RESUMO
Alcohol use disorders (AUD) have a high comorbidity with mental disorders. Vice versa, alcohol consumption plays an important role in affective disorders, anxiety disorders, ADHD, schizophrenic psychosis, and other mental disorders. In developing the current interdisciplinary, evidence-based treatment guideline on screening, diagnostics, and treatment of AUD, available research on comorbid mental diseases in AUD has been compiled to generate recommendations for treatment. The guideline was prepared under the responsibility of the German Association for Psychiatry, Psychotherapy, and Psychosomatics (DGPPN) and the German Association for Addiction Research and Therapy (DG-Sucht). To meet the methodological criteria for the highest quality guidelines ("S3-criteria") as defined by the Association of Scientific Medical Societies in Germany (AWMF), the following criteria were employed: (1) a systematic search, selection, and appraisal of the international literature; (2) a structured process to reach consensus; and (3) inclusion of all relevant representatives of future guideline users. After assessing and grading the available literature, the expert groups generated several recommendations for the screening, diagnosis, and treatment of comorbid mental disorders. These recommendations were subdivided into psycho-, pharmaco-, and combination therapies. These are the first guidelines ever to make specific treatment recommendations for comorbid mental diseases in AUD. The recommendations extend to different treatment approaches including diagnostics and settings to present available effective and state-of-the-art treatment approaches to clinicians. Hitherto, many clinical constellations have not been addressed in research. Therefore, recommendations for future research are specified.
Assuntos
Alcoolismo/epidemiologia , Transtornos Mentais/epidemiologia , Guias de Prática Clínica como Assunto/normas , Psiquiatria , Comorbidade , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Psiquiatria/métodos , Psiquiatria/normasRESUMO
Use and misuse of cannabis and marihuana are frequent. About 5% of the adult population are current users but only 1.2% are dependent. The medical use of cannabis is controversial but there is some evidence for improvement of chronic pain and spasticity. The somatic toxicity of cannabis is well proven but limited and psychiatric disorders induced by cannabis are of more relevance, e.g. cognitive disorders, amotivational syndrome, psychoses and delusional disorders as well as physical and psychological dependence. The withdrawal symptoms are usually mild and do not require pharmacological interventions. To date there is no established pharmacotherapy for relapse prevention. Psychosocial interventions include psychoeducation, behavioral therapy and motivational enhancement. The CANDIS protocol is the best established German intervention among abstinence-oriented therapies.
Assuntos
Terapia Comportamental/métodos , Cannabis/efeitos adversos , Abuso de Maconha/diagnóstico , Abuso de Maconha/terapia , Maconha Medicinal/efeitos adversos , Entrevista Motivacional/métodos , Medicina Baseada em Evidências , Humanos , Abuso de Maconha/etiologia , Resultado do TratamentoRESUMO
Calls are increasing for the legalization of cannabis. Some legal experts, various politicians, political parties and associations are demanding a change in drug policy. The legalization debate is lively and receiving wide coverage in the media. The German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN) comments on the most important questions from a medical scientific perspective: can cannabis consumption trigger mental illnesses, what consequences would legalization have for the healthcare system and where is more research needed?
Assuntos
Política de Saúde , Fumar Maconha/legislação & jurisprudência , Guias de Prática Clínica como Assunto , Psiquiatria/normas , Medicina Psicossomática/normas , Psicoterapia/normas , Alemanha , Legislação de Medicamentos , Maconha Medicinal , Sociedades MédicasRESUMO
BACKGROUND: Alcohol-related disorders have a high comorbidity with mental disorders and vice versa, alcohol consumption plays an important role in affective disorders and schizophrenic psychoses. In developing the current S3 guidelines evidence-based knowledge on the rate and significance of comorbid disorders in alcohol use disorders has been compiled to generate recommendations for treatment. METHODS: In preparation for the guidelines, previous international guidelines and a systematic literature search were taken into consideration. Recommendations for various and specific clinical situations were derived from these sources based on evidence grading. Evidence and recommendations were subdivided into psychotherapy, pharmacotherapy and combination therapy, each having differential efficacies in the treatment of psychiatric symptoms and alcohol consumption behavior. Furthermore, a separate treatment pathway was developed for a stepwise approach to affective disorders for both comorbidities. CONCLUSION: Appearing for the first time in guidelines are specific treatment recommendations for comorbid mental diseases in alcohol use disorders. These recommendations extend to different treatment approaches including diagnostics and settings, affording clinicians more pragmatic relevance.
