Tiagabine appears not to be efficacious in the treatment of acute mania.

BACKGROUND: Because a GABAergic hypofunction has been implied in the pathophysiology of mania, we have tested the antimanic properties of the GABA transporter 1 inhibitor tiagabine. METHOD: An open trial was conducted in 8 acutely manic inpatients with DSM-IV bipolar I disorder, 2 of them with tiagabine monotherapy and 6 with tiagabine as an add-on to previously insufficient mood-stabilizing medication. The study duration was 14 days. Changes in psychopathology were assessed by the Bech-Rafaelsen Mania Rating Scale. RESULTS: None of the patients showed clear-cut relief from manic symptoms during the 2-week observation period. In 2 patients, we saw pronounced side effects (nausea and vomiting in one and a generalized tonic-clonic seizure in the other). CONCLUSION: The results from this open trial suggest that tiagabine seems to have no pronounced antimanic efficacy compared with standard treatments such as valproate, lithium, or neuroleptics. It also appears that rapid dosage increases for antimanic treatment can cause potentially severe side effects.

Superior temporal gyrus and P300 in schizophrenia: a combined ERP/structural magnetic resonance imaging investigation.

Decrement of the auditory P300 component of the event-related potentials (ERP) is a robust finding in schizophrenic patients and seems to be most pronounced in the left temporal region. Structural MRI studies support the hypothesis that regional structural brain differences in this patient group include reduced volume in temporal lobe structures. The aim of the presented study was to investigate the possible gray matter volume reductions in the left posterior superior temporal gyrus (STG) and the P300 reduction and left

[Electroconvulsive therapy at the Department of Psychiatry and Psychotherapy, University of Munich. Development during the years 1995-2002]. / Elektrokonvulsionstherapie an der Klinik für Psychiatrie und Psychotherapie der Universität München Entwicklung in den Jahren 1995-2002.

BACKGROUND: So far, electroconvulsive therapy (ECT) has been proven to be a reliable and the most effective somatic treatment of depression or schizophrenia. This holds especially true for disturbances, which are refractory to pharmacological treatments. PATIENTS AND METHODS: We evaluated 4803 treatments in 445 patients. Main outcome criteria were efficacy and tolerability of treatment. Moreover, prospectively recorded neurophysiological parameters that might influence treatment outcome and treatment modalities and were assessed in a retrospective study design. RESULTS: During the last 7 years developmental changes show an increasing call for ECT treatment. Despite not being able to satisfy all demands the number of treatments more than doubled during the time period investigated. According to the latest scientific knowledge, especially in unipolar ECT, higher stimulation energy has been used to provide better treatment efficacy. Nevertheless, this was accompanied by a lower incidence of cognitive side effects. Due to the better tolerability of the treatment and the prospective neurophysiological indices, it appears that treatment quality has improved in recent years. Overall treatment efficacy was not improved, but could be maintained on a stable high level. This is presumably due to a stronger negative selection of patients with more pharmacotherapy-refractory disturbances. CONCLUSION: ECT still represents an important option in the treatment of therapy-resistant depression and schizophrenia despite recent progress in neuropsychopharmacology.