[New options in the treatment of depression]. / Neue Wege in der Depressionsbehandlung.

Despite the advances in the psychopharmacology, the treatment of depressive disorder is still not satisfactory. All current pharmacological substances are affecting the monoamines in the central nervous system. The present review discusses advances in the field of monoaminergic antidepressants as well as new treatment alternatives. The new monoaminergic substances include metabolites of known antidepressants, direct serotonin-agonists, and triple-reuptake inhibitors, blocking the transport of serotonin, norepinephrine, and dopamine. Non-monoaminergic strategies include substances affecting melatonin or neuropeptides. Glutamate modulating agents such as ketamine or riluzole are another promising approach in the treatment of depression. Some advances have also been achieved in the field of HPA-axis modulation.

[The concept of anniversary reaction - an explanation for the onset of depression]. / Das Konzept der anniversary reaction - Eine Erklärung für den Zeitpunkt des Auftretens einer Depression -

In this contribution, the concept of anniversary reaction is explained and elucidated by a paradigmatic case-report. The influence of a certain date, e.g. birthday, on mortality is epidemiologically well proven. The psychoanalytical comprehension of anniversary reaction emphasizes the significant coherence to a biographical trauma. An anniversary reaction emerges on a specific date or age of life that reminds and actualises the conflict attached to the trauma. The anniversary reaction may appear in the shape of a psychic or an organic disease. In the case described, the anniversary reaction emerged on the anniversary of the death of the partner of life that had initially been followed by pathological mourning.

A survey on psychiatric patients' use of non-medical alternative practitioners: incidence, methods, estimation, and satisfaction.

OBJECTIVES: We investigated to what extent psychiatric inpatients consult Heilpraktiker, i.e. non-academically trained providers of complementary and alternative medicine (CAM), which diagnostic and therapeutic methods Heilpraktiker employ, how patients assess Heilpraictikers' professional competence, CAM in general and issues of satisfaction for those who have had experience with Heilpraktiker. DESIGN: Four hundred and seventy three patients admitted to a psychiatric university department during a 9-month period filled out a questionnaire developed for this investigation. RESULTS: About one third of the patients had consulted a Heilpraktiker, a quarter of these for their current psychiatric illness. Women were in the majority. Patients with the highest secondary school education consulted Heilpraktiker less often. There was considerable 'customer loyalty' towards Heilpraktiker. Largely the same diagnostic and treatment methods were employed for mental illness as for somatic complaints. Except for iridology, exotic or dangerous methods played a secondary role. Patients generally revealed a very positive attitude toward Heilpraktiker and CAM, although methods were rated differently. CAM enjoyed greater appreciation among women and patients who had consulted Heilpraktiker. Patients with personal experience were, on the whole, very satisfied with the professional competence, with the atmosphere in the practice and staff concern for the patient's well-being. Degree of satisfaction correlated closely with frequency of consultation. More patients with neurotic disorders considered the cost unreasonable than others, despite comparatively frequent visits. CONCLUSIONS: Psychiatric patients seek out Heilpraktiker to a considerable degree. Especially those who have relevant experience rank Heilpraktiker highly, in particular due to their 'psychotherapeutic' attitude, but professional competence is also valued. Methods of CAM received mixed reviews from patients but are generally seen in a positive light. It is recommended that doctors collecting case history data on their patients also ask about experience with alternative practitioners and treatments.

On the physiological function of lithium from a psychiatric view point.

Lithium is a naturally occurring alkali metal, which living organisms ingest from dietary sources and which is also present in trace amounts in the human body. In much higher concentrations, lithium is effective as a medication for mania and mood swings including manic depressive disorders. Many studies have shown that a deficiency in 'endogenous' lithium, i.e. lithium in food and drinking water, can lead to defects in growth and development in animals and to grave psychopathological problems in humans. It is therefore conceivable that lithium has an essential function in the physiological regulation of mood and that a subgroup of pathological mood disorders cause a bodily requirement for drastically higher concentrations of lithium in compartments. Taking lithium long-term could have a prophylactic effect on this kind of change in bodily requirements.

[Psychotherapy and religion: a survey of Northern Bavarian psychotherapists]. / Psychotherapie und Religion. Eine repräsentative Umfrage unter fränkischen Psychotherapeuten.

