Frank-Gerald Pajonk

Hippocampal plasticity in response to exercise in schizophrenia.

CONTEXT Hippocampal volume is lower than expected in patients with schizophrenia; however, whether this represents a fixed deficit is uncertain. Exercise is a stimulus to hippocampal plasticity. OBJECTIVE To determine whether hippocampal volume would increase with exercise in humans and whether this effect would be related to improved aerobic fitness. DESIGN Randomized controlled study. SETTING Patients attending a day hospital program or an outpatient clinic. PATIENTS OR OTHER PARTICIPANTS Male patients with chronic schizophrenia and matched healthy subjects. INTERVENTIONS Aerobic exercise training (cycling) and playing table football (control group) for a period of 3 months. MAIN OUTCOME MEASURES Magnetic resonance imaging of the hippocampus. Secondary outcome measures were magnetic resonance spectroscopy, neuropsychological (Rey Auditory Verbal Learning Test, Corsi block-tapping test), and clinical (Positive and Negative Syndrome Scale) features. RESULTS Following exercise training, relative hippocampal volume increased significantly in patients (12%) and healthy subjects (16%), with no change in the nonexercise group of patients (-1%). Changes in hippocampal volume in the exercise group were correlated with improvements in aerobic fitness measured by change in maximum oxygen consumption (r = 0.71; P = .003). In the schizophrenia exercise group (but not the controls), change in hippocampal volume was associated with a 35% increase in the N-acetylaspartate to creatine ratio in the hippocampus. Finally, improvement in test scores for short-term memory in the combined exercise and nonexercise schizophrenia group was correlated with change in hippocampal volume (r = 0.51; P < .05). CONCLUSION These results indicate that in both healthy subjects and patients with schizophrenia hippocampal volume is plastic in response to aerobic exercise.

Psychiatric emergencies in prehospital emergency medical systems: a prospective comparison of two urban settings

BACKGROUND Psychiatric emergency situations (PES) are of high importance to the German prehospital physician-based emergency medical system. So far, however, no prospective studies regarding the incidence of PES have been performed, neither have effects of training programs on diagnostic and therapeutic accuracy been studied. METHOD The protocols of two emergency medical services (EMS) were collected and analyzed prospectively. Emergency physicians (EPs) in Kaiserslautern (KL) attended a standardized educational program and underwent daily supervision. EPs in Homburg (HOM) had not been informed about the study. In KL, sociodemographic variables were collected. An investigator who was not involved in the individual EMS mission assessed the correct classification of PES. RESULTS Among all calls for an EP, 11.8% were classified as PES. There was no difference between the two centers. Correct classification of PES in KL was significantly higher than that in HOM (94.3% vs. 80.6%). Documentation of suicidal behavior was deficient in both centers. EPs in KL gave verbal crisis intervention significantly more often, administered less medication overall, and dispensed more specific drugs in psychotic disorders and significantly less drugs in substance abuse disorders. Patients were more often treated at the scene and were less often transported to a hospital. Some sociodemographic variables were associated with psychiatric morbidity of treatment. CONCLUSION Accounting for 12% of all missions, psychiatric emergencies are a frequent reason for calls for EPs, equaling trauma-related and neurological emergencies. The most frequent reasons for calls were alcohol intoxication, states of agitation and suicidal behavior. The diagnostic and therapeutic accuracy of EPs may be improved with a concise standardized teaching program.

Cognitive decline correlates with low plasma concentrations of copper in patients with mild to moderate Alzheimer's disease

Alzheimers disease (AD) is a devastating brain disorder clinically characterised by progressive loss of characteristic cognitive abilities. Increasing evidence suggests a disturbed copper (Cu) homeostasis to be associated with the pathological processes. In the present study we analysed the plasma Cu levels and cognitive abilities using the Alzheimers disease Assessment Scale-cognitive subscale (ADAS-cog) in 32 patients with mild to moderate AD. Statistical analysis revealed a negative correlation between plasma Cu levels and cognitive decline (r=-0.49; P<0.01). Patients with low plasma Cu (mean 82 +/- SD 9) had significant higher ADAS-cog values (mean 23 +/- SD 7), than patients with medium plasma Cu (mean 110 +/- SD 7), who exhibited lower ADAS-cog scores (mean 16 +/- SD 4; ANOVA, P<0.0001). Despite the fact that all patients had plasma Cu levels within the physiological range between 65 microg and 165 microg/dL, 87.5% of the patients revealed a significant negative correlation between plasma Cu and ADAS-cog. This finding supports the hypothesis of a mild Cu deficiency in most AD patients.

