and management of adverse drug reactions (ADRs) need regular evaluations of attitude and knowledge of health care professionals regarding pharmacovigilance. Research design and methods: An exploratory survey among general practitioners in Germany was conducted. Results: We interviewed 302 indiv...
Article
Objectives: Malignant catatonia (MC) is a rare, yet potentially life-threatening neuropsychiatric condition. Evidence on its therapy is weak, treatment recommendations are scarce and predominantly unprecise. The aim of this study was to compare the effectiveness of different MC treatment approaches regarding outcome and severity of MC. Methods: We...
Article
Full-text available
Abstract: Purpose: Most psychiatric drugs, such as antidepressants (AD) and antipsychotics (AP), may cause cardiac adverse events(CAE). We used summaries of product characteristics (SmPC) for assessing the likelihood of AD and AP to cause CAE. Methods: We identified all original medicinal products (OMP) of AD and AP approved in Germany. We searched...
Article
ZUSAMMENFASSUNG Gegenstand und Ziel Arzneimittelassoziierte Hepatotoxizität (engl. Drug-induced liver injury, DILI) ist einer der häufigsten Gründe für akutes Leberversagen und die Rücknahme der Zulassung von Arzneimitteln. Das Risiko des Auftretens von DILI im Zusammenhang mit der Anwendung spezifischer Substanzen ist grundsätzlich gering, allerdi...
Article
Full-text available
The levonorgestrel-releasing intrauterine system (LNG-IUS) is used as hormonal contraception by millions of women worldwide. It is considered as a safe device with low rates of systemic adverse drug reactions (ADRs). However, an emerging evidence suggest mood changes as ADRs. Whereas most of these studies report psychiatric ADRs after the first imp...
Article
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Introduction Neuroleptic Malignant Syndrome (NMS) is a rare, potentially life‐threatening antipsychotic‐associated disorder that requires an efficient and timely therapy. The aim of the study was to compare the effectiveness of different NMS therapies and to analyze its outcome depending on NMS severity. Method Systematic search for NMS cases in b...
Article
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Background A wide variety of metabolic changes, including an increased incidence of diabetes mellitus (DM) and dyslipidaemia, has been described in amyotrophic lateral sclerosis (ALS). The aim of this study was to investigate the associations of statin use and history of DM with onset of disease and survival in patients with ALS. Methods 501 patie...
Article
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Zusammenfassung Hintergrund Die Fachinformationen (FI) wirkstoffgleicher Arzneimittel können inhaltliche Unterschiede aufweisen. Dies kann bei Verordnungen von Arzneimitteln im Rahmen der Aut-idem-Regelung zu Schwierigkeiten für die ärztliche Aufklärung führen. Zur Beurteilung des Nutzungsverhaltens von FI, der zur Informationsbeschaffung über Arz...
Article
Full-text available
Oxytocin (OT) is a neuropeptide associated with trauma, sociality, and depression. Despite the widely accepted assumption of OT playing a role in the etiology of mood and anxiety disorders, associations between stressful life events, depression, and epigenetic regulation of the gene coding for OT (OXT) have not yet been investigated. We therefore a...
Article
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Withdrawal symptoms after discontinuation of antidepressants are common and have long been known. Typical symptoms after dose reduction or discontinuation of antidepressants are dizziness, drowsiness, headache, flu-like symptoms, hyperarousal, imbalance, insomnia, irritability, and nausea. Rebound, relapse, or recurrence associated with the underly...
Article
Introduction The neuroleptic malignant syndrome (NMS) is a potentially life-threatening condition associated to the use of antipsychotics. Since it requires rapid and efficient medical care, high-quality treatment guidelines should be available. In this article, we analyzed and compared different international therapy guidelines for the treatment o...
Article
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Background: It is repeatedly reported that pregabalin (PRG) and gabapentin feature a potential for abuse/misuse, predominantly in patients with former or active substance use disorder. The most common route of use is oral, though reports of sublingual, intravenous, rectal, and smoking administration also exist. A narrative review was performed to...
Article
Objective Malignant catatonia (MC) is an extremely rare, life-threatening disorder. It is characterized by catatonic symptoms accompanied by autonomic instability, hyperthermia, and changes in laboratory values. In many cases, MC is not recognized as such. Evidence-based guidelines are essential to ensure quality of treatment, but what do current n...
