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Nach schrittweiser Umstellung der psychopharmakologischen Therapie konnte bei einem Patienten mit vorbekannter paranoider Schizophrenie Clozapin etabliert werden, nachdem es bei St. p. Lebertransplantation und laufender Immunsuppression mit Tacrolimus zu einer Exazerbation psychotischer Symptomatik gekommen war. Bisherige Therapieversuche mit Risperidon, Paliperidon, Quetiapin und Olanzapin hatten zu keiner wesentlichen Besserung geführt. In dem hier beschriebenen Zeitraum von ca. 20 Wochen fanden wöchentliche Termine und Blutbildkontrollen statt sowie regelmäßige Laborkontrollen der Leber- und Nierenfunktionsparameter, metabolischen Parameter und Medikamentenspiegel. Schwankungen im Clozapinspiegel waren wahrscheinlich auf starke Änderungen des Nikotinkonsums zurückzuführen. Nach der Etablierung von Clozapin kam es insgesamt zu einer deutlichen Verbesserung des Allgemeinzustandes des Patienten.

Neben psychosozialer und psychotherapeutischer Betreuung stehen in der Behandlung von Alkoholkonsumstörungen auch Psychopharmaka zur Verfügung. Trotz Zulassung und Evidenz über wirksame Unterstützung zur Aufrechterhaltung der Alkoholabstinenz wird diese Behandlungsoption oft erst verspätet, wenn sich bereits Folgeerkrankungen, insbesondere alkoholbedingte Lebererkrankungen (ALE) manifestiert haben, oder teilweise gar nicht angeboten. Die weitere Behandlung der Alkoholkonsumstörungen kann dadurch zusätzlich verkompliziert werden. Als mögliche Ursachen für den verspäteten Einsatz von Psychopharmaka in diesem Zusammenhang werden unter anderem ein mangelhafter Wissensstand und Stigmatisierung innerhalb des medizinischen Personals beschrieben. Die vorliegende Arbeit soll daher einen Überblick über wichtige Teilaspekte der multidisziplinären und integrativen Betreuung bei Alkoholkonsumstörung verschaffen.

This case report is about a 44-year-old woman with alcohol-related end-stage liver disease. Initial contact with the patient was made in the alcohol-outpatient clinic of the Department of Psychiatry and Psychotherapy, Clinical Division of Social Psychiatry, Medical University of Vienna. Due to a particularly poor general condition, Child Pugh Score C/MELD Score 20, the patient was admitted to ward 4A, with the clinical and scientific focus of treating patients with alcohol use disorder. The withdrawal process was complicated by a multitude of factors associated with end-stage liver disease. By explaining the theoretical background of possible somatic as well as psychiatric complications of end-stage liver disease and elaborating on treatment options a comprehensive overview of the psychiatric and somatic management of this patient population is given. Im vorliegenden Beitrag wird der Fall einer 44-jährigen Frau mit alkoholassoziierter Lebererkrankung im Endstadium beschrieben. Die Erstvorstellung der Patientin erfolgte in der Ambulanz für Alkoholismusgefährdete der Klinischen Abteilung für Sozialpsychiatrie, Universitätsklinik für Psychiatrie und Psychotherapie, Medizinische Universität Wien. Aufgrund eines ausgesprochen schlechten Allgemeinzustands mit Child-Pugh-Score C und MELD-Score 20 wurde die Patientin auf der Station 4A, mit klinischem und wissenschaftlichem Schwerpunkt der Behandlung von Patienten mit Alkoholabhängigkeit, aufgenommen. Der medikamentös-gestützte Entzug war durch eine Vielzahl an Faktoren, die mit einer Lebererkrankung im Endstadium zusammenhingen, erschwert. Im Beitrag wird der theoretische Hintergrund möglicher somatischer wie auch psychiatrischer Komplikationen der Lebererkrankung im Endstadium erläutert, zudem werden die Behandlungsoptionen ausführlich beschrieben. Es wird ein umfassender Überblick des psychiatrischen und somatischen Managements dieser Patientengruppe geboten.

