[Impact of medical TV series on surgical hospital patient's perception of reality]. / Einfluss von Arzt- und Krankenhausserien auf das Wirklichkeitsempfinden chirurgischer Krankenhauspatienten.

BACKGROUND: Medical TV series are very popular. Media research emphasizes that watching TV has an influence on patient's expectations and estimations concerning upcoming surgery. We analyzed these associations in our own patients. We suspected that reality as presented in the media and the actual reality of hospitals are not always conceived as two different worlds. METHODS: Over a 15-month period a standardized questionnaire was used to interview 162 in-house patients who had been admitted for an elective standard operation. They were interviewed 1-2 days prior to surgery and shortly before discharge from hospital. The questions aimed at their social situation and their TV viewing habits with special consideration of medical TV series. RESULTS: The knowledge of medical TV series is highly associated with a realistic assessment of these programs (p < 0.05). Furthermore, the knowledge of these programs is correlated with patient's unrealistic estimations of upcoming surgery. CONCLUSION: Medical TV series have a significant influence on surgical in-house patients. Patients with knowledge of many medical TV series believe that the medical setting in these shows is realistic. This can result in false estimations concerning real surgery.

Impact of Medical TV Shows on Preprocedural Fear of Surgical In-House Patients.

Background and Hypotheses: The growing number of medical television series and the increasing amount of time people spend watching TV will have an influence on what they expect from their treatment in a hospital. We suspect that reality as presented in the media and the actual reality of hospitals are not always conceived of as two different worlds. Many medical TV shows present dramatic, life-threatening operations much more often than they occur in reality. Patients who frequently watch such shows might be induced to believe that even routine operations are often dangerous, which could result in higher levels of fear before such an operation. We suspect then that there is a significant relation between preoperative levels of fear and TV viewing habits. METHODS: A standardized questionnaire was used to interview 162 in-house patients who had come to the hospital for an elective standard operation in a German hospital. They were interviewed 1-2 days prior to operation and shortly before discharge from hospital. The questions aimed at their social situation, their TV viewing habits with special consideration of medical TV shows, and the patients' preprocedural fear. RESULTS: The links between levels of education, age, and gender on the one hand, and viewing habits on the other, which have been shown in cultivation research, are supported by our findings. Approximately 50% reported a relevant anxiety level above 4 (on a scale of 0-10). There is a significant association between levels of fear and TV viewing habits. Thirteen subjects (8%) indicated that they suffered the highest imaginable degree of fear, all of them frequent watchers of medical TV shows. Frequent viewers of medical TV shows were definitely more scared than all other patients (p = 0.039). The preoperative level of fear was highest in the age group of under 40 years and significantly lower (p = 0.0042) in the age group of over 70 years. CONCLUSION: The assumed effects of cultivation with in-house patients caused by watching TV series could be shown to be statistically significant. Watching medical TV shows increases the patients' preoperative fear.

Severe Quetiapine Withdrawal Syndrome with Nausea and Vomiting in a 65-year-old Patient with Psychotic Depression.

A 65-year old patient suffering from severe psychotic depression obtained quetiapine for roughly one year. Several attempts to discontinue quetiapine by tapering the dose provoked severe withdrawal symptoms with nausea and vomitus. Pretreatment with domperidone largely prevented withdrawal so that he finally could successfully discontinue quetiapine administration.

[Concept of an additional physical education lesson in English ("moving words") per week in a secondary school: Results of controlled investigation]. / Konzept einer zusätzlichen Sportstunde pro Woche in englischer Sprache ("moving words") in einer Mittelschule : Ergebnisse einer kontrollierten Studie.

