Andreas Broocks

Test–retest reliability and validity of the Pittsburgh Sleep Quality Index in primary insomnia

OBJECTIVEnPsychometric evaluation of the Pittsburgh Sleep Quality Index (PSQI) for primary insomnia.nnnMETHODSnThe study sample consisted of 80 patients with primary insomnia (DSM-IV). The length of the test-retest interval was either 2 days or several weeks. Validity analyses were calculated for PSQI data and data from sleep diaries, as well as polysomnography. To evaluate the specificity of the PSQI, insomnia patients were compared with a control group of 45 healthy subjects.nnnRESULTSnIn primary insomnia patients, the overall PSQI global score correlation coefficient for test-retest reliability was .87. Validity analyses showed high correlations between PSQI and sleep log data and lower correlations with polysomnography data. A PSQI global score > 5 resulted in a sensitivity of 98.7 and specificity of 84.4 as a marker for sleep disturbances in insomnia patients versus controls.nnnCONCLUSIONnThe PSQI has a high test-retest reliability and a good validity for patients with primary insomnia.

Adjunctive lithium treatment in the prevention of suicidal behaviour in depressive disorders: a randomised, placebo-controlled, 1-year trial

Objective:u2002 Evidence based on controlled studies is still limited for treatment strategies that prevent recurrence of suicide attempts. Findings from observational as well as meta‐analytic studies strongly suggest that lithium may have suicide‐protective properties.

Quetiapine addition to serotonin reuptake inhibitors in patients with severe obsessive-compulsive disorder: a double-blind, randomized, placebo-controlled study.

Objective: Although many patients with obsessive-compulsive disorder (OCD) benefit from treatment with serotonin reuptake inhibitors (SRIs), it is estimated that 40% to 60% of them do not respond. The objective of the present study was to evaluate the efficacy of quetiapine added to baseline treatment with SRIs for the treatment of OCD in severely ill adult subjects. Method: Forty patients (21 men, 19 women) with primary OCD according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria participated in a 12-week, double-blind, placebo-controlled trial. They were randomly assigned to dosages of quetiapine titrated up to 400 mg/d (n = 20) or to placebo (n = 20) in addition to their SRI treatment. During the continuation phase (weeks 6-12), subjects received different dosages between 400 and 600 mg/d depending on clinical response. At entry, all patients were unresponsive to at least 1 course of at least 12 weeks of treatment with SRIs at defined doses. The total Yale-Brown Obsessive-Compulsive Scale score was the primary efficacy parameter. Results: Intention-to-treat, last-observation-carried-forward analysis demonstrated a mean ± SD decrease in Yale-Brown Obsessive-Compulsive Scale score of 5.2 ± 5.4 in the quetiapine group and 3.9 ± 4.9 in the placebo group. The analysis of treatment effects between the 2 groups showed no significant difference. There were no significant group differences in any of the other self-rating scales or clinician-administered rating scales. Conclusions: In this study, augmentation of SRI treatment with quetiapine in severe OCD had no additional effect.

Clinical outcome in patients with obsessive-compulsive disorder after discontinuation of SRI treatment: results from a two–year follow–up

AbstractBackgroundCombined treatment withnserotonin–reuptake inhibitors (SRI) and cognitive–behavioralntherapy (CBT) is a common therapy approachnfor obsessive–compulsive disorder (OCD). However, it isna matter of debate whether discontinuation of SRI afterncombined treatment leads to relapse.MethodSeventyfournconsecutively admitted patients suffering fromnOCD were included in the study. Thirty–seven patientsnwere treated with CBT alone, and 37 patients receivedncombined CBT and SRI treatment. Of these latter patients,nseventeen discontinued SRI treatment during thenfollow–up period (1 and 2 years after inpatient treatment).nOCD symptom severity was determined by Yale–Brown Obsessive Compulsive Scale (Y–BOCS), andnmood was assessed by Hamilton Depression RatingnScale (HDRS).ResultsDuring the initial treatment,nscores for Y–BOCS (p < 0.001), HDRS (p < 0.001) and thenGlobal Assessment of Functioning Scale (GAF)n(p < 0.001) improved significantly in all groups. Reassessmentntwo years later revealed that a) OCD symptomnseverity and depression scores were similar betweennthe groups and b) discontinuation of SRI did notnprompt by a recurrence of symptoms.ConclusionsWeninterpret our results as suggesting that discontinuationnof SRI treatment may be considered in formerly combinedntreated OCD patients after stable remission.