Assuntos
Transtornos Relacionados ao Uso de Álcool/psicologia , Transtornos Relacionados ao Uso de Álcool/terapia , Transtornos Mentais/psicologia , Transtornos Mentais/terapia , Guias de Prática Clínica como Assunto , Psiquiatria/normas , Transtornos Relacionados ao Uso de Álcool/diagnóstico , Tomada de Decisão Clínica/métodos , Medicina Baseada em Evidências , Alemanha , Fidelidade a Diretrizes , Humanos , Transtornos Mentais/diagnóstico , Neurologia/normas , Psicoterapia/normas , Resultado do TratamentoRESUMO
We report a GWAS of alcohol dependence (AD) in European-American (EA) and African-American (AA) populations, with replication in independent samples of EAs, AAs and Germans. Our sample for discovery and replication was 16 087 subjects, the largest sample for AD GWAS to date. Numerous genome-wide significant (GWS) associations were identified, many novel. Most associations were population specific, but in several cases were GWS in EAs and AAs for different SNPs at the same locus,showing biological convergence across populations. We confirmed well-known risk loci mapped to alcohol-metabolizing enzyme genes, notably ADH1B (EAs: Arg48His, P=1.17 × 10(-31); AAs: Arg369Cys, P=6.33 × 10(-17)) and ADH1C in AAs (Thr151Thr, P=4.94 × 10(-10)), and identified novel risk loci mapping to the ADH gene cluster on chromosome 4 and extending centromerically beyond it to include GWS associations at LOC100507053 in AAs (P=2.63 × 10(-11)), PDLIM5 in EAs (P=2.01 × 10(-8)), and METAP in AAs (P=3.35 × 10(-8)). We also identified a novel GWS association (1.17 × 10(-10)) mapped to chromosome 2 at rs1437396, between MTIF2 and CCDC88A, across all of the EA and AA cohorts, with supportive gene expression evidence, and population-specific GWS for markers on chromosomes 5, 9 and 19. Several of the novel associations implicate direct involvement of, or interaction with, genes previously identified as schizophrenia risk loci. Confirmation of known AD risk loci supports the overall validity of the study; the novel loci are worthy of genetic and biological follow-up. The findings support a convergence of risk genes (but not necessarily risk alleles) between populations, and, to a lesser extent, between psychiatric traits.
Assuntos
Alcoolismo/epidemiologia , Alcoolismo/genética , Predisposição Genética para Doença/genética , Estudo de Associação Genômica Ampla , Proteínas dos Microfilamentos/genética , Proteínas de Transporte Vesicular/genética , Proteínas Adaptadoras de Transdução de Sinal/genética , Negro ou Afro-Americano/genética , Álcool Desidrogenase/genética , Aminopeptidases/genética , Mapeamento Cromossômico , Estudos de Coortes , Fatores de Iniciação em Eucariotos/genética , Feminino , Seguimentos , Genótipo , Humanos , Proteínas com Domínio LIM/genética , Masculino , Proteínas Mitocondriais/genética , Polimorfismo de Nucleotídeo Único/genética , Escalas de Graduação Psiquiátrica , Estados Unidos/epidemiologia , População Branca/genéticaRESUMO
In Europe between 30 and 50% of all liver transplantations (LTX) are done within the context of chronic end-stage alcoholic liver disease (ALD). However, post-operatively 20-25% of these patients lapse or relapse into heavy alcohol use. Thus, assessment of alcohol relapse risk before enlisting and therapeutic follow-up during and after LTX is of utmost importance. However, as yet there are enormous differences between European countries and between transplant centers, with regard to the assessment methods and criteria and the implementation of therapeutic follow-up. Only the so-called '6-month abstinence' rule is widely used. However, there are not much scientific data validating its use in predicting relapse. Thus, there is a clear need of a more homogeneous approach, which was the focus of a symposium of the European Federation of Addiction Societies during the 14th conference of the European Society for Biomedical Research on Alcoholism, 2013 (ESBRA), entitled 'Liver transplantation: A European perspective'. In a follow-up on this symposium, the authors aim to sum up the evidence of psychiatric assessment criteria and psychiatric treatment interventions relevant in the context of patient selection and patient follow-up within ALD transplantation procedures. Based upon these findings, we propose elements of a procedure that can serve as a first step toward a model of good practice regarding addiction-specialist input within the pre- and post-transplantation period.
