Ulrich Frommberger

Interleukin-6-(IL-6) plasma levels in depression and schizophrenia: comparison between the acute state and after remission

The concentration of cytokines such as Interleukin-6 (IL-6) has been reported to be elevated in depressed and schizophrenic patients and, in healthy persons, upon stress. Interleukin-6 plasma levels were determined in depressed (n = 12) and schizophrenic (n = 32) patients during the acute state of illness and after remission at approximately 8 weeks after admission and were compared with healthy controls (n = 12). Patients were diagnosed according to DSM-III-R by the Structured Clinical Interview (SLID). Severity of illness was assessed for depression by the Montgomery Asberg Depression Rating Scale (MADRS) and for schizophrenia by the Brief Psychiatric Rating Scale (BPRS). Interleukin-6 plasma concentrations were elevated during the acute state either of depression or of schizophrenia if compared to controls. After remission, IL-6 concentrations in depressed and in schizophrenic patients had decreased and did not differ significantly from controls. We hypothesize that the elevated IL-6 levels during the acute state of depression or schizophrenia may reflect an unspecific stress response.

PREDICTION OF POSTTRAUMATIC STRESS DISORDER BY IMMEDIATE REACTIONS TO TRAUMA : A PROSPECTIVE STUDY IN ROAD TRAFFIC ACCIDENT VICTIMS

Abstract Road traffic accidents often cause serious physical and psychological sequelae. Specialists of various medical faculties are involved in the treatment of accident victims. Little is known about the factors which might predict psychiatric disorders, e.g. Posttraumatic Stress Disorder (PTSD) after accidents and how psychological problems influence physical treatment. In a prospective study 179 unselected, consecutively admitted road traffic accident victims were assessed a few days after the accident for psychiatric diagnoses, severity of injury and psychopathology. All were inpatients and had to be treated for bone fractures. At 6-months follow-up assessment 152 (85%) of the patients were interviewed again. Of the patients, 18.4% fulfilled the criteria for Posttraumatic Stress Disorder (DSM-III-R) within 6 months after the accident. Patients who developed PTSD were injured more severely and showed more symptoms of anxiety, depression and PTSD a few days after the accident than patients with no psychiatric diagnosis. Patients with PTSD stayed significantly longer in the hospital than the other patients. Multiple regression analysis revealed that the length of hospitalization was due mainly to a diversity of factors such as severity of injury, severity of accident, premorbid personality and psychopathology. Posttraumatic stress disorder is common after road traffic accidents. Patients with PTSD at follow-up can be identified by findings from early assessment. Untreated psychological sequelae such as PTSD cause longer hospitalization and therefore more costs than in non-PTSD patients.

Induction of cytokine synthesis and fever suppresses REM sleep and improves mood in patients with major depression

Beneficial effects of inflammatory events on certain psychiatric disorders, including depression, were reported sporadically by ancient Greek physicians, but have been described also in our times by a few psychiatrists during the past decades. During febrile inflammatory events, mediators of the immune system such as interleukin-1 can be detected in the brain and may act on their respective receptors which have also been demonstrated in the brain. Since cytokines such as interleukin-1 have been shown in animal studies to exert sedative behavioral effects, to be somnogenic, and to induce slow-wave sleep (SWS), we performed a pilot study to evaluate scientifically the anecdotically reported beneficial effects of inflammatory states on depressive disorders. Mood and sleep parameters were monitored in seven drug-free, severely depressed patients before, during, and after the administration of a single dose of endotoxin. All patients responded with a short pulse of increased synthesis of the cytokines tumor necrosis factor, interleukin-1, and interleukin-6 and elevated body temperature for several hours. During the night following endotoxin administration, rapid eye movement (REM) sleep was significantly suppressed, while changes in slow wave sleep were not significant. During the next day, all patients were in a significantly improved mood; however a rebound of REM sleep was observed in the second night after endotoxin administration and mood worsened again during the next days, indicating an only transient beneficial effect of the treatment.

Evaluation of the German Version of the PTSD Symptom Scale (PSS)

The psychometric properties of the PTSD Symptom Scale (PSS) were evaluated in a clinical sample of severely injured in-patients after a traffic accident (n = 123). The PSS contains 17 items which were derived from the DSM-III-R criteria of posttraumatic stress disorder (PTSD). The results indicate that the PSS has satisfactory reliability and validity (internal and external). The results are in correspondence with the results of Foa et al. using a sample of rape and non-sexual-assault patients.