Short-term training increases diagnostic and treatment rate for insomnia in general practice

SummaryObjective To evaluate the effect of short-term training of general practitioners (GPs) on their diagnosis and treatment of chronic insomnia. Methods A three-step randomized control group design was used: After baseline evaluation (T1) a group of 9 GPs underwent a training of half a day, while 7 GPs served as a control group. The diagnostic and therapeutic handling of insomnia patients was reevaluated under obligatory use of a structured diagnostic questionnaire (T2) and under optional use of it (T3). Results From 16 general practices, 4,754 patients were included. The frequency rate of insomnia was 19.3 %. The lowest diagnostic and treatment rate was found for insomnia patients without comorbidity (15 % at T1). Systematic non-pharmacological treatment was not offered by the GPs. At T2 the diagnosis rate increased significantly from 37.9 % (T1) to 71.5 % (T2, p = 0.038). It fell back to lower levels at T3 but remained better than at T1. At T3 non-pharmacological treatments and referral to a sleep expert were advised more often. Conclusion Short-term training of GPs can significantly improve their diagnostic sensitivity and first-line treatment efforts against insomnia.

Onset and maintenance of psychiatric disorders after serious accidents

The purpose of this study was to prospectively investigate the onset, course, and remission of psychiatric disorders in the first 6xa0months after a serious accident for consecutive patients in a hospital emergency department. Participants were 58 patients aged 18–65 who were assessed shortly after attending a hospital emergency department and were followed up 6xa0months afterwards. Patients were interviewed with regard to past and current psychiatric history using different instruments (e.g. SCID for DSM-IV).Prior to their accidents, 35% of all subjects had experienced one or more psychiatric disorders (lifetime prevalence). Shortly after the accident, the incidence of Acute Stress Disorder (7%), subsyndromal Acute Stress Disorder (12%), and adjustment disorder (1.5%) was increased as a reaction to the accident. At this time, 29% of all patients suffered from an acute psychiatric disorder. Six-months after the accident, 10% of the subjects met criteria for Major Depression, 6% for PTSD, 4% for subsyndromal PTSD, and 1.5% for Specific Phobia as newly developed disorders. The course of the psychiatric disorders shows that those patients who met criteria for any psychiatric diagnosis shortly after the accident ran a much higher risk for developing new or comorbid psychiatric disorders in the future.

Suicide prevention by lithium SUPLI--challenges of a multi-center prospective study.

Abstract Several studies have shown that there is a significantly increased risk of suicide related mortality in patients with a positive history of suicide attempts. The SUPLI-Study is the first prospective, randomized, double blind, placebo controlled multi-center trial focusing on the proposed suicide preventive effects of lithium in patients with suicidal behavior but not suffering from bipolar disorder or recurrent major depressive disorder. Patients with a recent history of a suicide attempt are treated with lithium versus placebo during a 12 month period. The hypothesis is that lithium treatment will lead to a 50% reduction of suicidal behavior. The protocol of the study and preliminary results are presented.

Adjunctive lithium treatment in the prevention of suicidal behavior in patients with depression and comorbid personality disorders.

Abstract Objective. Patients with both major depression and personality disorders have a high risk of suicidal behavior. Lithium is meant to have anti-suicidal properties in patients with affective disorders. The anti-suicidal effect of lithium in patients with affective disorders and comorbid personality disorders has not been investigated yet. Methods. A post-hoc analysis of a subsample of patients with depression and comorbid personality disorder (PD) and a recent suicide attempt (n = 19) from the prospective, placebo-controlled lithium intervention study (N = 167), was conducted. Results. Three patients in the lithium group (n = 8) and two patients in the placebo group (n = 11) presented a suicide attempt throughout the course of the study. No differences related to suicidal behavior could be detected between the placebo group and the group with lithium intervention. Conclusions. On the basis of the small sample size, among patients with comorbid PD, lithium does not seem to have an effect on suicidal behavior in contrast to patients with affective disorders without comorbid PD.

A multicenter study about Neurobiology of Suicidal Behavior: design, development, and preliminary results.

Abstract The subproject 1.5 “Neurobiology of Suicidal Behavior” is a multicenter study assessing peripheral parameters of the serotonergic, noradrenergic, and dopaminergic transmitter systems. Additionally, stress hormones and the lipid system as well as inhibitory and excitatory amino acids will be investigated. The different parameters are collected in cerebral spinal fluid (CSF), blood, and saliva. Patients with a depressive spectrum disorder with and without a suicide attempt (during the last three weeks) and being medication free for two weeks are included in the study. So far, 103 patients and controls have been recruited. The design and development of this project as well as interconnections with the others subprojects are described. Preliminary results about the stress hormone system and suicidality are presented.

Is MAO-B activity in platelets associated with the occurrence of suicidality and behavioural personality traits in depressed patients?

Objective:u2002 Low platelet monoaminoxidase B (MAO‐B) activity has been associated with various forms of impulsive behaviour and suicidality. The present study investigated the relationship between MAO‐B activity in platelets and aspects of suicidality in depressed patients and controls.