Psychosomatic factors in borderline hypertensive subjects and offspring of hypertensive parents.

Psychosomatic factors, sympathoneural and sympathoadrenal as well as cardiovascular mechanisms, were studied in 24 patients 18-24 years of age with borderline hypertension, 50 age-matched normotensive offspring of hypertensive parents, and 49 controls with no family history of hypertension. They were compared by projective and questionnaire-based psychological tests and their circulatory and neurohormonal reactivity to mental (Stroop color-word conflict test and arithmetic test) and physical stressors (orthostasis and bicycle ergometry test) were measured. Borderline hypertensive subjects externalized aggression less (p less than 0.05) but internalized it more (p less than 0.05) and were more submissive (p less than 0.05) when compared with controls. Offspring of hypertensive parents showed a similar but weaker pattern. Both risk groups reported more positive interactions with their parents (genetic risk subjects versus controls, p less than 0.05; borderline hypertensive patients versus controls, p = 0.08) and had higher state-anxiety levels (p less than 0.05). There were more subjective symptoms of beta-adrenergic receptor-mediated functions (e.g., tachycardia, tremor) in borderline hypertensive subjects and offspring of hypertensive parents, elevated heart rates (analysis of repeated measures, p less than 0.001), and enhanced plasma norepinephrine concentrations (p less than 0.05) when compared with controls. These findings in subjects at risk for the development of hypertension suggest that psychosomatic factors and sympathetic overactivity are involved in the early phase of hypertension.

Sleep deprivation and bright light as potential augmenters of antidepressant drug treatment--neurobiological and psychometric assessment of course.

The present study was designed to investigate the clinical efficacy of trimipramine with adjunct sleep deprivation (SD) or bright light (BL) and to evaluate psychometric and neurobiological variables that might be of predictive value for treatment response. We used (1) the combined dexamethasone-corticotropin releasing hormone test (DEX-CRH test) to characterize alterations of the hypothalamic-pituitary-adrenal (HPA) system; (2) polysomnography to evaluate sleep disturbances; and (3) a standardized test battery to assess cognitive psychomotor functions after study initiation and after 5 weeks of treatment. The overall response rate (> or = 50% decrease in score on Hamilton Rating Scale for Depression [HRS]) was 55% (N = 42). The response rate in the group with trimipramine monotherapy (N = 14) was 79%, whereas in the groups with adjunct SD (N = 14) and BL (N = 14), respectively, it was only 43%. All three groups showed significant improvement at the end of the third week of treatment. Neither of the adjunct treatments hastened the onset of antidepressant action as measured by HRS. A significantly higher proportion of nonresponders than responders (p < .05) had HPA dysregulation, disturbed rapid eye movement (REM) sleep (REM latency, REM% first third of night) and decreased non-REM sleep (% stage 2). The non-responders showed significantly more corticotropin (ACTH) secretion after CRH stimulation in the DEX-CRH test than the responders and a less rapid normalization of the neuroendocrine dysregulation (cortisol secretion) (p < .01). In addition, REM latency was significantly shorter in the BL group than in the monotherapy group and estimated duration of illness significantly longer in the SD group than in the monotherapy group. REM latency, percentage of REM sleep during the first third of the total sleep period, percentage of non-REM sleep stage 2 and ACTH release after a DEX-CRH challenge predicted response across all three treatment groups. The neurobiological symptoms were unevenly distributed, among the three groups, thus creating heterogeneity in these measures. This heterogeneity may have contributed to the different treatment response rates as defined by psychopathology (HRS). In contrast, the neuropsychological tests and some of the sleep-EEG investigations revealed different response patterns for different groups: The onset of improvement in simple cognitive functions and in sleep continuity was earlier in the adjunct treatment groups. This study underlines the need for a multidimensional approach including use of neurobiological and neuropsychological measures to identify the therapeutic profiles of different treatment strategies and predictors of outcome.