While only the LCHF diet showed an improvement in fat oxidation and the HIGH-GI group increased peak running speed and showed a trend towards an improvement in time to exhaustion, the LOW-GI group appears to combine both effects on substrate metabolism and performance.Administered under free-living conditions, energy intake changed in LOW-GI diet, possible due to higher intake of fibre, stable insulin levels and associated higher feeling of satiety. Energy intake in HIGH-GI showed no changes and in LCHF a trend towards a reduced intake was observed.While changes in body weight and composition were more pronounced in LOW-GI and LCHF group, muscle energy storage showed beneficial improvements in endurance runners on a high glycaemic index diet. With the muscle glycogen content being significantly lower in LCHF compared to LOW-GI group, it can be assumed that this might be a limiting factor in maximum values for the graded exercise test.

Background: First evidence indicates that the supplementation of specific collagen peptides (SCP) is associated with a significant improvement in running performance in physically active women; however, it is unclear if the same is true in males. The purpose of the present study was to investigate the effects of a concurrent training program including 60 min of continuous moderate intensity running training and 15 min of dynamic resistance training combined with supplementation of SCP on parameters of running performance in moderately trained males. Methods: In a double-blind, placebo-controlled, randomized trial, participants performed a 12 weeks concurrent training and ingested 15 g of SCP [treatment group (TG)] or placebo [control group (CG)] daily. Before and after the intervention, running endurance performance was measured by a 1-h time trial on a running track. Velocity at the lactate threshold (VLT) and at the individual anaerobic threshold (VIAT) were assessed on a treadmill ergometer. Body composition was evaluated by bioelectrical impedance analysis. Results: Thirty-two men (28.4 ± 5.2 years) completed the study and were included in the analysis. After 12 weeks, TG had a statistically significant (p≤ 0.05) higher increase in running distance (1727 ± 705 m) compared to the CG (1018 ± 976 m) in the time trial. VLTincreased in the TG by 0.680 ± 1.27 km h−1and slightly decreased by − 0.135 ± 0.978 km h−1in the CG, resulting in statistically significant group differences (p≤ 0.05). A significantly higher improvement in VIAT(p≤ 0.05) was shown in the TG compared with the CG only (1.660 ± 1.022 km h−1vs 0.606 ± 0.974 km h−1; p≤ 0.01). Fat mass decreased (TG − 1.7 ± 1.6 kg; CG − 1.2 ± 2.0 kg) and fat free mass increased (TG 0.2 ± 1.2 kg; CG 0.5 ± 1.3 kg) in both groups with no significant group differences. Conclusion: In summary, supplementation with 15 g of SCP improved running performance in a 1-h time trial and enhanced indicators of endurance capacity at submaximal exercise intensities such as an increased velocity at the lactate as well as the anaerobic threshold more effectively than CT alone.

Dieser Fallbericht gibt einen Überblick über die Aspekte des multidisziplinären Managements eines alkoholabhängigen Patienten mit Lebererkrankung im Endstadium. Wir berichten von einem 59-jährigen Patienten, der für einen stationären, medikamentös-gestützten Alkoholentzug aufgenommen worden war. Der Patient litt an einer dekompensierten, alkoholinduzierten Leberzirrhose. Die ursprüngliche Aufnahme erfolgte an einer chirurgischen Abteilung aufgrund einer zunehmenden Aszites und einer generellen Verschlechterung des Allgemeinzustands. Nach konsiliarpsychiatrischer Erstvorstellung und Einleitung einer Behandlung bei Alkoholentzug wurde er rasch an die Station 04A der Universitätsklinik für Psychiatrie und Psychotherapie, Klinische Abteilung für Sozialpsychiatrie übernommen. Der klinische und wissenschaftliche Schwerpunkt der Station 04A ist die Behandlung alkoholabhängiger Patienten. Neben der internistischen Behandlung der Folgen der Leberfunktionsstörung wurde ein schrittweiser Alkoholentzug mithilfe von Benzodiazepinen erfolgreich durchgeführt sowie eine Anti-craving-Therapie mit Baclofen etabliert. This case report delivers a concise overview of the multidisciplinary management of patients with alcohol use disorder and end-stage liver disease: We report the case of a 59-year-old patient, suffering from end stage liver disease as a result of alcohol use disorder, undergoing a pharmacological-supported alcohol withdrawal. The patient was initially admitted to the surgical department due to progressing ascites and a reduced general condition. However, as soon as the patient was stabilized and the alcohol withdrawal was initiated, he was transferred to ward 04A Department of Psychiatry and Psychotherapy, Clinical Division of Social Psychiatry. The clinical and scientific focus of this ward is the management of patients with alcohol use disorder. Besides treating the internistic conditions associated with the end-stage liver disease of this patient, a step-wise alcohol withdrawal was conducted and an anti-craving therapy with baclofen was established.

