WOLFGANG AMADEUS MOZART: SMRT GENIJA

The early and unexpected death of Wolfgang Amadeus Mozart (Salzburg, 1756 – Vienna, 1791) was a mystery from the very first day and the subject of wildest speculations and adventurous assertions. Over the last 100 years, medical science has investigated the physical sufferings and the mysterious death of Mozart with increasing intensity. The aim of this article was to recreate Mozart’s pathography relying on the his correspondence with father Leopold and sister Nannerl and on reports from his physicians and contemporaries. The rumour that Mozart was poisoned followed shortly after his death on 5 December 1791, at the age of 35, and has survived to this day. The alleged culprits were his physician van Swieten, Mozart’s freemasons lodge, and the Imperial Chapel Master Salieri. Mozart however died of chronic kidney disease and ultimately of uraemia. If kidney damage reaches a critical point, even a minimum additional stress can lead to its failure. This usually occurs in the fourth decade of life. Next time we listen to Mozart, we should remember that this apparently happy person was actually a precocious boy, ripped of his childhood, whose short life was an endless chain of complaints, fatigue, misery, concern, and malady.Rana i neočekivana smrt Wolfganga Amadeusa Mozarta (r. u Salzburgu 1756. – u. u Beču 1791.) obavijena je tajnom od prvoga dana te je postala predmetom nevjerojatnih nagađanja i hrabrih tvrdnji. Medicinska je znanost u posljednjih stotinu godina sa sve više interesa istraživala Mozartove tjelesne tegobe i tajanstvenu smrt. Želja je ovoga članka rekonstruirati Mozartovu patografiju osalanjajući se na njegovu korespondenciju s ocem Leopoldom i sestrom Nannerl te na izjave njegovih liječnika i suvremenika. Ubrzo nakon Mozartove smrti 5. prosinca 1791., u dobi od 35 godina, raširila se glasina da je otrovan, koja je i danas aktualna. Navodni osumnjičenici su njegov osobni liječnik van Swieten, Mozartova slobodnozidarska loža te dvorski skladatelj Antonio Salieri. Ipak, Mozart je umro od uremije uslijed kronične bolesti bubrega. Kada oštećenje bubrega dosegne kritičnu točku, dovoljan je i neznatan stres koji će dovesti do njegova zatajenja. To se obično događa u četrdesetim godinama života. Sljedeći put kada budemo slušali Mozartovu glazbu, sjetit ćemo se da je ova naizgled sretna osoba zapravo bilo prerano sazrijelo dijete kojemu je ukradeno djetinjstvo i čiji je život bio beskonačan niz tegoba, premorenosti, jada, briga i bolesti

