Peter Leiberich

Treatment of aggression with topiramate in male borderline patients: a double-blind, placebo-controlled study.

BACKGROUND Borderline personality disorder (BPD) is a complex mental disease associated with severe serious functional impairment, affective instability, and impulsive aggression. The aim of this study was to compare the efficacy of topiramate versus placebo in the treatment of aggression in men with borderline personality disorder. METHODS We conducted an 8-week, double-blind, placebo-controlled study of topiramate in 42 male subjects (42 of 44) meeting DSM-IV criteria for BPD. The Structured Clinical Interview (SCID I and II) was carried out. The subjects were randomly assigned to topiramate (n = 22) or placebo (n = 20). RESULTS Significant changes on four STAXI scales (State Anger, p < .01; Trait Anger, p < .05; Anger Out, p < .01; Anger Control, p < .01) were observed in the subjects treated with topiramate. A nonsignificant difference was found on the Anger In scale (p = .86). Additional significant weight loss was observed (difference in weight loss between the both groups was 5.0 kg, p < .01, 95% confidence interval = [-6.5 to 3.4]). All subjects tolerated topiramate relatively well. CONCLUSIONS Topiramate appears to be an effective agent in the treatment of anger in men with BPD. Mild weight loss can be expected.

Lamotrigine treatment of aggression in female borderline-patients: a randomized, double-blind, placebo-controlled study.

Anger and aggression are typical in borderline patients. The goal of this study was to compare the efficacy of lamotrigine versus placebo in the treatment of aggression in women meeting the criteria for borderline personality disorder (BPD). We conducted a randomized, double-blind, placebo-controlled study of lamotrigine in 24 female subjects meeting Structured Clinical Interview for DSM-IV (SCID) criteria for BPD. Thesubjects were randomly assigned in a 2: 1 manner ratio to lamotrigine (n = 18) or placebo (n = 9). Treatment duration was 8 weeks. Primary outcome measures were self-reported changes on the anger scales of the Trait Anger Expression Inventory (STAXI). In comparisone with theplacebo group, and according to the intention-to-treat principle, highly significant (p < 0.01) changes on four STAXI scales (State–Anger, Trait–Anger, Anger–Out, Anger–Control) were observed in those subjects treated with lamotrigine after 8 weeks. The only exception (p < 0.05) was found on the Anger–In scale, where a difference of only 8.5% (p < 0.2) was found. All the patients tolerated lamotrigine relatively well. Lamotrigine appears to be a safe and effective agent in thetreatment of anger in women with criteria-defined BPD as defined by SCID criteria. It did not produce any clinically significant effect on body weight.

Topiramate in treatment of patients with chronic low back pain: a randomized, double-blind, placebo-controlled study.

ObjectiveChronic low back pain (CLBP) is a widespread ailment. The aim of this study was to assess the efficacy of topiramate in the treatment of CLBP and the changes in anger status and processing, body weight, subjective pain-related disability and health-related quality of life during the course of treatment. MethodsWe conducted a 10-week, randomized, double-blind, placebo-controlled study of topiramate in 96 (36 women) patients with CLBP. The subjects were randomly assigned to topiramate (n=48) or placebo (n=48). Primary outcome measures were changes on the McGill Pain Questionnaire, State-Trait Anger Expression Inventory, Oswestry Low Back Pain Disability Questionnaire and SF-36 Health Survey scales, and in body weight. ResultsIn comparison with the placebo group (according to the intent-to-treat principle), significant changes on the pain rating index of McGill Pain Questionnaire (Ps<0.001), State-Trait Anger Expression Inventory Scales (all Ps<0.001), Oswestry Low Back Pain Disability Questionnaire (P<0.001), and SF-36 Health Survey scales (all P<0.001, except on the role-emotional scale) were observed after 10 weeks in the patients treated with topiramate. Weight loss was also observed and was significantly more pronounced in the group treated with topiramate than in those treated with placebo (P<0.001). Most patients tolerated topiramate relatively well but 2 patients dropped out because of side effects. DiscussionTopiramate seems to be a relatively safe and effective agent in the treatment of CLBP. Significantly positive changes in pain sensitivity, anger status and processing, subjective disability, health-related quality of life, and loss of weight were observed.

Mirtazapine treatment of social phobia in women: a randomized, double-blind, placebo-controlled study.

Abstract: Social phobia is an anxiety disorder characterized by extreme fear and phobic avoidance of social and performance situations and by a relatively poor health-related quality of life. The goal of this study was to compare the efficacy of mirtazapine versus placebo in the treatment of patients with social phobia. In 2004, we conducted a randomized, double-blind, placebo-controlled study of mirtazapine in 66 female subjects from the general population meeting the criteria for social phobia. The subjects were randomly assigned in a 1:1 manner to mirtazapine (n = 33) or placebo (n = 33). The treatment lasted 10 weeks. Seven patients dropped out. Primary outcome measures were self-reported changes on the Social Phobia Inventory, Liebowitz Social Anxiety Scale, and Health Survey (SF-36). In comparison with the placebo group and according to the intent-to-treat principle, significant differences on the Social Phobia Inventory and Liebowitz Social Anxiety Scale scales (all P < 0.001), as well as on most (5 from 8) scales of SF-36 (all P < 0.001), were observed in the mirtazapine-treated subjects. All patients tolerated mirtazapine relatively well. Mirtazapine appears to be an effective agent in the treatment of social phobia in women and in the improvement of their health-related quality of life.