Assuntos
Alcoolismo/prevenção & controle , Doença Hepática Terminal/cirurgia , Hepatopatias Alcoólicas/cirurgia , Transplante de Fígado , Alcoolismo/complicações , Alcoolismo/terapia , Doença Hepática Terminal/etiologia , Humanos , Hepatopatias Alcoólicas/etiologia , Seleção de Pacientes , Recidiva , Medição de Risco , Fatores de RiscoRESUMO
AIMS: We have analysed the MAOA-uVNTR polymorphism in the promoter region of the X-chromosomal monoamine oxidase A (MAOA) gene. The first aim was to examine the association between the MAOA genotype and the alcoholic phenotype. In the second part of the paper we have analysed the association of the MAOA genotype with impulsive and aggressive behaviour. Genotypes with 3 or 5-repeat alleles (MAOA-L-genotype) were reported to be associated with impulsive and aggressive traits. METHODS: The MAOA genotype was determined in 371 male alcohol-dependent subjects and 236 male controls all of German descent. Behavioural and personality traits were evaluated using the self-report questionnaires Barratt Impulsiveness Scale (BIS), Buss Durkee Hostility Inventory (BDHI), Temperament and Character Inventory (TCI) and NEO-Five Factor Inventory (NEO-FFI). A median split in BIS, Buss Durkee Physical Assault, Buss Durkee Irritability, TCI and NEO-FFI was conducted. RESULTS: No association could be detected between the MAOA genotype and the alcoholic phenotype. Based on the results of the BIS questionnaire, we were able to make out an association between the MAOA-L genotype and higher levels of impulsivity (pâ=â0.043). Furthermore - without reaching statistical significance - we detected a very slight association between the MAOA-L genotype and higher scores in the BDHI subcategory physical aggression (pâ=â0.058). CONCLUSION: Taken together, these findings suggest that the MAOA-L genotype is to some extent associated with impulsive and antisocial personality traits in alcoholic men. Further studies on that question are needed.
Assuntos
Alcoolismo/genética , Transtorno da Personalidade Antissocial/genética , Monoaminoxidase/genética , Adulto , Agressão/psicologia , Alcoolismo/epidemiologia , Alcoolismo/psicologia , Transtorno da Personalidade Antissocial/epidemiologia , Transtorno da Personalidade Antissocial/psicologia , Genótipo , Alemanha/epidemiologia , Hostilidade , Humanos , Comportamento Impulsivo , Masculino , Pessoa de Meia-Idade , Repetições Minissatélites/genética , Testes Neuropsicológicos , Testes de Personalidade , Polimorfismo Genético/genéticaRESUMO
INTRODUCTION: The DSM-5 alcohol use disorder (AUD) criteria proposal contains 11 criteria that include most of the DSM-IV abuse and dependence criteria plus craving. The aims of the current study in a large and international alcohol-consuming sample were to confirm the dimensionality of the DSM-5 AUD criteria and to differentiate grades of severity of DSM-5 AUD in subjects who pass the proposed DSM-5 diagnostic threshold of two criteria. METHOD: We used the World Health Organization (WHO)/International Society on Biomedical Research on Alcoholism (ISBRA) Study on State and Trait Markers of Alcohol Use and Dependence dataset. Subjects included in the analyses were aged ≥ 18 years and were recruited in five countries: Australia, Brazil, Canada, Finland and Japan. Assessment of AUD and additional characteristics was conducted using an adapted version of the Alcohol Use Disorder and Associated Disabilities Interview Schedule (AUDADIS). Dimensionality of the DSM-5 criteria was evaluated using factor analysis and item response theory (IRT) models. The IRT results led to the classification of AUD patients into three severity groups. External validators were used to differentiate statistically across subgroups. RESULTS: A total of 1424 currently drinking individuals were included in the analyses. Factor and IRT analyses confirmed the dimensional structure of DSM-5 AUD criteria. More than 99% of the subjects could be allocated to one of the suggested severity subgroups. The magnitude of the external validators differed significantly across the severity groups. CONCLUSIONS: The results confirm the dimensional structure of the proposed DSM-5 AUD criteria. The suggested stages of severity (mild, moderate and severe) may be useful to clinicians by grouping individuals not only in the mild but also in the moderate to severe spectrum of DSM-5 AUD.