Changes in EEG, blood levels, mood scales and performance scores during long term treatment with diazepam, phenobarbital or placebo in patients.

1. The patient population consisting of fifteen patients was divided into three groups, namely: diazepam group, phenobarbital group and placebo group. After three weeks the medicated groups were switched to placebo for a week and the placebo group was given phenobarbital. 2. The parameters to be assessed once a week comprised frequency-analyzed EEG recordings, performance in two attention tests and subjectively estimated mood modalities. 3. The EEG analysis suggested that EEG patterns: a) were drug-dependent, with a differential distribution for each drug of the four frequency bands analyzed; b) showed no change during the three-week treatment period; c) changed on cessation of medication or on switch from placebo to active medication; d) were task-dependent and changed in a systematic way with the level of activation (stress, vigilance or relaxation). 4. The results would allow a better understanding of the clinical course, the choice of therapeutic measures and of the underlying mechanisms of action.

Use and abuse of non-narcotic analgesics.

The definition of abuse and dependence of non-narcotic analgesics should take into consideration the interaction of drug and personality. Usually, definitions are based on qualitative aspects of the risk-benefit ratio in the use of psychotropic drugs. By means of modern research methods in epidemiology and clinical psychology, quantitative aspects might be integrated in the process of defining persons and drugs when evaluating their risk of abuse or dependence. In a prospective field study with working housewives of northwestern Switzerland who showed objective evidence of intake of non-narcotic analgesics and a control group, the interaction of drug use and personality features has been investigated. There was significant evidence that heavy use of non-narcotic analgesics was paralleled with a high risk of depression, emotional liability and disturbance in sexual identity. Using urine analysis, the study group was divided into two subgroups showing low or high intake of drugs, respectively. Special attention was focused on persons shifting from the study group into the control group and vice versa.

Psychopharmaca, psychic illness, and driving ability: a contribution to the debate.

Four studies treating methodological and clinical aspects of the question of driving ability of the mentally ill under psychopharmaca have been discussed. The complexity of the integral interplay in the domain of physiological, emotional, and psychomotor-cognitive functions relevant for driving behaviour makes an equally complex experimental design appear necessary to tackle this problem. Although the various test apparatus marketed for the investigation of driving fitness allow a relatively proper estimate, the examination of mentally ill patients under psychopharmaca calls for the differentiated inclusion of physiological, pharmacological, pharmacokinetic, psychomotor-cognitive, and personality-specific dimensions. The present state of science requires the repeated judgment of the treating therapist in addition. This judgment can only be made on the basis of a partnership between doctor and patient.

How capable of driving are hospitalized psychiatric patients under psycho-active drug therapy?

In an open investigation design two patient groups, under neuroleptics (n=30) and under antidepressants (n=31), were examined three times, the third time under steady-state conditions. A matched control group (n=32) provided the normative values. Various variables, thought to be psychologically relevant in traffic situations were measured on two test apparatus (tracking and complex reaction time). The result shows that the antidepressant group closely approaches the achievement of the control group on the most important variables measured. It may be concluded that psychopharmacologically well balanced depressive patients at the time of the steady-state are capable of producing results comparable to a control group with respect to traffic-relevant cognitive-psychomotor functions. The neuroleptic group, however, exhibits deviations on the same variables. In this sub-sample the primary disturbances of the underlying morbus (maintaining attention, continuous focusing ability) become conspicuous. From the medical point of view, the call for an individual clinical judgement of driving capacity by the treating physician continues to remain necessary, although the results produced offer some general decision aids.

The effect of bromazepam on psychomotor activity and subjective mood.

