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  • 1
    ISSN: 1432-1041
    Keywords: adverse drug reactions ; psychotropic drugs ; intensive drug monitoring ; organized spontaneous reporting ; psychiatric patients ; adverse reaction frequency
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Summary A system for monitoring adverse drug reactions (ADR) in psychiatric inpatients was introduced in psychiatric hospitals in the FRG in May 1979. It consists of intensive drug monitoring (IDM) and a so-called “organized spontaneous reporting system” (OSR). ADR are rated separately according to impact on therapy and probability of causal relationship. With IDM all ADR (Grades I–III) are assessed in a randomly selected sample of inpatients. With OSR only ADR leading to discontinuation of the drugs in question (=ADR Grade III) are assessed. In 406 drug-treated inpatients monitored by IDM in the psychiatric hospitals of Berlin and Munich from May 1979 to Dec. 1981, ADR were observed in 60,4%. In 15% of IDM-patients ADR led to discontinuation of the drugs in question; with OSR the relative frequency of these Grade III ADR was 9,0% in 5096 patients monitored throughout the entire period. Life-threatening events were observed in 1,2% of patients undergoing IDM as well as 1.2% of those undergoing OSR. The most frequently observed ADR by IDM were sedation, extrapyramidal signs, disturbances of the autonomic nervous system and increase in transaminases, and by OSR Parkinsonism, akathisia, sedation, toxic delirium and increased transaminases. The relative frequency of Grade III ADR was similar for neuroleptics and antidepressants (5,4% and 5,3% in OSR); a very low relative frequency of ADR Grade III was found for tranquilizers and hypnotics (0,7% and 0,2%). Methodological aspects of this drug monitoring system are discussed in the light of current literature.
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  • 2
    ISSN: 1432-1041
    Keywords: benzodiazepines ; psychotropic drug intake ; long-term use ; epidemiological study ; multiple logistic regression analysis ; drug interaction ; sex differences
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Summary Psychotropic drug intake by a random sample of citizens of the city of Munich aged 30–69 years has been assessed. A 1-week prevalence of 9.3% for all psychotropic drug users was found, benzodiazepines accounting for approximately two-thirds (6.6%) of the users. Two-thirds of drug users were women. Drug use in both sexes increased with age. The doses of benzodiazepines prescribed in most cases were less than 10 mg diazepam equivalent per day. Intake of benzodiazepines in combination with analgesics or alcohol (⩾40 g/day) did not appear to represent a major problem. Multiple logistic regression analysis showed that the number of chronic diseases was the strongest predictor of benzodiazepine intake in men, whereas stress and age determined intake in women. Long-term use seemed to be relatively rare at 11% of all benzodiazepine users, so it was not considered to be a severe public health problem.
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  • 3
    ISSN: 1433-0407
    Keywords: Schlüsselwörter Schlafapnoe ; Gewichtsreduktion ; Optifast®-Programm ; Polysomnographie ; Key words Sleep apnea ; Body weight reduction ; Optifast®-program ; Polysomnography
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary We investigated the therapeutic effect of marked body weight reduction on the predominantly obstructive sleep apnea syndrome by the application of an out-patient, behaviour therapy based body weight reduction program (Optifast®-program) in five of our obese apnea patients (mean overweight by Broca 53,6 ± 24,8 kg). Mean body weight reduction was 32,7 ± 15,8 kg after six months. The mean apnea-index of 34,5 ± 23,1/h prior to the weight reduction dropped to 7,8 ± 6,1/h after therapy. The mean apnea-hypopnea-index (so called „respiratory disturbance index“, RDI) could be reduced from 45,7 ± 26,0/h to 14,0 ± 11,4/h. The best therapeutic effect on the sleep related respiratory parameters was seen in patients who reached their normal weight whereas the absolute weight reduction itself seems to be less important. Our results should encourage this causal therapy in appropriate patients.