Assuntos
Transtornos Relacionados ao Uso de Álcool/classificação , Índice de Gravidade de Doença , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Transtornos Relacionados ao Uso de Álcool/diagnóstico , Austrália , Brasil , Canadá , Manual Diagnóstico e Estatístico de Transtornos Mentais , Progressão da Doença , Feminino , Finlândia , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
OBJECTIVE: The study was conducted to explore the effects of EGb 761 (Dr. Willmar Schwabe GmbH & Co. KG, Karlsruhe, Germany) on neuropsychiatric symptoms (NPS) and cognition in patients with mild cognitive impairment (MCI). METHODS: One hundred and sixty patients with MCI who scored at least 6 on the 12-item Neuropsychiatric Inventory (NPI) were enrolled in this double-blind, multi-center trial and randomized to receive 240 mg EGb 761 daily or placebo for a period of 24 weeks. Effects on NPS were assessed using the NPI, the state sub-score of the State-Trait Anxiety Inventory and the Geriatric Depression Scale. Further outcome measures were the Trail-Making Test (A/B) for cognition and global ratings of change. Statistical analyses followed the intention-to-treat principle. RESULTS: The NPI composite score decreased by 7.0 ± 4.5 (mean, standard deviation) points in the EGb 761-treated group and by 5.5 ± 5.2 in the placebo group (p = 0.001). Improvement by at least 4 points was found in 78.8% of patients treated with EGb 761 and in 55.7% of those receiving placebo (p = 0.002). Superiority of EGb 761 over placebo (p < 0.05) was also found for the State-Trait Anxiety Inventory score, the informants' global impression of change, and both Trail-Making Test scores. There were statistical trends favoring EGb 761 in the Geriatric Depression Scale and the patients' global impression of change. Adverse events (all non-serious) were reported by 37 patients taking EGb 761 and 36 patients receiving placebo. CONCLUSIONS: EGb 761 improved NPS and cognitive performance in patients with MCI. The drug was safe and well tolerated.
Assuntos
Ansiedade/tratamento farmacológico , Disfunção Cognitiva/tratamento farmacológico , Transtorno Depressivo/tratamento farmacológico , Fitoterapia/métodos , Extratos Vegetais/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Método Duplo-Cego , Feminino , Ginkgo biloba , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Extratos Vegetais/efeitos adversosRESUMO
Delirium and dementia as organically caused mental disorders exhibit similarities in the clinical and neurological sense and often occur together. The existence of one appears to increase the risk for the development of the other. Although delirium is a very common disorder especially among the elderly, it is often not recognized. For the diagnosis of delirium, an exact family and case history including medication, clinical examination and determination of routine laboratory values are not infrequently necessary. Causal treatment of delirium is possible and not necessarily complicated. Both non-medicative and medicative measures are available for the symptomatic treatment. The non-medicative measures are to a large extent applied by nursing staff and comprise, among others, orientation guidance and attaining a balance between perceptual overload and deprivation. A good knowledge of symptomatology is decisive, also from the prevention point of view (nurses specialized in delirium). For symptomatic medicative treatment neuroleptic agents appear to be favorable. With regard to extrapyramidal side effects atypical neuroleptics are better than the typical ones. The use of cholinesterase inhibitors is not robustly supported by the literature. The use of benzodiazepines is rather discouraged except for the treatment of withdrawal delirium. Preparations with short half-lives and absence of active metabolites can be used as accompanying measures for a short time. Prevention appears to be extremely important for which the treating personnel require a good knowledge of risk factors and their management. The occurrence of delirium among cases of alpha-synucleinopathies represents a special case. Both international and German guidelines on the management of delirium are available.