WOLFGANG AMADEUS MOZART: SMRT GENIJA

The early and unexpected death of Wolfgang Amadeus Mozart (Salzburg, 1756 – Vienna, 1791) was a mystery from the very first day and the subject of wildest speculations and adventurous assertions. Over the last 100 years, medical science has investigated the physical sufferings and the mysterious death of Mozart with increasing intensity. The aim of this article was to recreate Mozart’s pathography relying on the his correspondence with father Leopold and sister Nannerl and on reports from his physicians and contemporaries. The rumour that Mozart was poisoned followed shortly after his death on 5 December 1791, at the age of 35, and has survived to this day. The alleged culprits were his physician van Swieten, Mozart’s freemasons lodge, and the Imperial Chapel Master Salieri. Mozart however died of chronic kidney disease and ultimately of uraemia. If kidney damage reaches a critical point, even a minimum additional stress can lead to its failure. This usually occurs in the fourth decade of life. Next time we listen to Mozart, we should remember that this apparently happy person was actually a precocious boy, ripped of his childhood, whose short life was an endless chain of complaints, fatigue, misery, concern, and malady.Rana i neočekivana smrt Wolfganga Amadeusa Mozarta (r. u Salzburgu 1756. – u. u Beču 1791.) obavijena je tajnom od prvoga dana te je postala predmetom nevjerojatnih nagađanja i hrabrih tvrdnji. Medicinska je znanost u posljednjih stotinu godina sa sve više interesa istraživala Mozartove tjelesne tegobe i tajanstvenu smrt. Želja je ovoga članka rekonstruirati Mozartovu patografiju osalanjajući se na njegovu korespondenciju s ocem Leopoldom i sestrom Nannerl te na izjave njegovih liječnika i suvremenika. Ubrzo nakon Mozartove smrti 5. prosinca 1791., u dobi od 35 godina, raširila se glasina da je otrovan, koja je i danas aktualna. Navodni osumnjičenici su njegov osobni liječnik van Swieten, Mozartova slobodnozidarska loža te dvorski skladatelj Antonio Salieri. Ipak, Mozart je umro od uremije uslijed kronične bolesti bubrega. Kada oštećenje bubrega dosegne kritičnu točku, dovoljan je i neznatan stres koji će dovesti do njegova zatajenja. To se obično događa u četrdesetim godinama života. Sljedeći put kada budemo slušali Mozartovu glazbu, sjetit ćemo se da je ova naizgled sretna osoba zapravo bilo prerano sazrijelo dijete kojemu je ukradeno djetinjstvo i čiji je život bio beskonačan niz tegoba, premorenosti, jada, briga i bolesti

Adolescents' self-reported sleep quantity and sleep-related personality traits—A pilot study

Summary: Question of the study: The aim of this pilot study was to assess adolescents' self-reported sleep quantity and personality traits in order to describe typical personality patterns related to sleep and characteristics that distinguish between good and poor sleepers. Participants and methods: A total of 134 adolescents (mean age: 18.60; 74 females and 60 males) completed a single sleep-related personality traits questionnaire (FEPS-I) and daily sleep logs for seven consecutive days. The daily logs data were used to cluster participants in three subgroups of poor, normal, and good sleep quality. Results: Up to 25 % of the adolescents could be considered ‘poor' sleepers and displayed personality traits such as decreased self-confidence, increased mental arousal, and self-perception of body sensations. Female adolescents were at high risk of being ‘poor' sleepers, yet up to 20 % of the adolescents could be described as ‘good' sleepers. Fifty-five per cent of the adolescents could be considered ‘normal' sleepers without appropriate sleep-related personality traits or sleeping habits. Conclusions: The pilot project, using exclusively self-reported sleep data, showed that about a quarter of adolescents were considered ‘poor' sleepers with specific sleep-related personality traits. Further investigations are needed to support these results and to allow possible preventive intervention

Side effects of adjunct light therapy in patients with major depression

Adjunct bright-light therapy has been suggested to augment antidepressant drug treatment in patients with non-seasonal major depression. Side effects of the combined therapy have not been investigated thus far. Therefore, somatic complaints and side effects of combined therapy were evaluated in 28 patients with major depression (DSM-III-R) randomly assigned to either trimipramine or trimipramine and serially applied adjunct bright-light therapy. Response rates were comparable in both treatment groups and rates of newly emergent side effects during treatment were generally low. The most prominent unfavourable side effects of adjunct bright-light therapy as compared with trimipramine monotherapy were aggravated sedation, persisting restlessness, emerging sleep disturbance and decreased appetite as well as the worsening of vertigo. Discriminant analysis revealed that the combination of trimipramine with bright light results in a different side effect profile compared with drug monotherap

Effects of Aerobic Exercise as Add-On Treatment for Inpatients With Moderate to Severe Depression on Depression Severity, Sleep, Cognition, Psychological Well-Being, and Biomarkers: Study Protocol, Description of Study Population, and Manipulation Check