Entwicklung eines Screeninginstrumentes zur Identifizierung von Risikopatienten für die Entwicklung einer Posttraumatischen Belastungsstörung (PTB) nach einem Verkehrsunfall

Zusammenfassung. Theoretischer Hintergrund: Verkehrsunfalle stellen haufige Ereignisse dar, die von Personen als Trauma erlebt werden konnen. Oft weisen die Verletzten eine Reihe psychischer Symptome auf, die meist jedoch vorubergehend sind. Eine Minderheit entwikkelt jedoch psychische Storungen, vor allem eine Posttraumatische Belastungsstorung (PTB). Fragestellung: Entwicklung eines Screeningfragebogens zur Identifizierung von Patienten mit dem Risiko der Entwicklung einer PTB oder dem subsyndromalen Bild einer PTB. Methode: Einer Stichprobe von 182 Unfallpatienten wurde kurz nach dem Unfall verschiedene Selbstbeurteilungsverfahren vorgelegt. Nach 6 Monaten wurde untersucht, welche Patienten innerhalb dieser Zeit eine PTB resp. ein subsyndromales Bild einer PTB entwickelten hatten. Diejenigen Items, die am besten zur Trennung dieser Patienten von den anderen Patienten beitrugen, wurden zu einem Screeningfragebogen zusammengestellt. Ergebnisse: Es konnte ein aus 10 Items bestehender Screeningfragebogen e...

Comparison between paroxetine and behaviour therapy in patients with posttraumatic stress disorder (PTSD): A pilot study

Antidepressants and cognitive-behavioural therapy (CBT) have been reported to decrease severity of psychopathology in PTSD-patients. To date, no study has been carried out which compares psychopharmacolo-gical and psychotherapeutic treatments. In a randomized pilot study, PTSD-patients were treated either with paroxetine or CBT. Diagnoses were made by structured clinical interviews (ADIS, CAPS). The duration of treatment was 3 months; the paroxetine dosage was 10-50 mg; exposure and cognitive restructuring were the main elements in cognitive-behavioural therapy. Twenty-one patients were included. Drop-outs in both groups occurred within the first 2 weeks. Paroxetine and CBT significantly decreased PTSD-symptoms (CAPS) as well as concurrent depression (MADRS) after 3 months treatment. At 6 month follow-up, symptoms of PTSD had slightly increased in the paroxetine group and further decreased in the cognitive-behavioural therapy group. (Int J Psych Clin Pract 2004; 8: 19-23)

Computerized brain tomography measures compared with spontaneous and suppressed plasma cortisol levels in major depression

We determined brain density and ventricular measurements with computerized tomography (CT) in 33 depressed patients and compared the results with basal plasma cortisol and its suppressibility by dexamethasone. Mean plasma cortisol was positively related to elevated ventricular brain ratio (VBR). No association could be found between dexamethasone suppression test (DST) status and VBR or any other CT parameter. Elevated plasma cortisol levels and increased VBRs were positively correlated with total scores on the Brief Psychiatric Rating Scale, the Global Assessment Scale and the Bech-Rafaelsen Melancholia Scale, but they were not significantly correlated with total score on the Hamilton Anxiety Scale.

Die psychischen folgen nach verkehrsunfällen@@@Psychological sequelae of traffic accidents. Part II: Results from a prospective study: Teil 11: Ergebnisse einer prospektiven studie

ZusammenfassungIm ersten Teil wurden die Relevanz, diagnostischen Kriterien psychischer Störungen nach Verkehrsunfällen und ihre Therapie beschrieben.Der zweite Teil zeigt die unfallchirurgisch relevanten Ergebnisse einer prospektiven Studie zu psychischen Störungen an 179 stationär behandelten Verkehrsunfallopfern. Nahezu jeder fünfte schwerverletzte Patient entwickelte eine posttraumatische Belastungsstörung nach einem Verkehrsunfall. Diese Patienten waren schwerer verletzt als die Patienten ohne psychische Störungen. Bereits kurz nach dem Unfall zeigten sie mehr psychische Symptome, hatten mehr negative Befürchtungen bezüglich ihrer Gesundheit and lagen länger im Krankenhaus. Die prämorbide Persönlichkeit beeinflußte die Entwicklung psychischer Störungen nach einem Unfall. In der Nachuntersuchung gaben die Patienten mit einer posttraumatischen Belastungsstörung mehr körperliche Beschwerden an und benögtigten mehr Hilfen als Patienten ohne psychiatrische Diagnosen.Die Studie zeigt, daß psychische Störungen nach Verkehrsunfällen den Genesungsverlauf and die chirurgische Behandlune erheblich beeinflussen.AbstractIn Part I of this paper the relevance, diagnostic criteria of psychiatric disorders after trattic accidents and their therapy were described.In this second paper we present the relevant data for surgeons out of a prospective study on psychological sequelae after traffic accidents in 179 patients.Nearly every 5th severely injured patient developed a posttraumatic stress disorder (PTSD) after a traffic accident. These patients were injured more severely compared to patients without any psychiatric disorder. Already shortly after the accident they reported more psychological symptoms and had more negative apprehensions towards their health. Premorbid personality influenced the development of psychiatric disorders after an accident significantly but in a modest degree. At follow-up patients with a PTSD reported more physical complaints and needed more help than patients without any psychiatric diagnosis.The study reveals that nsvchological factors influence the healing process and the surgical treatment significantly.