Assuntos
Delírio/terapia , Demência/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Canadá , Inibidores da Colinesterase/uso terapêutico , Delírio/diagnóstico , Delírio/tratamento farmacológico , Delírio/psicologia , Demência/diagnóstico , Demência/tratamento farmacológico , Demência/psicologia , Diagnóstico Diferencial , Feminino , Guias como Assunto , Humanos , Masculino , Pessoa de Meia-Idade , Estados UnidosRESUMO
In addition to self reports and questionnaires, biomarkers are of relevance in the diagnosis of and therapy for alcohol use disorders. Traditional biomarkers such as gamma-glutamyl transpeptidase or mean corpuscular volume are indirect biomarkers and are subject to the influence of age, gender and non-alcohol related diseases, among others. Direct metabolites of ethanol such as ethyl glucuronide (EtG), ethyl sulphate (EtS) and phosphatidylethanol (PEth) are direct metabolites of ethanol, that are positive after intake of ethyl alcohol. They represent useful diagnostic tools for identifying alcohol use even more accurately than traditional biomarkers. Each of these drinking indicators remains positive in serum and urine for a characteristic time spectrum after the cessation of ethanol intake - EtG and EtS in urine up to 7 days, EtG in hair for months after ethanol has left the body. Applications include clinical routine use, emergency room settings, proof of abstinence in alcohol rehabilitation programmes, driving under influence offenders, workplace testing, assessment of alcohol intake in the context of liver transplantation and foetal alcohol syndrome. Due to their properties, they open up new perspectives for prevention, interdisciplinary cooperation, diagnosis of and therapy for alcohol-related problems.
Assuntos
Consumo de Bebidas Alcoólicas/metabolismo , Alcoolismo/diagnóstico , Depressores do Sistema Nervoso Central/metabolismo , Etanol/metabolismo , Consumo de Bebidas Alcoólicas/sangue , Alcoolismo/sangue , Alcoolismo/terapia , Biomarcadores/sangue , Biomarcadores/metabolismo , Biotransformação , Glucuronatos , Glicerofosfolipídeos/sangue , Humanos , Ésteres do Ácido Sulfúrico/sangue , Ésteres do Ácido Sulfúrico/metabolismo , Inquéritos e QuestionáriosRESUMO
INTRODUCTION: There is a need for more studies on the clinical effectiveness, tolerability and pharmacokinetics of atypical antipsychotics in adolescents with psychotic disorders, as this represents a vulnerable and difficult population to treat. According to recent concerns regarding disabling side effects of antipsychotics, particularly weight gain, further monitoring of their safety profiles is needed. This situation prompted the authors to carry out an investigation on the clinical effectiveness of quetiapine in psychotic adolescents. METHODS: 23 adolescents (13-18 years old) with psychotic disorders participated in a 12-week open label trial, including 6 visits assessing clinical efficacy, tolerability and safety of quetiapine (50-750 mg daily). RESULTS: Adolescents were treated with lower doses compared to adults. Significant decreases in CGI and PANSS total scores were observed after both 4 and 12 weeks of quetiapine treatment compared to baseline. Sedation was the main adverse effect, but medication was generally well tolerated. Irregular compliance, (as assessed by pill counts, a questionnaire and by plasma quetiapine concentration monitoring), and alcohol and/or cannabis consumption were factors identified in this study which add to the difficulty in treating this population. DISCUSSION: The results of the present study help to consolidate evidence of the usefulness of quetiapine as a treatment for adolescents with psychotic disorders. However, this study also highlights the issues encountered in treating this group, including the presence of comorbidities such as drug abuse.
Assuntos
Antipsicóticos/uso terapêutico , Dibenzotiazepinas/uso terapêutico , Transtornos Mentais/tratamento farmacológico , Transtornos Psicóticos/tratamento farmacológico , Adolescente , Ansiolíticos/uso terapêutico , Antidepressivos/uso terapêutico , Antipsicóticos/efeitos adversos , Antipsicóticos/sangue , Antipsicóticos/farmacocinética , Comorbidade , Dibenzotiazepinas/efeitos adversos , Dibenzotiazepinas/sangue , Dibenzotiazepinas/farmacocinética , Quimioterapia Combinada , Feminino , Humanos , Masculino , Transtornos Mentais/epidemiologia , Transtornos Mentais/psicologia , Escalas de Graduação Psiquiátrica , Transtornos Psicóticos/epidemiologia , Transtornos Psicóticos/psicologia , Fumarato de Quetiapina , Projetos de Pesquisa , Inquéritos e QuestionáriosRESUMO
INTRODUCTION: The prepulse inhibition (PPI) of acoustic startle reflex is impaired in schizophrenic individuals compared to normal controls, and has been suggested to be a biomarker for sensorimotor gating. In fact, some cross-sectional studies suggest a different type of effect on PPI changes depending on the kind of antipsychotic treatment but few prospective studies have been conducted to investigate the short-term course of PPI alterations during the first few weeks of treatment. This study aimed to investigate schizophrenic subjects and controls over 4 weeks to analyze the course of PPI changes between groups at baseline and during follow-up, to determine whether potential PPI alterations are influenced by type of antipsychotic medication and whether these alterations are accompanied by changes in psychopathology. METHODS: 39 schizophrenic patients and 39 controls were enrolled into this open prospective trial. Acoustic startle response (PPI) measurements and clinical (PANSS) performance were obtained shortly after admission and every 14 days for a 4-week follow-up period (T1 to T3). RESULTS: Patients were treated with first and/or second generation antipsychotics in an open-label design. At baseline (T1) significant deficits were detected between schizophrenic subjects and controls for several PPI conditions. Neither was a relationship between type of antipsychotic treatment and PPI measures detected at baseline and during follow-up, nor was any association with PANSS psychopathology found. DISCUSSION: The results of our study confirm previous research on PPI deficits in schizophrenic subjects. As with previous prospective PPI studies in schizophrenic subjects, initial PPI deficits were not observed during the follow-up period, independent of the kind of antipsychotic treatment and severity of psychopathology. These findings may indicate that PPI serves as a biological marker of schizophrenic psychosis and sensorimotor gating independent of type of antipsychotic administered or severity of psychotic symptoms.
