Protocol for the conceptualization and evaluation of a screening-tool for fitness-to-drive assessment in older people with cognitive impairment

Introduction: Due to aging and health status people may be subjected to a decrease of cognitive ability and subsequently also a decline of driving safety. On the other hand there is a lack of valid and economically applicable instruments to assess driving performance. Objective: The study is designed to develop a valid screening-tool for fitness-to-drive assessment in older people with cognitive impairment externally validated on the basis of on-road driving performance. Methods: In a single-centre, non-randomized cross-sectional trial cognitive functioning and on-road-driving-behavior of older drivers will be assessed. Forty participants with cognitive impairment of different etiology and 40 healthy controls will undergo an extensive neuropsychological assessment. Additionally, an on-road driving assessment for external validation of fitness to drive will be carried out. Primary outcome measures will be performance in attention, executive functions and visuospatial tasks that will be validated with respect to performance on the on-road-driving-test. Secondary outcome measures will be sociodemographic, clinical- and driving characteristics to systematically examine their influence on the prediction of driving behavior. Discussion: In clinical practice counselling patients with respect to driving safety is of great relevance. Thus, having valid, reliable, time economical and easily interpretable screening-tools on hand to counsel patients is of great relevance for practitioners. Ethics and dissemination: Ethics approval was obtained from the Ethics Committee at the Ludwig-Maximilians-University Munich. The trial results will be disseminated through peer-reviewed publications and various conferences

Auswirkungen eines kontrollierten Ausdauertrainings auf die kognitive Leistungsfähigkeit schizophrener Patienten

Ziel: Untersucht wurden die Auswirkungen eines aeroben Ausdauertrainings auf die kognitive Leistungsfähigkeit bei schizophrenen Patienten. Methodik: 31 Patienten wurden randomisiert einer Ausdauertrainings- bzw. Ergotherapiegruppe zugewiesen. An zwei Testzeitpunkten wurden Parameter der kognitiven Leistungsfähigkeit erhoben. Ergebnisse: In beiden Gruppen ergaben sich, mit Ausnahme der Aufmerksamkeit, für die erhobenen kognitiven Bereiche signifikante Verbesserungen über die Zeit. Bezüglich verbaler mnestischer Leistungen zeigten sich spezifische Interventionseffekte bei den Patienten der Ausdauertrainingsgruppe.Schlussfolgerung: Schizophrene Patienten können im Hinblick auf verbale Gedächtnisleistungen von einem kontrollierten Ausdauertraining profitieren

Schizophrenie und Depression: Kognitive Leistungsfähigkeit und Lebensqualität

Ziel: Zusammenhänge zwischen kognitiver Leistungsfähigkeit und der Lebensqualität schizophrener und depressiver Patienten wurden untersucht. Methoden: Schizophrene (n=21) und depressive Patienten (n=25) sowie eine nach Alter, Geschlecht und Bildung parallelisierte Gruppe Gesunder (n=40) wurden vor Entlassung aus der stationären Behandlung untersucht. Ergebnisse: Depressive Patienten schätzten ihre Lebensqualität deutlich negativer ein als schizophrene Patienten und die gesunde Kontrollgruppe. Für beide Patientengruppen zeigten sich Zusammenhänge der Lebensqualität mit verbalen Gedächtnisparametern, zudem mit Konzentrationsleistungen bei den schizophrenen Patienten sowie im Bereich exekutiver Funktionen bei den Depressiven. Schlussfolgerungen: Vor allem verbale Gedächtnisleistungen scheinen kritische Funktionsbereiche im Zusammenhang mit der Lebensqualität schizophrener und depressiver Patienten darzustellen

Cognitive Performance in Schizophrenic Inpatients: Are there Differential Effects within Antipsychotics?

oai:ojs.pkp.sfu.ca:article/4Ziel: Untersucht wurde die kognitive Leistungsfähigkeit schizophrener Patienten unter Berück-sichtigung der antipsychotischen Medikation und im Vergleich zu depressiven Patienten. Methodik: Bei 66 Schizophrenen und 47 Depressiven wurden die kognitive Leistungsfähigkeit und das subjektive Beschwerdeerleben erhoben. Ergebnisse: Schizophrene erzielten in allen Funktionsbereichen schlechtere Leistungen als Depressive bei geringerem Beschwerdeerleben. Patienten unter Paliperidon waren in Gedächtnisfunktionen den anderen Behandlungsgruppen überlegen, Patienten unter Olanzapin erzielten in Exekutivfunktionen bessere Leistungen. Schlussfolgerung: Obwohl kausale Zusammenhänge nicht hergestellt werden können, weisen die Ergebnisse auf pharmakodifferenzielle Effekte bezogen auf kognitive Funktionen innerhalb der Antipsychotika hin.Objective: The cognitive performance of schizophrenic inpatients has been investigated considering antipsychotic treatment and compared to depressive controls. Methods: Cognitive function and mental state of schizophrenic (n=66) and depressive (n=47) inpatients were assessed. Results: The performance of the schizophrenic group was significantly worse compared to the depressive group in all cognitive functions. Schizophrenic inpatients treated with Pali-peridone were superior in memory tasks, patients treated with Olanzapine performed better in executive functions. Conclusions: Although causal relationships cannot be drawn results point to pharmacodifferential effects on cognitive functions within antipsychotics

Adsorption Isotherms of Hydrogen: The Role of Thermal Fluctuations

It is shown that experimentally obtained isotherms of adsorption on solid substrates may be completely reconciled with Lifshitz theory when thermal fluctuations are taken into account. This is achieved within the framework of a solid-on-solid model which is solved numerically. Analysis of the fluctuation contributions observed for hydrogen adsorption onto gold substrates allows to determine the surface tension of the free hydrogen film as a function of film thickness. It is found to decrease sharply for film thicknesses below seven atomic layers.Comment: RevTeX manuscript (3 pages output), 3 figure

