A proposal for a psychopharmacology-pharmacotherapy catalogue of learning objectives and a curriculum in Europe.

Objectives Post-graduate training for specialisation in psychiatry and psychotherapy is part of a 4-6-year programme. This paper aims to inform on the general situation of teaching and training of psychopharmacology-psychopharmacotherapy in Europe. It presents the need for a psychopharmacotherapy education in psychiatric training programmes. Arguments as well as a proposal for a catalogue of learning objectives and an outline of a psychopharmacology curriculum are presented. Methods Based on their experience and on an analysis of the literature, the authors, experts in psychopharmacology-pharmacotherapy teaching, critically analyse the present situation and propose the development of a curriculum at the European level. Results Teaching programmes vary widely between European countries and, generally, teaching of psychopharmacology and pharmacotherapy does not exceed two-dozen hours. This is insufficient if one considers the central importance of psychopharmacology. A psychopharmacology-psychopharmacotherapy curriculum for the professional training of specialists in psychiatry and psychotherapy is proposed. Conclusions As the number of hours of theoretical teaching and practical training is insufficient, a catalogue of learning objectives should be established, which would then be part of a comprehensive curriculum at the European level. It could be inspired partly by those few previously proposed by other groups of authors and organisations

Der Einfluss von Psychopharmaka auf selbstschädigende Tendenzen bei emotional instabiler Persönlichkeitsstörung

Wir untersuchten retrospektiv die Effekte verschiedener Psychopharmaka(-gruppen) auf selbstschädigendes Verhalten in seinen unterschiedlichen Ausprägungsformen bei der Behandlung der emotional instabilen Persönlichkeitsstörung. Eingeschlossen wurden 64 weibliche und 13 männliche Patienten mit einem Durchschnittsalter von 25,88 Jahren, die auf einer offen geführten Psychotherapiestation mit einem multimodalen verhaltens-therapeutisch orientierten Psychotherapieprogramm (dialektisch-behaviourale Therapie nach M. Linehan) behandelt wurden. Die Patienten protokollierten wöchentlich Gedanken an bzw. die Ausführung von selbstschädigendem Verhalten anhand einer von uns entwickelten Liste mit 13 Items. Daraus wurde jeweils ein Summenscore gebildet und zum Zeitpunkt T0 (vor Psychopharmakotherapie und T1 (durchschnittlich 24 Tage später) miteinander verglichen. Zu einer Reduktion selbstschädigenden Verhaltens kam es dabei vor allem bei Behandlung mit einem SSRI als Monotherapie oder in Kombination mit Lithium, verglichen mit Carbamazepin, Valproat, Lithium als Monotherapie, einem Neuroleptikum, einer Kombination aus SSRI und Neuroleptikum oder einer Kontrollgruppe ohne Psychopharmakotherapie

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

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

Mortalität in der Vor-Neuroleptika-Ära

Schizophrene Patienten haben ein erhöhtes Sterblichkeitsrisiko und eine kürzere Lebenserwartung. Im historischen Verlauf ist zwar das absolute Sterblichkeitsrisiko gesunken, relativ hat die Sterblichkeit aber zugenommen. Neuroleptika stehen im Verdacht, zu dieser Zunahme beigetragen zu haben, da diese mittelbar über eine Verstärkung des metabolischen Syndroms und negative Beeinflussung des Gesundheitsverhaltens wirken könnten. Untersuchungen an Patienten aus der Vor-Neuroleptika-Ä;ra und Vergleiche von neuroleptikabehandelten mit nicht medikamentös behandelten  Patienten lassen aber den Schluss zu, dass die Behandlung mit Neuroleptika eher einen Schutzfaktor gegen eine erhöhte Sterblichkeit darstellt. &nbsp

Le dosage plasmatique des médicaments psychotropes à des fins thérapeutiques: recommandations du groupe d'experts AGNP-TDM

