The overnight reduction of amyloid ß 1-42 plasma levels is diminished by the extent of sleep fragmentation, sAPP-ß, and APOE ε4 in psychiatrists on call.

INTRODUCTION: In mice there might be an association between sleep deprivation and amyloid ß plasma levels. Hence, we examined whether amyloid plasma levels are associated with sleep duration or fragmentation in 17 psychiatrists on-call. METHODS: Amyloid ß (Aß)42, Aß40, and soluble amyloid precursor protein ß (sAPP-ß) plasma concentrations were measured at the beginning and end of 90 on-call nights, and analyzed using generalized linear models. RESULTS: In on-call nights, a 10.7% reduction of Aß42 was revealed overnight. Every single short sleep interruption diminished this reduction by 5.4%, as well as every pg/mL of sAPP-ß by 1.2%, each copy of APOE ε4 by 10.6%, and each year of professional experience by 3.0%. DISCUSSION: The extent of sleep fragmentation diminishes the physiological overnight reduction of Aß42 but not Aß40 plasma levels in the same direction as the enzyme for Aß42 production, the genetic risk factor for Alzheimer's disease (AD), and on-call experience. Might on-call duty and sleep fragmentation in general alter the risk for AD?

[Nighttime restlessness in elderly patients: differential diagnosis and treatment - Differential diagnosis and therapy]. / Dilemmasituation: Nächtlicher Unruhezustand beim älteren Patienten.

Elderly individuals, particularly those with cognitive impairment, are oftentimes restless during the night, and this increases the distress of relatives, professional carers and themselves. A number of conditions other than dementia need to be considered from nyctophobia and insomnophobia, to pain, specific motor disorders during sleep, parasomnias as REM-sleep behaviour disorder, dipping, hypoglycemia, withdrawal or excessive tea, coffee and alcohol consumption. A clear-cut differential diagnosis between dementia and delirium is not always possible, as dementia is the major risk factor for confusional states decreasing the vulnerability by anticholinergic medication and any other disruptive factor, biological or psychological. Treatment of nocturnal agitation usually requires (1) reassurance and re-orientation; (2a) the discontinuation of anticholinergic substances; (2b) symptomatic psychotropic intervention; and (3) causal treatment of underlying problems. Benzodiazepines should only be used at the lowest necessary dosage for the shortest possible time, particularly in individuals who are already benzodiazepine-dependent. Quetiapine or mirtazapine at low dosages can be employed in patients with psychotic or depressive symptoms. Melatonin and its derivatives hold promise for chronic circadian rhythm disorders. There is no "one fits all" recipe for this notorious problem and each case needs to be examined individually.

[COVID-19 Crisis: Early Observations on a Pandemic's Psychiatric Problems]. / Psychische Probleme in der Pandemie ­ Beobachtungen während der COVID-19-Krise.

We have recently observed several clusters of psychiatric symptoms in the context of COVID-19: (1) increased anxiety in psychiatric in- and outpatients with different diagnoses; (2) more cases of domestic violence often associated with increased drug- or alcohol-consumption in offenders and victims; (3) a nihilistic "apocalyptic" syndrome of elderly patients cut-off from their families; (4) visual and acoustic hallucinoses due to pneumonia and sepsis-related confusional states. Cases of chloroquine-related toxicity have been reported elsewhere, but have not been observed in our hospital so far. Mental issues related to COVID-19 reported from China and practical recommendations are briefly summarized. Many patients with serious mental disorders will suffer world-wide due to a reallocation of medical, social and financial ressources.

Bilateral Basal Ganglion Hemorrhage after Severe Olanzapine Intoxication.

Olanzapine is a second-generation antipsychotic drug which is generally considered safe with well therapeutic antipsychotic effects. We describe a patient suffering from bilateral intracerebral hemorrhage after severe olanzapine intoxication without underlying thrombocytopenia, arterial hypertension, or vascular malformation as cause of intracerebral hemorrhage. This raises the possibility of a direct side effect of high-dose olanzapine intake. So far, intracranial hemorrhage after olanzapine intoxication in such constellation has not been reported before. Given the high number of its prescription rates, our finding of intracranial hemorrhage after olanzapine intoxication is of high clinical relevance.

[COVID-19 Concerns and Worries in Patients with Mental Illness]. / Psychisch krank in Krisenzeiten: Subjektive Belastungen durch COVID-19.

OBJECTIVE:  This study examines the impact of the COVID-19 pandemic and the lock-down on patients with mental illness. METHODS:  Patients in inpatient or outpatient psychiatric treatment received a questionnaire, examining psychological distress and psychiatric care during the COVID-19 pandemic. RESULTS:  More than half of the patients indicated that the state of emergency had a negative impact on their mental illness. Severely ill patients were more affected. CONCLUSION:  Patients with mental illness are a particularly vulnerable group in the current crisis. Psychiatric and psychotherapeutic care needs to be adapted accordingly; the specific burden and distress needs to be examined actively in patients from all diagnostic groups.

[Antipsychotic pharmacotherapy for delirious syndromes - only temporary, symptom-oriented and considering QTc time]. / Antipsychotische Pharmakotherapie bei deliranten Syndromen : Nur zeitlich begrenzt, symptomorientiert und unter Beachtung der QTc-Zeit.

BACKGROUND: QTc prolongation is a common and serious side effect of antipsychotics in the treatment of delirium. Nevertheless, the occurrence of ventricular tachycardia is rarely reported, so that the clinical relevance of a QTc prolongation triggered in this way remains unclear. METHOD: The focus of this review is on the antipsychotic pharmacotherapy of delirium. RESULTS AND CONCLUSIONS: In individual cases, before the prescription of an antipsychotic due to a delirium, a risk-benefit assessment must be made for the patient. For this purpose, patient and substance-specific risk factors for QTc prolongation must be checked and, if possible, reduced. A specific recommendation for an antipsychotic with assured low QTc interference can not be given because all antipsychotics for delirium treatment are potentially QTc-prolonging. Antipsychotic delirium treatment should be monitored, especially in patients with a high risk profile, for QTc prolongation by regular ECG controls.

Wnt signaling components in the chicken intestinal tract.

Wnt signal transduction has emerged as an increasingly complex pathway due to the numerous ligands, receptors, and modulators identified in multiple developmental systems. Wnt signaling has been implicated in the renewal of the intestinal epithelium within adult animals and the progression of cancer in the colon. The Wnt family, however, has not been explored for function during embryonic gut development. Thus, to dissect the role of Wnt signaling in the developing gastrointestinal tract, it is necessary to first obtain a complete picture of the spatiotemporal expression of the Wnt signaling factors with respect to the different tissue layers of the gut. Here, we offer an in depth in situ gene expression study of Wnt ligands, frizzled receptors, and frizzled related modulators over several days of chicken gut development. These data show some expected locations of Wnt signaling as well as a surprising lack of expression of factors in the hindgut. This paper describes the first comprehensive characterization of the dynamic expression of Wnt signaling molecules during gut development. These data form the basis for future studies to determine the role of Wnt signaling in the developing gastrointestinal tract.