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Dive into the research topics where Tilman Wetterling is active.

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Featured researches published by Tilman Wetterling.


Drug Safety | 2001

Bodyweight gain with atypical antipsychotics. A comparative review.

Tilman Wetterling

The atypical antipsychotics have been shown to have superior efficacy compared with typical antipsychotics such as haloperidol, particularly in the treatment of negative symptoms of schizophrenia. Furthermore, they induce less extrapyramidal effects. However, following clinical use, marked bodyweight gain has been frequently observed with some of the atypical antipsychotic drugs.In order to examine and compare the frequency, amount and conditions of bodyweight gain during treatment with atypical antipsychotics, studies concerning bodyweight gain with these agents were identified through a MEDLINE search from 1966 to March 2000.Although comparison is limited by the different designs and recruitment procedures of the reviewed studies, the available data support the notion that the frequency as well as the amount of bodyweight gain is high in patients treated with olanzapine (average bodyweight gain 2.3 kg/month), clozapine (1.7 kg/month), quetiapine (1.8 kg/month), and possibly also zotepine (2.3 kg/month). Moderate changes in bodyweight have been observed in the treatment with risperidone (average bodyweight gain 1.0 kg/month). Ziprasidone seems to induce only slight bodyweight changes (0.8 kg/month). Bodyweight gain most frequently occurs in the first 12 weeks of treatment. Patients who were underweight at the beginning of treatment are at highest risk of gaining bodyweight.The underlying pathomechanism still remains largely unclear. The relative receptor affinities of the atypical antipsychotics for histamine H1 receptors as well as the ratio of their affinity for serotonin 5-HT2 and dopamine D2 receptors appear to be the most robust correlate of bodyweight gain. Furthermore, the induction of leptin secretion may have an important impact on bodyweight gain in patients treated with atypical antipsychotics.Although many questions concerning the pathogenesis of bodyweight gain remain unresolved, this adverse effect has to be taken into consideration when prescribing the atypical antipsychotics, particularly in view its affect on compliance during long term treatment and the long term effects of obesity on mortality and morbidity.


Journal of Clinical Psychopharmacology | 2002

Lack of efficacy of naltrexone in the prevention of alcohol relapse: results from a German multicenter study.

Markus Gastpar; Udo Bonnet; Jobst Böning; Karl Mann; Lutz G. Schmidt; Michael Soyka; Tilman Wetterling; Volker Kielstein; Dominic Labriola; Robert Croop

In a placebo-controlled, double-blind German multicenter study (seven sites) the efficacy of naltrexone as an adjunctive treatment in alcoholism to maintain abstinence was assessed for 12 weeks. A total of 171 detoxified patients (97.7% met the DSM-III-R criteria for alcohol dependence) were included. Patients had been abstinent for a mean of 19.5 ± 9.4 days at study entry. Eighty-four and 87 patients were randomized to receive naltrexone (50 mg/day) and placebo, respectively. Each site was instructed to provide its usual psychosocial alcohol treatment program. The primary effectiveness measure was the time to first heavy drinking as derived from self-reports of drinking (timeline-follow-back method). Secondary effectiveness measures included time to first drink, amount of alcohol consumption, intensity of craving, severity of alcoholism problems, and liver enzymes. Thirty-three (38%) placebo patients and 28 (33%) naltrexone patients discontinued the study. At endpoint, 62% of the patients in each group did not have an episode of heavy drinking. Also, there were no significant differences between the study groups concerning secondary effectiveness measures as well as compliance and adverse clinical events—with the exception of the γ-GT, which was significantly greater reduced in the naltrexone group throughout the study. Based upon an intention-to-treat population, this study confirms the safety but not the efficacy of naltrexone in prevention of alcohol relapse. Nevertheless, the question arises whether self-reports of drinking are more reliable than γ-GT as a measure of recent alcohol consumption.


European Psychiatry | 2003

Late onset alcoholism

Tilman Wetterling; Clemens Veltrup; Ulrich John; Martin Driessen

Rather high prevalence rates of alcohol abuse in the elderly have been reported in the literature. However, there is some evidence that many elderly persons with alcohol problems are not identified, probably due to the nonspecificity of alcohol-related presentations in old individuals. Thus, there is an ongoing discussion on appropriate diagnostic criteria for alcohol dependence in elder people who frequently begin to abuse alcohol in late life. This study was aimed to explore whether alcoholics with late onset (beginning after the age of 45) differ from those with an early onset (prior the age of 25). Two hundred and sixty eight subjects consecutively referred to a ward of a general hospital specialized for alcohol detoxification were divided into three groups by the age at onset of harmful alcohol consumption. The duration of harmful drinking was rather similar in all groups. However, alcohol dependence according to the ICD-10 criteria (three or more have to be fulfilled) was diagnosed in 94.1% of the alcoholics with an early onset (</= 25 years), but only in 62.2% of those with late onset (P < 0.0001). Significant differences between these groups were found for the following criteria: preoccupation with drinking (P < 0.0001), impaired capacity to control drinking (P < 0.01), strong desire to drink alcohol (P < 0.01), and a trend towards a lower rate of lifetime psychiatric comorbidity. The alcoholics with late onset reported fewer previous detoxifications and a lower actual alcohol consumption. Moreover, they showed a higher rate of abstinence in the 12 month follow-up. Regarding the difficulties in comparing groups of different ages at onset of harmful alcohol use our results suggest that the alcoholics with late onset differ in many ways from those with early onset.


