[Weight gain and treatment with psychotropic drugs : Background and management]. / Gewichtszunahme unter Therapie mit Psychopharmaka : Hintergründe und Management.

Psychotropic drug-induced weight gain (PIWG) is a well-known and frequent side effect which is relevant for the prognosis of patients. Individual medications have varying risks for the occurrence of PIWG, and at the same time there are individual risk factors on the part of patients, such as age, gender, metabolic and genetic factors. As the metabolic changes in the context of PIWG result in increased mortality in the long term, it is important to prevent PIWG by appropriate prevention and to intervene in a targeted manner if PIWG has already occurred. Appropriate monitoring is therefore essential. This article provides an overview of underlying mechanisms, risk constellations and possible countermeasures.

[The challenge of treating bipolar outpatients]. / Herausforderungen der ambulanten Behandlung von Patienten mit bipolar-affektiven Störungen.

The course of bipolar illness comprises a wide range, which may vary between one single episode once every five years and a severe ultra rapid cycling course with mood changes within days. Even with optimal pharmacological treatment the functional outcome in bipolar patients is still poor. Underlying pathomechanisms are not fully understood yet. This article addresses three possible illness specific-aspects: cognitive defects, high relapse frequency and poor adherence. Causes as well as therapeutic interventions for these therapeutic pitfalls are summarised.

[The White man's burden - a case study caught between bipolar affective disorder and Huntington's disease]. / White Man's Burden - Im Grenzgebiet zwischen bipolarer affektiver Störung und Huntington-Erkrankung.

We report upon a case of a 55 year old patient with a bipolar affective disorder, presenting herself with a depressive symptomatology in addition to a severe motor perturbation. The main emphasis upon admittance was perfecting and improving her latest medication. Four weeks prior to her stay at our clinic a thorough neurological examination had taken place in terms of an invalidity pension trial which did not result in any diagnostic findings. Therefore a neurological disease seemed at first highly unlikely. Even though the prior testing was negative, the ensuing neurological examination at our clinic resulted in movement disorders very much indicative of Huntington's Disease. A detailed investigation in regards to the particular family history of the patient was positive for Huntington's Disease. However, whether the patient's mother had also been a genetic carrier of Huntington's Disease was still unknown at the time the patient was admitted to our clinic. It was nevertheless discovered that her mother had also suffered from a bipolar affective disorder. A genetic testing that followed the neurological examination of the patient proved positive for Huntington's Disease. Neuro-imaging resulted in a bicaudate-index of 2.4 (the critical value is 1.8). In a clinical psychological test battery the ensuing results were highly uncommon for patients with solely a bipolar affective disorder people. Under the medical regimen of Quetiapine, Citalopram and Tiaprid the patient's mood could be stabilized and there was some improvement of her motor pertubation.

The relationship of Akathisia with treatment emergent suicidality among patients with first-episode schizophrenia treated with haloperidol or risperidone.

Akathisia as well as younger age, early illness onset and discharge are important risk factors for suicidality in patients with first-episode schizophrenia. The aim of the present study was to analyze on a single case basis the relationship between a sudden increase in suicidality, anxiety symptoms, medication dosing and clinician- and patient-rated akathisia. A small subsample of patients demonstrated a positive relationship between suicidality and akathisia scores within the titration period of the study medication.

Attachment mediates the link between childhood maltreatment and loneliness in persistent depressive disorder.

BACKGROUND: A central concept of attachment theory is that early experiences with close attachment figures shape the way we interact with and relate to other social partners throughout life. As such, early experiences of childhood maltreatment (CM) have been suggested as a key precursor of adult insecure attachment representations. As CM has been linked to feelings of loneliness in adulthood, this study examines whether insecure attachment could explain the relationship between CM and loneliness. Also, the moderating role of a diagnosis of persistent depressive disorder (PDD) is investigated, a disorder characterized by high levels of CM and loneliness. METHOD: 60 patients with PDD (DSM-5) and 60 gender- and age-matched non-clinical control participants (NC) completed self-report questionnaires measuring attachment, loneliness, and CM. Mediation analyses (PDD as a moderator) were performed. RESULTS: PDD patients reported higher levels of CM, attachment anxiety, attachment avoidance, and loneliness than NC. CM was positively associated with loneliness in both groups. Mediation analyses demonstrated that the relationship between CM and loneliness was mediated by avoidant, but not anxious attachment, regardless of a diagnosis of PDD. LIMITATIONS: Caution when interpreting these results is crucial as the study lacked a clinical control group, relied on self-report measures, and the cross-sectional design limits the ability to draw causal inferences. CONCLUSIONS: All constructs studied were present to a greater degree in PDD. Above, findings provide initial evidence that avoidant attachment may explain the relationship between CM and loneliness. Potentially, adult avoidant attachment may lead to and maintain feelings of loneliness, regardless of PDD.

