Nikola Schoofs

Gender differences in psychotic bipolar mania

OBJECTIVE This study examined gender differences in the prevalence and types of psychotic symptoms in bipolar mania. METHODS Participants were drawn from consecutive admissions to the psychiatric clinic in Chemnitz, Germany, in 2005. The diagnosis of bipolar disorder, manic episode was made within 24 hours of admission, and the severity of mania was assessed using the Young Mania Rating Scale (YMRS) and the German version of the Altman Self-Rating Mania Scale. Data collected for each patient included age at the onset of bipolar illness, number of previous episodes, social functioning between episodes, and duration of hospitalization for the index episode. Based on the Task Force for Methods and Documentation in Psychiatry system, psychotic symptoms were classified as hallucinations (visual, auditory, olfactory, tactile, acousma, somatic); delusions (paranoid, reference, guilt, grandeur, religious, erotomania, hypochondriac, poverty, jealousy); and ego disorder (thought control, thought broadcasting). RESULTS One hundred thirty-seven women and 109 men met the criteria for an acute manic episode, of whom 93 women and 62 men had psychotic symptoms. Compared with psychotic men, psychotic women had more delusions and hallucinations, both overall and per patient, and more delusions of reference and paranoid delusions. Psychotic women had more mixed states compared with psychotic men. Psychotic women differed from both psychotic men and nonpsychotic women on a number of clinical and social variables: they had higher YMRS scores and more previous episodes of depression despite an earlier onset of illness. CONCLUSION Women with bipolar mania exhibited a specific pattern of psychotic symptoms that appeared to be associated with greater severity of the acute episode, more mixed states, and a more severe course of illness.

Binge eating disorder and menstrual cycle in unmedicated women with bipolar disorder.

OBJECTIVE Weight increase is a problem in women with bipolar disorder (BD). Furthermore, there is evidence that both binge eating disorder (BED) and menstrual cycle abnormalities occur more frequently in women with affective disorders than in the general population. We investigated whether there is a clinical link between the two disorders and menstrual cycle. METHOD Epidemiological and clinical variables associated with both BD and BED were assessed as well as menstrual cycle influence. RESULTS The prevalence of BED in the sample was 28.8%. Menstrual cycle significantly influenced BED in all participants in that BED became worse prior to menses. 80% of the participants noticed regular weight gain prior to menses. DISCUSSION BED is a common comorbidity in unmedicated subjects with BD, as is overweight. In women with BD menstrual cycle should be taken into consideration, as it can worsen the BD itself and associated comorbidities such as BED and overweight. Alteration in menstrual cycle-associated eating behavior should be routinely assessed in women with BD.

Methadon und Levomethadon – Dosierung und Nebenwirkungen

OBJECTIVE The aim of our survey was to assess the dosage and the frequency of side effects in patients with opioid dependency receiving opioid maintenance therapy (OMT). METHODS A region-wide anonymous survey was carried out in the city of Berlin. The dosage, the frequency of side effects, data on the dependence disorder and type of OMT was assessed. RESULTS Out of all 5032 patients receiving OMT in Berlin 986 participated in the study. Of all included patients 460 were treated with methadone, 371 with levomethadone. The average dose of levomethadone was significantly higher than the dose of methadone even when adequately adjusting for differential effect sizes. In the total sample, 484 participants reported side effects. The most frequent named ones were sweating and sedation. The incidence of the side effects irritability and gastrointestinal troubles was significantly higher under OMT with levomethadone, although when an adjustment for dosage was performed. CONCLUSIONS Levomethadone is dosed significantly higher than methadone. After an adjustment for dosage was performed, some of the specific side effects occurred more often under OMT with levomethadone. The results of our survey support the use of methadone as first line treatment for OMT.

