Cardiovascular effects of paroxetine.

In a double-blind clinical study, electrocardiogram, blood pressure and systolic time intervals were measured in 40 depressive patients treated with either paroxetine (30 mg/day) or amitriptyline (150 mg/day) for 6 weeks. While amitriptyline significantly increased the heart rate, the QTc interval and the PEP/LVET ratio, paroxetine did not alter any of the cardiovascular parameters measured.

The recruitment process for a multicenter study on the long-term prophylactic treatment of affective disorders.

The paper reports on the process of patient recruitment for a controlled clinical multicenter study on the treatment of affective disorders. Two thirds of the patients screened did not participate because prophylactic treatment was either unnecessary or not justified for medical reasons. Further, a number of patients equal to that eventually allocated to the trial refused to participate for personal, idiosyncratic reasons. In spite of this, the patients in the trial were very similar to those not participating with respect to relevant variables such as age, sex, number of and intervals between previous episodes or severity of the present episode.

Lithium versus carbamazepine in the maintenance treatment of bipolar disorders--a randomised study.

In a randomised multicentre study, the prophylactic efficacy of lithium and carbamazepine was compared in 144 patients with bipolar disorder (74 vs. 70 patients; observation period: 2.5 years; lithium serum level: 0.63 +/- 0.12 mmol/l, carbamazepine dose: 621 +/- 186 mg/day). Hospitalisations, recurrences, need of psychotropic comedication and adverse effects prompting discontinuation were defined as treatment failures. Survival analyses regarding hospitalisations and recurrences showed no statistically significant differences between both drugs. Results were distinctly in favour of lithium, considering recurrences combined with comedication (P = 0.041) and/or adverse effects (P = 0.007). Whereas adverse effects prompting discontinuation were more frequent under carbamazepine (9 vs. 4, ns), lithium patients reported more often slight/moderate side effects (61% vs. 21% after 2.5 years; P = 0.0006). In completers, recurrences occurred in 28% (lithium) vs. 47% (carbamazepine) of the patients (P = 0.06). Lithium seems to be superior to carbamazepine in maintenance treatment of bipolar disorder, in particular when applying broader outcome criteria including psychotropic comedication and severe side effects.

Comparative efficacy of lithium and amitriptyline in the maintenance treatment of recurrent unipolar depression: a randomised study.

The present study, including 81 depressive patients, compares the prophylactic efficacy of lithium and amitriptyline in recurrent unipolar depression over a treatment period of 2.5 years in a randomised multicentre design. Hospitalisation, re-emergence of depressive or subdepressive recurrences, unwanted side-effects and need of concomitant psychotropic medication were considered to indicate treatment failures. Average dosage for amitriptyline was 98 +/- 37 mg/day, average lithium blood level was 0.59 +/- 0.12 mmol/l. Survival analyses demonstrated a significant superiority of lithium (P = 0.015) regarding the outcome criteria 'recurrences and/or subclinical recurrences' and non-significantly better results of lithium compared to amitriptyline concerning 'recurrence' (P = 0.059) or 'recurrence and/or concomitant medication' (P = 0.066).

[Highly dosed St. John's wort extract improves quality of life]. / Johanniskrautextrakt verbessert die Lebensqualität. Eine Anwendungsbeobachtung an 4337 depressiven Patienten über zwölfWochen.

AIM: Aim of the post-marketing surveillance was to investigate if the single-dose-administration of highlydosed St. John's Wort extract improves quality of life of patients with depressive symptoms. METHOD: During a twelve week treatment 4337 patients with depression were observed. Mental and physical state of health were documented using the SF-12-sumscore as a measure for quality of life. Further efficacy and tolerability was rated by physician and patient. Adverse drug reactions were documented as well. RESULTS: During therapy the mental and the physical SF-12-sumscore had improved significantly. At the end ofthe observation the values rise up to the norm. About 80 percent of the physicians and patients marked the drug's efficacy as good or very good. Tolerability was assessed as good or very good in more than 95%. CONCLUSION: A post-marketing surveillance including 4337 depressive patients shows that a single-dose therapy with highly dosed St. John's Wort extract causes to improve significantly the quality of life. The patients suffered from mild to moderate depression.

[Cerebral arteriosclerosis: neurologic and psychiatric consequences]. / Arteriosklerose der Hirngefässe: Neurologische und psychiatrische Folgen.

Cerebral arteriosclerosis is a frequent, often not sufficiently diagnosed disease in the second half of the life span. Possible causes, diagnosis, and therapy are explicitly shown of its somatic and psycho-pathological symptoms, often acute, and chronically persistent. Particular emphasis is put on acute-care and the therapeutic relevance of socio-and psychotherapy. Finally, consequences for forensic medical opinions are shown.

Sleep deprivation and circadian rhythm in depression.