    Notes: Zusammenfassung Zur Überprüfung der therapeutischen Effektivität einer drastischen Gewichtsreduktion auf das vorherrschend obstruktive Schlafapnoesyndrom wurde bei 5 unserer adipösen Apnoepatienten (mittleres Übergewicht nach Broca 53,6 kg ± 24,8 kg) eine ambulante, ganzheitliche, verhaltenstherapeutisch orientierte Gewichtsreduktion (Optifast ®-Programm) durchgeführt. Nach einem halben Jahr hatten die Patienten ihr Körpergewicht um durchschnittlich 32,7 kg ± 15,8 kg reduziert. Der mittlere Apnoeindex von 34,5 ± 23,1/h vor Gewichtsreduktion betrug nach Therapie 7,8 ± 6,1/h. Der mittlere Apnoe-Hypopnoe-Index (entspricht dem „respiratory disturbance index“, RDI) reduzierte sich von 45,7 ± 26,0/h auf 14,0 ± 11,4/h. Die besten Therapieergebnisse der schlafbezogenen Atmungsparameter wurden erreicht, wenn die Patienten durch die Gewichtsabnahme in den Bereich ihres Normalgewichts gelangten. Die absolute Gewichtsreduktion scheint weniger entscheidend für den Therapieerfolg zu sein. Die Ergebnisse der ambulanten Gewichtsreduktion bei unseren adipösen Apnoepatienten sollten dazu führen, daß diese kausale Therapieform vermehrt geeigneten Patienten angeboten wird.
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  • 4
    ISSN: 1433-0407
    Keywords: Schlüsselwörter Botulinumtoxin ; Therapie ; Rehabilitationsneurologie ; Spastik ; Spasmen ; Dystonie ; Rigor ; Key words Botulinum toxin ; Therapeutic use ; Rehabilitative neurology ; Spasticity ; Spasms ; Dystonia ; Rigor
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Intramuscular injections of botulinum toxin (BT) induce a localized, long-lasting paresis of the target muscle that can be graded by the BT dose administered and that is free of major side effects. With this profile, BT can be used for symptomatic treatment of various disorders caused by pathological muscle hyperactivities. These disorders occur frequently in patients in institutions for neurological rehabilitation. They are difficult to treat with conventional methods, can cause major suffering and induce substantial costs for our health care system. In the present study we therefore sought to delineate the use of BT in rehabilitative neurology. Regardless of the etiology of the particular muscle hyperactivity syndrome, five main indication groups are identified: (1) improvement of function of the hyperactive muscles; (2) relief of pain in the hyperactive muscles; (3) improvement of patient care; (4) avoidance of sequelae in joints, tendons, ligaments, and teeth; (5) various special indications.
    Notes: Zusammenfassung Intramuskuläre Injektionen von Botulinumtoxin (BT) führen zu einer lokalen, reversiblen, nebenwirkungsarmen, in ihrer Stärke gut steuerbaren und ausreichend lang anhaltenden Schwächung des Zielmuskels. Mit diesem Wirkungsprofil kann BT zur symptomatischen Therapie verschiedener Krankheitsbilder verwendet werden, die durch pathologische Muskelhyperaktivitäten hervorgerufen werden. Diese Krankheitsbilder kommen bei Patienten in neurologischen Rehabilitationseinrichtungen häufig vor, sind konventionellen Behandlungsverfahren meist kaum zugänglich, führen nicht selten zu einem ausgeprägten Leidensdruck und verursachen erhebliche Kosten für unser Gesundheitssystem. In der vorliegenden Arbeit sollen daher die Einsatzmöglichkeiten der BT-Therapie in der Rehabilitationsneurologie dargestellt werden. Unabhängig von der Art der behandelten Muskelhyperaktivitätssyndrome zeichnen sich dabei 5 Indikationsgruppen ab: 1. Verbesserung der Funktion der hyperaktiven Muskulatur, 2. Reduktion des Schmerzes der hyperaktiven Muskulatur, 3. Verbesserung der Pflege des Patienten, 4. Vermeidung von Sekundärschäden an Gelenken, Sehnen, Bändern und Zähnen, 5. verschiedene Sonderindikationen.
