[Determinants of unplanned discharge from in-patient drug and alcohol detoxification: a retrospective analysis of 239 admissions]. / Determinanten eines Therapieabbruchs während der stationären qualifizierten Entgiftungsbehandlung bei Patienten mit Alkohol- und Drogenabhängigkeit.

Unplanned and premature discharge from in-patient alcohol or drug detoxification is a common and severe problem in the treatment of substance abuse. So far, most of the relevant studies focused on drug detoxification, whereas only few studies also investigated alcohol detoxification. The aim of the present study was to comparatively identify and analyse determinants of unplanned discharge during in-patient treatment in both diagnostic groups which simultaneously underwent detoxification under the same treatment setting. Subjects were 239 consecutive admissions (alcohol: n = 90; illegal drugs: n = 149) to a specialised qualified detoxification unit at the Psychiatric University Hospital of Heidelberg during the year 2000. Data on sociodemographical and psychosocial variables, medical history, psychopathological findings on admission and presence of psychiatric and/or somatic comorbidity as well as intensity level of withdrawal symptoms were collected retrospectively and analysed with respect to the prediction of planned/unplanned discharge. The high overall rates of unplanned discharge (alcohol: 43.3 % and drugs 62.4 %) confirm the previously reported figures. Treatment success of drug patients was rather affected by sociodemographical and psychosocial factors such as level of education, delinquency, unemployment and hepatitis C diagnosis. Relating to alcohol patients psychopathological findings on admission including orientation, affective state and cognition were most relevant for planned discharge. Furthermore, the results of this study underline the central role of motivation during in-patient treatment as well as the importance of a planned treatment continuation after discharge from the detoxification program.

Pergolide as adjuvant therapy to amisulpride in the treatment of negative and depressive symptoms in schizophrenia.

Negative and cognitive symptoms of schizophrenia are associated with a hypodopaminergic state in the frontal cortex and do not respond to neuroleptics equally well as positive symptoms. Therefore pharmacological strategies, which increase dopamine metabolism in the mesocortical pathways, may prove beneficial to ameliorate these symptoms. We report on a case of a patient with paranoid schizophrenia, who still presented negative and depressive symptoms during treatment with amisulpride for more than 6 weeks. We prescribed pergolide (a mixed D1/D2 agonist) as adjuvant therapy to treat these symptoms. The patient showed an improvement of global psychopathology, decrease of negative and depressive symptoms, while no changes in positive symptoms nor EPS were present. For this patient, the adjuvant therapy of pergolide to amisulpride constituted a valid pharmacological approach to treat negative and depressive symptoms of schizophrenia, without increasing positive symptoms.

Does prophylaxis-delay in bipolar disorder influence outcome? Results from a long-term study of 147 patients.

OBJECTIVE: This study investigated the impact of latency (the time between illness onset and initiation of prophylactic treatment) on the outcome of prophylaxis in bipolar disorders. METHOD: The effect of prophylaxis delay (latency) on the course of illness was assessed in 147 patients. Dependent variables were: reduction of days spent in the hospital (prior to vs. during prophylaxis), time to first recurrence, and Morbidity-Index during prophylaxis (lithium or carbamazepine). Latency and other independent variables were tested using a multivariate approach. RESULTS: Latency (9.3 years on average) had no significant effect on the subsequent response. Illness severity prior to prophylaxis, however, did predict the relative response. The course of illness during treatment could not be predicted by any one factor. CONCLUSION: The delay in initiating prophylaxis appears to have no influence on prophylaxis outcome. Instead, those whose illness was more severe were treated earlier and these patients subsequently showed a relatively greater response. If severity is not controlled for as part of the analysis, latency may be mistaken as an important predictor for response.