Psychiatry Research-neuroimaging | 2009

Substance use disorders as risk factors for suicide in an Eastern and a Central European city (Tallinn and Frankfurt/Main).

Barbara Schneider; Kairi Kolves; Maria Blettner; Tilman Wetterling; Axel Schnabel; Airi Värnik

Cultural and regional differences on the well-known elevated suicide risk in substance use disorders have not been clarified yet. Therefore, the suicide risk associated with substance use disorders in a society of transition and in a socially and economically stable society should be identified and compared. Data from two population-based matched case-control studies were used to analyse the association between alcohol and other substance consumption and the risk of suicide. Data in Frankfurt were obtained by a semi-structured interview including the Structured Clinical Interview for DSM-IV Axis I (SCID-I) in 163 suicides that occurred in 1999 and 2000, and data from Tallinn were collected according to DSM-IV criteria on 156 deceased persons who committed suicide in 1999 by using the psychological autopsy method and in each city in matched population-based control persons by personal interview. In both cities, substance use disorders were significantly associated with suicide. Odds ratios for suicide were higher in Tallinn than in Frankfurt. The highest risk was observed in Tallinn among men with alcohol use disorders, aged 35 to 59 years. Although substance use and, in particular, alcohol use disorders were confirmed as risk factors for suicide in Tallinn and in Frankfurt, the much higher suicide risk associated with alcoholism in Tallinn than in Frankfurt indicates the importance of cultural, socio-political, and regional impact of suicide risk in alcoholism.


Journal of Personality Disorders | 2008

How do personality disorders modify suicide risk

Barbara Schneider; Axel Schnabel; Tilman Wetterling; Bernadette Bartusch; Bernhard Weber; Klaus Georgi

There is a lack of psychological autopsy studies assessing the influence of axis II disorders on other risk factors for suicide. Therefore, we investigated if the estimated suicide risk for axis I disorders and socio-demographic factors was modified by personality disorders. Psychiatric disorders were evaluated by a semi-structured interview including the Structured Clinical Interview for DSM-IV Axis I (SCID-I) and Personality Disorders (SCID-II) by psychological autopsy method in 163 completed suicides and by personal interview in 396 population-based control persons. Personality disorders modify suicide risk, differently for affective disorders, substance use disorders, smoking, life events during the last three months, and socio-demographic factors such as being single. Estimated suicide risk for socio-demographic factors and life events is not substantially altered following adjustment for affective disorders or substance use disorders. These findings suggest that treatment of personality disorders is essential for suicide prevention.


European Archives of Psychiatry and Clinical Neuroscience | 2005

Detection of alcohol consumption in suicides

Barbara Schneider; Axel Schnabel; Dieter Sargk; Konrad Maurer; Bernhard Weber; Tilman Wetterling

AbstractScreening instruments for detection of alcohol consumption, abuse, and dependence for use in psychological autopsy studies with case control design are not validated. Therefore, interrater and test–retest reliability of the Luebeck Alcohol Dependence and Abuse Screening Test (LAST) and the usability of this test for the psychological autopsy method were investigated. Alcohol consumption was evaluated by a semi–structured interview including the Structured Clinical Interview for DSM–IV Axis I (SCID–I) and the LAST in 163 completed suicides (mean age 49.6 ± 19.3 years; 64.4% men) and by personal interview in 396 population–based controls (mean age 51.6 ± 17.0 years; 55.8% men). Of the controls, 35 were additionally assessed by interviewing informants; these results were compared with those generated by personal interview. Comparison of LAST scores by personal and informant’s interview of controls generated a Spearman correlation coefficient of 0.74 (P < 0.0001). The LAST (7 item–version, cut–off of 2) revealed high sensitivity and specificity for alcohol abuse and dependence, in both controls and suicides. LAST scores were significantly associated with high, frequent, and hazardous alcohol consumption (P < 0.001) in suicides. Our findings provide support for reliability and validity of identifying individuals with alcohol dependence and abuse obtained through the best–estimate method using the LAST. This 7–item questionnaire can be recommended as a useful tool for the psychological autopsy procedure in postmortem research.


