Global panic reaction II - a 7-step repetitive vicious circle.

The GPR-II model describes a "7-step" panic model. In this model, the single panic patient is not only affected as single member. The pressure weighing on him is not only exerted by external factors but also by group members of his network. Therefore, he has to cope with his individual problems and with the expectations of all members. The "therapeutic" model of instant sedation used (rescue screens) and long-lasting steps (behavioural therapy in group models) are not appropriate to treat the patients successfully.

Why not "double schizophrenia"?

The current approach to schizophrenic psychoses comprises the concept of a course characterized by a prodromal phase, an intermittent acute phase, and residual formation. Similar to the concept of the so-called double depression, there are, in addition to the subgroups of patients with primarily cognitive changes, patients in whom neurotic-dissociative components dominate prior to the disease outbreak itself. The question arises whether this process, considered thus far as prodromal, may possibly be interpreted beyond this as a combined pattern of progression in the sense of a "double schizophrenia" and thus differ symptomatically in the further course from other forms of schizophrenia. If so, in addition to the usual neuroleptic treatment, therapy should include an additional focus with more psychotherapeutic attention.

Time perception in patients with major depressive disorder during vagus nerve stimulation.

BACKGROUND: Affective disorders may affect patients' time perception. Several studies have described time as a function of the frontal lobe. The activating eff ects of vagus nerve stimulation on the frontal lobe might also modulate time perception in patients with major depressive disorder (MDD). METHODS: Time perception was investigated in 30 patients with MDD and in 7 patients with therapy-resistant MDD. In these 7 patients, a VNS system was implanted and time perception was assessed before and during stimulation. A time estimation task in which patients were asked "How many seconds have passed?" tested time perception at 4 defined time points (34 s, 77 s, 192 s and 230 s). The differences between the estimated and actual durations were calculated and used for subsequent analysis. RESULTS: Patients with MDD and healthy controls estimated the set time points relatively accurately. A general linear model revealed a significant main eff ect of group but not of age or sex. The passing of time was perceived as significantly slower in patients undergoing VNS compared to patients with MDD at all time points (T34: t = − 4.2; df = 35; p < 0.001; T77: t = − 4.8; df = 35; p < 0.001; T192: t = − 2.0; df = 35; p = 0.059; T230 t = −2.2; df = 35; p = 0.039) as well as compared to healthy controls (at only T77: t = 4.1; df = 35; p < 0.001). There were no differences in time perception with regard to age, sex or polarity of depression (uni- or bipolar). CONCLUSIONS: VNS is capable of changing the perception of time. This discovery furthers the basic research on circadian rhythms in patients with psychiatric disorders.

Nucleus lentiformis--a new model for psychiatry?

In a regions of interest analysis (ROI) of the most frequent psychiatric disorders (schizophrenia, depression, anxiety, addiction), we found the nucleus lentiformis to be the topographical brain region most frequently cited in connection with these disorders in a regions of interest survey of publications between 1990-2010. This structure, which controls particularly motorics, appears to have a much greater importance than has thus far been assumed in the control and modulation of psychiatric disorders. The question of the extent to which this region has its own control function with respect to the disorders should be addressed in further studies along with clarification of possible influence factors on the activity.

Changes in gustatory perceptions of patients with major depression treated with vagus nerve stimulation (VNS).

BACKGROUND: Olfactory and gustatory functions were investigated before and during vagus nerve stimulation (VNS) in a group of 9 patients with therapy-resistant depression, implanted with a VNS system. METHODS: Gustation and olfaction were tested using standard sniffing tests. Subjects participated in 2 sessions with the vagal stimulator switched on and off, respectively. RESULTS: Under conditions of stimulation of the VNS, there were statistically significant differences of the threshold of perception, with an intensification of the taste "sweet" (Z = -2.0; p = 0.048) and "bitter" (Z = - 2.5; p = 0.011) compared to the "off-mode". A statistical trend (Z = - 1.7; p=0.098) for increased intensity of the taste "salty" was observed, however, these results would supposedly disappear after correction for multiple testing presumably due to the large number of variables and the small sample size. There were no statistically relevant differences concerning olfactory perception. CONCLUSIONS: The changes of gustatory perception under conditions of vagal nerve stimulation observed in this study show another important central nervous effect of vagal stimulation on the limbic system that might be of importance in the elucidation of mechanisms of action of VNS especially on refractory depression.

[Long-term analysis of disability pensions in survivors of the Holocaust: somatic and psychiatric diagnoses]. / Erwerbsminderung bei Holocaustopfern: eine langzeitkatamnestische Betrachtung somatischer und psychiatrischer Diagnosen unter Berücksichtigung des Gesamtschauaspekts.