Assuntos
Antipsicóticos/uso terapêutico , Reflexo de Sobressalto/efeitos dos fármacos , Esquizofrenia/tratamento farmacológico , Psicologia do Esquizofrênico , Filtro Sensorial , Antipsicóticos/efeitos adversos , Quimioterapia Combinada , Feminino , Humanos , Masculino , Inibição Neural/efeitos dos fármacos , Inibição Neural/fisiologia , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Tempo de Reação/efeitos dos fármacos , Tempo de Reação/fisiologia , Reflexo de Sobressalto/fisiologia , Esquizofrenia/diagnóstico , Esquizofrenia/patologia , Inquéritos e Questionários , Fatores de TempoRESUMO
BACKGROUND: Cholinesterase inhibitors form the mainstay of treatment for persons with mild-to-moderate Alzheimer's disease (AD). The rivastigmine patch may increase compliance and the proportion of patients maintaining an efficacious dose compared with oral cholinesterase inhibitors. OBJECTIVE: To investigate the proportion of patients who reached and maintained the target rivastigmine patch dose compared with the target rivastigmine capsule dose reported in clinical trials. METHODS: This was a multicentre, 24-week, open-label study in persons with probable AD and a Mini-Mental State Examination (MMSE) score of ≥ 10 and ≤ 26. The primary outcome was the proportion of patients (ITT population) treated with 9.5 mg/24 h rivastigmine patch for at least 8 weeks at week 24. Secondary outcomes included week 24 MMSE, Alzheimer's Disease Cooperative Study-Clinical Global Impression of Change (ADCS-CGIC), Trail Making Test Part A (TMT-A) and Alzheimer's Disease Cooperative Study-Activities of Daily Living (ADCS-ADL) scores. RESULTS: Overall, 208 participants received treatment and 155 (74.5%) completed the study. Within the ITT population, 147/182 patients (80.8%; 95% CI 75.0-86.5%) were treated for at least 8 weeks with the 9.5 mg/24 h rivastigmine patch; 135/182 patients (74.2%; 95% CI 67.8-80.5%) were treated for at least 8 weeks and completed the study. The most common adverse events were nausea (10.1% of patients), erythema (8.7%), pruritus (8.2%) and vomiting (7.2%). At week 24, patients treated with the rivastigmine patch showed improvements on MMSE, ADCS-ADL, ADCS-CGIC and TMT-A scores. Caregivers reported acceptance, preference and satisfaction with the patch. CONCLUSION: Transdermal delivery may allow more patients to reach and maintain therapeutic doses of rivastigmine compared with oral rivastigmine.