Influence of topiramate on olanzapine-related adiposity in women: a random, double-blind, placebo-controlled study.

Abstract: The aim of this study was to compare the efficacy of topiramate versus a placebo in the treatment of adiposity in women undergoing olanzapine therapy. We also assessed changes health-related quality of life, the patients actual state of health, and psychologic impairments. The 10-week, random, double-blind, placebo-controlled study included 43 women who had been treated with olanzapine (mean dose 7.8 ± 3.6 in the topiramate group and 7.2 ± 3.1 in the placebo group) and had gained weight as a side effect. The subjects were randomly assigned to topiramate (n = 25) or a placebo (n = 18). Primary outcome measures were weight checks and self-reported changes on the scales of the SF-36 Health Survey, Bf-S Scale of Well-Being, and the Adjective Checklist EWL-60-S. Weight loss was observed and was significantly more pronounced in the topiramate-treated group (difference in weight loss between the 2 groups: 5.6 kg, 95% CI = −8.5, −3.0, P < 0.001). In comparison with the placebo group, significant changes on 7 (7/8) scales of SF-36 Health Survey (all P < 0.001), on all 6 scales of the EWL-60-S, and on the Bf-S were observed in the topiramate-treated subjects after 10 weeks. All patients tolerated topiramate well. Topiramate appears to be a safe and effective agent in the treatment of weight gain that occurred during olanzapine treatment. Significantly positive changes in health-related quality of life, the patients actual state of health, and psychologic impairments were observed.

The Occurrence of Posttraumatic Stress Disorder in Patients Following Intensive Care Treatment: A Cross-Sectional Study in a Random Sample

Posttraumatic stress disorder (PTSD) can now be applied to patients who have just had intensive care treatment. The authors tested whether the reliability of the diagnosis depends on the measuring instrument used and whether the occurrence of PTSD is related to the presence of preexisting psychic disorders or to a worsening of the patients’ general condition. The authors examined 41 former patients of an intensive care unit (ICU) with the Posttraumatic Scale (PTSS-10) and, afterward, with the Structured Clinical Interview (SCID). Screening with PTSS-10 showed that 17.07% of the patients met the recommended threshold for probable diagnosis of PTSD of 35 or more points. With SCID, PTSD could be confirmed in 9.76% of the cases. Patients with a prior psychiatric disease showed more frequent (P< .02) occurrences of PTSD. The severity of their Acute Physiology and Chronic Health Evaluation System II (Apache II) scores had no significant influence. PTSS-10 can be used for a preliminary diagnostic orientation. With the PTSD module of the SCID, a structured diagnostic tool is available. Almost twice as many PTSD cases were diagnosed among the subjects with the PTSS-10 as with SCID. Post-ICU PTSD occurred more frequently among patients with prior psychiatric diseases; however, it was not dependent on exacerbation of the patient’s Apache II scores.

Medical decision-making of the patient in the context of the family: results of a survey

Goals of the studyFrom the perspective of patient autonomy, the family is often looked upon as a troublemaker in medical decision-making. The question remains open as to whether it is possible to do justice to the autonomy of the individual patient and to the claims of his family at the same time.Patients and methodsA clinical study was undertaken when both patients and dependants were interviewed. One hundred people (50 pairs) participated in this study and could be analyzed. A questionnaire consisting of 15 items was used and was evaluated to see if and how the attitudes concerning medical decision-making differ between patient and dependant.ResultsThe majority of the interviewees (89%) agreed with the opinion that medical decisions should be made jointly by the patient, the family, and the doctor. Ninety-three percent approved of the claim to inform not only the patient, but also the family. Seventy percent of the patients and 54% of the dependants think that the family is entitled to have a say in matters concerning medical decision-making, only 30% of the patients, but 42% of the dependants argued against this view. Eighty-four percent of the patients argued against a change in this right at the end of life, which was approved by 32% of the family members.ConclusionsThe family plays a central role in medical decision-making. This could be shown by a survey among patients with malignant diseases and their dependants. These initial findings must be verified in a larger population. The increased inclusion of the family in the process of medical decision-making corresponds in general to the expressed will of the patients. The model of shared decision-making is favored by values which both the family and the patient have in common. Thus, a family-based decision-making theory needs to be formulated in the future.