The computational complexity of the circuit and expression evaluation problem for finite semirings is considered, where semirings are not assumed to have an additive or a multiplicative identity. The following dichotomy is shown: If a finite semiring is such that (i) the multiplicative semigroup is solvable and (ii) it does not contain a subsemiring with an additive identity 0 and a multiplicative identity 1 ≠ 0, then the circuit evaluation problem is in DET ⊆ NC2, and the expression evaluation problem for the semiring is in TC0. For all other finite semirings, the circuit evaluation problem is P-complete and the expression evaluation problem is NC1-complete. As an application, we determine the complexity of intersection non-emptiness problems for given context-free grammars (regular expressions) with a fixed regular language.

Es gibt zunehmende Evidenz für einen protektiven Effekt natürlicher Lithiumsalzvorkommen im Trinkwasser auf die Suizidraten der betroffenen Bevölkerung. Ziel der Studie war es zu untersuchen, ob die lithiumreiche Atacama-Region in Chile im Vergleich zu anderen Regionen mit einer niedrigeren Suizidmortalität assoziiert ist. Suizidstatistiken wurden vom chilenischen Gesundheitsministerium erhoben. Sozioökonomische Variablen (Arbeitslosenrate, medianes Haushaltseinkommen, Grad der Urbanisierung, Anteil der indigenen Bevölkerung) aller chilenischen Regionen wurden vom nationalen Statistikinstitut angefordert. Wir berechneten die jährliche Suizidraten pro 100.000 jeder Region in den Jahren 2000–2009. Die lithiumreiche Region der Atacama-Region zeigt eine signifikant geringere Suizidrate (9,99 pro 100.000) als andere chilenische Landesteile (12,50 pro 100.000) (t = 4,75; df = 18, p< 0,001). Chilenische Regionen, die reich an natürlich vorkommenden Lithiumsalzen sind, zeigen niedrigere Suizidmortalitätsraten im Vergleich zu anderen Regionen. Obwohl auf Grund des Studiendesigns keine Kausalität nachgewiesen werden kann, bestärken diese Resultate frühere Studien und unterstreichen die Notwendigkeit weiterer Forschung über die Effekte natürlich vorkommenden, gering dosierten Lithiums auf die psychische Gesundheit. There is increasing evidence for the hypothesis that lithium salts at naturally occurring levels in drinking water may have a moderating effect on suicide rates of the exposed population. The aim of this study was to examine whether the lithium rich Atacama region in Chile is associated with lower suicide mortality in comparison to other regions. Suicide data was acquired from the Chilean Ministry of Health. Socio-economic variables (rate of unemployment, urbanity, median household income, percentage of indeginous population) were obtained for all regions of Chile from the national statistical institute. We calculated annual suicide rates per 100,000 for each group for the years 2000–2009 and tested the hypothesis that suicide rates are lower in lithium rich regions in comparison to other regions of Chile. The lithium rich Atacama Desert shows a significantly lower suicide rate (9.99 per 100,000) in comparison to other parts of Chile (12.50 per 100,000) (t = 4.75, df = 18, p< 0.001). Chilean regions rich in naturally occurring lithium salts show lower suicide mortality rates in comparison to other regions. Although causality cannot be proven by this design, these findings add to previous findings and warrant further research on the effects of naturally occurring low-dose lithium on health.