Assuntos
Doença de Alzheimer/tratamento farmacológico , Inibidores da Colinesterase/administração & dosagem , Fármacos Neuroprotetores/administração & dosagem , Fenilcarbamatos/administração & dosagem , Adesivo Transdérmico , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Inibidores da Colinesterase/efeitos adversos , Cognição/efeitos dos fármacos , Feminino , Humanos , Masculino , Adesão à Medicação , Fármacos Neuroprotetores/efeitos adversos , Fenilcarbamatos/efeitos adversos , Rivastigmina , Resultado do TratamentoRESUMO
BACKGROUND: This naturalistic study investigates in detail symptom reduction during acute inpatient treatment (response), long-term symptom improvement in the post-acute phase (remission) and the rate of re-hospitalisations. MATERIAL AND METHODS: A total of 183 patients were enrolled. Criteria for response were PANSS total score and syndrome reductions of 20, 30, 40 and 50%. Remission criteria employed were based on recommendations from Andreasen et al. RESULTS: The average length of stay was 45.6 days (SD 42.7). PANSS total score response rates were found to be 63.9% for the 20% level and were reduced in the following consecutive levels by approximately 15%. Only 10.3% of the patients remitted during a 1-year follow-up period. At least one re-hospitalisation was reported for 43.9% of the subjects. CONCLUSION: Compared to previous randomised and controlled trials, the rates of response and remission are significantly lower. In daily inpatient care, the chronic course of schizophrenia is far commoner than expected from previous reports.
Assuntos
Hospitalização/estatística & dados numéricos , Pacientes Internados/estatística & dados numéricos , Esquizofrenia/epidemiologia , Esquizofrenia/terapia , Adulto , Idoso , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Indução de Remissão , Medição de Risco , Fatores de Risco , Esquizofrenia/diagnóstico , Resultado do Tratamento , Adulto JovemRESUMO
The study focused on expectations of alcohol effects and patterns of consumption in German and Polish adolescents in the border region of Pomerania. In 2005/2006 a cross-sectional study was conducted in various schools. Adolescents with an average age of 14 from one German town (Greifswald) and two Polish towns (Szczecin and Kolobrzeg) were assessed using the ESPAD (European School Project on Alcohol and Other Drugs) questionnaire. Altogether 757 (444 Polish and 313 German) students in their 7th and 8th grades were assessed. Differences between alcohol consumption patterns and expectations between Germany and Poland, and relationships between alcohol consumption and anticipated alcohol effects were tested. There is a difference in patterns of consumption between the two countries. Among all adolescents, expectations of positive alcohol effects dominated, and the negative effects were estimated to be less likely. In a country-specific comparison, German students estimated the occurrence of positive as well as negative effects to be likely. Adolescents who consumed a lot of alcohol in both countries estimated the positive effects to be stronger. Adolescents are more focused on short-term experiences than the long-term consequences of alcohol consumption. The results show potential targets for prevention and intervention of future risky consumption and alcohol use disorders.
Assuntos
Comportamento do Adolescente/psicologia , Consumo de Bebidas Alcoólicas/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Adolescente , Consumo de Bebidas Alcoólicas/efeitos adversos , Comparação Transcultural , Feminino , Alemanha , Humanos , Masculino , PolôniaRESUMO
INTRODUCTION: Remission in schizophrenia is defined as a period of at least 6 months in which symptom reduction occurs. In comparison, the term recovery is defined to include not only long-term symptomatic improvement but also good psychosocial functioning and improved quality of life. The aim of this naturalistic study is to prospectively investigate all these variables and their interrelationship in a sample of subjects with schizophrenia over a period of two years. METHODS: Seventy-seven subjects were included into the analysis. Criteria of remission for each domain were assessed using the BPRS (brief psychiatric rating scale, symptomatic remission), GAF (global assessment of functioning, functional remission) and the SWN-K (subjective well-being under neuroleptics, remission of subjective well-being). Subjects were considered to have "recovered" if they remitted in all three domains at discharge (t0), one (t1) and two-year (t2) follow-up assessments. RESULTS: Symptomatic and functional remissions were rare and occurred only in 10 % of the subjects at t0, t1 and t2. Approximately one-third of the individuals had remission with a stable quality of life. Correlations between quality of life and functional and symptomatic remissions were weak. None of the subjects met the criteria for recovery. CONCLUSION: Compared to previous studies, the rates of remission and recovery in the current sample were quite low. The contrasting results may be due to the naturalistic characteristics of this sample of initially inpatient subjects while previous studies investigated selected samples of schizophrenic individuals. However, despite their functional and symptomatic impairments, the results also indicate that the schizophrenic subjects have a largely satisfying quality of life.