Longitudinal Development of Distress, Coping and Quality of Life in HIV-Positive Persons

BACKGROUND Longitudinal study on burdens, quality of life and coping strategies of HIV-positive persons to identify patterns of successful adaptation to the demands of the infection. METHODS In a semiprospective multimodal approach, 61 HIV-positive persons in all stages of the infection attending an HIV ambulatorium were assessed by inventories (3 times) and by a half-standardized interview (baseline T1 focussing on first reactions after diagnosis, follow-up T3 1.5 years later). Subjects had a mean age of 35.3 years and 69% were male. Forty-four percent were infected via homosexual intercourse, 46% via intravenous needle sharing and 10% via heterosexual intercourse or an unknown source. RESULTS Global, psychic and familial distress decreased significantly from the first period after the diagnosis of HIV to the third time of measurement, while somatic complaints increased. Most test persons were able to deal effectively with the demands of the infection and showed a great degree of flexibility in their use of cognitive-actional and emotional-palliative strategies; they achieved a high quality of life. In contrast, highly distressed individuals, mainly drug users, tended to cope in an evasive-regressive way and reported a low quality of life. Correlations between ineffective coping strategies and low quality of life were found to be significant. CONCLUSIONS After an initial phase of sorrow and lack of orientation regarding their future life, most HIV-positive persons deal effectively with the demands of the HIV infection and report a good quality of life. In contrast, HIV-positive persons with a high degree of distress and an evasive-regressive coping pattern need professional support, such as psychotherapy.

Bullying Girls - Changes after Brief Strategic Family Therapy: A Randomized, Prospective, Controlled Trial with One-Year Follow-Up

Background: Many girls bully others. They are conspicuous because of their risk-taking behavior, increased anger, problematic interpersonal relationships and poor quality of life. Our aim was to determine the efficacy of brief strategic family therapy (BSFT) for bullying-related behavior, anger reduction, improvement of interpersonal relationships, and improvement of health-related quality of life in girls who bully, and to find out whether their expressive aggression correlates with their distinctive psychological features. Methods: 40 bullying girls were recruited from the general population: 20 were randomly selected for 3 months of BSFT. Follow-up took place 12 months after the therapy had ended. The results of treatment were examined using the Adolescents’ Risk-taking Behavior Scale (ARBS), the State-Trait Anger Expression Inventory (STAXI), the Inventory of Interpersonal Problems (IIP-D), and the SF-36 Health Survey (SF-36). Results: In comparison with the control group (CG) (according to the intent-to-treat principle), bullying behavior in the BSFT group was reduced (BSFT-G from n = 20 to n = 6; CG from n = 20 to n = 18, p = 0.05) and statistically significant changes in all risk-taking behaviors (ARBS), on most STAXI, IIP-D, and SF-36 scales were observed after BSFT. The reduction in expressive aggression (Anger-Out scale of the STAXI) correlated with the reduction on several scales of the ARBS, IIP-D, and SF-36. Follow-up a year later showed relatively stable events. Conclusions: Our findings suggest that bullying girls suffer from psychological and social problems which may be reduced by the use of BSFT. Expressive aggression in girls appears to correlate with several types of risk-taking behavior and interpersonal problems, as well as with health-related quality of life.

Zur psychopathologischen und psychosozialen Charakteristik von Patienten, die häufig ihre Psychotherapeuten wechseln

SummaryThis study was performed on a clinic group of patients (n = 1000, 83.9% responder) to test characteristics of persons who switched psychotherapists on three or more occasions (n = 74). Compared with the group of minor variation, these patients had higher rates of psychosomatic symptoms, lower systemic operativeness, a dissatisfying sexuality, tended towards alcohol and pharmaceutical abuse, and had significantly higher exposure in infancy to violence and sexual abuse (all p < 0.01 after Bonferroni correction). Psychosocial factors including early experience in forming relationships in addition to current factors appear to play a decisive role in a persons dropout liability as well as the attitude to therapy.ZusammenfassungIn der vorliegenden Querschnittstudie an einer klinischen Stichprobe (n = 1000; Responderquote, 83,9 %) wurden die Merkmale von Patienten untersucht, die dreimal oder häufiger ihre Psychotherapeuten gewechselt haben (n = 74). Diese Personen zeigten im Vergleich zur Gruppe ohne häufigen Therapeutenwechsel u. a. signifikant mehr psychosomatische Symptome, eine unbefriedigende Lebensgestaltung und Sexualität, mangelnde Leistungsfähigkeit, neigten mehr zum Konsum von Alkohol und Medikamenten und waren in ihrer Kindheit signifikant mehr Gewalt und Missbrauch ausgesetzt (p jeweils <0,01 nach Bonferroni-Korrektur). Psychosoziale Faktoren, sowohl die frühen Beziehungserfahrungen als auch die aktuellen Faktoren, scheinen entscheidend für das Risikoverhalten zu sein und die Einstellung zur medizinischen Handlung zu beeinflussen.