Search

In der vorliegenden Arbeit werden aktuelle Aspekte des Betreuungsregimes bei Schizophrenen, Suchtkranken und Psychotherapiepatienten behandelt. Aus der Sicht des jeweiligen Bereiches werden Konstanz und Veranderung im Vergleich der Jahrgange 1985 und 1991 dargestellt. Wahrend im ersten Teil der Arbeit jetzt moglicher Zugang zum Psychopharmakaweltmarkt in seinem Einflus auf das akute medikamentose Regime bei erstaufgenommenen Schizophrenen analysiert wurde, konnten in den anderen Abschnitten der Arbeit Versorgungsstrukturaspekte und inhaltliche Probleme des Wandels der Therapiestile dargestellt werden. In den sucht- und psychotherapeutischen Arbeitsbereichen stehen wesentliche konzeptionelle Neugestaltungen im Mittelpunkt der zukunftigen Arbeit, wahrend im untersuchten medikamentosen Bereich eher punktuelle Prufungen von Einzelfragen das therapeutische Regime determinieren.

A case of an acute dyskinesia of a young, schizophrenic woman caused by neuroleptic therapy is reported. The acute dyskinesia was the reason for a complete luxation in the jaw-joint. The patient showed phenomenons (brain-atrophy, cognitive dysfunction, negative symptoms) which are discussed to be connected with acute dyskinesia. They also are a danger-signal regarding the beginning of a tardive dyskinesia.

The antidepressants trimipramine and imipramine were compared within the framework of a multiclinical study performed under the conditions of a controlled clinical experiment. There has been found a time-different remission of affective und psychomotoric symptoms. The panthymoleptic action of trimipramine and other antidepressants is discussed with reference to these results. Trimipramine influences psychotic states, especially if in depression anxiety is combined with agitation, also in hypochondriac forms of depression.

The present study is intended to discuss use of video tape technics in psychiatric research in reference to method, engineering and clinical investigation. A self created variant of a clinical television system is debated. With the support of video tape methods will be realize improvements in quality of psychiatric investigation in view of procedure and determination of the results as well as reliability, objectiveness and exactitude in connection with a postgraduate continued professional training. Reconsiderations of psychiatric documentation systems with regard to reliability represent an other important field of employment.

Among 593 children treated as inpatients because of epilepsy, 191 (32.2%) showed indications of a pre- and/or perinatal brain damage. Under partial consideration of another six children (7.8%) with postnatal brain damage, the relations of various clinical and encephalographic parameters between the time of the brain damage and the occurrence of epilepsy were studied. The risk to fall ill with epilepsy after an infantile brain damage is independent of the time the brain damage took place. Children with a perinatal brain damage, however, show the prognostically more unfavourable form of epilepsy with a higher frequency of attacks and greater difficulties of influencing the disease with drugs. Children below the age of six years predominantly showed an occipital localisation of the foci spread over several brain regions and associated with a tendency to attacks while in older children temporally localised foci occurred more frequently.

The use of computer based diagnostic decision and artificial intelligence are discussed in relation to the problems of validity and reliability of psychiatric diagnoses. The authors suggest a definition of a computer aided classificator as an existent decision system for an automatically analysis of findings.

The following survey is intended to demonstrate and discuss some principle problems of biomagnetism and the application in clinical fields. The development of special technical parameters especially by the SQUID method is initiating new possibilities of research and completing the neurobiologically determinated basis and conditions of neuropsychiatric disorders. The Magnetoencephalography (MEG) will be represent an important role of a new functional diagnostic method.

The purpose of this paper is to discuss possibilities for developing operational criteria in psychopathological states and to identify the parameters that differentiate psychotic patients. Statistical analysis was performed in the first step with the aid of factor analysis with extraction of syndromatic characteristics of so-called psychopathological basis syndromes. By cluster analysis in the second step we found out more approaches to a differentiated definition of psychotic states. The classification of individuals into 'natural' and not preestablished groups enabled the construction of descriptive psychopathological algorithms to determine ICD-9 diagnosis within the limitations of descriptive psychiatry.