The RSM-scale: a pilot study on a new specific scale for self- and observer-rated quality of life in patients with schizophrenia.

PURPOSE: To develop and evaluate a self- and observer-rating scale on quality of life in patients suffering from schizophrenia with regard to the efficacy of atypical antipsychotics based on different dimensions and to apply within a pilot study. METHODS: Following review of existing scales and a prevalidation phase, the Riedel-Spellmann-Musil (RSM) scale was developed comprising 36 items assigned to different subscales. As reference scales, the Quality of Life Scale (QLS) and the Subjective Well-being Under Neuroleptic Treatment Scale-short version (SWN-K) were performed, psychopathology and adverse events were measured at all visits. Reliability was assessed using Cronbach's alpha, Pearson's correlation coefficients were used to assess construct validity, and Intraclass Correlation Coefficients (ICCs) were used for test-retest reliability. T tests were performed in normal distributed samples; otherwise Wilcoxon tests were used. RESULTS: One hundred and thirty-six patients were included in the study. Cronbach`s α was 0.917 for the self-rating and 0.915 for the interviewer-rating part. ICCs were >0.70 for all subscales. The self-rating part correlated strongly with the SWN-K and the observer part with the QLS. Changes in psychopathology over the study period and different levels of functioning were detected. CONCLUSION: The RSM-scale is a new scale to assess the quality of life in different dimensions of patients with schizophrenia treated with antipsychotics and shows good internal consistency, test-retest reliability, construct and discriminant validity.

Dynamics of the immediate behavioral response to partial social exclusion.

Social rejection and exclusion (ostracism) represent main stressors in daily life and even threaten mental and physical health. Abundant data from subjective measures in social exclusion paradigms are available, but the dynamic behavioral response is largely unexplored. Here, we applied modified variants of the Cyberball paradigm in two consecutive experiments to investigate the adaptive behavioral and emotional reactions to partial social exclusion. In experiment 1, 68 healthy participants (females, mean age 24.76 ± 4.05 years) played 2 min inclusion, 5 min partial exclusion and 2 min total exclusion. In experiment 2, 94 healthy participants (48 females, mean age 34.50 ± 12.08 years) underwent an experimental condition (2 min inclusion, 10 min partial exclusion) and a control condition (12 min inclusion only) in randomized order. In experiment 1, behavioral responses to partial exclusion showed two characteristics: (1) an immediate increase in ball passes to the excluding player followed (2) by a later return of participants' behavior to baseline. This finding was replicated for both genders and in comparison to a control condition in experiment 2. The dynamic behavioral response observed here may point to overlapping principles of cooperation in this ball tossing paradigm and serves as a novel experimental proxy.

Neurocognition and its influencing factors in the treatment of schizophrenia-effects of aripiprazole, olanzapine, quetiapine and risperidone.

BACKGROUND: To examine influencing variables of neurocognition in patients with schizophrenia and to predict cognition during antipsychotic treatment. METHODS: Data were obtained from patients with an acute episode of schizophrenia participating in two double-blind and one open label trial comparing the effects of different atypical antipsychotics on cognition. In total, 129 patients were enrolled in this analysis. Cognitive function was assessed at admission, week 4 and 8. Efficacy and tolerability were assessed weekly using the Positive and Negative Syndrome Scale (PANSS) and the Simpson Angus Sale (SAS). Patients were treated with aripirazole, olanzapine, quetiapine and risperidone. Regression analysis including mixed effect models was performed. RESULTS: A significant improvement in all cognitive domains was observed from baseline to week 8. Regarding the antipsychotic treatment applied quetiapine seemed to achieve the most favourable cognitive improvement. Negative and depressive symptoms, the patient's age and the concomitant and antipsychotic treatment applied were observed to significantly influence and predict neurocognition. CONCLUSION: The results may indicate that schizophrenia is a static disorder with trait and state dependent cognitive components especially in the memory domains. The influence of negative and depressive symptoms should be considered in daily clinical routine.