Opioidsubstitution bei heroinabhängigen Patienten mit Migrationshintergrund

ZusammenfassungHintergrundBisher liegen im deutschsprachigen Raum keine regionsumfassenden Untersuchungen zu opioidabhängigen Patienten mit Migrationshintergrund in Substitutionsbehandlung vor.Ziel der ArbeitDie vorliegende Arbeit untersucht, inwieweit sich opioidabhängige Patienten mit und ohne Migrationshintergrund in Substitutionsbehandlung hinsichtlich sozioökonomischer Parameter, Charakteristika der Abhängigkeitserkrankung sowie der Bewertung der Substitutionstherapie unterscheiden.Material und MethodenVon Mai bis Oktober 2011 wurden substituierte Personen in allen 20 psychiatrischen Kliniken sowie den 110 Praxen mit Lizenz zur Opioidsubstitution in Berlin befragt.ErgebnisseVon 986 teilnehmenden Personen machten 956 Angaben zur Herkunft. Davon gaben 204 Personen (21,3 %) einen Migrationshintergrund an. Diese waren, verglichen mit Patienten ohne Migrationshintergrund, signifikant kürzer substituiert, wünschten häufiger eine Möglichkeit zur Beendigung ihrer Substitutionstherapie und sprachen sich häufiger für deren grundsätzliche zeitliche Begrenzung aus.DiskussionDie Unterschiede hinsichtlich der Substitutionsdauer und des Beendigungswunsches können für einen stärkeren Abstinenzwunsch und für eine andere Bewertung der Substitutionstherapie von Personen mit Migrationshintergrund stehen.SummaryBackgroundNo regional analyses regarding opioid-dependent patients in maintenance treatment with a migration background have so far been performed in German-speaking countries.ObjectivesThis study examined patients with and without a migration background regarding socioeconomic parameters, characteristics of dependency and attitude towards opiate maintenance treatment (OMT).Material and methodsFrom May to October 2011 patients in OMT from all of the 20 psychiatry clinics and 110 physician practices in Berlin with a licence to provide OMT were included in this analysis.ResultsOut of the 986 participating patients, 956 gave information on migration background and of these, 204 (21.3 %) originated from a country other than Germany. Compared to patients without a migration background, their participation in a maintenance program was significantly shorter and they more often expressed a desire to end OMT and wanted a limited duration of OMT.ConclusionThe differences regarding duration of OMT and the wish to end OMT can reflect a stronger desire for abstinence and a different attitude towards maintenance treatment of patients with a migration background.BACKGROUND No regional analyses regarding opioid-dependent patients in maintenance treatment with a migration background have so far been performed in German-speaking countries. OBJECTIVES This study examined patients with and without a migration background regarding socioeconomic parameters, characteristics of dependency and attitude towards opiate maintenance treatment (OMT). MATERIAL AND METHODS From May to October 2011 patients in OMT from all of the 20 psychiatry clinics and 110 physician practices in Berlin with a licence to provide OMT were included in this analysis. RESULTS Out of the 986 participating patients, 956 gave information on migration background and of these, 204 (21.3 %) originated from a country other than Germany. Compared to patients without a migration background, their participation in a maintenance program was significantly shorter and they more often expressed a desire to end OMT and wanted a limited duration of OMT. CONCLUSION The differences regarding duration of OMT and the wish to end OMT can reflect a stronger desire for abstinence and a different attitude towards maintenance treatment of patients with a migration background.

[Maintenance treatment in opioid-dependent patients with migration background].

ZusammenfassungHintergrundBisher liegen im deutschsprachigen Raum keine regionsumfassenden Untersuchungen zu opioidabhängigen Patienten mit Migrationshintergrund in Substitutionsbehandlung vor.Ziel der ArbeitDie vorliegende Arbeit untersucht, inwieweit sich opioidabhängige Patienten mit und ohne Migrationshintergrund in Substitutionsbehandlung hinsichtlich sozioökonomischer Parameter, Charakteristika der Abhängigkeitserkrankung sowie der Bewertung der Substitutionstherapie unterscheiden.Material und MethodenVon Mai bis Oktober 2011 wurden substituierte Personen in allen 20 psychiatrischen Kliniken sowie den 110 Praxen mit Lizenz zur Opioidsubstitution in Berlin befragt.ErgebnisseVon 986 teilnehmenden Personen machten 956 Angaben zur Herkunft. Davon gaben 204 Personen (21,3 %) einen Migrationshintergrund an. Diese waren, verglichen mit Patienten ohne Migrationshintergrund, signifikant kürzer substituiert, wünschten häufiger eine Möglichkeit zur Beendigung ihrer Substitutionstherapie und sprachen sich häufiger für deren grundsätzliche zeitliche Begrenzung aus.DiskussionDie Unterschiede hinsichtlich der Substitutionsdauer und des Beendigungswunsches können für einen stärkeren Abstinenzwunsch und für eine andere Bewertung der Substitutionstherapie von Personen mit Migrationshintergrund stehen.SummaryBackgroundNo regional analyses regarding opioid-dependent patients in maintenance treatment with a migration background have so far been performed in German-speaking countries.ObjectivesThis study examined patients with and without a migration background regarding socioeconomic parameters, characteristics of dependency and attitude towards opiate maintenance treatment (OMT).Material and methodsFrom May to October 2011 patients in OMT from all of the 20 psychiatry clinics and 110 physician practices in Berlin with a licence to provide OMT were included in this analysis.ResultsOut of the 986 participating patients, 956 gave information on migration background and of these, 204 (21.3 %) originated from a country other than Germany. Compared to patients without a migration background, their participation in a maintenance program was significantly shorter and they more often expressed a desire to end OMT and wanted a limited duration of OMT.ConclusionThe differences regarding duration of OMT and the wish to end OMT can reflect a stronger desire for abstinence and a different attitude towards maintenance treatment of patients with a migration background.BACKGROUND No regional analyses regarding opioid-dependent patients in maintenance treatment with a migration background have so far been performed in German-speaking countries. OBJECTIVES This study examined patients with and without a migration background regarding socioeconomic parameters, characteristics of dependency and attitude towards opiate maintenance treatment (OMT). MATERIAL AND METHODS From May to October 2011 patients in OMT from all of the 20 psychiatry clinics and 110 physician practices in Berlin with a licence to provide OMT were included in this analysis. RESULTS Out of the 986 participating patients, 956 gave information on migration background and of these, 204 (21.3 %) originated from a country other than Germany. Compared to patients without a migration background, their participation in a maintenance program was significantly shorter and they more often expressed a desire to end OMT and wanted a limited duration of OMT. CONCLUSION The differences regarding duration of OMT and the wish to end OMT can reflect a stronger desire for abstinence and a different attitude towards maintenance treatment of patients with a migration background.