Preprint
Oxytocin (OXT) is a neuropeptide associated with trauma, sociality and depression. Despite the widely accepted assumption of OXT playing a role in the etiology of mood and anxiety disorders, associations between stressful life events, depression and epigenetic regulation of the gene coding for OXT have not yet been investigated. We therefore aimed...
Article
Zusammenfassung Gegenstand und Ziel Bei Verordnungen von Arzneimitteln im Rahmen der Aut-idem-Regelung ist für den Arzt häufig unklar, welches wirkstoffgleiche Handelspräparat in der Apotheke abgegeben wird; die in Frage kommenden wirkstoffgleichen Handelspräparate können sich jedoch in zahlreichen Merkmalen unterscheiden, was Fragen in Bezug auf d...
Article
Full-text available
Introduction: Takotsubo cardiomyopathy (TCM) is frequently associated with emotional or physical stress. Thus, patients with TCM might present primarily at a psychiatric clinic. Appropriate diagnosis and therapy may thus be delayed.Case report: A 43-year-old female patient presented as an emergency to the psychiatric outpatient clinic after experie...
Article
Background Volume reductions in brain structures of patients with schizophrenia spectrum disorder (SSD) have repeatedly been found in voxel-based morphometry MRI studies. Hence, an underlying neurodegenerative etiological component of SSD is currently being discussed. In recent years, the imaging method of optical coherence tomography (OCT) has sho...
Article
Zusammenfassung Gegenstand und Ziel: Blutungsereignisse unter Therapie mit Antidepressiva, die die Serotoninwiederaufnahme hemmen (SRI), sind in den Fokus der klinischen und wissenschaftlichen Aufmerksamkeit gerückt. In der vorliegenden Übersichtsarbeit wird ein Überblick über den Kenntnisstand zu SRI-assoziierten Blutungen, insbesondere in Hinblic...
Article
Zusammenfassung Gegenstand und Ziel: Das Tako-Tsubo-Syndrom (TTS) ähnelt klinisch einem akuten Myokardinfarkt und ist häufig mit emotionalem oder physischem Stress assoziiert. Patienten mit TTS stellen sich daher häufig zuerst in einer psychiatrischen Klinik vor; dies kann die adäquate Diagnostik und Therapie verzögern, insbesondere wenn der Psychi...
Article
Objective: Psychopharmacotherapy is essential in the treatment of many mental disorders. Adverse drug reactions (ADR) have impact on compliance and tolerability. Sleep disorders or impaired sleep may occur as ADRs of psychopharmacotherapy. Sleep disorders are associated with an increased risk for physical and mental illness and may impair cognitio...
Article
Psychotropic drugs may induce impairments in the mouth, jaw and face area. Currently, appropriate pharmacoepidemiologic data are missing. Therefore, a questionnaire-based telephone survey of two non-representative samples of psychiatrists and dentists was conducted. Most of the psychiatrists (79.7%) and dentists (76.5%) indicated that psychotropic...
Article
Background: Recent studies on the pathophysiology of major depression (MD) indicate that degenerative and inflammatory processes may play a role. This finding is supported by magnetic resonance imaging (MRI)-based meta-analysis that show volume reductions in circumscribed areas of the brain in patients with MD. Using optical coherence tomography (...
Article
This narrative review summarizes current available information about cardiac arrhythmias (QT prolongation, Torsade de pointes Tachycardia [TdP], sudden cardiac death) associated with psychiatric medication. Among the most commonly used antipsychotics, amisulpride and ziprasidone are most frequently associated with TdP. Treatment with some antidepre...
Article
Beeinträchtigungen des Schlafs gehören zu den häufigsten Symptomen in der Hausarztpraxis. Die Diagnostik bereitet jedoch vielfach Probleme. Ein Überblick über Systematik und Leitsymptome, Diagnose und Therapie — mit besonderem Augenmerk auf die häufigste Störung, die Insomnie.
Article
Zusammenfassung Hintergrund Psychiatrische Notfälle (PN) im präklinischen Notarzt- und Rettungsdienst repräsentieren ca. 5 – 10 % aller Notfälle und führen oft zu Problemen bei den nichtpsychiatrischen Versorgern. Aus Deutschland gibt es nur wenige Studien, die Auskunft über quantitative und qualitative Änderungen von PN in der Präklinik geben. Met...