Die psychischen folgen nach verkehrsunfällen

Psychische Stoerungen nach Verkehrsunfaellen sind haeufig. Bereits kurz nach einem Unfall koennen psychische Beschwerden auftreten. Diese Symptome beeinflussen den Heilungsprozess auf der erstversorgenden Station, in der Rehabilitation und die Beurteilungen im Gutachten. In zwei Teilen (Teil 2 siehe ITRD-Nummer D346289) werden unfallchirurgisch relevante psychiatrische Krankheitsbilder dargestellt, ihre diagnostischen Kriterien und Therapie sowie Ergebnisse aus einer prospektiven Studie. Der vorliegende erste Teil beschreibt Konzepte von psychischen Stoerungen nach Unfaellen, ihre Epidemiologie und Diagnostik sowie ihre Therapie. Es sind Fragen formuliert, mit deren Hilfe sich der Unfallchirurg am Krankenbett und im Gutachten ueber den psychischen Zustand schnell orientieren kann. Das stufenweise Vorgehen bei Verdacht auf psychische Stoerungen nach Unfaellen wird beschrieben. (A)ZusammenfassungPsychische Störungen nach Verkehrsunfällen sind häufig. Bereits kurz nach einem Unfall können psychische Beschwerden auftreten. Diese Symptome beeinflussen den Heilungsprozeß auf der erstversorgenden Station, in der Rehabilitation und die Beurteilungen im Gutachten.In zwei Teilen werden unfallchirurgisch relevante psychiatrische Krankheitsbilder dargestellt, ihre diagnostischen Kriterien und Therapie Bowie Ergebnisse aus einer prospektiven Studie.Der erste Teil beschreibt Konzepte von psychischen Störungen nach Unfällen, ihre Epidemiologie und Diagnostik sowie ihre Therapie. Es sind Fragen formuliert, mit deren Hilfe sich der Unfallchirurg am Krankenbett und im Gutachten über den psychischen Zustand schnell orientieren kann. Das stufenweise Vorgehen bei Verdacht auf psychische Störungen nach Unfällen wird beschrieben.AbstractPsychiatric disorders often occur after traffic accidents. Shortly after the accident psychopathological symptoms may develop. These symptoms modify the healing process during hospitalisation or rehabilitation and litigation.In 2 articles of this journal we describe psychiatric disorders which are relevant for surgical traumatology, their diagnostic criteria, the therapy and the results of a prospective study on traffic accident victims.This 1st part deals with the concept of psychiatric disorders after traffic accidents, its epidemiology, diagnosis and therapy. We add questions for the surgeon to get a tool for a quick orientation about the psychological status of the patient suitable to ask at bedside or during litigation process. We describe the stepwise process the surgeon can initiate when a psychiatric disorder is questionable or obvious.

Mobility behaviour and driving status of patients with mental disorders - an exploratory study.

Abstract Background Driving is an important activity of daily life and an integral part of mobility. However, impact of mental illness on road mobility is widely unexplored. Method Driving status in 1497 psychiatric inpatients (PPs) and a clinical control group of 313 neurological inpatients (NPs) was investigated using a brief questionnaire. Results 67% of PPs (89% NPs) reported to have a valid drivers licence and 77% of them (92% NPs) reported to regularly use their cars. Within drivers license holders, patients with organic mental disorder (32%), substance dependence (37%) and psychotic disorder (40%) had the lowest proportion of current drivers. Higher educational qualification (odds ratio [OR] from 2.978 to 17.036) and being married/partnered (OR 3.049) or divorced (OR 4.840) significantly advanced the probability of possession of a driving license. Predictive factors for driving cessation were being female, an older age, drawing a pension and having an organic mental disease or schizophrenic disorder. Conclusion Mental disease has a negative impact on driving status and this is especially true for illnesses frequently being accompanied by distinct cognitive impairments. Factors predicting road mobility elucidate the strong relationship with psychosocial status indicating that recovery of driving competence should be an integral goal of treatment strategies.