Rapid dose titration of quetiapine for the treatment of acute schizophrenia and acute mania: a case series

To quickly reduce symptoms and to optimize long-term outcome, patients with an acute episode of schizophrenia or mania require prompt treatment intervention. The atypical antipsychotic quetiapine (‘Seroquel’) has been approved for the treatment of schizophrenia and manic episodes associated with bipolar disorder. For patients with acute symptoms such as aggression or agitation, higher doses of quetiapine than the recommended initiation schedule are often required. This report presents the tolerability findings from rapid initiation with high-dose quetiapine for eight patients who were consecutively admitted with acute symptoms of schizophrenia (n 5) or mania (n 3). The results from this case series show that quetiapine treatment could be safely titrated at a more rapid rate and to doses greater than that described in the current prescribing information. For most patients, rapid dose escalation was well tolerated; no serious side effects were observed and vital clinical parameters were unchanged; one patient experienced transient somnolence. In conclusion, these results suggest that rapid dose escalation of quetiapine could be a useful treatment approach for acutely ill patients with schizophrenia and bipolar mania in order to improve acute symptoms and support the need for randomized controlled trials. However, dose adjustments should be considered with respect to each patient’s individual level of tolerability.

Risperidone in acute and long-term therapy of schizophrenia—a clinical profile

Data from a range of well-controlled clinical trials, observational studies, and clinical use support the efficacy of risperidone for both acute and long-term therapy of schizophrenic psychoses. With regard to positive symptoms, the efficacy of risperidone was shown to be at least comparable with that of haloperidol. However, risperidone differs from conventional antipsychotics because it is more effective against the negative symptoms, has beneficial effects on affective and cognitive symptoms, and carries less risk of extrapyramidal side effects (EPS). To date, risperidone is the only atypical antipsychotic to have shown a significantly lower relapse rate compared with haloperidol in a long-term double-blind trial. This review describes comprehensive trial data and therapeutic observations gained with risperidone in the treatment of schizophrenia since its approval.

Illegale Drogen – Welche gibt es und wie wirken sie?

Intoxikationen mit psychotropen Substanzen sind ein relevantes Thema fur Arzte in der Notaufnahme: Im Jahr 2013 mussten sich > 130 000 Patienten deswegen stationar behandeln lassen; neben Alkohol waren v. a. illegale Drogen die Ursache der Vergiftungen. Dieser Artikel vermittelt einen Uberblick der verschiedenen Substanzen, damit Sie Intoxikationen durch illegale Drogen besser erkennen konnen.

Illegale Drogen – Diagnostik und Therapie von Intoxikationen

Die Vielfalt der Komplikationen und Differenzialdiagnosen erschwert Diagnostik und Behandlung von Intoxikationen mit illegalen Drogen. Immer wieder stehen neben versehentlicher Uberdosierung auch suizidale Absichten hinter einer Vergiftung. In beiden Fallen kann es ein Schlusselerlebnis sein, um den Betroffenen zur Suchttherapie zu motivieren.

Alternative biologische Therapien - In der Behandlung der Negativsymptomatik und der kognitiven Störungen

The biological therapy of schizophrenia is based on psychopharmacology. In this paper two novel approaches are presented which might contribute to future treatment of patients with schizophrenia. Exercise might improve negative symptoms and cognitive impairment through increased synaptic plasticity. Repetitive transcranial magnet stimulation is already used for the treatment of negative symptoms and acustic hallucinations. For both treatments the rationale and the current state of evidence is reviewed.

Agitation, aggression and violence in emergency medicine

A state of agitation occurs in 15-25% of all patients with mental disorder who are seen by pre-hospital emergency physicians (EPs) in the German emergency medical system. Additionally, there is an unknown number of calls due to injury subsequent to violence. Aggression against EPs and paramedics, however, is rare. This paper gives an overview on the models for the onset of aggression, the single stages of agitation and violence, and the stage-dependent steps for de-escalation and crisis intervention in the emergency situation. Action has to be determined but unexcited and, depending on the situation, swift but well coordinated, including psychopharmacotherapy.