[Implementation of Continuity of Care in Everyday Care - A Comparison Between two Psychiatric Hospitals].

Objective: The rigid separation of outpatient and inpatient care in the German health care system prevents continuity of care, although it has been shown to be of great importance for psychiatric patients. This study analyzes continuity of care of a model hospital with a global treatment budget according to § 64b SGB V and constant treatment staff across all settings in comparison to a control hospital with regular financing without such a team.

Methods: In a prospective cohort study with a 20-month observation period, we collected data on continuity of care of 220 model and 215 control clinic patients.

Streptococcus salivarius MS-oral-D6 promotes gingival re-epithelialization in vitro through a secreted serine protease.

Gingival re-epithelialization represents an essential phase of oral wound healing in which epithelial integrity is re-establish. We developed an automated high-throughput re-epithelialization kinetic model, using the gingival epithelial cell line Ca9-22. The model was employed to screen 39 lactic acid bacteria, predominantly including oral isolates, for their capacity to accelerate gingival re-epithelialization.

High frequency repetitive transcranial magnetic stimulation (rTMS) reduces EEG-hypofrontality in patients with schizophrenia.

The reduced metabolic activity in the prefrontal brain lobes, so-called hypofrontality, is associated with increased electrophysiological delta-band activity. Schizophrenia inpatients (N=35) received sham-controlled 10Hz rTMS over the left dorsolateral prefrontal cortex in a randomised design. After treatment, the resting electroencephalography revealed a significant decrease in the delta-band activity, which originated in the right prefrontal cortex and correlated with improvements in facial affect recognition.

Cardiovascular adverse reactions during antidepressant treatment: a drug surveillance report of German-speaking countries between 1993 and 2010.

Background: Antidepressants (ADs) are known to have the potential to cause various cardiovascular adverse drug reactions (ADRs). The tricyclic antidepressants (TCAs) were first revealed to be a possible source of cardiovascular ADRs. In recent years, newer classes of ADs were also suggested to have a higher risk of cardiovascular adverse effects.

Repetitive transcranial magnetic stimulation (rTMS) improves facial affect recognition in schizophrenia.

Objective: Facial affect recognition, a basic building block of social cognition, is often impaired in schizophrenia. Poor facial affect recognition is closely related to poor functional outcome; however, neither social cognitive impairments nor functional outcome are sufficiently improved by antipsychotic drug treatment alone. Adjunctive repetitive transcranial magnetic stimulation (rTMS) has been shown to enhance cognitive functioning in both healthy individuals and in people with neuropsychiatric disorders and to ameliorate clinical symptoms in psychiatric disorders, but its effects on social cognitive impairments in schizophrenia have not yet been studied.

Naturalistic pharmacotherapy of acute episodes of schizophrenic disorders in comparison to treatment guidelines.

Introduction: This study was designed to investigate to what extent guidelines regarding the pharmacological treatment of patients suffering from schizophrenia-like psychosis are adopted in a naturalistic treatment setting.

Methods: Medical records of n=819 patients undergoing inpatient treatment for schizophrenia-like psychosis in 11 psychiatric hospitals in northwestern Germany were retrospectively analyzed and findings were compared to current schizophrenia guideline recommendations.

Results: The prescription rate of second generation antipsychotics increased from 47.

Can an early weight management program (WMP) prevent olanzapine (OLZ)-induced disturbances in body weight, blood glucose and lipid metabolism? Twenty-four- and 48-week results from a 6-month randomized trial.

Objectives: This study was designed to investigate whether a preventive weight management program (WMP) reduces weight gain during olanzapine (OLZ) treatment. Moreover, we examined the effects of intervention on metabolic parameters.

Methods: Patients (N = 100) with schizophrenia or schizoaffective disorder (DSM-IV) who had commenced treatment with OLZ were recruited.

Clomipramine-induced serum prolactin as a marker for serotonin and dopamine turnover: results of an open label study.

Central nervous system (CNS) monoamine deficits have been linked to a number of pathological conditions such as major depressive disorder. Individual biological variations in 5-hydroxyindoleacetic acid (5-HIAA), homovanillic acid (HVA) and 3-methoxy-4-hydroxyphenylglycol (MHPG) might account for the variation in responses of neurotransmitter systems observed after the administration of clomipramine. The prolactin response to clomipramine has been widely used to assess CNS functioning.

Effects of 10 Hz repetitive transcranial magnetic stimulation (rTMS) on clinical global impression in chronic schizophrenia.

Unlabelled: We conducted a randomized, sham-controlled repetitive transcranial magnetic stimulation (rTMS) study in chronic schizophrenia in-patients (n=35) to evaluate the therapeutic efficacy of 10 Hz stimulation. Patients, who were on stable antipsychotic treatment, were randomly assigned to the active or sham condition. In the active rTMS group, ten sessions with a total of 10,000 stimuli were applied over the left dorsolateral prefrontal cortex at 110% of motor threshold.

Is successful electroconvulsive therapy related to stimulation of the vagal system?

Background: Electroconvulsive therapy (ECT) has been shown to exhibit strong beneficial effects in the treatment of major depressive disorder (MDD). While the exact underlying mechanisms are under debate, a role for the sympathetic response upon ECT has been suggested. When assessing patients with MDD for autonomic function, however, a loss of vagal function is prominent.

The tolerability of rTMS treatment in schizophrenia with respect to cognitive function.

Introduction: The purpose of this study was to assess tolerability and safety of high-frequency rTMS with regard to cognitive performance when conducted as "add-on" treatment in chronic schizophrenia in-patients (n=32).