In psychiatry, therapeutic drug monitoring (TDM) is an established procedure for most psychotropic drugs. However, as its use in everyday clinical practice is far from optimal, the AGNP-TDM group has worked out consensus guidelines to assist psychiatrists and laboratories involved in drug analysis. Based on a thorough analysis of available literature, 5 levels of recommendation were defined with regard to TDM of psychoactive drugs, from 1) (strongly recommended) to 5) (not recommended). A list of indications for TDM, alone or in combination with pharmacogenetic tests is presented. Instructions are given with regard to preparation of TDM, analytical procedures, reporting and interpretation of results and the use of information for patient treatment. Using the consensus guideline will help to ensure optimal clinical benefit of TDM. [References: 75]]]> fre oai:serval.unil.ch:BIB_2D18D21C9C20 2022-05-07T01:13:59Z openaire documents urnserval <oai_dc:dc xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd"> https://serval.unil.ch/notice/serval:BIB_2D18D21C9C20 Effect of nutritive and non-nutritive sweeteners on hemodynamic responses to acute stress: a randomized crossover trial in healthy women. info:doi:10.1038/s41387-019-0104-y info:eu-repo/semantics/altIdentifier/doi/10.1038/s41387-019-0104-y info:eu-repo/semantics/altIdentifier/pmid/32066654 Cros, J. Bidlingmeyer, L. Rosset, R. Seyssel, K. Crézé, C. Stefanoni, N. Schneiter, P. Tappy, L. info:eu-repo/semantics/article article 2020-01-02 Nutrition &amp; diabetes, vol. 10, no. 1, pp. 1 info:eu-repo/semantics/altIdentifier/eissn/2044-4052 urn:issn:2044-4052 <![CDATA[The mechanisms by which chronic stress increases the risk of non-communicable diseases remain poorly understood. On one hand, chronic stress may increase systemic vascular resistance (SVR) and blood pressure, which may lead to blood vessels injury and altered myocardial perfusion. On the other hand, chronic stress may promote the overconsumption of sugar-containing foods and favor obesity. There is indeed evidence that sweet foods are preferentially consumed to alleviate stress responses. The effects of nutritive and non-nutritive sweeteners (NNS) on hemodynamic stress responses remain however largely unknown. This study aimed at comparing the effects of sucrose-containing and NNS-containing drinks, as compared to unsweetened water, on hemodynamic responses to acute stress in twelve healthy female subjects. Acute stress responses were elicited by a 30-min mental stress (5-min Stroop's test alternated with 5-min mental arithmetic) and a 3-min cold pressure test (CPT), each preceded by a resting baseline period. Hemodynamic stress responses were investigated by the repeated measurement of mean arterial pressure and the continuous monitoring of cardiac output by thoracic electrical bioimpedance measurement. SVR was selected as a primary outcome because it is a sensitive measure of hemodynamic responses to acute stress procedures. With all three drinks, SVR were not changed with mental stress (P = 0.437), but were increased with CPT (P = 0.045). Both mental stress and CPT increased mean arterial pressure and heart rate (all P &lt; 0.001). Cardiac output increased with mental stress (P &lt; 0.001) and remained unchanged with CPT (P = 0.252). No significant differences in hemodynamic responses were observed between water, sucrose and NNS (stress × condition, all P &gt; 0.05). These results demonstrate that sucrose and NNS do not alter hemodynamic responses to two different standardized acute stress protocols

The AGNP-TDM Expert Group Consensus Guidelines: focus on therapeutic monitoring of antidepressants

Therapeutic drug monitoring (TDM) of psychotropic drugs such as antidepressants has been widely introduced for optimization of pharmacotherapy in psychiatric patients. The interdisciplinary TDM group of the Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP) has worked out consensus guidelines with the aim of providing psychiatrists and TDM laboratories with a tool to optimize the use of TDM. Five research-based levels of recommendation were defined with regard to routine monitoring of drug plasma concentrations: (i) strongly recommended; (ii) recommended; (iii) useful; (iv) probably useful; and (v) not recommended. In addition, a list of indications that justify the use of TDM is presented, eg, control of compliance, lack of clinical response or adverse effects at recommended doses, drug interactions, pharmacovigilance programs, presence of a genetic particularity concerning drug metabolism, and children, adolescents, and elderly patients. For some drugs, studies on therapeutic ranges are lacking, but target ranges for clinically relevant plasma concentrations are presented for most drugs, based on pharmacokinetic studies reported in the literature. For many antidepressants, a thorough analysis of the literature on studies dealing with the plasma concentration–clinical effectiveness relationship allowed inclusion of therapeutic ranges of plasma concentrations. In addition, recommendations are made with regard to the combination of pharmacogenetic (phenotyping or genotyping) tests with TDM, Finally, practical instructions are given for the laboratory practitioners and the treating physicians how to use TDM: preparation of TDM, drug analysis, reporting and interpretation of results, and adequate use of information for patient treatment. TDM is a complex process that needs optimal interdisciplinary coordination of a procedure implicating patients, treating physicians, clinical pharmacologists, and clinical laboratory specialists. These consensus guidelines should be helpful for optimizing TDM of antidepressants

Results from the Randomized Controlled Multicenter German Algorithm Project 3 Trial