BACKGROUND: Physical exercise improves physical fitness of children and pupils may also benefit from sports with regard to cognitive competence. However, timetable and syllabus often give little scope so that alternatives such as combined lessons in English and sports may be suited to integrate the desire for exercise and leaning. METHOD: Parallel classes of a secondary school (form V; 39 pupils) were determined by random as control group (CG: age 10.5 ys, m 11, f 10) or intervention group (IG: age 10.7 ys, m 7, f 11). All pupils got regular physical education of 3 hours per week. In the IG one English lesson was relocated into the sports hall according to the "moving words" concept for one year. Both physical fitness (Munich fitness test) and concentration (d2-test) were assessed before and 3 times with intervals of 3 months. Moreover, 6-month marks were documented. All data were analyzed descriptively in addition to confirmative statistics (Repeated Measures ANOVA). RESULTS: Neither physical fitness nor concentration showed significant differences between the two groups. Both groups improved both criteria within one year, girls of the IG tended to work exacter with fewer mistakes (d2-Test), but dropped behind with regard to physical fitness. Otherwise, boys in the IG ameliorated rate of mistakes, tempo and exactness in the d2-test (p < 0.05) including a positive trend in physical fitness. Whereas English marks in the reports of the IG improved (0.4 versus 0.1), in both groups marks in sports did not change substantially. CONCLUSIONS: Particularly, boys benefit from the "moving-words" concept improving both their physical fitness as well as concentration. Why girls aged 10 to 11 years, on the contrary, do not benefit from the combined learning to the same degree is an interesting issue for further studies.

[Quality management in psychiatry: evaluation of an ergotherapeutical questionnaire before and after treatment]. / Qualitätsmanagement der psychiatrischen Behandlung: Evaluation ergotherapeutischer Befundbögen bei Aufnahme und Entlassung.

In analogy to somatic medicine, modern psychiatry strives to measure the outcome of treatment and care. In order to warrant an effective therapy, this request is reasonable from the standpoint of both the therapist and the patient as well as hospitals or insurance companies. However, how can I measure friendliness, empathy or humanity, the "being available for somebody"? For sure, psychiatric DRGs, which connote efficacy based on periods of time, are by no means suitable. The present study analyses routine clinical data of an ergotherapeutic questionnaire, as an aid to estimating treatment quality. The naturalistic character of this data collection during daily routine may be an advantage to assessing the quality of results in psychiatry.

Ten years of chronic cluster--attacks still cluster.

The chronic variant can be found in 10-20% of all cluster headache patients. While circadian and circannual rhythmicity are characteristic of the episodic variant, little is known on chronobiology in chronic cluster headache. We report a patient with chronic cluster evolved from episodic who recorded a total of 5447 attacks over 10 years. After spectral analysis, cosinor models were calculated within the frequency ranges of 23-25 h (circadian) and 11-13 months (circannual), respectively. Significant results (P < 0.01) were found for 24-h periods, but not for circannual intervals (12 months). However, with regard to circannual periodicity, a semi-circannual rhythm (5-7 months) was suitable for curve fit and yielded significant results in the cosinor analysis at 6 months (P < 0.05). This remarkable long observation period of 10 years shows that, at least for secondary chronic cluster headache which evolved from the episodic form, a typical circadian and circannual rhythmicity comparable to that of episodic cluster headache exists.

Antidepressants in long-term migraine prevention.

Migraine and depression coincide in some 20-30% of patients. Although antidepressants (namely tricyclics) are not considered as first-line prophylactic compounds in patients with migraine alone, several clinical trials support a remarkable benefit in the treatment of migraine and related headache disorders. However, treatment with one antidepressant alone often does not suffice to treat both disorders effectively. Therefore, combinations of classical antidepressants with both newer antidepressants and established prophylactic drugs (e.g. beta-adrenergic receptor antagonists [beta-blockers], topiramate and sodium valproate) are required. In addition, acute attack medication (such as triptans, ergotamines or analgesics) is regularly combined with the preventive medication, thus requiring elaborate knowledge about the complex network of potential interactions and contraindications. Fear of potentially serious interactions can frequently lead to insufficient treatment of both underlying disorders, with an enormous impact on the patient's life. Pathophysiologically, multiple neurotransmitters have been attributed an important role in the aetiology of migraine (mainly serotonin and calcitonin gene-related peptide) and depression (among others, serotonin, dopamine and noradrenaline [norepinephrine]). Most drugs used to treat both disorders influence at least one of these transmitter systems, such as classical tricyclics. This review discusses the efficacy of antidepressants in migraine prevention. In addition, recommended combinations in patients with concomitant depression and migraine are presented with regard to their proposed pharmacological mechanism of action and their potential interactions.

[Empirical investigation to assess the quality of psychiatric treatment]. / Empirische Untersuchung zur Behandlungsqualität in der Psychiatrie.