By taking a survey of physicians and psychologists accredited as psychotherapists in Franconia (northern Bavaria), we attempted to draw conclusions about the importance of religion for the therapists themselves and for their therapeutic settings. 253 physicians and 78 psychologists returned usable questionnaires (a return rate of 70% for each group). 30% of each group were non-denominational, significantly more men than women were not religious or considered themselves "agnostic/atheistic." Catholic therapists appeared to be more loyal toward their church and more open-minded toward religion in general than protestants and non-denominationals, respectively. Around 1/5 of the psychologists had prayed for their patients. Among the psychoanalysts there were no fewer non-denominationals or agnostics/atheists than among physician/psychotherapists or behavioural therapists. The physician/psychoanalysts classified the role of religion as less important than physician/psychotherapists; however, there were marked differences between the psychoanalytic schools. Many therapists could imagine consulting a spiritual counselor in appropriate cases. The results indicate a correlation between the subjective attitude of therapists toward religion and their handling of this topic in therapeutic practice.

Spontaneous slow and fast MEG activity in male schizophrenics treated with clozapine.

RATIONALE: The atypical neuroleptic clozapine induces specific electroencephalogram changes, which have not been investigated using the technique of magnetoencephalography (MEG). OBJECTIVE: The present study investigated whether spontaneous magnetoencephalographic (MEG) activity in patients treated with clozapine differs from that in patients treated with haloperidol and untreated control subjects. METHODS: A 2 x 37 channel biomagnetic system was used to record spontaneous magnetic activity for the frequency ranges (2-6 Hz), (7.5-12 Hz), (12.5-30 Hz) in schizophrenic patients and controls in two trials within 3 weeks. After data acquisition, the processed data were digitally filtered and the spatial distribution of dipoles was determined by a 3-D convolution with a Gaussian envelope. The dipole localisation was calculated by the dipole density plot and the principal component analysis. The target parameters were absolute dipole values and the dipole localisations. The relationship between absolute dipole values, dipole localisations and psychopathological findings (documented by the use of the PANSS, BPRS-scale) during a 3 week period with constant doses of clozapine and haloperidol was investigated using correlation analysis. RESULTS: Our results lend strong support to the assumption of a significant elevation of absolute dipole values [dipole density maximum (Dmax), dipole number (Dtotal), absolute and relative dipole density] in the fast frequency range (12.5-30 Hz) over the left hemisphere, especially in the temporoparietal region by clozapine. In this area, we found a dipole concentration effect only in patients treated with the atypical neuroleptic, whereas the dipole distribution in patients treated with haloperidol and healthy controls was concentrated in the central region. With regard to the absolute dipole values in the frequency ranges 2-6 Hz (delta, theta) and 7.5-12 Hz (alpha), we found no statistically significant differences between the groups investigated. In the slow frequency range (2-6 Hz) no difference was found between the clozapine and haloperidol group for the dipole localisation, which predominated in the temporoparietal region, in contrast to the central dipole distribution in control subjects. CONCLUSIONS: The results of an increase in beta activity under clozapine demonstrate a smaller reduction in activity in terms of unspecific sensory and motor paradigms in comparison with typical neuroleptics. The temporoparietal concentration of dipoles, in particular over the left half of the brain, might illustrate either their special role in the disease process, or the effects of the medication. The latter possibility was supported by the differing dipole distribution in the clozapine group with a left temporoparietal centre in both frequency ranges, and a deviating central dipole localisation in the fast activity range in the haloperidol group.

Duration of lithium treatment and brain lithium concentration in patients with unipolar and schizoaffective disorder--a study with magnetic resonance spectroscopy.

Twenty psychiatric patients on lithium medication were examined with 7-Li-magnetic resonance spectroscopy of the brain. Patients on long-term lithium treatment (> 6 months) were compared with a short-term group who had been taking lithium for between 4 and 8 weeks. Patients met DSM-III-R criteria for either recurrent unipolar depressive disorder (DSM-III-R 296.3x) or schizoaffective disorder, depressive type (DSM-III-R 295.70). The brain:serum lithium ratio was 0.76 +/- 0.26; there was no significant difference between short-term and long-term treatment. In the group of long-term treatment patients there was a positive correlation between lithium dose per day and brain lithium concentration (R = .72, p < .01), and between lithium plasma concentration and brain lithium concentration (R = .65, p < .05). In the short-term group, however, there was no significant correlation for these parameters. No differences between unipolar and schizoaffective disorder were found.