The effect of total sleep deprivation for one night on the depressive state (measured using the depression rating scale of Bojanovsky and Chloupkova) and the patients' actual state of well being (measured using the self-rating scale of von Zerssen) is investigated in a group of 40 randomly selected inpatient depressives (29 endogenous depressives, 11 neurotic depressives) over a period of 36 h. The endogenous depressives exhibited a statistically significant change. The total index of the depression scale improved by 22.6%, recorded as a 'daily mean difference'. The individual symptoms of depressive mood, lack of interest, inhibition and inappetence were significantly improved. The feature of vital disorders and its common appearance with diurnal variations correlates positively with the degree of sleep deprivation effect. The symptomatology of the neurotic depressive patients also showed a significant improvement but the relatively small group of particularly severe neurotic depressives who also exhibited vital disorders is not representative. In a group of cases, sleep deprivation caused reversion in the depressive symptomatology not only during the night of deprivation but influenced the diurnal rhythm of the depressive symptomatology on the following day, in a therapeutically favourable direction. The results are compared with those of other studies. The methodological problems are discussed and methodological improvements for further investigation are proposed.

Circadian rhythm of circulatory functions in depressives and on sleep deprivation.

Continuous examinations of circulatory functions in three 24-hour periods, before, during and after sleep deprivation, were carried out on 26 endogenous depressives and 10 neurotic depressives. The blood pressure recordings scarcely revealed relevant findings. The diurnal rhythm of heart rate in endogenous depressives is less pronounced than in healthy subjects, a phasal shift not being noted. A correlation between diurnal variation of depression symptomatology and the circadian rhythm of hear rate could be presumed on the basis of these findings. The heart rate curve is further flattened, almost levelling off, on sleep deprivation. The extent of this change is related to the therapeutic effect of sleep deprivation. A less pronounced diurnal rhythm of heart rate was also noted in neurotic depressives; however, there was no relationship between the therapeutic effect of sleep deprivation and its influence on heart rate.

What provision is made by practicing physicians for psychogeriatric patients in western Germany?

This study examined some aspects of psychogeriatric care in Münster, Germany. The diagnostic and therapeutic attitudes of 94 general practitioners/internists and neurologists/psychiatrists toward demented patients were investigated by questionnaire. This figure represents a return rate of approximately 55% on the questionnaires. As is typical in Germany, no physicians were specializing in geriatric patients, and fewer general practitioners/internists than neurologists/psychiatrists had undergone supplementary psychogeriatric training. A higher percentage of the latter group estimated more than 10% of their elderly patients were demented. Both estimated Alzheimer's disease as less frequent than multi-infarct dementia. Physicians with training in psychogeriatrics claimed to treat more elderly patients than physicians without it. With regard to therapeutic procedure, physicians with psychogeriatric training prescribed nootropics more guardedly. The data from this pilot study suggest that there are no eminent discrepancies between the different medical groups with regard to psychogeriatric care, but there is a great need for supplementary training.

Schizophrenic autism. 1. Historical evolution and perspectives.

Cardinal importance has often been attached to the term 'autism' within the scope of schizophrenic symptomatology since its introduction by E. Bleuler in 1911. However, this term has been used purely intuitively in most cases, giving rise to a great deal of speculation about autism and its role within different psychiatric disorders, speculation which could not then be examined empirically for lack of intersubjective definition. This article reviews and examines the historical concept of autism, and finally makes and discusses proposals for future perspectives on autism.

Schizophrenic autism. 2. Proposal for a nomothetic definition.

Since its introduction by E. Bleuler in 1911, the so-called 'basic symptom' autism has often been considered cardinally important within schizophrenic symptomatology. A lack of precise definition and hence of reliability, however, has eroded the former importance of this term, which cannot be found in modern diagnostic systems. Using a specific text-analytical method, we evaluated all accessible publications on schizophrenic autism, focusing on the descriptive-empirical approach. The entire material was then summed up in five essential points, providing a possibly more reliable (nomothetic) explication of the complex term of autism.

Relationship between parameters of serotonin transport and antidepressant plasma levels or therapeutic response in depressive patients treated with paroxetine and amitriptyline.

In a double-blind clinical study, antidepressant plasma levels, parameters of platelet serotonin (5-HT) transport (Km, Vmax and basal platelet 5-HT content) and therapeutic response were measured in depressive patients treated with either paroxetine (30 mg/day) or amitriptyline (150 mg/day) for 6 weeks. No correlation could be found between paroxetine plasma levels and therapeutic outcome after 2, 4 and 6 weeks of treatment. In contrast to the amitriptyline group, a marked increase in Km from baseline to week 2 was determined in paroxetine-treated patients, with Km increase being correlated with paroxetine plasma levels at week 2. However, no significant relationship could be found between 5-HT transport parameters and any of the outcome measures in either treatment group.