Effect of aripiprazole on cognition in the treatment of patients with schizophrenia.

BACKGROUND: The aim of this study was to assess the cognitive effects of aripiprazole in inpatients with schizophrenia. METHODS: This was an investigator-initiated, open label eight-week trial evaluating 56 inpatients with the DSM-IV diagnosis of schizophrenia. Efficacy was assessed weekly using the Positive and Negative Syndrome Scale (PANSS) and tolerability was assessed each week using the Udvalg for Klinske Undersogelser side effect rating scale (UKU). Cognitive function was assessed at baseline, week 4 and week 8. RESULTS: Aripiprazole showed significant improvement in PANSS total score and all subscores between baseline and endpoint visit. The substance was very well tolerated. Patients improved significantly in verbal memory, reaction time and reaction quality/attention from baseline to week eight. Furthermore, mean z-values of individual cognitive domains summarized in a global cognitive index improved significantly from baseline to week eight. DISCUSSION: Our results suggest that aripiprazole provides a valuable treatment option for patients with schizophrenia.

[Polymorphisms of the human chromosome no. 15 (author's transl)]. / Polymorphismus des Chromosoms Nr. 15 beim Menschen.

The short arm of the human chromosome No. 15 is composed of various heterochromatic regions. By using silver staining, mithramycin, Da-DAPI and quinacrine mustard fluorescence staining at least 5 different regions may be differentiated. All these components show independent heteromorphisms allowing easy individual identification of a given chromosome No. 15. These features may be useful for studies on heredity including affiliation cases.

Elevated macrophage migration inhibitory factor and decreased transforming growth factor-beta levels in major depression--no influence of celecoxib treatment.

OBJECTIVES: The involvement of an immune process in the pathophysiology of major depression disorder (MDD) was substantiated by studies demonstrating elevated levels of proinflammatory cytokines and prostaglandin E(2) (PGE(2)). Cyclooxygenase-2 (COX-2) inhibitors lead to a reduced production of PGE(2) and have been shown to improve depressive symptoms. We investigated the three immune parameters macrophage migration inhibitory factor (MIF), transforming growth factor-ß (TGF-ß) and soluble CD14 (sCD14) in a randomized, placebo-controlled trial of the COX-2 inhibitor celecoxib as add-on therapy in patients with MDD treated with reboxetine. METHODS: Thirty-two patients with depression and 20 healthy controls participated in the study. The patients were treated with reboxetine and celecoxib or placebo. Immune parameters were measured from serum at baseline, after three and five weeks using ELISA. RESULTS: Celecoxib as add-on strategy resulted in a significant reduction of Hamilton Depression Scale scores compared to placebo. Depressed patients showed significantly elevated MIF (p < 0.001) and reduced TGF-ß (p = 0.006) concentrations at baseline. There was no difference in sCD14-concentrations. There was no difference between the placebo and the celecoxib group and no change over time. LIMITATIONS: Limitations of the study are the relatively small sample size and lack of functional assessment of HPA axis in parallel. CONCLUSIONS: MIF is a promising new candidate in the neuro-immune interplay that may link depressive symptoms, altered immune state and HPA-axis dysregulation. Reduced levels of TGF-ß replicate previous findings and support the importance of this regulatory cytokine in major depressive disorder.

[Impression taking in the edentulous mouth with special regard to closed mouth impression with simultaneous determination of the jaw relation]. / Die Abformung des zahnlosen Mundes unter besonderer Berücksichtigung der mundgeschlossenen Abformung mit gleichzeitiger Relationsbestimmung.

In view of the increase in mean life expectancy and in the need for care in the gerostomatological sphere, more attention must be paid to such methods which optimize the construction of full dentures from the anatomico-pathological viewpoint, exert a rationalizing effect, and are likely to improve the success rate in the treatment of edentulous patients. The method of closed mouth impression and simultaneous determination of the jaw relation refers to well-proved principles of impression making, considers new findings concerning the determination of the jaw relation, incorporates modern materials and instruments, and forms the system character of clinico-technological measures.