The effects of short-term (acute) doses of bromazepam were studied in a double-blind trial with the aid of three dosage groups comprising a total of fifty-five healthy male medical students (who received placebo, and 1.5 mg or 3.0 mg bromazepam, respectively). Subjective well-being was recorded through self-ratings by the volunteers, and the variables of psychomotor function by standard testing instruments. In terms of subjective well-being, fatigue and decreased performance (statistically confirmed throughout) were reported by the probands in all three dosage groups after they were administered either the drug or placebo. None of the dose-effect relationships were statistically significant, although this trend was more pronounced, purely in quantitative terms, in the group that received 3 mg bromazepam than in either the placebo or the 1.5 mg bromazepam group. In the reaction time and in critical flicker-frequency (CFF) testing, the trend mentioned above was confirmed. In the attentiveness and memory span test, learning effects were statistically confirmed in equally uniform fashion. The action of the substance was again not statistically significant. It may be concluded from this that subjective, and also in part objective, fatigue and decreased performance were related to the type of trial design employed, and not, generally speaking, to the action of the substance. However, again independently of the drug's activity, statistical confirmation was obtained of improved performance and/or learning activity in three variables of the alertness testing apparatus. Variables of driving ability were not adversely affected, but--if anything--stabilized. Our investigation studied the single-dose schedules of bromazepam--viz. 1.5 mg and 3 mg--that are most commonly prescribed for patients. The subacute and personality-related effects of the drug will be the subject of a later report.

The subacute effect of bromazepam on psychomotor activity and subjective mood.

In a double-blind study, fifty-five healthy, male medical students received a tranquilizer (bromazepam, 'Lexotanil') or placebo according to dosage group (placebo, 1.5 mg and 3 mg bromazepam). The subjects were randomly allocated to three groups (placebo: n = 19; 1.5 mg: n = 19; and 3 mg: n = 17). Dependent variables tested were the subjective assessment of performance and the level of activation (self-rating), and aspects of psychomotor function were assessed using the standard testing devices. The medication was administered for a total of 14 days. The testing times reported here were: before start, and after 7 and 14 days of administration of serum or placebo. The subjective evaluation (self-rating) such as performance assessment and level of activation demonstrated no changes related to either the medication or the length of time elapsed. The objective measures of performance revealed two main effects: lengthening of time of reaction to optical stimuli during the course of the study, especially in the higher bromazepam dosage group (sedative effect). This sedative effect was, however, relatively weak since, despite this observation, there was a significant training effect in the 3 mg group with regard to attentiveness and alertness testing. The results were also evaluated for a possible effect on driving ability. In the group studied here and at the relatively low dosage administered, any possible negative influence can be disregarded.

Driving ability of depressive patients under antidepressants.

A group of twenty depressive patients was compared during a 3-4 month course of antidepressant therapy (Maprotiline: n = 6, age = 46.1; dibenzepin: n = 4, age = 43.0; lithium: n = 6, age = 44.5; "mixed" (maprotiline, dibenzepin trimeprimine): n = 4, age = 50.2) with a healthy control group (n = 32, age = 38.2) for subjective assessment of their depressive mood and performance as well as objective measurement of variables relating to driving behaviour. The measurements were taken 2-4 weeks after a pre-treatment period (day 1) and after 2-3 months of further therapy (day 2). During therapy, all patients felt "less depressive" and "more capable" in subjective terms. All patient groups made learning progress in the objectively measured variables (psychomotor co-ordination and attentiveness tests). By day 2, the patient groups had almost reached the performance level of the control group, providing they received antidepressant therapy (regardless of the action profile) which was suitable for the basic disorder and the symptoms, and therapy was successful in the opinion of the physician. It may be concluded that depressive patients, assuming suitable antidepressant treatment and good response, are capable of driving while under maintenance therapy.

[A report on experiences using Goldberg's GHQ (General Health Questionnaire)]. / Mitteilungen über die Erfahrungen mit dem GHQ (General Health Questionnaire) von D.G. Goldberg.