Background Treatment algorithms are considered as key to improve outcomes by enhancing the quality of care. This is the first randomized controlled study to evaluate the clinical effect of algorithm-guided treatment in inpatients with major depressive disorder. Methods Inpatients, aged 18 to 70 years with major depressive disorder from 10 German psychiatric departments were randomized to 5 different treatment arms (from 2000 to 2005), 3 of which were standardized stepwise drug treatment algorithms (ALGO). The fourth arm proposed medications and provided less specific recommendations based on a computerized documentation and expert system (CDES), the fifth arm received treatment as usual (TAU). ALGO included 3 different second-step strategies: lithium augmentation (ALGO LA), antidepressant dose-escalation (ALGO DE), and switch to a different antidepressant (ALGO SW). Time to remission (21-item Hamilton Depression Rating Scale ≤9) was the primary outcome. Results Time to remission was significantly shorter for ALGO DE (n=91) compared with both TAU (n=84) (HR=1.67; P=.014) and CDES (n=79) (HR=1.59; P=.031) and ALGO SW (n=89) compared with both TAU (HR=1.64; P=.018) and CDES (HR=1.56; P=.038). For both ALGO LA (n=86) and ALGO DE, fewer antidepressant medications were needed to achieve remission than for CDES or TAU (P<.001). Remission rates at discharge differed across groups; ALGO DE had the highest (89.2%) and TAU the lowest rates (66.2%). Conclusions A highly structured algorithm-guided treatment is associated with shorter times and fewer medication changes to achieve remission with depressed inpatients than treatment as usual or computerized medication choice guidance

Evaluating Depressive Symptoms in Schizophrenia: A Psychometric Comparison of the Calgary Depression Scale for Schizophrenia and the Hamilton Depression Rating Scale

Background: The aim of this study was to compare two measures of depression in patients with schizophrenia and schizophrenia spectrum disorder, including patients with delusional and schizoaffective disorder, to conclude implications for their application. Sampling and Methods: A total of 278 patients were assessed using the Calgary Depression Scale for Schizophrenia (CDSS) and the Hamilton Depression Rating Scale (HAMD-17). The Positive and Negative Syndrome Scale (PANSS) was also applied. At admission and discharge, a principal component analysis was performed with each depression scale. The two depression rating scales were furthermore compared using correlation and regression analyses. Results: Three factors were revealed for the CDSS and HAMD-17 factor component analysis. A very similar item loading was found for the CDSS at admission and discharge, whereas results of the loadings of the HAMD-17 items were less stable. The first two factors of the CDSS revealed correlations with positive, negative and general psychopathology. In contrast, multiple significant correlations were found for the HAMD-17 factors and the PANSS sub-scores. Multiple regression analyses demonstrated that the HAMD-17 accounted more for the positive and negative symptom domains than the CDSS. Conclusions:The present results suggest that compared to the HAMD-17, the CDSS is a more specific instrument to measure depressive symptoms in schizophrenia and schizophrenia spectrum disorder, especially in acutely ill patients. Copyright (c) 2012 S. Karger AG, Base

Which chronic diseases and disease combinations are specific to multimorbidity in the elderly? Results of a claims data based cross-sectional study in Germany

<p>Abstract</p> <p>Background</p> <p>Growing interest in multimorbidity is observable in industrialized countries. For Germany, the increasing attention still goes still hand in hand with a small number of studies on multimorbidity. The authors report the first results of a cross-sectional study on a large sample of policy holders (n = 123,224) of a statutory health insurance company operating nationwide. This is the first comprehensive study addressing multimorbidity on the basis of German claims data. The main research question was to find out which chronic diseases and disease combinations are specific to multimorbidity in the elderly.</p> <p>Methods</p> <p>The study is based on the claims data of all insured policy holders aged 65 and older (n = 123,224). Adjustment for age and gender was performed for the German population in 2004. A person was defined as multimorbid if she/he had at least 3 diagnoses out of a list of 46 chronic conditions in three or more quarters within the one-year observation period. Prevalences and risk-ratios were calculated for the multimorbid and non-multimorbid samples in order to identify diagnoses more specific to multimorbidity and to detect excess prevalences of multimorbidity patterns.</p> <p>Results</p> <p>62% of the sample was multimorbid. Women in general and patients receiving statutory nursing care due to disability are overrepresented in the multimorbid sample. Out of the possible 15,180 combinations of three chronic conditions, 15,024 (99%) were found in the database. Regardless of this wide variety of combinations, the most prevalent individual chronic conditions do also dominate the combinations: Triads of the six most prevalent individual chronic conditions (hypertension, lipid metabolism disorders, chronic low back pain, diabetes mellitus, osteoarthritis and chronic ischemic heart disease) span the disease spectrum of 42% of the multimorbid sample. Gender differences were minor. Observed-to-expected ratios were highest when purine/pyrimidine metabolism disorders/gout and osteoarthritis were part of the multimorbidity patterns.</p> <p>Conclusions</p> <p>The above list of dominating chronic conditions and their combinations could present a pragmatic start for the development of needed guidelines related to multimorbidity.</p