BACKGROUND: Quality of treatment is of increasing importance in psychiatry. Since the 1950s psychiatry has developed plenty of psychological and occupational approaches in addition to an arsenal of biological procedures. These treatment options have contributed to markedly lower the residence times in psychiatric medical centers to about 3 or 4 weeks. METHOD: The quality of treatment of a psychiatric clinic was evaluated on the basis of a limited number of parameters and in a short time. The data of 657 patients were evaluated. RESULTS: The patients profited significantly from the treatment, particularly when specific therapies were available as in depression or schizophrenia. About » of the patients received no psychoactive drugs. Most of the patients could be discharged from hospital within 3 weeks. The legal basis of hospitalization did not play a decisive role in the success of treatment. Most of the patients were after-treated by general practitioners. CONCLUSION: The result underlines the effectiveness of psychiatric treatment, but also the importance of cooperation between inpatient and outpatient treatment.

Typical and atypical antipsychotics--the misleading dichotomy. Results from the Working Group 'Drugs in Psychiatry' (AGATE).

OBJECTIVES: (1) To investigate the risk of extrapyramidal motor side effects (EPS) associated with the prescription of different antipsychotics under naturalistic treatment conditions; (2) to test the rationale of the terms 'typical' and 'atypical' based on EPS rates. DESIGN: Cross-sectional study in the federal state of Bavaria. SETTING: 20 psychiatric hospitals in Bavaria. PARTICIPANTS: 6,061 inpatients, aged 18-65 years, with psychotic disorders. MAIN OUTCOME MEASURES: Co-medication with the anticholinergic biperiden was used as an index of EPS. Odds ratios for EPS and numbers needed to harm [number of patients who would need to be treated to obtain one more case with an adverse outcome (i.e. EPS) as compared with the control treatment (clozapine)] were calculated to obtain risk estimates for 15 different antipsychotics. RESULTS: Groups of 'typical' and 'atypical' antipsychotics were not homogeneous in their EPS rates, and showed wide variation within each group. Nor did the frequency of EPS allow a clear distinction between the groups. There were 2 reasons for this: first, EPS rates rose continuously over the whole spectrum of drugs under study, and therefore precluded the definition of a cut-off score; second, there was considerable overlap between the 2 groups as EPS rates of various 'atypicals' (e.g. amisulpride, risperidone and zotepine) did not differ from some 'typical' substances (e.g. fluphenazine), while one 'typical' antipsychotic (perazine) even had a lower EPS risk than most 'atypicals'. CONCLUSIONS: The odds of inducing EPS are not distinguishable between 'typical' and 'atypical' antipsychotics as EPS rates rise on a continuous scale throughout both classes. We propose dropping the categorization of antipsychotics as 'typical' and 'atypical' and instead using risk estimates like number needed to harm for EPS to help in benefit/risk considerations for antipsychotic treatment.

Memantine: a therapeutic approach in treating Alzheimer's and vascular dementia.

Memantine has been clinically used in the treatment of organic disorders in Germany for over ten years and has now been approved in Europe and also in the US for moderate to severe Alzheimer's disease. The rationale for this indication is strongly related to the physiological and pathological role of glutamate in neurotransmission. Glutamate is an agonist of NMDA, kainate and AMPA (ionotropic) receptors, where its influence on NMDA receptors plays an important role with regard to neuronal plasticity effecting memory and learning. Excessive levels of glutamate result in neurotoxicity, in part by overactivation of NMDA receptors. Memantine acts as an uncompetitive antagonist of NMDA receptors and therefore compensates for this overactivation. Furthermore, memantine is a neuroprotective agent in various animal models based on both neurodegenerative and vascular processes, as it ameliorates cognitive and memory deficits. Memantine was effective and safe in several clinical studies, particularly in Alzheimer's disease. The compound is completely absorbed after oral intake and undergoes little metabolism. Having a low probability for drug-drug interactions, memantine, in principle, is suited for elderly patients exposed to multiple therapeutic therapies.

ROC analysis as an additional method to characterize time to event data.

The receiver operating characteristic (ROC) is predominantly used to assess the discriminant power of diagnostic tests. The present paper proposes this method as an additional alternative to compare survival data of in oncology or related fields. Survival data of brain tumors were analysed with conventional Kaplan-Meier method and ROC. The Area und the Curve (ROC-curve) gives additional illustrative information to distinguish between two therapeutic approaches and low or high grade brain tumors.

Correlation of Mini-Mental-State-Examination (MMSE), Syndrom-Kurztest (SKT) and Clock test (CT) scores in patients with cognitive impairment assessed by means of multiple regression and response surface analysis.