Article
Zusammenfassung Einleitung Psychopharmaka sind gut bekannte Auslöser klinisch bedeutsamer Blutdruckänderungen. Unser Ziel war es, Rangreihen für das Risiko einer Psychopharmaka-assoziierten arteriellen Hyper- bzw. Hypotonie zu erstellen. Methoden Es wurden für 105 in Deutschland in der Erwachsenenpsychiatrie zugelassene Psychopharmaka sämtliche in...
Article
Introduction There is only little data regarding drug safety related to agents used for opioid maintenance therapy (OMT). Objectives/aims To study drug safety and the reporting behaviour of adverse drug reactions (ADR) related to OMT. Methods A cross-sectional questionnaire-based telephone survey among physicians providing outpatient OMT in a fed...
Article
Introduction Drug-induced liver injury is a major problem of pharmacotherapy and is also frequent with anti-depressive psychopharmacotherapy. Objectives/aims However, there are only few studies using a consistent methodologic approach to study hepatotoxicity of a larger group of antidepressants. Methods We performed a quantitative signal detectio...
Article
Introduction Drug safety surveillance strongly depends on the spontaneous and voluntary reporting of adverse drug reactions (ADR). A major limiting factor of spontaneous reporting systems is underreporting (UR) which describes incorrectly low reporting rates of ADR. Factors contributing to UR are numerous and feature country-dependent differences....
Article
Zahlreiche Psychopharmaka sowohl aus dem Bereich der Antidepressiva als auch der Antipsychotika sind mit metabolischen unerwünschte Arzneimittelwirkungen (UAW) assoziiert. Dieser zweite Teil unseres Beitrags befasst sich mit dem Risiko für Gewichtszunahme und andere metabolische UAW im Zusammenhang mit konkreten Wirkstoffen. Gegenwärtig sind versch...
Article
Introduction Persons using the Internet generate large amounts of health-related data, which are increasingly used in modern health sciences. Objectives/aims We analysed the relation between annual prescription volumes (APV) of several antidepressants with marketing approval in Germany and corresponding web search query data generated in Google to...
Article
Introduction Intoxications with alcohol are very frequent in clinical psychiatry and may lead to death depending on (maximum) blood alcohol concentration (BAC) and accompanying factors as liver function, tolerance, comedication, etc. Death may occur due to ethanol-induced respiratory depression and/or aspiration of gastric content (due to an impair...
Article
Opipramol was developed in the 1960s as an antidepressant and has chemical similarities with tricyclic antidepressants. Pharmacodynamic properties with absent reuptake inhibition of serotonin and noradrenaline and agonism at sigma receptors distinguish opipramol from tricyclics. Furthermore, antidepressive effects are smaller than the anxiolytic on...
Article
Im Rahmen von zwei Übersichtsarbeiten werden die wesentlichen Aspekte der metabolischen Nebenwirkungen von Psychopharmaka erläutert. Teil 1 gibt einen Überblick über die epidemiologischen Aspekte und den aktuellen Stand zur Pathophysiologie der psychopharmakaassoziierten metabolischen Nebenwirkungen. In Teil 2 erfolgt eine substanzspezifische Betra...
Article
Full-text available
Pharmacological neuroenhancement (PNE) is a form of abuse and has not yet been addressed by methods of pharmacovigilance. In the present study, we tested if quantitative signal detection may be sensitive in regards to PNE. We evaluated the risk of drug abuse and dependence (DAAD) related to substances that are known to be used for PNE and divided t...
Article
Zusammenfassung Metabolische unerwünschte Arzneimittelwirkungen (UAW) unter Psychopharmakotherapie besitzen in Hinblick auf Morbidität, Mortalität und Therapieadhärenz eine erhebliche klinische Relevanz. Die vorliegende Übersichtsarbeit gibt einen Überblick über epidemiologische Aspekte, prädiktive Faktoren, die Pathophysiologie sowie über Monitori...
Article
Objective: Metabolic adverse drug reactions (ADR) have considerable clinical relevance regarding morbidity, mortality and adherence to treatment. The present review article provides an overview of epidemiological aspects, predictive factors, pathophysiology, monitoring and possible therapeutic approaches for the treatment of metabolic ADR related t...
Article
Zusammenfassung Metabolische unerwünschte Arzneimittelwirkungen (UAW) unter Psychopharmakotherapie besitzen in Hinblick auf Morbidität, Mortalität und Therapieadhärenz eine erhebliche klinische Relevanz. Die vorliegende Übersichtsarbeit gibt einen Überblick über epidemiologische Aspekte, prädiktive Faktoren, die Pathophysiologie sowie über Monitori...