Methods: Patients, who were on stable antipsychotic treatment, were randomly assigned to verum or sham condition (double-blind). In the verum group, ten sessions of 10 Hz rTMS with a total of 10 000 stimuli were applied over the left dorsolateral prefrontal cortex (PFC) at 110% of motor threshold over a period of two weeks.

[Biological correlates of prefrontal activating and temporoparietal inhibiting treatment with repetitive transcranial magnetic stimulation (rTMS)].

Repetitive transcranial magnetic stimulation (rTMS) is a tool that enables clinicians and neuroscientists to modulate cortical activity in a non-invasive way. High-frequency rTMS has predominantly an activating effect on the stimulated brain region while low-frequency rTMS has an inhibitory effect. In addition to its usefulness as a research tool and in neurological diagnostics, rTMS may prove useful as a therapeutic option in psychiatry, especially in disorders that are associated with regional changes in cortical activity.

Acute effects of sildenafil on flow mediated dilatation and cardiovascular autonomic nerve function in type 2 diabetic patients.

Background: Sildenafil, frequently used as on demand medication for the treatment of erectile dysfunction (ED), has been suggested to improve endothelial function but also to alter blood pressure (BP) and induce sympathetic activation. In people with type 2 diabetes mellitus (T2DM), a high-risk population, the safety profile and the effects on endothelial function of a maximal sildenafil dose (100 mg) have not been investigated and therefore constituted the aim of our study.

Methods: A double-blind, placebo-controlled, cross-over trial using a single dose of 100 mg sildenafil or placebo has been conducted in 40 subjects with T2DM without known CVD.

Increased vagal modulation in atopic dermatitis.

Background: Atopic dermatitis has been shown to be associated with neurogenic and psychosocial factors. In related atopic diseases such as rhinitis or asthma, a shift in autonomic balance towards a parasympathetic modulation has been described. On the other hand, the psychiatric symptoms known for atopic dermatitis are often associated with decreased vagal modulation.

The interaction between pupil function and cardiovascular regulation in patients with acute schizophrenia.

Objective: Cardiac autonomic dysregulation has been reported in patients with schizophrenia. However, there are no definite data examining whether other branches of the autonomic nervous system are compromised as well and how they interrelate with cardiac function. In this study, we tested the hypothesis that the autonomic dysregulation at the heart is reflected in the regulation of the pupillary light reflex.

Cardiovagal modulation upon postural change is altered in Huntington's disease.

Background: Cardiac autonomic nervous system (ANS) dysfunction in Huntington's disease (HD) might affect both the sympathetic and parasympathetic branch of the ANS.

Results And Conclusions: The pattern of linear heart rate variability we found in mid stage HD patients points towards a predominately reduced cardiovagal modulation compared with healthy subjects, which might influence HD patients' susceptibility for cardiovascular complications such as syncopes and cardiac arrhythmias.

The effects of sildenafil on heart rate variability in healthy subjects.

The effects of sildenafil on heart rate variability were investigated in 20 healthy male subjects aged 24 (21 to 32) years (median; range). Subjects orally received single 100-mg doses of sildenafil and placebo under randomized double-blind crossover conditions on 2 separate study days. Time domain measures of heart rate variability were assessed under conditions of relaxed rest, metronomic breathing (6 cycles per minute), and bicycle ergometry before administration of sildenafil and placebo as well as 60 minutes afterwards.

Relationship between cardiovagal modulation and psychotic state in patients with paranoid schizophrenia.

Disturbed autonomic nervous system (ANS) function in schizophrenia might contribute to increased cardiovascular mortality. We obtained heart rate variability indices from 40 unmedicated schizophrenic patients and 58 matched controls. Mainly we found that patients displaying stronger psychotic symptoms as assessed by the Brief Psychiatric Rating Scale exhibit more severe cardiac ANS disturbances compared with controls.

[Psychosocial problems and mental disorders among immigrants of German origin].

Objective: The number of ethnic German immigrants from former East bloc countries (Aussiedler) has considerably increased during the past 20 years. However, studies on the frequency of psychiatric disorders or on psychosocial risk factors for psychiatric morbidity in this partially inhomogenous population group are remarkably rare.

Method: We undertook a comprehensive research of the current literature to gain the first systematic review on this issue.

Brugada syndrome as a potential cardiac risk factor during electroconvulsive therapy (ECT).

A case of asystole (> 5 s) during electroconvulsive therapy (ECT) is reported in a patient who was subsequently diagnosed to have Brugada syndrome (BS). This hereditary sodium-channelopathy is characterized by typical, though intermittent, ECG abnormalities and carries a high risk of ventricular arrythmia and sudden cardiac death. The general occurence of BS is rare; however, it is more prevalent in men and in southeast Asian populations.

[40 years beta-adrenoceptor blockers in psychiatry].

Beta-adrenoceptor blockers belong to the most successful drug classes of medicine. Mainly they are used in internal medicine. 40 years ago beta-adrenoceptor blockers have occasionally been used in psychiatry for the treatment of anxiety disorders.

Potential clinical targets of repetitive transcranial magnetic stimulation treatment in schizophrenia.

Despite the introduction of atypical antipsychotic drugs, treatment-resistant symptoms still represent a serious problem in schizophrenia. Currently, there is evidence from clinical studies suggesting that treatment with repetitive transcranial magnetic stimulation (rTMS) may improve schizophrenia symptoms. Our review provides an overview of clinical rTMS studies in schizophrenic patients.

Guillain-Barré syndrome after septicemia following clozapine-induced agranulocytosis. A case report.

We report the case of a patient with schizophrenia, who experienced agranulocytosis during clozapine treatment, followed by bronchopulmonal infection and Guillain-Barré syndrome. The case was recorded within the German surveillance project "drug safety in psychiatry" (AMSP).