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  • 5
    ISSN: 1433-0407
    Keywords: Schlüsselwörter Manganintoxikation ; Parkinsonismus ; MRT ; Verlaufskontrolle ; L-Dopa-Therapie ; Key words Manganese intoxication ; Parkinsonism ; MRI ; Follow-up study ; L-dopa treatment
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Manganese intoxication is an unusual, severe form of intoxication. This report deals with a patient now 80 years old who accidentally ingested a solution of potassium permanganate for a period of at least 4 weeks 14 years ago. Since then, the patient suffers from a mild parkinsonian syndrome and distally accentuated polyneuropathies. Psychiatric disorders, especially demential or depressive symptoms, were not observed. Manganese analysis of his hair still shows a clear increase in manganese concentration. The MRI of his brain showed no pathological changes, in particular none of those often described with symmetric signal elevation in T1 in the area of the basal ganglia. In this study, we present clinical, laboratory, and neuroradiological findings. Unusual in this case with a short exposition is the long duration and clinical improvement without L-dopa treatment.
    Notes: Zusammenfassung Eine Manganintoxikation ist eine ungewöhnliche, schwere Intoxikationsform. Wir berichten über einen jetzt 80-jährigen Patienten, der vor 14 Jahren über die Dauer von mindestens 4 Wochen versehentlich Kaliumpermanganat eingenommen hatte. Der Patient leidet weiterhin unter einem leichten Parkinsonsyndrom und einer distal betonten Polyneuropathie. Psychiatrische St¨rungen, insbesondere ein dementielles oder depressives Symptom, fanden sich nicht mehr. Die Mangananalysen der Haare zeigen auch jetzt noch deutlich erhöhte Konzentrationen. Das MRT des Gehirns erbrachte keinen pathologischen Befund, insbesondere keine häufig bei Manganintoxikationen beschriebenen Veränderungen mit symmetrischen Signalanhebungen in T1-Wichtung im Bereich der Basalganglien (Globus pallidus). In einer aktuellen Untersuchung werden klinische, laborchemische sowie neuroradiologische Ergebnisse vorgestellt. Die Besonderheit des Falles erklärt sich aus einer kurzen Expositionsdauer mit einer langen Verlaufszeit und klinischer Befundbesserung ohne L-Dopa-Behandlung.
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  • 6
    ISSN: 1433-8491
    Keywords: Key words Rebound ; Withdrawal ; Insomnia ; Sleep ; Hypnotics
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The effect of abrupt medication withdrawal (no-pill discontinuation) was investigated in 1507 insomniacs using the patients’ self-ratings on visual analogue scales. Drug discontinuation followed a 28-day treatment period with either 7.5 mg zopiclone, 0.25 mg triazolam, 1.0 mg flunitrazepam, or placebo in a randomized, double-blind, parallel group, multicenter study in private practice. Deterioration below individual pretreatment values (no-pill baseline) in at least one of three subjective parameters of sleep quality (sleep latency, total sleep time, nocturnal awakenings) and three parameters of daytime well-being (morning freshness, daytime tiredness, anxiety) were defined as rebound. The number of patients with rebound (rebound rate) was analyzed for every day of a 2-week posttreatment period. The overall rebound rate was higher in the placebo group (p≤ 0.001) than in each group treated with active drugs. Rebound rates affecting sleep quality were higher for placebo than for zopiclone (p≤ 0.001) and for flunitrazepam (p≤ 0.05). Rebound rates were smaller for zopiclone (p≤ 0.001) and flunitrazepam (p≤ 0.01) than for triazolam. Rebound in at least one item per day appeared in 21.5% (sleep quality) and 25.5% (daytime well-being) of the patients. Rebound decreased with increasing numbers of items of sleep quality or daytime well-being. Patients who did not respond to treatment showed higher rebound rates than those who were treatment responders (p≤ 0.001). Concerning treatment nonresponders, highest rebound was seen in the placebo group, whereas rebound was lowest in placebo responders. These results show that pill discontinuation itself may worsen sleep and daytime well-being in the sense of a rebound phenomenon. Furthermore, the number of patients with rebound remained at a high and varying level during the whole posttreatment period. This result indicates that a deterioration of sleep after drug withdrawal is not apparent during a few days but may last for longer periods in some patients and is modified by marked night-to-night variations.