Background: Aerobic exercise (AE) may be a non-pharmacological strategy to improve depression treatment and lessen the burden of somatic comorbidity of depression. Only few studies have examined the effect of AE as an add-on treatment for moderate to severe depression in an inpatient setting, and most studies have focused on depression severity and cardiovascular parameters. The purpose of the present article is to present the study protocol, to provide information about the assessed study population, and to perform a manipulation check in order to examine whether the intervention program was properly implemented.Methods: We conducted a randomized controlled trial in two centers comparing 6 weeks of AE to a placebo control intervention (stretching) as an add-on to standardized inpatient treatment of moderate to severe depression. Besides depression severity, several other psychological and biological variables were measured such as salivary cortisol, brain-derived neurotropic factor, cognitive tests, and polysomnography. To evaluate long-term effects of the intervention, we also scheduled a follow-up 6 months after completion of the study intervention.Results: Forty-five patients were randomized to either AE (n = 23) or the placebo intervention (n = 22); 36 patients completed the 6-week intervention. In the AE group, 65% completed all 18 training sessions. Patients who were less physically active prior to admission were less likely to complete the study. With regard to energy expenditure, mean kcal/kg/week was 16.4 kcal/kg/week (range: 13.8–17.7), coming close to the targeted dose of 17.5 kcal/kg/week.Conclusions: Overall, patients showed good adherence to the intervention protocol despite at least moderate depression severity. However, the dropout rate suggests that depressed inpatients may need special support to adhere to a structured exercise intervention program. This study will add evidence on the effects of AE as an add-on to inpatient treatment of moderate to severe depression. Besides antidepressant effects, potentially beneficial effects of AE on a broad array of further variables associated with depression will be evaluated.Clinical Trial Registration:www.ClinicalTrials.gov, identifier NCT02679053

Effects of Aerobic Exercise on Cortisol Stress Reactivity in Response to the Trier Social Stress Test in Inpatients with Major Depressive Disorders: A Randomized Controlled Trial

Physical activity is associated with a favourable (blunted) cortisol stress reactivity in healthy people. However, evidence from experimental study and with psychiatric patients is missing. This study examines whether exercise training impacts on cortisol stress reactivity in inpatients with major depressive disorder (MDD). These new insights are important because the stress reactivity of healthy people and patients with severe symptoms of depression might differ. Methods: The study was designed as a randomized controlled trial (trial registration number: NCT02679053). In total, 25 patients (13 women, 12 men, mean age: 38.1 12.0 years) completed a laboratory stressor task before and after a six-week intervention period. Nine samples of salivary free cortisol were taken before and after the Trier social stress test (TSST). Fourteen participants took part in six weeks of aerobic exercise training, while 11 patients were allocated to the control condition. While the primary outcome of the study was depressive symptom severity, the focus of this paper is on one of the secondary outcomes (cortisol reactivity during the TSST). The impact of aerobic exercise training was examined with a repeated-measures analysis of variance. We also examined the association between change in depression and cortisol response via correlational analysis. Cortisol reactivity did not change from baseline to post-intervention, either in the intervention or the control group. Participation in six weeks of aerobic exercise training was not associated with participants' cortisol reactivity. Moreover, depressive symptom change was not associated with change in cortisol response. Aerobic exercise training was not associated with patients' stress reactivity in this study. Because many patients initially showed a relatively flat/blunted cortisol response curve, efforts might be needed to find out which treatments are most efficient to promote a normalization of HPA axis reactivity

Having versus not having social interactions in patients diagnosed with depression or social phobia and controls

Humans need meaningful social interactions, but little is known about the consequences of not having them. We examined meaningful social interactions and the lack thereof in patients diagnosed with major depressive disorder (MDD) or social phobia (SP) and compared them to a control group (CG). Using event-sampling methodology, we sampled participants' everyday social behavior 6 times per day for 1 week in participants' natural environment. We investigated the quality and the proportion of meaningful social interactions (when they had meaningful social interactions) and degree of wishing for and avoidance of meaningful social interactions (when they did not have meaningful social interactions). Groups differed on the quality and avoidance of meaningful social interactions: Participants with MDD and SP reported perceiving their meaningful social interactions as lower quality (in terms of subjective meaningfulness) than the CG, with SP patients reporting even lower quality than the MDD patients. Further, both MDD and SP patients reported avoiding meaningful social interactions significantly more often than the CG. Although the proportion of meaningful social interactions was similar in all groups, the subjective quality of meaningful social interactions was perceived to be lower in MDD and SP patients. Future research might further identify what variables influenced the reinforcement of the MDD and SP patients so that they engaged in the same number of meaningful social interactions even though the quality of their meaningful social interactions was lower. Increasing awareness of what happens when patients do or do not have meaningful social interactions will help elucidate a potentially exacerbating or maintaining factor of the disorders