Based on earlier experiences of various groups of authors, we developed and modified a programme of cognitive therapy for schizophrenic patients. The aim of the application of the therapeutic programme to subacute patients was to decrease subjectively perceptible basic disorders and to improve the functions of performance. The present results and experiences with 4 groups consisting of a total of 31 patients encourage us to continue applying cognitive procedures of therapy. Problems of the ascertainment of measuring values and fundamental questions of therapeutic efficacy are discussed.

The aim of research in the field of "Biological Psychiatry" is the phenomenological description of several aspects of psychiatric diseases and the exploration of their pathological mechanisms. The most used methods are biochemical, morphological, genetical, social psychiatric, neuro- and psychophysiological ones. From the pathophysiological view the most discussed hypothesis is that of a disturbed central information processing. In this paper a short introduction should be given on psychosocial influence on the development of psychotic symptomatology and on the periphere vegetative and electroencephalographic parameters in psychiatric patients.

The paper is concerned with an attempt to generalize and categorize current hypotheses on the biochemical basis of ECT. The hypotheses are critically evaluated with respect to the relevance of their experimental fundamentals. Thus, certain hypotheses are valid only in a qualified sense. Particular interest is focussed on those conceptions which try to correlate ECT-induced changes in synaptic receptor sensitivities (up-/down-regulation) with super- resp. subsensitivity hypotheses of psychoses. In this connection, noradrenergic and opioid systems on the one hand, and the axis hypothalamus-hypophysis on the other hand seem to play a dominant role.

Among 406 children with anamnestically and clinically verified infantile brain damage, 356 (87.7%) showed a pathologically changed EEG. In the coordination to clinical symptoms and syndromes, the frequency of the pathological EEG findings was greatest in the group of children suffering from cerebral convulsions (96.7%). It can be derived from the results that the EEG as a method of examination that does not produce any stress and can be carried out in every child is particularly well suited for the verification of the diagnosis of an infantile brain damage.

Results obtained in a single encephalography examination of 79 stuttering and 143 healthy children, both 7 to 10 years old, were compared. While the difference in the frequency between the two groups with respect to focal findings without peak potentials and a focal and generalised tendency to attacks could not be substantiated, 29.1 per cent of all children in the group of stutterers showed a background activity that was too slow for their age. This finding is interpreted as an expression of delayed development which, because of a psychic compensation capacity not corresponding to the age of the test person, offers a favourable basic condition for the development of stuttering. The danger of a misinterpretation of electroencephalographic findings obtained from specific study groups without comparison with a normal population is pointed out.

The present study is intended to discuss some problems of introduction of the International System of Units (SI) in neuropsychiatry. Tabular surveys with important measuring points in the clinical field were demonstrated and connected with helps for calculation between traditional values and the SI.

Until now the "neuroleptic threshold" (Haase) was considered to be the efficiency criterion of the antipsychotic effect of a neuroleptic substance and it was thought therefore that the extrapyramidal symptoms were a necessary although undesired side effect. The benodiazepine derivative Leponex developed by Sandox - Basel upsets this view because it has an excellent antipsychotic effect without creating definite extrapyramidal symptoms. It is noted for its quick soporfic effect after only a few minutes, for subdueing psychopathological productivity in a very impressive way, for acting rapidly on the "plus"-symptomatology typical of psychosis, as early as in the first days of treatment, and for its equally visible effect on the "minus"-symptoms, typical of psychosis, in the last third of an average period of treatment lasting 40 days. The clinic using Leponex (Dresden, Halle, Brandenburg-Görden) belonged to the clinical application programme of the Sandox - Basel firm. The article gives a summary of essential results and particulars about the treatment. A detailed evaluation of the case sheets which are at present being statistically reviewed will be given in the next paper.

Departing from false interpretations of results obtained in psychopharmacological studies, the mathematical-statistical methods of the trend test after WILCOXON, of the WILCOXON comparative test for processes and of the HOTELLING-PABST test are presented and discussed on the basis of a computer programme. Using the example of the psychotropics clomipramine and tisocromide, differential-typological aspects have been recognised. These permit to draw conclusions for the optimisation of pharmacotherapy as well as reactions on the psychopharmacological development research. In the appraisal of the effectiveness of psychotropic substances a greater fundamental importance should be attached to operational procedures.