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  • 7
    ISSN: 1432-0711
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
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  • 8
    Electronic Resource
    Electronic Resource
    Springer
    Archives of gynecology and obstetrics 193 (1959), S. 298-299 
    ISSN: 1432-0711
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
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  • 9
    ISSN: 1433-8491
    Keywords: Sleep disturbance ; Methadone ; Naltrexone ; Opioid-dopamine interaction
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Previous studies have described sleep disturbance secondary to chronic opiate use and abuse. Drug-dependency insomnia is of interest because chronic sleep disturbances can promote depressive symptoms which could lead to a drug relapse. For the first time we compared the polysomnographic parameters of 10 methadone-substituted outpatients and 10 naltrexone-treated outpatients. Methadone (μ-opioid agonist) produced a marked fragmentation of the sleep architecture with frequent awakenings and a decrease in EEG arousals. In comparison with methadone and controls, the naltrexone (μ-opioid antagonist) group showed the shortest sleep latency and the longest total sleep time. These data indicate that μ-agonists and μ-antagonists have different effects on sleep. The implications, especially the involvement of opioid-dopamine interactions on sleep and movements during sleep, are discussed.
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  • 10
    ISSN: 1435-1463
    Keywords: 3,4 Methylenedioxymethamphetamine ; degeneration ; ecstasy ; MDMA ; neurotoxicity ; serotonin ; substituted amphetamines
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The massive and prolonged stimulation of serotonin (5-HT)-release and the increased dopaminergic activity are responsible for the acute psychomimetic and psychostimulatory effects of 3,4-methylenedioxy-methamphetamine (MDMA, “ecstasy”) and its congeners. In vulnerable subjects, at high doses or repeated use, and under certain unfavorable conditions (crowding, high ambient temperature), severe, in some cases fatal, averse systemic reactions (hyperthermia, serotonin-syndrome) may occur during the first few hours. Animal experiments revealed the existence of similar differences in vulnerability and similar dose- and context-related influences on a similar sequence of acute responses. The severity of these acute systemic responses is closely related to the severity of the long-term damage to 5-HT axon terminals caused by the administration of substituted amphetamines. Attempts to identify the mechanisms involved in this selective degeneration of 5-HT presynapses brought to light a multitude of different factors and conditions which either attenuate or potentiate the loss of 5-HT terminals caused by MDMA and related amphetamine derivatives. These puzzling observations suggest that the degeneration of 5-HT presynapses represents only the final step in a sequence of events which compromize the ability of 5-HT terminals to maintain their functional and structural integrity. The common feature of all these events is a profound wastage of energy. Substituted amphetamines selectively tax energy metabolism in 5-HT presynapses through their ability to exchange with 5-HT and to dissipate transmembrane ion gradients. The active carrier systems in the vesicular and presynaptic membrane operate at a permanently activated state. The resulting energy deficit can no longer adequately restored by the 5-HT presynapses when their availability of substrates for ATP production is additionally reduced by the hyperthermic and other energy consuming reactions which are elicited by the systemic administration of substituted amphetamines. The exhaustion of energy in 5-HT nerve terminals compromizes all energy-requiring endogenous mechanisms involved in the regulation of transmembrane-ion exchange, internal Ca++-homeostasis, prevention of oxidative stress, detoxification, and repair. Above a critical threshold the failure of these self-protective mechanisms will lead to the degeneration of the 5-HT axon terminals. Based on the role of 5-HT as a global modulatory transmitter-system involved in the stabilization and integration of impulse flow between distributed multifocal neuronal networks, the partial loss of 5-HT presynapses must be expected to impair the ability of these networks to maintain the integrity of signal flow pattern, and increase the likelihood of switching to unstable information processing. Behavioral responding may therefore become more dominated by activities generated in individual networks, and hitherto “buffered” personality traits and predisposition may become manifested as defined psychiatric syndromes in certain predisposed subjects.
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