[Mianserin: pharmacology and clinical aspects of an effective antidepressive agents]. / Mianserin: Pharmakologie und Klinik eines bewährten Antidepressivums.

Among the non-tricyclic "newer" antidepressants, mianserin is one of the most thoroughly investigated agents. In the present review its chemical and pharmacological properties, as well as clinically relevant aspects of the use of this antidepressant are discussed. In the first instance, mianserin is indicated for the treatment of depressive illness associated with anxiety and agitation, even including severe forms of depression. Mianserin is characterised by a favourable side effect profile and low toxicity, and thus offers distinct advantages in the treatment of he elderly, as also in patients with a suicidal tendency.

Individual day-to-day variations in plasma amino acid levels in healthy persons.

Fasting plasma levels of the large neutral amino acids (LNAA;L-forms) andL-tryptophan (TRP) ratios were determined in thirteen healthy volunteers (7 males, 6 females) on five consecutive mornings, and the same procedure was repeated for each individual three months later. We found characteristic overall ranges for the parameters studied, and, in addition to certain differences between the sexes, considerable inter- and intraindividual daily variations. Although the individuals showed statistically identifiable mean levels that, in the majority of subjects, were maintained over a period of three months, it is concluded that the degree of intraindividual variability does not allow us to regard a single value as "characteristic" for a given individual. This should be borne in mind in particular in follow-up studies of plasma LNAA in patients with, for example, depressive disorders.

[Recognizing and treating suicidal behavior. Part 1. Results of scientific suicide research, relevant for general practice]. / Erkennung und Behandlung der Suizidalität. Teil 1: Praxisrelevante Ergebnisse der wissenschaftlichen Suizidforschung.

PROBLEM: Whatever his specialty, every medical practitioner will at some time encounter patients at risk of suicide. MAJOR TOPICS: Medical research into suicide has produced a wealth of knowledge with which the practitioner should be familiar if he is to provide such patients with adequate care. Great importance attaches to a knowledge of groups at a particularly high risk, of motivations, and of the phases of psychodynamic development leading to a suicidal crisis. CONCLUSIONS: On the basis of the particular features of the suicide risk, the family doctor, who is often consulted shortly before an attempt at suicide is enabled to recognize the mental distress of the patient.

[Recognition and treatment of suicidal risk. Part 2: Diagnostic and therapeutic procedure in medical practice]. / Erkennung und Behandlung der Suizidalität. Teil 2: Das diagnostische und therapeutische Vorgehen in der ärztlichen Praxis.

UNLABELLED: The knowledge gained by medical suicide research and clinical experience provides a practical basis for diagnostic and therapeutic guidelines for the care providing physician. Practical approach: The danger of suicide can be estimated on the basis of mental abnormalities and the health or social situation, and the level of risk approximately assessed. The appropriate therapeutic approach is determined in talks with the patient, which often decide his/her subsequent fate and that of the immediate family. The question as to whether to refer the patient to institutional psychiatric care--a step that should rarely have to be taken against the patient's will--must be carefully considered. CONCLUSIONS: The provision of care to suicidal patients on an outpatient basis requires from the physician a high level of knowledge, sensitivity and commitment that goes beyond mere specialized expertise.

[Brotizolam--an easy to tolerate hypnotic. Broad application spectrum in general practice and the clinic]. / Brotizolam--ein gut verträgliches Schlafmittel. Breites Anwendungsspektrum in Praxis und Klinik.

Sleep disorders constitute one of the most common complaints of patients in general practice. Although drug therapy is not always necessary, a hypnotic is, for a limited time, indispensable in severe cases with strong subjective impairment. Among the numerous hypnotics available on the market, Brotizolam is one of the most effective and well-tolerated of these drugs to initiate and maintain sleep. In the following survey, pharmacological and clinical properties of Brotizolam are described in detail.