ÜBER DIE BEI DER REINEN BIEGUNG DER GERADEN UND DER EBENEN GEKRÜMMTEN STÄBE SICH ZEIGENDEN ÄHNLICHKEITEN

Objective The aim of this repeated cross-sectional study was to compare patients from a psychiatric intensive care unit (PICU) over 30years regarding their diagnostic and therapeutic characteristics. Method Three samples including 100 consecutive inpatients each from the Viennese PICU were submitted to a chart review: sample no. 1 from the years 1985/86, no. 2 from 1995/96 and no. 3 from 2007/08. Results Changes in referral modes were associated with a decrease of patients with substance induced disorders and an increase of patients with affective disorders over time. The rate of admissions after accidents and suicides was stable. The use of cranial MRI increased, while intravenous psychopharmacotherapy and parenteral nutrition decreased. Involuntary admission occurred in 43% and in 37% of patients physical restraints were necessary. We saw a shift from tricyclic antidepressants to SSRIs and SNRIs from sample 1 to 3. Likewise, we observed the emergence of atypical antipsychotics and a reduction of use of typical neuroleptics mainly from sample 2 to 3. The percentage of patients receiving benzodiazepines increased over time, while the mean dosage of benzodiazepines decreased. 7% of patients received electroconvulsive therapy. Conclusions The changes over time in our samples reflect the medical progress made during the last decades. Future studies should focus on evaluation of efficacy of psychiatric intensive care using standardized measurements.(VLID)490129

Annals of General Psychiatry / Alcohol consumption in Austrian physicians

Background Alcohol is one of the leading exogenous causes for adverse health consequences in Europe. The aim of the present study was to examine the pattern of alcohol consumption in Austrian physicians. Methods A telephone survey was conducted in 400 office-based physicians in Austria. Our questionnaire included the four questions of the CAGE questionnaire and questions to assess alcohol consumption on the previous day. Results 131 participants (32.8%) completed the interview. 3.8% of the subjects had a CAGE score of 2 or higher indicating a problem with alcohol, but this rate was not statistically different from numbers reported for the general population (4.1%). 46.6% of our subjects had drunken alcohol on the previous day. Compared to the general population, the rate of having drunk alcohol yesterday was higher in both gender of our sample, but the amount of alcohol drunk was significantly lower. Doctors in rural areas had drunken alcohol more frequently and in greater quantities on the previous day than those in urban areas. There was a positive correlation between age and the amount of drinking on the previous day, and between age and CAGE scores. Furthermore, subjects who had consumed alcohol yesterday obtained higher scores on the CAGE. Conclusions Our findings indicate that the rate of Austrian physicians with problematic alcohol consumption is similar to the general population. Physicians in rural areas and older doctors might be of higher risk for alcohol abuse.(VLID)488925

Implementing prevention of seasonal affective disorder from patients’ and physicians’ perspectives – a qualitative study

Abstract Background Seasonal affective disorder (SAD) is a seasonally recurrent type of major depression that has detrimental effects on patients’ lives during winter. Little is known about how it affects patients during summer and about patients’ and physicians’ perspectives on preventive SAD treatment. The aim of our study was to explore how SAD patients experience summers, what type of preventive treatment patients implement, which preventive treatment methods, if any, physicians recommend, and what factors facilitate or hinder implementation/recommendation of SAD prevention. Methods We conducted 15 semi-structured interviews, ten with adult patients with a history of SAD and five with physicians. Transcripts were analyzed by two researchers using an inductive thematic analysis approach. Results One group of patients was able to enjoy summer and ignore thoughts of the upcoming winter. The other group feared the impending depressive episode in winter, and this fear negatively impacted these patients’ well-being during the summer. Preventive treatment was a relevant issue for all patients, and all but one person implemented SAD prevention during summer. We identified six factors that influenced patient use of preventive treatment of SAD. Four factors occur on an individual level (knowledge about disease and preventive treatment options, experience with treatment in acute phase, acceptability of intervention, willingness to take responsibility for oneself), one on an interpersonal level (social and work environment), and one on a structural level (healthcare system). All psychiatrists recommended some kind of preventive intervention, most commonly, lifestyle changes. Four factors influenced psychiatrists in recommending prevention of SAD (patient expectations, disease history and stability, risk/benefit ratio, lack of evidence). Conclusions Success in the implementation of SAD prevention does not solely depend on the willingness of the patients, but is also influenced by external factors. Raising awareness of SAD among general practitioners and low-level access to mental-health support could help patients find appropriate help sooner. To better guide the optimal treatment choice, comparative effectiveness research on treatments to prevent a new onset in patients with a history of SAD and clinical practice guidelines on SAD are needed

Brain monoamine oxidase A in seasonal affective disorder and treatment with bright light therapy

Increased cerebral monoamine oxidase A (MAO-A) levels have been shown in non-seasonal depression using positron emission tomography (PET). Seasonal affective disorder (SAD) is a sub-form of major depressive disorder and is typically treated with bright light therapy (BLT). The serotonergic system is affected by season and light. Hence, this study aims to assess the relevance of brain MAO-A levels to the pathophysiology and treatment of SAD. Changes to cerebral MAO-A distribution (1) in SAD in comparison to healthy controls (HC), (2) after treatment with BLT and (3) between the seasons, were investigated in 24 patients with SAD and 27 HC using [11C]harmine PET. PET scans were performed in fall/winter before and after 3 weeks of placebo-controlled BLT, as well as in spring/summer. Cerebral MAO-A distribution volume (VT, an index of MAO-A density) did not differ between patients and HC at any of the three time-points. However, MAO-A VT decreased from fall/winter to spring/summer in the HC group (F1, 187.84=4.79, p<0.050), while SAD showed no change. In addition, BLT, but not placebo, resulted in a significant reduction in MAO-A VT (F1, 208.92=25.96, p<0.001). This is the first study to demonstrate an influence of BLT on human cerebral MAO-A levels in vivo. Furthermore, we show that SAD may lack seasonal dynamics in brain MAO-A levels. The lack of a cross-sectional difference between patients and HC, in contrast to studies in non-seasonal depression, may be due to the milder symptoms typically shown by patients with SAD.(VLID)462643