OBJECTIVE: Survivors of the Holocaust are known to suffer more often from mental as well as somatic consequential illness. The assessment of the degree of disability and invalidity due to the persecution complies with the interaction of directly Holocaust-related mental and somatic primary injuries as well as physical, psychical and psychosocial disadvantages and illnesses acquired later on. METHODS: The presented descriptive as well as multivariate analyses included complete reports (expertise, medical records, physicians' assessments, witnessed hand-written notes of the patients) of 56 survivors of the Holocaust (36 women and 20 men). RESULTS: The disability pension reports of 56 Holocaust survivors (36 women and 20 men) were analysed referring to the diagnostic groups and socio-demographic aspects. In 92.3 % a psychiatric illness could be diagnosed within the first year after liberation. In a separate analysis of somatic diagnoses, gastrointestinal diseases were statistically significant more often in Holocaust survivors with a degree of disability of more than 30 % (chi-square χ (2) = 4.0; df = 1; p = 0.046). CONCLUSIONS: The question of an aggravation of psychiatrically relevant and persecution-associated symptomatology is mainly the objective of the expert opinion taking into account endogenous and exogenous factors such as so-called life events. Above all, newly acquired somatic diseases seem to be responsible for an aggravation of persecution-associated psychiatric symptoms, at least in the presented sample of Holocaust survivors.

A functional magnetic resonance imaging navigated repetitive transcranial magnetic stimulation study of the posterior parietal cortex in normal pain and hyperalgesia.

Noxious stimuli activate a complex cerebral network. During central sensitization to pain, activity in most of these areas is changed. One of these areas is the posterior parietal cortex (PPC). The role of the PPC during processing of acute pain as well as hyperalgesia and tactile allodynia remains elusive. Therefore, we performed a functional magnetic resonance imaging (fMRI) based, neuro-navigated, repetitive transcranial magnetic stimulation (rTMS) study in 10 healthy volunteers. Firstly, pin-prick hyperalgesia was provoked on the right volar forearm, using the model of electrically-induced secondary mechanical hyperalgesia. fMRI was performed during pin-prick stimulation inside and outside the hyperalgesic areas. Secondly, on four different experimental sessions, the left and right individual intraparietal BOLD peak-activations were used as targets for a sham-controlled 1 Hz rTMS paradigm of 10 min duration. We measured psychophysically the (i) electrical pain stimulus intensity on an 11-point numeric pain rating scale (NRS, 0-10), the (ii) area of hyperalgesia, and the (iii) area of dynamic mechanical allodynia. Sham stimulation or rTMS was performed 16 min after induction of pin-prick hyperalgesia and tactile allodynia. Compared to sham stimulation, no significant effect of rTMS was observed on pain stimulus intensity and the area of allodynia. However, a reduction of the hyperalgesic area was observed for rTMS of the left PPC (P<0.05). We discuss the role of the PPC in central sensitization to pain, in spatial discrimination of pain stimuli and in spatial-attention to pain stimuli.

[An exploration of the association between disability pension and psychiatric diseases]. / Frühberentung aufgrund psychiatrischer Erkrankungen. Eine Analyse von 94 Berufsunfähigkeitsgutachten.

OBJECTIVE: The necessity to establish disability and invalidity pensions due to psychiatric diseases has become more and more demanding in recent years. So far there is little knowledge about the aetiology and socio-demographic aspects of this phenomenon. METHODS: The presented explorative analyses included 94 examinations (43 women, 51 men) to address, if a person should be medically certified as partly or permanently unfit for work. The data, including psychiatric diagnosis and socio-demographic data were obtained between 1999 and 2006 in a German specialised psychiatric university unit. RESULTS: The diagnoses of neurotic diseases, stress related and somatoform disorders (ICD-10 F 40 - 48) were the most prevalent group (48 %) within the sample. It was a statistically significant predictive factor in a later declaration of disability and invalidity. In this diagnosis group (F 40 - 48) more participants were female when compared to other diagnosis groups. In general, participants were more likely to be divorced and have a lower education level when compared to the general population. However, the mean level of intelligence was similar to the general population. CONCLUSION: The results of the presented study could be beneficial for a better understanding of the association between disability pensions and psychiatric diseases. The increase of neurotic diseases, stress related and somatoform disorders may justify the development of targeted prevention strategies.

Cardiac effects of vagus nerve stimulation in patients with major depression.

INTRODUCTION: Changes in the heart rate variability are well known among patients with depression. Amongst others, a modulation of the autonomic nervous system is discussed. An investigation of heart rate variability during terms of stimulation could give some insight in the central nervous effect of vagus nerve stimulation (VNS) and possible cardiac side effects. METHODS: The effects of VNS on heart rate (HR) and heart rate variability were studied (HRV) during stimulation in nine patients with major depression according to ICD-10. RESULTS: When comparing treated depressive patients with a sex- and age-matched healthy control group, the analysis of heart rate revealed significantly (t=2.8; df=16, p=0.012) elevated heart rates during completely switched off conditions, during switched on VNS programme in stimulation-free intervals (5 min period) (t=3.0; p=0.009) and during stimulation conditions (30 s) (t=2.8, Levene corrected, p=0.015). The RMSSD (root mean square of successive differences) as a measure of the HRV increased significantly in switched on conditions during stimulation (30 s) in six patients compared to stimulation-free intervals (t=-4.7; df=5, p=0.006) and baseline. DISCUSSION: Clinically relevant cardiac effects were not observed throughout the study. VNS induces reversible changes in heart rate variability in patients with major depression during stimulation conditions.