[Total and partial sleep deprivation in the treatment of depression: preliminary communication]. / Totaler und partieller Schlafentzug in der Behandlung von Depressionen: Vorläufige Mitteilung

Sleep deprivation (SD) has been proved to be an effective measure of antidepressive treatment (especially in endogenous depression). In a new study, 125 SD were examined on 93 depressed patients. The therapeutic benefit of SD on endogenous depression consists not only of the nightly clear up but also of provoking or improving a typical day wave the day after DS. A period of at least 36 h is necessary to survey the total effect of this method. The best results are achieved in patients with severe endogenous depression, especially in those with the typical day wave and distinct somatic symptoms. The effect of partial SD (for the second half of the night) is almost the same as that of total SD. The advantages of partial SD are: the patient can stand it easier, more often, and - in the company of a suited person - even at home. Finally, it is less complicate in clinical routine than selective REM-deprivation.

[Circulatory function in depression with the circadian rhythm uninfluenced or modified (author's transl)]. / Kreislauffunktionen im unbeeinflussten und modifizierten zirkadianen Rhythmus bei Depressionen: Vorläufige Mitteilung

The effect of sleep deprivation (SD) on the altered circadian rhythm of endogenous-depressed patients has been investigated. 61 patients (39 endogenous- and 22 neurotic-depressed) with normal cardio-circulatory activities were tested: During SD-night pulse rate is less lowered in endogenous than in neurotic depression. The increase of systolic blood pressure is quicker and higher in endogenous than in neurotic depression. - Surveying the patients for 72 h (before, during and after SD), pulse rate in endogenous- and neurotic-depressed is less markedly fluctuating than in normal individuals. There is a close connection between the circadian fluctuationsof the depressive symptoms and of the pulse rates. The more SD improves depressive symptoms the more it also flattens the wave of pulse rates. - The circadian courses of systolic blood pressure in endogenous- and neurotic-depressed and in normal subjects are nearly the same. SD markedly flattens the circadian rhythm of blood pressure. In neurotic depression, SD does not clearly alter the course of pulse and blood pressure rates.

Double-blind multicenter study of paroxetine and amitriptyline in depressed inpatients.

Paroxetine is a new compound in the group of the selective serotonin-reuptake inhibitors. The results of several open and double-blind control-group studies demonstrate clear antidepressive efficacy of paroxetine. However, most data were collected in samples of outpatients. To overcome this restriction, a six-week double-blind control-group study, comparing 30 mg paroxetine with 150 mg amitriptyline per day, was performed in a sample of inpatients suffering from major depression. Generally speaking, the efficacy analysis of 160 patients was not able to demonstrate statistically significant differences in the antidepressive activity of paroxetine or amitriptyline, either with respect to the total score on the Hamilton Depression Scale (HAMD) and the Clinical Global Impressions or with respect to the subscores of the HAMD. One exception was the retardation subscore, in which amitriptyline showed a greater degree of reduction. Both drugs had a characteristic side-effect profile. Paroxetine was characterized by a lack of anticholinergic side-effects and a higher rate of nausea.

Lithium vs carbamazepine in the maintenance treatment of schizoaffective disorder: a randomised study.

In a randomised multicentre study, the prophylactic efficacy of lithium and carbamazepine was compared in schizoaffective disorder. A total of 90 ICD-9 schizoaffective patients were included in the maintenance phase (2.5 years). They were also diagnosed according to RDC and DSM-III-R and classified into subgroups. Mean serum levels were 0.58 +/- 0.12 mmol/l for lithium and 6.4 +/- 1.5 micrograms/ml for carbamazepine (mean dose 643 +/- 179 mg/d). Outcome criteria were hospitalisation, recurrence, concomitant psychotropic medication and adverse effects leading to discontinuation. There were more non-completers under carbamazepine than under lithium (p = 0.02). Survival analyses demonstrated no significant differences between lithium and carbamazepine in treatment outcome. Patient's ratings of side effects (p = 0.003) and treatment satisfaction (p = 0.02) favoured carbamazepine. Following the RDC criteria, patients of the schizodepressive and non-classifiable type did better under carbamazepine (p = 0.055 for recurrence), whereas in the schizomanic patients equipotency of both drugs was found. Applying DSM-III-R, carbamazepine demonstrated a superiority in the patient group with more schizophrenia-like or depressive disorders (p = 0.040 for recurrence), but not in patients fulfilling the DSM-III-R criteria of bipolar disorder. Lithium and carbamazepine seem to be equipotent alternatives in the maintenance treatment of broadly defined schizoaffective disorders. However, in subgroups with depressive or schizophrenia-like features and regarding its long-term tolerability carbamazepine seems to be superior.