Psychiatric In-Patients Are More Likely to Meet Recommended Levels of Health-Enhancing Physical Activity If They Engage in Exercise and Sport Therapy Programs

Background:; People with mental disorders engage in sedentary behaviors more often than their healthy counterparts. In Switzerland, nearly all psychiatric hospitals offer structured exercise and sport therapy as part of their standard therapeutic treatment. However, little is known about the degree to which psychiatric patients make use of these treatment offers. The aim of this study is to examine, in a sample of psychiatric in-patients (a) how many participate in the structured exercise and sport therapy programs offered by the clinic, (b) how many engage in exercise and sport activities on an individual basis, and (c) how many meet recommended levels of health-enhancing physical activity during their stay at the clinic. Furthermore, we examine whether those who engage in exercise and sport activities are more likely to meet internationally accepted physical activity recommendations.; Methods:; 107 psychiatric in-patients (49% women, M; age; = 39.9 years) were recruited at three psychiatric clinics in the German-speaking part of Switzerland. All participants were engaged in treatment and received usual care. Based on accelerometer data, participants were classified as either meeting or not meeting physical activity recommendations (≥150 min of moderate-to-vigorous physical activity per week). Participation in structured and individually performed exercise and sport activities was assessed with the Simple Physical Activity Questionnaire.; Results:; In total, 57% of all patients met physical activity recommendations. 55% participated in structured exercise and sport therapy activities, whereas only 22% of all patients engaged in exercise and sport activities independently. Psychiatric patients were significantly more likely to meet recommended levels of health-enhancing physical activity if they engaged in at least 60 min per week of structured exercise and sport therapy or in at least 30 min of individually performed exercise and sport activity.; Conclusions:; Given that prolonged immobilization and sedentary behavior have harmful effects on patients' physical and mental well-being, promoting exercise and sport activities is an important endeavor in psychiatric care. Clinics currently succeed in involving between 50 and 60% of all patients in sufficient physical activity. While this is encouraging, more systematic efforts are needed to ensure that all patients get enough physical activity

The effect of anticipatory stress and openness and engagement on subsequently perceived sleep quality - an Experience Sampling Method Study

High stress levels can influence sleep quality negatively. If this also applies to anticipatory stress is poorly documented, however. Across insomnia severity levels, this study examined participants’ evening levels of (a) anticipatory stress and (b) their skills hypothesized to downregulate the impact of stress, namely openness to internal experiences and continuous engagement in meaningful activities (openness and engagement) and their association with the quality of the subsequent night's sleep. The moderating role of insomnia severity was also tested. We used a quasi‐experimental longitudinal design with Experience Sampling Method using smartphones over the course of 1 week (3,976 assessments; 93.2% of prompted queries). Participants recorded their sleep quality, anticipatory stress, and openness and engagement within their daily context. Participants included in the study were diagnosed with major depressive disorder (n = 118), social phobia (n = 47) or belonged to the control group (n = 119). Both anticipatory stress and openness and engagement predicted subsequent sleep quality. Diagnostic group was associated with overall sleep quality, but did not interact with the predictors. These findings were invariant across levels of self‐reported insomnia severity. Furthermore, openness and engagement and anticipatory stress did not interact in their effect on sleep quality. The results suggest that both stress reduction and increased openness and engagement are associated with improved subjective sleep quality on a day to day basis, regardless of insomnia severity. Targeting these variables may help improve sleep quality. Future research should disentangle the effects of openness and engagement on anticipatory stress