Opioidsubstitution bei heroinabhängigen Patienten mit Migrationshintergrund@@@Maintenance treatment in opioid-dependent patients with migration background

ZusammenfassungHintergrundBisher liegen im deutschsprachigen Raum keine regionsumfassenden Untersuchungen zu opioidabhängigen Patienten mit Migrationshintergrund in Substitutionsbehandlung vor.Ziel der ArbeitDie vorliegende Arbeit untersucht, inwieweit sich opioidabhängige Patienten mit und ohne Migrationshintergrund in Substitutionsbehandlung hinsichtlich sozioökonomischer Parameter, Charakteristika der Abhängigkeitserkrankung sowie der Bewertung der Substitutionstherapie unterscheiden.Material und MethodenVon Mai bis Oktober 2011 wurden substituierte Personen in allen 20 psychiatrischen Kliniken sowie den 110 Praxen mit Lizenz zur Opioidsubstitution in Berlin befragt.ErgebnisseVon 986 teilnehmenden Personen machten 956 Angaben zur Herkunft. Davon gaben 204 Personen (21,3 %) einen Migrationshintergrund an. Diese waren, verglichen mit Patienten ohne Migrationshintergrund, signifikant kürzer substituiert, wünschten häufiger eine Möglichkeit zur Beendigung ihrer Substitutionstherapie und sprachen sich häufiger für deren grundsätzliche zeitliche Begrenzung aus.DiskussionDie Unterschiede hinsichtlich der Substitutionsdauer und des Beendigungswunsches können für einen stärkeren Abstinenzwunsch und für eine andere Bewertung der Substitutionstherapie von Personen mit Migrationshintergrund stehen.SummaryBackgroundNo regional analyses regarding opioid-dependent patients in maintenance treatment with a migration background have so far been performed in German-speaking countries.ObjectivesThis study examined patients with and without a migration background regarding socioeconomic parameters, characteristics of dependency and attitude towards opiate maintenance treatment (OMT).Material and methodsFrom May to October 2011 patients in OMT from all of the 20 psychiatry clinics and 110 physician practices in Berlin with a licence to provide OMT were included in this analysis.ResultsOut of the 986 participating patients, 956 gave information on migration background and of these, 204 (21.3 %) originated from a country other than Germany. Compared to patients without a migration background, their participation in a maintenance program was significantly shorter and they more often expressed a desire to end OMT and wanted a limited duration of OMT.ConclusionThe differences regarding duration of OMT and the wish to end OMT can reflect a stronger desire for abstinence and a different attitude towards maintenance treatment of patients with a migration background.BACKGROUND No regional analyses regarding opioid-dependent patients in maintenance treatment with a migration background have so far been performed in German-speaking countries. OBJECTIVES This study examined patients with and without a migration background regarding socioeconomic parameters, characteristics of dependency and attitude towards opiate maintenance treatment (OMT). MATERIAL AND METHODS From May to October 2011 patients in OMT from all of the 20 psychiatry clinics and 110 physician practices in Berlin with a licence to provide OMT were included in this analysis. RESULTS Out of the 986 participating patients, 956 gave information on migration background and of these, 204 (21.3 %) originated from a country other than Germany. Compared to patients without a migration background, their participation in a maintenance program was significantly shorter and they more often expressed a desire to end OMT and wanted a limited duration of OMT. CONCLUSION The differences regarding duration of OMT and the wish to end OMT can reflect a stronger desire for abstinence and a different attitude towards maintenance treatment of patients with a migration background.