AbstractBackground/Objective:To examine the lipoprotein profiles of men and women with paraplegia and tetraplegia. Impairment of the sympathetic nervous system (dependent on the level of injury) and the extent of physical capacity and activity were correlated with the lipid profile in men with spinal cord injury (SCI). Sex-related differences of the lipoprotein profiles could be found in nondisabled and premenopausal women with SCI mainly because of the different effects of sexual hormones.Methods:Lipoprotein profiles of 112 participants with SCI (32 premenopausal women, 80 men) were analyzed and correlated to sex, lesion level, and physical performance capacity.Results:Women with tetraplegia or paraplegia showed significantly higher levels of high-density lipoprotein and lower ratios of total cholesterol to high-density lipoprotein-cholesterol compared with men with corresponding lesion levels, without a difference in peak oxygen consumption. Concentrations of very-low-density lipoproteins were lower in women with paraplegia than in men with paraplegia, no differences were found in total cholesterol, low-density lipoprotein-cholesterol, and triglycerides. Sexindependent elevations in total cholesterol and low-density lipoprotein-cholesterol were associated with paraplegia, and sex-independent elevations in triglyceride levels were associated with tetraplegia.Conclusions:Persons with SCI showed sex-related differences in their lipoprotein profiles. Independent of physical fitness, the lipoprotein profile of premenopausal women with SCI did not exhibit the adverse lipoprotein characteristics observed in men with SCI, probably because of the influence of sexual hormones independent of lesion level.

Zusammenfassung. Eine wesentliche Aufgabe des Herz-Kreislauf-Systems ist die ausreichende Versorgung der Organe und Skelettmuskulatur mit Blut und Sauerstoff in Ruhe und unter Belastung. Bei schwerer körperlicher Arbeit oder Leistungssport mit überwiegenden Ausdaueranteilen kommt es zu einer chronischen Mehrbelastung des Kreislaufsystems mit Anpassungsreaktionen, die zu einer erhöhten Leistungsfähigkeit des kardiovaskulären Systems und damit zu einer gesteigerten maximalen Sauerstoffaufnahmefähigkeit führen. Man kann regulative und strukturelle Adaptationen (Sportherz) unterscheiden, die individuell eine sehr unterschiedliche Ausprägung erfahren und Schwierigkeiten in der Abgrenzung gegenüber pathologischen Reaktionen bereiten können. Solche Trainingswirkungen treten hauptsächlich als Folge chronisch dynamischer Belastungsformen auf; bei reinem Krafttraining oder Schnelligkeitstraining sind selbst im Hochleistungssport keine oder nur geringe Effekte nachweisbar. Nach Beendigung der körperlichen Aktivität bzw. des Trainings kommt es zur Rückbildung der regulativen und strukturellen Anpassung, die allerdings nicht vollständig sein muss, dann aber auch mit erhöhter Leistungsfähigkeit einhergeht. Dies hat nach heutigem Wissen keine gesundheitlichen Nachteile.

KÖNIG, D., M. HUONKER, A. SCHMID, M. HALLE, A. BERG, and J. KEUL. Cardiovascular, metabolic, and hormonal parameters in professional tennis players. Med. Sci. Sports Exerc., Vol. 33, No. 4, 2001, pp. 654–658. During the past decade, the physical and mental stress in professional tennis has been constantly increasing. The overall intensity in tennis ranges between 60 and 70 of maximum oxygen uptake and the energy requirements are mainly provided by aerobic energy metabolism. Therefore, particularly with respect to the duration of the tournaments and the length of the matches, a good aerobic capacity promotes continuous success in professional tennis. During frequent periods of high intensity, however, muscular energy is derived from anaerobic glycolysis. Therefore, sports-specific conditioning programs in tennis should improve both glycolytic and oxidative muscular metabolism. Years of training and competition induce a number of cardiovascular and metabolic adaptations an increase in heart size in terms of an athlete’s heart, higher oxygen uptake capacity, improved muscular oxidative enzyme activities, reduced baseline catecholamine levels, and a lower resting heart rate. In addition, tennis induces side-specific increments in bone density, bone diameter, and bone length of the upper extremity. Furthermore, structural and functional adaptations of the conducting arteries in the preferred arm could be demonstrated in professional tennis players. In conclusion, tennis is a very complex sport involving strength, power, speed, agility and explosiveness, as well as endurance components. Scientific data on exercise-related cardiovascular and metabolic parameters in professional tennis are important to evaluate the players individual fitness level and will help to improve sports-specific conditioning programs. This in turn will not only enhance performance but also prevent overstrain and burnout syndromes.