The objective of our study was to assess the correlation of routine neuropsychological test results in elderly patients referred to a gerontopsychiatric ward. MMSEs, CTs and SKTs were performed in 94 patients (age: median = 74 years, range = 54-89 years; 64 f, 30 m) with mild to moderate dementia and evaluated retrospectively. Pairwise Spearman rank correlation, multiple regression and response surface analysis were used to assess relations between test results. The scores of all three tests used were reciprocally correlated (P < 0.05) yielding the following pairwise R-values: SKT versus MMSE: -0.77, SKT versus CT: 0.69, MMSE versus Clock test: -0.61. Multiple regression analysis showed a maximum correlation of 0.87 and marked standardised beta values, if SKT was chosen as dependent variable. Test scores could be well fitted to both symmetric linear (SKT = a + b x CT + c x MMSE; R(2) = 0.67, P < 0.01) and non-linear (SKT = a + b x CT + c x MMSE + d x CT(2) + e x MMSE(2) + f x CT x MMSE; R(2) = 0.67, P < 0.01) response surfaces. In conclusion, test scores of SKT, CT or MMSE in patients with dementia showed a marked correlation. In clinical practice the may be considered as almost interchangeable test options.

The relationship between plasma D-dimer concentrations and acute ischemic stroke subtypes.

Elevated concentrations of D-dimers (DDs) in patients with acute ischemic stroke may cause differential diagnostic problems with regard to pulmonary or deep venous thrombosis. The true relationship between plasma DDs and acute ischemic stroke remains uncertain. We studied acute stroke patients admitted to a single acute neurology department with a specialized stroke unit. As part of our clinical protocol, blood samples of each patient had been taken within the first 24 hours after the onset of stroke symptoms and before anticoagulant treatment had been started, to evaluate the coagulation profile. Each patient's medical record was reviewed, and demographic, clinical, laboratory and neuroimaging information was abstracted. Univariate and multivariate statistical analyses were performed. A total of 59 patients admitted to our stroke unit between October 2003 and March 2004 with different stroke subtypes according to the TOAST criteria were evaluated to characterize the impact of stroke category on DD concentration. Family members (n = 23) served as controls in this study. Multivariate regression analysis revealed that patients who sustained cardioembolic stroke had significantly higher DD concentrations than controls and patients who sustained transient ischemic attacks. We identified a correlation between plasma DD levels and different acute ischemic stroke subtypes before any stroke treatment was started. Thus DD concentrations may be considered a direct consequence of marked cerebral infarction and may be useful for physicians when making decisions on treatment for acute ischemic stroke.

NMDA-antagonism (memantine): an alternative pharmacological therapeutic principle in Alzheimer's and vascular dementia.

Memantine, a non-competitive NMDA antagonist, has been clinically used in the treatment of dementia in Germany for over ten years. The rationale for this indication is strongly related to the physiological and to the pathological role of glutamate in neurotransmission. Physiologically, NMDA receptors mediate synaptic plasticity by acting as a coincidence detector. Only those synapses that show temporally and spatially discrete activation of NMDA receptors undergo plastic changes secondary to Ca++ influx after rapid unblocking of Mg++, thus crucially contributing to memory and learning processes. The voltage-dependency of Mg++ is so pronounced that under pathological conditions it leaves the NMDA channel upon moderate depolarisation, thus interrupting memory and learning. Its pharmacological properties allow memantine to rapidly leave the NMDA channel upon transient physiological activation by synaptic glutamate (restoring significant signal transmission), but to block the sustained activation of low glutamate concentration under pathological conditions, i.e. to protect against excitotoxicity as a pathomechanism of neurodegenerative disorders. Memantine acts as a neuroprotective agent in various animal models based on both neurodegenerative and vascular processes as it ameliorates cognitive and memory deficits. Memantine has shown to be effective and safe in the treatment of dementia, particularly Alzheimer's disease, in controlled clinical trials. Provided that the dose is slowly increased it is generally well tolerated and safe up to 20 and 30 mg per day, with intake preferably in the morning. The compound is completely absorbed after oral intake with Cmax values after 6 hours, undergoes little metabolism and has a terminal elimination half life between 60 and 100 hours. Due to its low potential of interaction, memantine can be combined with acetylcholinesterase inhibitors, the mainstay of current symptomatic treatment of Alzheimer's disease and it is suited in elderly patients receiving multiple drug therapy.