Article
Zusammenfassung Unter pharmakologischem kognitiven Neuroenhancement (PKN) versteht man die Einnahme von Substanzen von Gesunden zur kognitiven Leistungssteigerung, ohne dass damit eine präventive oder therapeutische Absicht verfolgt wird. Epidemiologische Daten zeigen für Deutschland eine steigende Prävalenz von PKN in den vergangenen Jahren und es...
Chapter
Methylphenidate (MPH) belongs to the group of (psycho) stimulants and enhances the activity of the central and peripheral nervous system, resulting in, for example, enhanced alertness, improved vigilance and working memory, as well as reduced need for food and sleep, and increased arousal, heart rate, and blood pressure. MPH is the first-line agent...
Article
To study drug safety and the reporting behavior of adverse drug reactions (ADR) related to agents used for opioid replacement therapy (ORT) we conducted a cross-sectional questionnaire-based telephone survey among physicians who provide outpatient ORT in Germany (n = 176; response rate = 55.7%). Most respondents (n = 97/55.1%) reported that they ob...
Article
Risperidone is a widely used, second-generation antipsychotic approved for treating schizophrenia as well as for treating aggression in children and adolescents with mental retardation. The substance has a well-established risk profile including alterations of body temperature. Apart from hyperthermia with and without full-blown malignant neurolept...
Article
Objective: Psychopharmacotherapy is essential in the treatment of many mental disorders. Adverse drug reactions (ADR) have impact on compliance and tolerability. Metabolic ADR are increasingly drawing attention. Objective of the following study was the systematic presentation of type and risk of metabolic ADR of frequently prescribed psychotropic d...
Article
Full-text available
Conversion (functional) limb weakness or paralysis (FW) can be a debilitating condition, and often causes significant distress or impairment in social, occupational, or other important areas of functioning. Most treatment concepts are multi-disciplinary, containing a behavioural approach combined with a motor learning program. Non-invasive brain st...
Article
Intoxications with alcohol may lead to death depending on (maximum) blood alcohol concentration (BAC) and accompanying factors such as liver function, tolerance, and comedication. Death may occur due to ethanol-induced respiratory depression and/or aspiration of gastric content (due to an impaired gag reflex); thus, securing of the airway and venti...
Article
Introduction: Drug safety surveillance strongly depends on the spontaneous reporting of adverse drug reactions (ADRs). A major limiting factor of spontaneous reporting systems is underreporting (UR) which describes incorrectly low reporting rates of ADRs. Factors contributing to UR are numerous and feature country-dependent differences. Understandi...
Article
Selective serotonin reuptake inhibitors (SSRI) are essential in the pharmacotherapy of multiple psychiatric disorders. Previous evidence showed a flat dose response curve of SSRI in the treatment of depressive disorders. Results of a meta-analysis published by Jakubovski et al. indicate that the dose-response relationship of SSRI in the treatment o...
Article
Objective: Psychopharmacotherapy is essential in the treatment of many mental disorders. Adverse drug reactions (ADR) have impact on compliance and tolerability. Metabolic ADR are increasingly drawing attention. Objective of the following study was the systematic presentation of type and risk of metabolic ADR of frequently prescribed psychotropic d...
Chapter
Psychiatrische Notfälle machen über 10% der im Rettungsdienst versorgten Patienten aus. Die Versorgung dieser Notfälle im präklinischen Setting stellt den Notarzt und das Rettungsteam vor besondere Herausforderungen und führt oft zu Verunsicherung, insbesondere bei akuter Eigen- oder Fremdgefährdung oder fehlender Kooperation des Patienten. Die dia...
Article
Zusammenfassung Selektive Serotoninwiederaufnahmehemmer (SSRI) sind bei der pharmakologischen Therapie zahlreicher psychischer Störungen sehr wichtig. Bei der Behandlung depressiver Störungen mit SSRI zeigte die Evidenz eine flache Dosis-Wirkungsbeziehung. Ergebnisse einer Metaanalyse von Jakubovski et al. zeigen, dass die Dosis-Wirkungsbeziehung v...