Assuntos
Esquizofrenia/terapia , Psicologia do Esquizofrênico , Adulto , Idade de Início , Antipsicóticos/uso terapêutico , Feminino , Seguimentos , Humanos , Pacientes Internados , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Qualidade de Vida , Recuperação de Função Fisiológica , Remissão EspontâneaRESUMO
Several lines of evidence indicate that alterations of the central cortico-accumbens glutamate pathway are involved in the development and maintenance of alcohol- and substance-use disorders. The HOMER protein family is encoded by 3 genes HOMER (1-3) which are components of the excitatory postsynaptic density complex and function to modulate synaptic activity by the regulation of glutamate signaling. HOMER 1 and 2 have been reported to contribute to chronic alcohol-induced long-term neurochemical changes in the endogenous reward system. Data from animal models suggest a potential role of the Homer protein family in the development of alcohol and substance use. The aim of this study is to assess potential associations between HOMER 1 and 2 genetic variants in a larger sample of alcohol-dependent individuals and unrelated controls. Five genetic variants of HOMER 1 and 3 of HOMER 2 were genotyped in a multi-site sample of 1,923 German healthy controls and 2,039 alcohol-dependent subjects. Neither single SNP nor haplotype analysis could detect significant associations with alcohol dependence (AD) and related phenotypes. While most of the HOMER 1 and 2 SNPs are in low-to-moderate linkage disequilibrium, three major haplotypes of HOMER 1 and 4 haplotypes of HOMER 2 are present in the majority of alcohol-dependent and control subjects. In conclusion, our results suggest that single SNPs, respectively, haplotypes of the HOMER 1 and 2 genes are unlikely to play a major role in the pathophysiology of AD.
Assuntos
Alcoolismo/genética , Proteínas de Transporte/genética , Predisposição Genética para Doença , Polimorfismo de Nucleotídeo Único/genética , Adulto , Estudos de Casos e Controles , Feminino , Frequência do Gene , Haplótipos/genética , Proteínas de Arcabouço Homer , Humanos , Desequilíbrio de Ligação/genética , MasculinoRESUMO
The rate of axis II disorders in alcohol-dependent individuals is suggested to be high. The aim of this investigation is to assess the rate of DSM-IV axis II diagnoses in alcohol-dependent inpatients and their correlation with clinical characteristics of alcohol dependence (AD). 1,079 inpatients with DSM-IV AD from three inpatient addiction treatment centers ('qualified detoxification', open psychiatric university hospital wards) were included. Characteristics of AD were obtained using standardized structured interviews. Diagnoses of DSM-IV personality disorders (PDs) were generated with SCID-II-PQ and SCID-II interviews. Alcoholism severity was measured using the number of DSM-IV criteria endorsed and age at first drinking. Approximately 60% of the sample had at least one PD. However, rates of Axis II disorders differed significantly across centers. The most frequent PDs were obsessive-compulsive, borderline, narcissistic and paranoid PD. Diagnosis of any PD was related to a more severe clinical profile of AD. Regression analyses revealed that obsessive-compulsive PD was related to the number of DSM-IV criteria endorsed while antisocial PD was related to early age at first drinking. The majority of alcohol-dependent individuals had one or more comorbid axis II disorders. Univariate and multivariate analyses indicate that different PDs are related to age at first dinking and alcoholism severity.
Assuntos
Alcoolismo/complicações , Alcoolismo/diagnóstico , Transtornos da Personalidade/complicações , Transtornos da Personalidade/diagnóstico , Adulto , Idade de Início , Diagnóstico Duplo (Psiquiatria) , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Índice de Gravidade de Doença , Caracteres Sexuais , Centros de Tratamento de Abuso de SubstânciasRESUMO
Both depression and dementia occur by themselves or together in elderly subjects aged 65 and above. The aim of this review is to discuss several hypotheses which try to explain the frequent co-occurrence exceeding chance alone, based on a systematic literature search. A series of studies revealed potential biological similarities between both disorders which, however, were not found in all investigations. Lifetime history of depression can be considered as a distant risk factor for dementias. Depression occurs most frequently within one year before and after the onset of dementia, in which the association between both disorders is probably strongest. In a subgroup of subjects with more "cognitive reserve", depression was found to be a consequence of patient's realisation of beginning cognitive deficits. Several studies indicate that depression in Alzheimer and other dementia forms can be considered as a separate disease entity, as the clinical syndrome differs from depression in earlier periods of life. Studies on the therapy of depression in dementia have aroused increasing interest in recent years. Herewith, certain guidelines in the treatment of older patients with antidepressants must be followed.