Innovation, pricing and regulatory policies in the German pharmaceutical market

The legislator uses regulative instruments to induce a specific behavior in the drug market of the German Statutory Health Insurance. Empirical and theoretical models were used to evaluate them. Reference pricing, co-payments, lead compounds, and rebate contracts have an effect on prescription behavior. The latter however might lead to monopolies while the early benefit evaluation does not encourage investments into leap innovations. Overall, the instruments only partially fulfill their goal

Treatment response of lithium augmentation in geriatric compared to non-geriatric patients with treatment-resistant depression

BACKGROUND Lithium augmentation (LA) of antidepressants is an effective strategy for treatment-resistant depression (TRD). Nevertheless, it is rarely used in geriatric patients. The purpose of this study was to investigate treatment response of LA in geriatric compared to non-geriatric patients. METHOD In a prospective multicenter cohort study, severity of depression was measured weekly in 167 patients with unipolar depression (nage≥65years = 22; nage<65years = 145) at baseline and over at least four weeks of LA. RESULTS Geriatric patients showed a significantly better response to LA compared to non-geriatric patients (Hazard Ratio = 1.91; p = 0.04). LIMITATIONS An important limitation of our study is the lack of a control group of LA and the missing evaluation of side effects in both groups. CONCLUSIONS This is the first study investigating the efficacy of LA for TRD in geriatric compared to non-geriatric patients. Our data suggest that LA is an effective treatment option in geriatric patients that clinicians might consider more frequently and earlier on in the course of treatment

Electrocardiographic Changes During Initiation of Lithium Augmentation of Antidepressant Pharmacotherapy

PURPOSE/BACKGROUND Lithium augmentation of antidepressants represents a common strategy to overcome treatment resistance in patients with major depressive disorder. The use of lithium has been associated with cardiovascular adverse effects such as QTc prolongation and tachyarrhythmia. Although the previous studies investigated monotherapy with lithium, the aim of this study was to investigate electrocardiographic changes in LA. METHODS/PROCEDURES A 12-lead surface electrocardiogram (ECG) was obtained from 38 patients with major depressive disorder before and during LA. Changes in heart rate, PQ, QRS and QTc interval, QT dispersion, ST segment, and T- and U-wave alterations were analyzed using a linear mixed model. FINDINGS/RESULTS The ECG readings of 33 patients were evaluated. Lithium augmentation was not significantly associated with changes in heart rate, QTc, PQ, or QRS interval. We found a significant decrease in QT dispersion. These results were independent of sex, age, stable comedication, and comorbidities. During LA, we observed 9 cases of T-wave alterations and 2 cases of new U waves. CONCLUSIONS Our data provide no evidence for serious ECG abnormalities at therapeutic serum lithium levels in patients treated with LA. In particular, we did not find evidence for QTc time lengthening or tachyarrhythmia, such as torsades des pointes. The recommended intervals for ECG checks should be considered to detect long-term effects of LA

Cognitive and emotional empathy in individuals at clinical high risk of psychosis

Background Impairments of social cognition are considered core features of schizophrenia and are established predictors of social functioning. However, affective aspects of social cognition including empathy have far less been studied than its cognitive dimensions. The role of empathy in the development of schizophrenia remains largely elusive. Methods Emotional and cognitive empathy were investigated in large sample of 120 individuals at Clinical High Risk of Psychosis (CHR-P) and compared with 50 patients with schizophrenia and 50 healthy controls. A behavioral empathy assessment, the Multifaceted Empathy Test, was implemented, and associations of empathy with cognition, social functioning, and symptoms were determined. Results Our findings demonstrated significant reductions of emotional empathy in individuals at CHR-P, while cognitive empathy appeared intact. Only individuals with schizophrenia showed significantly reduced scores of cognitive empathy compared to healthy controls and individuals at CHR-P. Individuals at CHR-P were characterized by significantly lower scores of emotional empathy and unspecific arousal for both positive and negative affective valences compared to matched healthy controls and patients with schizophrenia. Results also indicated a correlation of lower scores of emotional empathy and arousal with higher scores of prodromal symptoms. Conclusion Findings suggest that the tendency to 'feel with' an interaction partner is reduced in individuals at CHR-P. Altered emotional reactivity may represent an additional, early vulnerability marker, even if cognitive mentalizing is grossly unimpaired in the prodromal stage. Different mechanisms might contribute to reductions of cognitive and emotional empathy in different stages of non-affective psychotic disorders and should be further explored

Сomparison of Exams in Terms of Benefits for the Future Engineer

This article describes advantages and disadventages of international exams for students. to motivate students to pass the English exam as soon as possible. Based on our survey, many students have never even heard about language exams and benefits it gives

Numerical simulations of jets

When astrophysical jets were discovered one hundred years ago, the field of numerical simulations did not yet exit. Since the arrival of programmable computers though, numerical simulations have increasingly become an indispensable tool for dealing with “tough nut” problems which involve complex dynamic and non-linear phenomena. Astrophysical jets are an ideal example of such a tough nut, where multi-scale plasma physics, radiative and non-thermal processes, turbulence and relativity combine to present a formidable challenge to researchers. Highlighting major achievements obtained through numerical simulations concerning the validity and nature of the Blandford–Znajek mechanism, the launching, collimation, acceleration and stability of jets, their interaction with the surrounding plasma, jet-galaxy feedback mechanisms etc., we trace how the field developed from its first tentative steps into the age of “maturity”. We also give a brief and personal outlook on how the field may evolve in the foreseeable future