Influenza H1N1 and the world wide economic crisis--a model of coherence?

A recent published model described the phenomenon of a global panic reaction (GPR) on the stock markets based on two remarkable stock market crashes in the months of January and March [Sperling W, Bleich S, Reulbach U, Black Monday on stock markets throughout the world - a new phenomenon of collective panic disorder? A psychiatric approach. Med Hypotheses; 2008]. This model was completed by a therapeutic approach following typical elements of cognitive behavioural therapy (CBT) [Sperling W, Biermann T, Maler JM, Global panic reaction - a therapeutic approach to a world-wide economic crisis. Med Hypotheses; 2009]. The phenomenon of a global panic reaction due to economic crises seems to have even larger implications on human health as well. It is well known that acute and chronic distress is competent to suppress the immune system by various mechanisms that are discussed in detail. This global panic reaction - that has also been observed in former times - might therefore be responsible for the new variation of recent influenza pandemic coming from Mexico.

Clinical benefits and cost effectiveness of vagus nerve stimulation in a long-term treatment of patients with major depression.

BACKGROUND: To evaluate clinical aspects and cost effectiveness of the treatment with vagus nerve stimulation (VNS), a group of 9 VNS-implanted patients and 9 age- and sex-matched patients suffering from treatment-resistant depression were included in a prospective study. METHODS: The psychopathological ratings over 12 months as well as socio-economic data on the duration of hospitalisation, frequency of outpatient treatment, and subsequent drug treatment were compared with the pre-implantation period. RESULTS: Compared with baseline values in the HAMD scale (mean 23.7; SD 2.4), there was a significant (t=14.5; df=8; p<0.001) improvement in symptoms after 12 months' stimulation (mean 10.2; SD 2.4). The duration of hospitalisation dropped on average by 20 days in the first post-implantation year, the treatment frequency from 33 to 14 visits, and drug treatment from 4 to an average of 3 psychotropic drugs. CONCLUSION: In addition to an improvement in clinical symptoms, the VNS method might enable an amortisation of costs.

Global panic reaction--a therapeutic approach to a world-wide economic crisis.

Drastic losses on the stock markets within short periods have been the subject of numerous investigations in view of the fact that they are often irrational. In a recently published model we reported about the world-wide phenomenon of Global panic reaction (GPR) [Sperling W, Bleich S, Reulbach U. Black Monday on stock markets throughout the world - a new phenomenon of collective panic disorder? A psychiatric approach. Med Hypotheses 2008;71(6):972-4], which illustrate typical psychiatric symptoms of panic disorder. We now complete this model by a therapeutic approach for the patient. Therefore the identification of a therapeutic regime "step by step" was necessary.

Herp mRNA expression in patients classified according to Lesch's typology.

Chronic alcoholism is associated with hyperhomocysteinemia. Herp (homocysteine-induced endoplasmic reticulum [ER] protein) levels are elevated as a response to ER stress prior to mitochondrial dysfunction and cell death. The Lesch classification system has been applied in many studies and has been found useful. This study was undertaken to assess Herp mRNA expression in actively drinking patients with alcoholism who were classified according to Lesch's typology. Herp mRNA expression levels were measured by quantitative PCR in the blood of 76 male alcoholic patients. Patients were classified according to Lesch's typology (type I-IV). With respect to Lesch's typology, a significant difference in Herp mRNA expression regarding the four subtypes could be shown (F[3,72]=2.83, P=.044). In a logistic regression model (dependent variable Herp dichotomized by a median-split; adjusted for age and homocysteine levels) the subtype II differed statistically significant from the others (odds ratio, 5.75; 95% confidence interval, 2.07-15.98; P=.001). Type II alcoholic patients had a statistically significant higher expression of Herp mRNA due to upregulation of the expression of this neuroprotective cell non-chaperone by toxic effects of ethanol. These findings might explain why type II patients do not express severe withdrawal symptomatology (i.e., withdrawal seizures). These findings may be useful in the understanding and treatment considerations of different subtypes of alcohol dependence.

Memantine fails to facilitate partial cigarette deprivation in smokers--no role of Memantine in the treatment of nicotine dependency?

The efficacy of Memantine in the treatment of nicotine dependency in humans remained to be evaluated. The aims of our pilot study were to investigate (1) the effectiveness of Memantine in facilitating smoking reduction and (2) the influence of Memantine on the perception of nicotine. In order to achieve these aims we conducted a placebo controlled double-blind parallel group study in smokers (n = 20 per group). Before the beginning of the treatment-phase (10/20 mg Memantine per day) all participants were instructed to reduce smoking (partial deprivation). Before and during partial deprivation we registered the daily cigarette consumption and craving estimates. Following nasal stimulation with nicotine enantiomers hedonic and intensity estimates and the discrimination ability were assessed. Memantine failed to facilitate smoking reduction and did not influence the perception of nicotine with the exception of a weak reduction of olfactory intensity estimates reaching statistical significance for one nicotine enantiomer only.