The effect of physical exercise and vitamin C on iron absorption after oral iron administration was investigated. Eight healthy male subjects without iron deficiency were studied after administration of 100 mg ferric sodium citrate complex, 100 mg ferric sodium citrate complex with 200 mg ascorbic acid, and without iron intake, both under resting conditions and after a 1-h bicycle ergometer test at moderate exercise. Serum concentrations for iron, transferrin, and ferritin were measured before and 30 min, and 1, 2, and 4 h after each administration.

Elevated concentrations of lipoprotein(a) [Lp(a)] have been shown to be an independent risk factor for atherosclerotic disease. Physical activity and physical fitness have been shown to improve lipoprotein metabolism and reduce the risk of coronary artery disease. Studies on the influence of physical activity and physical fitness on Lp(a) levels including a large number of endurance as well as power athletes have not been performed before. Therefore, we determined parameters of physical fitness (maximal oxygen consumption), physical activity, and lipoproteins in 105 endurance athletes, 57 power athletes, and 87 sedentary young men. As expected, we found that endurance athletes with a good physical fitness had significantly higher concentrations of high-density lipoprotein cholesterol than power athletes and sedentary controls. Regarding mean Lp(a) levels (rocket immunoelectrophoresis), however, there were no significant differences between endurance athletes, power athletes, and sedentary controls. Even when including only those with Lp(a) values >10 mg · dl-1, no differences were observed between the groups. These findings indicate that intensive training over years and good aerobic fitness improve the ratio of low-density lipoprotein to high-density lipoprotein cholesterol but have no or only minor effects on Lp(a) concentrations.

Fifteen athletes were investigated 24 h before, 1 h after, and 20 h after an exhaustive exercise stress test (mean duration 68 min). Testing for cytokines was done in serum, urine, and the supernatants of whole blood cell cultures, which were stimulated with lipopolysaccharide (LPS), concanavalin A(Con A), or phythaemagglutinin (PHA). Elevated levels of interleukin 6 (IL-6) and soluble IL-2 receptor (sIL-2R) were found 1 h after the run in both serum and urine samples. TNF-α in serum was also increased, whereas IL-2 in urine was decreased after the exercise. All other testings in serum and urine(including IFN-γ) gave borderline or negative results. In cell cultures, the LPS-induced release of the inflammatory cytokines TNF-α, IL-1, and IL-6 was suppressed 1 h after exercise. Also, the Con-A-induced and LPS-induced release of IFN-γ, and the PHA-induced release of IL-2 were suppressed 1 h after exercise. In contrast, Con-A-induced release of IL-2 was mildly increased after the run. We conclude that exercise of the intensity and duration described here causes an activation of the immune system, which is immediately counter-regulated. Twenty hours after the exercise, most of the observed changes were back to pre-exercise levels, indicating only a short duration for this suppressive counter-regulation.

The purpose of this study was to investigate the influence of different injury levels in persons with spinal cord injury (SCI) on epinephrine (Epi) and norepinephrine (NE) at rest and during graded wheelchair exercise and the related changes in heart rate and O2uptake (V˙o2). Twenty tetraplegics (Tetra), 10 high-lesion paraplegics (HLPara), 20 paraplegics with SCI below T5(MLPara), and 18 able-bodied, nonhandicapped persons (AB) were examined. Because of the higher level of interruption of the sympathetic pathways, Tetra persons showed lower Epi and NE at rest and only slight increases during exercise compared with all other groups; the Tetra subjects’ impaired cardiac sympathetic innervation caused restricted cardioacceleration and strongly reduced maximalV˙o2. When compared with AB persons, HLPara had comparable NE but lower Epi levels as a result of partial innervation of the noradrenergic system and denervation of the adrenal medulla. MLPara subjects showed an augmented basal and exercise-induced upper spinal thoracic sympathetic activity compared with AB subjects. The increase in heart rate in relation toV˙o2was higher in HLPara because of a smaller stroke volume as a result of venous blood pooling. The different exercise response in persons with SCI is a result of the interruption of pathways in the spinal cord to the peripheral sympathetic nervous system in addition to the motor paralysis.