The General Health Questionnaire (Goldberg and Hiller, 1978, 1979) is a screening instrument for clinical and preclinical assessment of psychosomatic disorders and proneness to such disturbance. It has been translated into German by F. Gutzwiller for a national health survey (SNF 8/SOMIPOPS) and has been used thereafter in several studies in combination with other psychometric instruments. This current paper presents a set of test-related theoretical and statistical parameters of the GHQ (28-item version). The specificity of the proposed scales (somatic symptoms, anxiety and insomnia, social dysfunction, severe depression) is relatively low in the German version. Nevertheless may the questionnaire be recommended for nonclinical and nonpsychiatric in-patient use, as it picks up aspects of depression and suicidal behavior, of a general disturbance feeling, and of mental and psychophysical stress and exhaustion. Further evaluation is recommended.

[Acute sedative effect of a herbal relaxation tablet as compared to that of bromazepam]. / Die sedative Akutwirkung eines pflanzlichen Entspannungsdragées im Vergleich zu Bromazepam.

The relaxing effect and the systemic tolerance of a single oral dose of Valverde relaxation dragées have been examined double-blinded against 3 mg of bromazepam and placebo in groups of 20 healthy male volunteers each treatment. The systemic tolerance was assessed at the end of the examination, relying on spontaneous remarks or comments made on side effects upon questioning. As the four plants from which Valverde has been extracted (valerian, balm, passion-flower, and pestilence wort) have a reputation of being tranquilizing agents with spasmolytic effect, not only this effect needs to be demonstrated, but also sedative side effects and impairment of vigilance must be assessed to explore the risk for accident proneness. We expected that the relaxing-tranquilizing effect of bromazepam as well as of Valverde relaxation dragées compared with placebo is perceived subjectively. A potentially existing impairment of performance due to Valverde was assumed to be milder than impairment due to bromazepam. The study, however, inspite of a sophisticated test battery with extended testing, could not detect any effect for either of the two drugs; nor could it detect a side effect. The sedation and reduction of vigilance observed in a pre-study without placebo controls (Gerhard and Hobi, unpublished) was explained by natural fatigue which appeared in the course of the morning also under placebo. Therefore, sedative side effects, leading to an impairment in performance, can be excluded for both drugs at the studied dose level.

[Dyskinesias in a clinical population. Results of a comparative follow-up]. / Dyskinesien in einer klinischen population. Ergebnisse einer Nachuntersuchung im Vergleich.

646 patients of a psychiatric clinic (272 m, 374 f) have been examined for tardive dyskinesia by two physicians, a neurologist and a psychiatrist. 192 patients exhibited some dyskinetic disturbances (32%). Thus the prevalence in this sample is rather high. The applied rating scale has proved successful (interrater reliability of .88). A year later the same sample of 192 patients (shrunk by 63 patients due to releases from the clinic and cases of death, non availability) was reexamined by the same physicians. The following results are noteworthy: Age exercises the strongest influence on the severity of tardive dyskinesia; women are more heavily affected than men; the clinical differential diagnosis has little influence on the degree of the disturbance; the same holds true for duration of therapy and dose. In the reexamination (computed as a dependent sample on the basis of 129 complete cases) a reduction of the intensity of dyskinesias has been observed. The results are discussed thoroughly from a clinical and methodological point of view.

[A new rating for the detection of dyskinesias. Clinical and metric problems]. / Ein Fremdrating zur Erfassung von Dyskinesien. Die klinische und metrische Problematik.

In context with a study on tardive dyskinesia in a psychiatric clinic, two ward psychiatrists rated patients with respect to extrapyramidal dyskinetic reactions. (Age, sex, type of neuroleptic treatment and diagnosis were taken into account.) Few multiple dyskinesias have been found. When they occur at all then predominantly in the area of head and limbs; dyskinesia of the eyes and joints of knee and elbow are rare. Although three factors can be extracted by a factor analysis (head, trunk, and limbs) the insufficient reliability of single subscales becomes evident. In spite of these metric problems the use of the rating in the existing version is justified for clinical and educational reasons. It is recommended to secure statistical reliability mainly with the total score which provides a good interrater reliability (.88 and .82) and a sufficient internal consistency (.70). For analyses of the course we suggest a data screening at the level of single items or subscales.