Psychiatrische Praxis | 2013

Alkoholintoxikation und akute Suizidalität

Tilman Wetterling; Barbara Schneider

OBJECTIVE Although there is a rich literature showing that addictive disorders are important risk factors for suicide, corresponding studies on suicidal behavior are rare. This study was aimed to evaluate the impact of alcohol intoxication on suicidal behavior. METHODS Prospective study. All patients admitted to a psychiatric department providing the psychiatric services for a district of Berlin (250,000 inhabitants) within 15 month. RESULTS Within this period 184 persons were admitted after showing suicidal behaviour (n = 227 admissions). 54.3 % of them were alcohol intoxicated (BAC > 1 g/l). Apart from substance use disorders the most common diagnoses were adjustment disorders (41.0 %), followed by depressive disorders (27.3 %). 28.2 % committed a suicide attempt. All kinds of suicidal behaviour were accompanied by alcohol intoxication, particularly threatening of committing suicide. Persons admitted without alcohol ingestion frequently suffered from depression or schizophrenia. CONCLUSIONS This study shows that persons showing the suicidal behaviour were frequently alcohol intoxicated.


Psychiatrische Praxis | 2012

Medikamentenmissbrauch bei älteren psychiatrischen Patienten

Tilman Wetterling; Barbara Schneider

OBJECTIVE Due to demographic changes there will be a fraction of elderly patients with substance use disorders. However, only a few data have been published about elderly abusers of prescription drugs. Since substance abuse is frequently comorbid with psychiatric disorders, treatment in a psychiatric hospital is often needed. In this explorative study elderly people with prescription drug abuse who required psychiatric inpatient treatment should be characterized. METHODS This study was part of the gerontopsychiatry study Berlin (Gepsy-B), an investigation of the data of all older inpatients (≥ 65 years) admitted to a psychiatric hospital within a period of 3 years. RESULTS Among 1266 documented admissions in 110 cases (8.7 %) (mean age: 75.7 ± 7.1 years) prescription drug abuse, mostly of benzodiazepines was diagnosed. Females showed benzodiazepine abuse more often than males. In only a small proportion of the cases the reason for admission was withdrawal of prescribed drugs. 85.5 % suffered from psychiatric comorbidity, mostly depression. As risk factors for abuse depressive symptoms (OR: 3.32) as well as concurrent nicotine (OR: 2.69) or alcohol abuse (OR: 2.14) were calculated. CONCLUSIONS Psychiatric inpatient treatment was primarily not necessary because of prescription drug abuse but because of other psychopathological symptoms.


Computers in Human Behavior | 2008

Computer attitude in psychiatric inpatients

Bernhard Weber; Barbara Schneider; Stefan Hornung; Tilman Wetterling; Jürgen Fritze

Negative computer attitude has been shown to be a possible co-variable in computerized examinations of psychiatric patients, affecting patient-computer interaction as well as reliability and validity of assessments. It remains still uncertain if the psychological construct of computer attitude can be dependably measured in acute psychiatric inpatients or whether it is impeded by the effects of mental illness. For that reason a German translation of the Groningen Computer Attitude Scale (GCAS) was evaluated in 160 acute psychiatric inpatients under naturalistic conditions. General test criteria (internal structure, item analysis, internal consistency, split half reliability) to a large extent corresponded to those formerly found in healthy subjects and psychiatric outpatients. The mean GCAS score was calculated as 56.2+/-10.8 points and a significantly better computer attitude was found in male, better educated and younger patients. Some diverging correlation patterns were found in diagnostic subgroups, indicating a possible minor impact of mental disorder on computer attitude. Overall, the GCAS was found to be a suitable instrument for measuring computer attitude in acute psychiatric inpatients. It should be used in identifying patients with a negative attitude to computers in order to ensure reliability and validity of computerized assessment.


Psychiatrische Praxis | 2015

Ablehnendes Verhalten bei älteren psychiatrischen Patienten

Tilman Wetterling

OBJECTIVE Rejecting nursing or medication is an increasing challenge for professional care in elderly people. METHODS This explorative study was part of the Gerontopsychiatry study Berlin (Gepsy-B), an investigation of the data of all older inpatients (≥ 65 years) admitted to a psychiatric hospital within 3 years (1266 admissions). RESULTS 150 cases (11.8 %) rejected care. 94 (7.4 %) refused nursing and 89 (7.0 %) medication intake. 79.3 % of them suffered from organic brain diseases, particularly from delirium superimposed on dementia (ICD-10 F05.1). Nursing was more often rejected by older and more severely cognitive impaired patients, while refusal of medication was associated with delusions. CONCLUSIONS Resisting nursing and refusing medication are 2 separate behavioral syndromes that may also occur together.

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Barbara Schneider

Goethe University Frankfurt

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Bernhard Weber

Goethe University Frankfurt

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Axel Schnabel

Goethe University Frankfurt

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Ulrich John

University of Greifswald

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Klaus Georgi

Goethe University Frankfurt

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Konrad Maurer

Goethe University Frankfurt

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