[Multidimensional diagnostics in pharmacopsychiatry/results of therapy with desmethyl-loxapine (author's transl)]. / Mehrdimensionale Diagnostik in der Pharmakopsychiatrie Ergebnisse eines Therapieversuchs mit Desmethyl-loxapine

In view of the particular problems of psychiatric classification the advantages and disadvantages of standardised rating scales are discussed. The result is that these instruments at present are irreplaceable in psychopathological research on behalf of their reliability in transmitting information and the possibility of quantifying psychopathological syndromes. The practice of 4 rating scales, which are still uncustomary mainly in the area of German language, is demonstrated by means of a psychopharmacological investigation example. These rating scales are: 1. the Hamilton Psychiatric Rating Scale for Depression, 2. the Wittenborn Psychiatric Rating Scale, 3. the Structured clinical Interview (Burdock and Hardesty) and 4. the Befindlichkeitsskala (Condition Scale) (v. Zerssen). Within a duration of treatment of 3 and 4 weeks desmethyl-loxapine [CL 67 772, 2-chloro-11-(1-piperazinyl)-dibenz (b,f)(1,4)-oxazepine] was tested in an open study as an antidepressant on 16 patients with different depressive syndromes. The results of treatment, which can be considered positive, are represented and discussed in an intra-individual pre- and after-treatment comparison in respect of the differences between these scales. The good therapeutic efficacy of desmethyl-loxapine results mainly from a marked anxiolytic effect. All the clinical and chemical examinations performed point out an excellent tolerance of this drug. German versions of standardised rating scales appear urgently indicated.

[The significance of standardized evaluation scales in psychiatric diagnosis as exemplified by the therapeutic intervention with desmethyl-loxapine (author's transl)]. / Die Bedeutung standardisierter Beurteilungsskalen in der psychiatrischen Diagnostik--dargestellt am Beispiel eines Therapieversuchs mit Desmethyl-Loxapin

Taking into account the particular problems of psychiatric classification the advantages and disadvantages of standardised rating scales are discussed. The authors come to the conclusion that these instruments at present are irreplaceable in psychopathological research because of their reliability in transmitting information and the possibility of quantifying psychopathological syndromes. The use of four rating scales which are little known yet within German speaking countries in demonstrated by means of a psychopharmacological investigation on the clinical effects of Desmethyl-Loxapine. These rating scales are: 1. the Hamilton-Psychiatric-Rating-Scale for Depression 2. the Wittenborn-Psychiatric-Rating-Scale 3. the Structured Clinical Interview (Burdock and Hardesty) and 4. the Befindlichkeits-Skala (Condition-Scale). Desmethyl-Loxapine was given in an open study as an antidepressant to 16 patients with different depressive syndromes. The results of treatment which lasted 3 to 4 weeks are discussed. The good therapeutic efficacy of Desmethyl-Loxapine was mainly due to its marked anxiolytic effect. All accomplished clinical examinations showed an excellent tolerance of this drug.

[Importance of timing of music therapy in chemotherapy of cancer patients]. / Musiktherapie bei der Chemotherapie von Krebserkrankungen: wann beginnen, wann einsetzen? Beeinflussung der Stresshormone durch Musiktherapie während der chemotherapeutischen Behandlung von Patientinnen mit radikal reseziertem Mammakarzinom.

Neither the measured stress-hormones, nor Beta-Endorphin have been influenced by music therapy. Music therapy should be initiated before the beginning of chemotherapy, preferably shortly after the operation. The greatest profit of an accompanying music therapy is between the chemotherapy courses, because the whole energy of the patient during chemotherapy is directed to questions, worries and practical aspects.

[Visual evaluation of conventional roentgen pictures and dual x-ray absorptiometry in the diagnosis of osteopenia]. / Visuelle Beurteilung konventioneller Röntgenaufnahmen und duale Röntgenabsorptiometrie in der Diagnostik der Osteopenie.

Routine radiographs and PA dual x-ray absorptiometry (DXA) of the lumbar spine were performed in 253 patients. A T-score of -2SD (approximately 20% reduction from young normal bone mineral density (BMD)) as measured by DXA, was used as threshold for the diagnosis of osteopenia. A lumbar spine index (LSI) as proposed by Barnett and Nordin was assessed by one radiologist. The correlation between LSI and bone mineral density, measured by DXA, was poor, and our results indicate that osteopenic patients cannot be differentiated from non-osteopenic patients by LSI. 100 radiographs of the lumbar spine were evaluated by 9 observers in order to determine observer variation in the detection of osteopenia. A complete agreement between the readers for the diagnosis of osteopenia was achieved in 43 percent of all radiographs. DXA and observers agreed in 68 to 76 percent of all cases. For a decrease of BMD of more than 60 percent compared to young normal adults, as determined by DXA, all readers agreed in the diagnosis of osteopenia, whereas for higher BMD values the agreement between readers and DXA worsened. The inconsistency between DXA and observer agreement was greatest for patients with a BMD reduction between 10 and 20 percent. The mean values of the kappa-coefficients were 0.574 +/- 0.06 for interobserver variation and 0.437 +/- 0.06 for the agreement between readers and DXA-results. An only moderate kappa-coefficient of 0.573 for the intraobserver variation as determined in one reader was found.

Interobserver variation in the detection of osteopenia by radiography and comparison with dual X-ray absorptiometry of the lumbar spine.

In 100 patients (20 male, 80 female) radiographs of the lumbar spine were obtained in both planes, anteroposterior and lateral. Nine readers independently and without specific criteria or training assessed the radiographs for presence of osteopenia in the form of a binary decision. A posteranterior dual x-ray absorptiometry (PA DXA) measurement of the lumbar spine was performed in all patients using the Hologic QDR 1000 bone densitometer. A bone mineral density (BMD) of 0.83 g/cm2 (T-score about 2 SD and 2.5 SD lower than BMD in normal young female and male subjects respectively) was used as a threshold for the diagnosis of osteopenia. Complete agreement amongst the 9 readers was achieved in 43 patients. In 26 more patients at least 8 readers agreed. kappa-coefficients for interobserver variation ranged from 0.458 to 0.691 for reader pairs. For agreement between the observer ratings and the DXA results, kappa-coefficients ranging between 0.347 and 0.555 were found. The vast majority of readers agreed in the diagnosis of osteopenia in cases where the BMD was less than 0.73 g/cm2. Where the BMD was between 0.73 and 1.03 g/cm2 a substantial disagreement was found between reader evaluation and DXA measurement, and also amongst the readers. We conclude from our results that osteopenia can reliably be detected from lumbar spine radiographs by all readers only after a substantial amount of BMD is lost. On the other hand, a diagnosis based solely on PA DXA measurement of the spine may also lack accuracy, due to a substantial influence of degenerative changes of the lumbar spine and aortic calcification.(ABSTRACT TRUNCATED AT 250 WORDS)