Glutamate is believed to be quantitatively the most outstanding of the excitatory transmitters in the CNS. Certain conformationally related analogues, e. g. kainate, N-methyl-D-aspartate, ibotenate, and homocysteate, act as glutamate agonists. The local or systemic administration of these "excitotoxic" compounds induces epileptiform activity pointing out new and deeper insights into the epileptic process. Additionally, the glutamate transmitter hypothesis is expected to give a chance of a causal comprehension for choreatic processes as well as for the mode of action of anticonvulsant and antispastic agents.

In 50 right handed and 50 left handed subjects we researched the phenomenon of spreading fingers. In the right hand of right-handers we found the smallest angels between fingers, in the right hand of left-handers we found the biggest angels between the spreaded fingers. The higher the dominance of the hand, the lower is the phenomenon of spreading fingers. We assumed smaller motor units at the side of dominance.

Longoperidol/Janssen, an orally administered neuroleptic with a five- to seven-day duration of effects, was clinically tested in six mental hospitals in the G.D.R. where the agent was administered to subjects of chronic to subacute schizophrenia. It was not possible for fully consistent results to be obtained in these tests. Workers at mental hospitals in Leipzig and Mühlhausen recommended that the drug should be imported, whereas those at the four other centers (Dresden, Halle, Jena, and Schwerin) did not consider the medication to be indispensable, although they were also able to observe the good effects of the agent.

We examined the influence of thioridazine (2 x 200 mg/d for 14 days) on cognitive (d 2-cancellation test, digit symbol substitution task), psychomotor (aiming, visual coordination as screwdriving test) as well as simple- and choice-reaction measurements in 16 in-patients suffering from dysthymic-depressive syndrome. The different thioridazine serum levels and the intelligence quotients of the patients were used as criteria of stratification. In this way we demonstrated differentiated impairments or improvements of the human performance. Such differences would have been masked by a more global evaluation and interpretation.

In recent years the clinical study of pharmacopsychiatric basic reactions has directed our attention to syndromatic complex-structures in the impulse-range, which we have temed as basic syndromes. In so doing, a series of significant psychotic symptoms are being neglected, when these are not of primary pharmacopsychiatric relevance. This applies particularly to such psychopathological conceptions, which in addition prejudice at the same time a nosological coordination and thereby reduce the valency of other parameters. The limiting of basic psychopathological conditions now allow us to probe syndromatically through polarisation (stimulated-inhibited) and further differentiations in the quantitative and qualitative spheres the psychosis-spectrum. The four basic functions discovered hereby (Hyper- and Hypo- as well as Para- and Dys-functions) now show themselves with explicit reference to their nosological independence in various psychopathological planes eg. motoricity, affectivity, perception, power to experience, intrapsychical consumption-modality etc. With a process of this kind in our view not only is psychiatric pathology pharmacotherapeutically determined, but also the medico-curative connection is more exactly definable. Furthermore these results contribute directly to current experimental projects on the use of material for documentation.

The antidepressants desipramine and imipramine were compared within the framework of a multiclinical study performed under the conditions of a controlled clinical experiment. There has been found a time-different remission of affective symptoms, which was not detectable for the inhibition of drive. The tachythymoleptic action of desipramine is discussed with reference to these results. Evaluation of the possibility of controlling affects shows different ranges of activity of desipramine and imipramine, with desipramine influencing especially negative psychoenergetic symptoms in the area of drives and emotions and imipramine, restrictive symptoms in addition to differential phenomena of the psychomotor expression.

The medical profession is using computers to an increasing extent, and the graphic epicrises described here, which is intended mainly to augment the conventional epicrisis, is another useful application. It is based on a standardised psychopathological examination and documentation procedure and permits the course of psychopathological syndromes to be demonstrated in an illustrative way.