Article
Zusammenfassung Grübeln ist Symptom und Vulnerabilitätsfaktor psychischer Erkrankungen. Auf der Basis unterschiedlicher psychologischer Erklärungsmodelle wurden in den letzten Jahren psychotherapeutische Interventionen gegen depressives Grübeln entwickelt, die positive Effekte aufweisen. Als neuronales Korrelat des Grübelns konnte bildgebend eine H...
Book
Full-text available
Neuropathology of Drug Addictions and Substance Misuse, Volume 3: General Processes and Mechanisms, Prescription Medications, Caffeine and Areca, Polydrug Misuse, Emerging Addictions and Non-Drug Addictions is the third of three volumes in this informative series and offers a comprehensive examination of the adverse consequences of the most common...
Article
Rumination is symptom of and factor of vulnerability to psychiatric disorders. Based on different psychological models, new psychotherapeutic interventions against depressive rumination were developed over the last years which showed positive effects. Increased functional connectivity between the Default-Mode-Network and subgenual prefrontal cortex...
Article
Drug-induced liver injury is a major problem of pharmacotherapy and is also frequent with antidepressive psychopharmacotherapy. However, there are only few studies using a consistent methodologic approach to study hepatotoxicity of a larger group of antidepressants. We performed a quantitative signal detection analysis using data from the Uppsala M...
Article
Persons using the Internet to retrieve medical information generate large amounts of health-related data, which are increasingly used in modern health sciences. We analyzed the relation between annual prescription volumes (APVs) of several antidepressants with marketing approval in Germany and corresponding web search query data generated in Google...
Article
Inhibition of serotonin uptake in platelets seems to be the crucial mechanism underlying SSRI-associated haemorrhages. This effect is also present in antidepressants featuring non-selective serotonin reuptake inhibition (non-SSRI). Impact of selectivity of serotonin reuptake and/or affinity to the serotonin reuptake transporter on the bleeding risk...
Article
Objective: Despite of the importance of psychiatric emergencies (PE) requiring treatment at an emergency room (ER) little is known about their frequency and current trends in terms of quantity and quality. Methods: A retrospective analysis of all PE treated at the ER of the University Hospital Ulm (Germany) in 2000 and 2010. Results: 6 % (2000) or...
Article
Optical Coherence Tomography (OCT) is a noninvasive imaging method, which provides an in vivo image of the retina. It allows for quantitative measurements of retinal and macular thickness, including single-layer analysis. Because the retinal nerve fibre layer comprises the first axons of the visual pathway and is unmyelinated, it can be considered...
Article
Psychiatrische Notfälle machen über 10 % der im Rettungsdienst versorgten Patienten aus. Die Versorgung dieser Notfälle im präklinischen Setting stellt den Notarzt und das Rettungsteam vor besondere Herausforderungen und führt oft zu Verunsicherung, insbesondere bei akuter Eigen- oder Fremdgefährdung oder fehlender Kooperation des Patienten. Die di...
Article
Several findings suggest that there may be an overlap of anti-N-methyl-d-aspartate receptor (NMDAR) antibody encephalitis with neuromyelitis optica spectrum disorders or acute demyelinating encephalomyelitis (ADEM)-like demyelination. We present a case of a patient with anti-NMDAR antibody encephalitis, who on MRI featured a single prominent T2-hyp...
Article
The colleagues Weber and Anlauf list substances with blood pressure-increasing effects to be considered in differential diagnosis (Box, p. 427). However, for psychiatric medications it is not correct to link entire drug classes, such as antipsychotics, monoamine oxidase (MAO) inhibitors and tricyclic antidepressants, with arterial hypertension in...
Article
Since its marketing approval the attention to the hepatic side effect profile of the antidepressant agomelatine (AGM) has gradually increased. Several cases of severe hepatotoxic adverse drug reactions (ADR) have been reported and the European Medicines Agency has released a safety warning regarding AGM-associated hepatotoxicity. However, there is...
Article
Introduction: There is increasing evidence for an association between treatment with selective serotonin reuptake inhibitors (SSRI) and an increased risk of bleeding events. The most important underlying mechanism appears to be inhibition of serotonin uptake in platelets, an effect that is also present in antidepressants with non-selective seroton...
Article
Optical coherence tomography (OCT) is a non-invasive, contact-less imaging method which provides an "in vivo" representation of the retina. It allows the quantitative measurement of retinal nerve fibre layer thickness (RNFLT) and macula thickness (MT) and, in addition, is suitable to measure volumes (e.g., macula volume/MV). In the research of neur...