The CANNA-TICS Study Protocol: A Randomized Multi-Center Double-Blind Placebo Controlled Trial to Demonstrate the Efficacy and Safety of Nabiximols in the Treatment of Adults With Chronic Tic Disorders

Background: Gilles de la Tourette syndrome (TS) is a chronic neuropsychiatric disorder characterized by motor and vocal tics. First-line treatments for tics are antipsychotics and tic-specific behavioral therapies. However, due to a lack of trained therapists and adverse events of antipsychotic medication many patients seek alternative treatment options including cannabis. Based on the favorable results obtained from case studies on different cannabis-based medicines as well as two small randomized controlled trials using delta-9-tetrahydrocannabinol (THC), we hypothesize that the cannabis extract nabiximols can be regarded as a promising new and safe treatment strategy in TS. Objective: To test in a double blind randomized clinical trial, whether treatment with the cannabis extract nabiximols is superior to placebo in patients with chronic tic disorders. Patients and Methods: This is a multicenter, randomized, double-blind, placebo controlled, parallel-group, phase IIIb trial, which aims to enroll 96 adult patients with chronic tic disorders (TS or chronic motor tic disorder) across 6 centers throughout Germany. Patients will be randomized with a 2:1 ratio into a nabiximols and a placebo arm. The primary efficacy endpoint is defined as tic reduction of at least 30% (compared to baseline) according to the Total Tic Score of the Yale Global Tic Severity Scale (YGTSS-TTS) after 13 weeks of treatment. In addition, several secondary endpoints will be assessed including changes in different psychiatric comorbidities, quality of life, driving ability, and safety assessments. Discussion: This will be the first large, controlled study investigating efficacy and safety of a cannabis-based medicine in patients with TS. Based on available data using different cannabis-based medicines, we expect not only a reduction of tics, but also an improvement of psychiatric comorbidities. If the cannabis extract nabiximols is proven to be safe and effective, it will be a valuable alternative treatment option. The results of this study will be of high health-economic relevance, because a substantial number of patients uses cannabis (illegally) as self-medication. Conclusion: The CANNA-TICS trial will clarify whether nabiximols is efficacious and safe in the treatment of patients with chronic tic disorders

A systematic review of evidence for fitness-to-drive among people with the mental health conditions of schizophrenia, stress/anxiety disorder, depression, personality disorder and obsessive compulsive disorder

BACKGROUND: Limited evidence exists regarding fitness-to-drive for people with the mental health conditions of schizophrenia, stress/anxiety disorder, depression, personality disorder and obsessive compulsive disorder (herein simply referred to as 'mental health conditions'). The aim of this paper was to systematically search and classify all published studies regarding driving for this population, and then critically appraise papers addressing assessment of fitness-to-drive where the focus was not on the impact of medication on driving. METHODS: A systematic search of three databases (CINAHL, PSYCHINFO, EMBASE) was completed from inception to May 2016 to identify all articles on driving and mental health conditions. Papers meeting the eligibility criteria of including data relating to assessment of fitness-to-drive were critically appraised using the American Academy of Neurology and Centre for Evidence-Based Medicine protocols. RESULTS: A total of 58 articles met the inclusion criteria of driving among people with mental health conditions studied, and of these, 16 contained data and an explicit focus on assessment of fitness-to-drive. Assessment of fitness-to-drive was reported in three ways: 1) factors impacting on the ability to drive safely among people with mental health conditions, 2) capability and perception of health professionals assessing fitness-to-drive of people with mental health conditions, and 3) crash rates. The level of evidence of the published studies was low due to the absence of controls, and the inability to pool data from different diagnostic groups. Evidence supporting fitness-to-drive is conflicting. CONCLUSIONS: There is a relatively small literature in the area of driving with mental health conditions, and the overall quality of studies examining fitness-to-drive is low. Large-scale longitudinal studies with age-matched controls are urgently needed in order to determine the effects of different conditions on fitness-to-drive

Depression, Antidepressiva und Fahrtüchtigkeit

Aus der Zusammenschau der gegenwärtigen Studienliteratur sowie den Ergebnissen der vorliegenden Untersuchung lässt sich ableiten, dass die Fahrtüchtigkeit eines unter Reboxetin oder Mirtazapin zum Teil remittierten Patienten als günstiger einzuschätzen ist als die eines unbehandelten depressiven Patienten. Die Bewertung eines Antidepressivums kann, wie die vorliegenden Ergebnisse zeigen, nicht vorrangig auf Basis der sedierenden Eigenschaften eines Präparats vorgenommen werden. Die experimentellen Daten belegen, dass neben der Verordnungsdauer und den damit zu erwartenden Adaptationsmechanismen auch der Einnahmezeitpunkt entscheidend bei der Bewertung der Substanz in Bezug auf die Verkehrssicherheit ist. Die vorliegenden Ergebnisse haben darüber hinaus wichtige Implikationen für die Einschätzung des Risikopotenzials neuerer selektiver Antidepressiva im Rahmen gesetzlicher Verordnungen. Bei der Bewertung des Gefährdungspotenzials dieser Substanzgruppe scheinen weit weniger die pharmakologischen Effekte als vielmehr morbogene Faktoren zu berücksichtigen zu sein. Die meisten der derzeit erhältlichen Antidepressiva sind weitgehend vergleichbar in Bezug auf ihre therapeutische Effektivität, sodass bei der Auswahl der Medikamente in erster Linie das Nebenwirkungsprofil ausschlaggebend ist