[Tooth preservation and tooth extraction within the framework of prevention-oriented treatment planning]. / Zahnerhaltung und Zahnextraktion im Rahmen präventiv orientierter Behandlungsplanung

The improvement in efficiency of prosthodontic therapy is linked to a strategic basic conception, the question of tooth preservation and extraction being of particular importance. The decisive criterion may consists in answering the question whether the step intended might contribute to structure preservation and function securing till old age or might be detrimental to these objective. The stomatologist may play a passive or an active role in the strategy of treatment.

[Foundations and methods of rational crown preparation]. / Grundlagen und Methoden einer rationellen Kronenpräparation.

The targeted removal of dental hard tissues for the purposes of crown stump preparation may be designated as rational if the technique used ist atraumatic and implies the deliberate use of driving systems within different speed ranges and the utilization of adapted abrasive tools in a phase-synchronous and segment-oriented manner. Goal of the preparation is to realize a copy of the clinical crown that is reduced in size, presents less details and has a defined line of preparation.

[Rational methods of crown preparation]. / Rationelle Verfahren der Kronenpräparation.

Today, a rational technique of crown preparation seems to be defined by the following features: 1. Speed-conscious operation 2. Sectionalization into a phase of coarse preparation and a phase of fine preparation 3. Phase-synchronous and segment-oriented coarse preparation in the maximum speed range 4. Fine preparation by means of abrasive tools to achieve a defined preparation limit in the high-speed range 5. Finishing with the aid of properly formed diamond stones or tungsten-carbide finishers in the normal speed range 6. Speed-dependent supply of cooling water according to the principle of double safety (spray and additional cooling).

Nucleoli visualized by silver staining combined with a new RNA-specific fluorochrome.

A technique for distinguishing nucleolar components by light microscopy is described. Silver staining is used for localizing nuceolar-organizing regions. A new RNA-specific fluorochrome, 4''-6-bis(2'-imidazolinyl-4'-5'H)-2-phenyl-4'-phenoxyindole, visualizes the RNA-containing "partes fibrillares et granulares" of the nucleolus. Both staining procedures can be combined to analyze nucleolar structure and function by light microscopy.

On the structure and polymorphism of the human chromosome no. 15.

Chromosome preparations from 67 randomly selected healthy individuals were consecutively stained with silver, mithramycin, pentamidine-DAPI, and quinacrine mustard. In the short arm of the chromosome 15 up to six regions, which were highly polymorphic, apparently independently of each other, could be detected by the given methods. The frequency of occurrence of each individual polymorphic feature in the population investigated ranges from 70% to 87%. They appear randomly and independently of each other.

The inhibition of yeast enolase by Li+ and Na+1.

The activity of yeast enolase is inhibited by Li+ and Na+. At pH 7.1, inhibition by Li+ is "mixed" with respect to Mg2+; both Vmax and Km (Mg2+) are increased by Li+. The inhibition by Li+ appears to be partial, indicating that enzyme with Li+ bound is active. The step inhibited by Li+ cannot be proton abstraction since Li+ decreases the kinetic isotope effect on Vmax. At pH 9.2, where proton abstraction is no longer partially rate-limiting, inhibiton by Li+ is competitive with respect to Mg2+. The rate of enzyme-catalyzed exchange of the C-2 hydrogen with solvent is not affected by Li+. We interpret these results as follows: Li+ (and Na+) binds to enolase and decreases the rate of at least one step in the mechanism. At pH 7.1, this step is partially rate-limiting; at pH 9.2, this step is a fast step in the reaction. The step inhibited by Li+ cannot be proton abstraction but may be release of product (phosphoenol pyruvate) or Mg2+.

[Experimental studies of electroplating-resin bonding systems]. / Experimentelle Untersuchungen an Galvano-Kunststoff-Verbunden.

Optimized conditioning of galvanically produced gold frameworks (Auro-Galva-Crown-System) by means of Silicoater, Silicoater MD and Rocatec techniques gives rise to a reliable bond to veneering resins. After experimental stress (thermocycling) the strength of the compound could be found between 17 and 26 MPa and SEM investigations of the contact zone showed no crevices.