[Diagnostics and therapy of depression in the general practice]. / Patient mit Depression in der Hausarztpraxis. Selbst behandeln oder zum Facharzt?

Depressive disorders are commonly encountered by primary care practitioners. Some four million people in Germany suffer from depression. This disease, which is life-threatening primarily due to the suicide risk, is still often not recognized and, consequently, undertreated. Once diagnosed, depression can be treated successfully with antidepressants, cognitive behavior therapy/interpersonal psychotherapy or a combination of both. Newer, selective drugs are preferred when choosing a suitable antidepressant due to their better tolerability and lower toxicity. A synopsis of the diagnosis and therapeutic algorithm of depressive disorders as well as recommendations for referrals to a specialist or hospital for the primary care physician are provided.

[Diagnosis and treatment of depressive disorders in the doctor's office]. / Depression--erkennen, behandeln, vorbeugen. Was kann der Hausarzt tun?

Depression is underdiagnosed and undertreated though its high prevalence and life-threatening character. Once identified, depression can be treated successfully with antidepressants, cognitive behavior therapy/interpersonal psychotherapy or a combination of both. Regarding selection of a particular antidepressant, newer, selective drugs are preferred due to better tolerability and low toxicity.

Cloning of phospholipid hydroperoxide glutathione peroxidase (PHGPx) as an anti-apoptotic and growth promoting gene of Burkitt lymphoma cells.

Burkitt Lymphoma (BL) cells are highly sensitive to suboptimal growth conditions and undergo apoptosis when seeded at low cell density or reduced serum concentration. Irradiated fibroblasts or a mix of pruvate, alpha-thioglycerol, and bathocuproine disulfonate can protect BL cells from apoptosis induced by lowering cell density or serum concentration by promoting cystine uptake in the cells. The availability of cystine is the limiting factor for glutathione biosynthesis in BL cells and thus for the ability of the cells to cope with oxidative stress. We have set up an expression cloning strategy to clone genes that protect BL cells from apoptosis induced by low cell density and/or serum. Using this approach we have cloned among others the cDNA for Phospholipid Hydroperoxide Glutathione Peroxidase (PHGPx).

[Acoustic hallucinations as a symptom of a REM sleep-associated parasomnia]. / Akustische Halluzinationen als Symptom einer REM-Schlaf-assoziierten Parasomnie.

This 52-year-old man suffered from auditory hallucinations that occurred during brief episodes of sleep paralysis at the end of REM sleep periods. During these episodes the patient experienced a dissociated state of consciousness with REM sleep intrusions into wakefulness. The occurrence of this mixed state, and of excessive sleep-onset REM periods during daytime polysomnography (MSLT = Multiple Sleep Latency Test), point to a disorder of REM sleep generation. The existence of narcolepsy could be ruled out. The observation of REM sleep-associated hallucinations has been reported earlier. In the presented polysomnographic sleep studies the existence of a REM sleep associated parasomnia characterised by hallucinations and sleep paralysis could be confirmed.

[Pharmacotherapy]. / Pharmakotherapie.

The high prevalence of anxiety disorders implies the necessity of adequate treatment by GPs. Regarding psychopharmacological treatment benzodiazepines and antidepressants are the drugs of first choice, low potency neuroleptics, beta-blockers as well as the herbal medicine kava-kava may be indicated in special cases (e.g. low degree of anxiety, abuse or tolerability problems). The separation of generalized anxiety disorder from panic disorder seems to be essential due to treatment implications: antidepressants like Imipramine or SSRIs are the drugs of choice in the latter case. Hints regarding handling as well as possible side-effects of the different psychotropics are given, the combination with psychotherapy (relaxation techniques, behaviour therapy) is recommended being the best way of effective treatment.

[Concept for a behavior therapy treatment program in primary insomnia]. / Konzept eines verhaltenstherapeutischen Programms bei primärer Insomnie.

The need to find effective non-drug treatments for primary insomnia has lead to the application of a variety of psychological approaches. However, one difficulty in the treatment of insomnia is the variety of types, such as sleep-onset and sleep-maintenance insomnia, as well as individual differences in the specific antecedents and conditions maintaining poor sleep. There is no consensus regarding treatment selection. This paper documents the authors' work in formulating a group intervention approach for patients suffering from primary insomnia. A multiple treatment approach was used to provide flexibility. The group treatment consists of the following elements: (1) stimulus control, (2) restriction of time in bed, (3) general education regarding sleep and sleep hygiene, (4) progressive muscle relaxation and (5) cognitive strategies aimed at reducing stimulating mental activities. A description of the techniques used and the structure and process of the group model used is provided.