1,721,130 research outputs found
Risikoidentifikation bei Polypharmazie in einer Pflegeheimpopulation
No full textINTRODUCTION: Multimorbidity in old age is one reason for intensified pharmacotherapy. At the same time, an increase in medications could augment multimorbidity, especially when drug interactions leading to undesired drug effects occur. METHODS: In this cross-sectional study 918 mentally ill seniors living in nursing homes (mean age 79.3 (±11.6) years; 31.8% male) were included. Two different approaches to assess risks due to pharmacotherapy were applied: first mediQ, an online-based clinical decision support software (CDSS) and the PRISCUS list, which indicates potentially inappropriate medication. PRISCUS is the German equivalent to the American Geriatrics Society Beers criteria. RESULTS: Of the patients in the study 76.3% were at clinical risk, 2.2% at potentially high risk for drug interactions regarding the entire medication as tested by mediQ, and about 25% of the studied population received potentially inappropriate medication according to the PRISCUS list. CONCLUSION: This difference clearly underlines the cumbersome complexity of identifying patients at risk by using these exemplary devices. The focus of avoiding undesired drug side effects should be taking medication only after thorough verification of clinical indications and under close monitoring. The CDSS or negative lists may support this process
ADHS im Erwachsenenalter und substanzbezogene Störungen – Prävalenz, Diagnostik und integrierte Behandlungskonzepte
No full textZusammenfassungSubstanzbezogene Störungen (SUD) sind nach Angst- und affektiven Störungen die psychischen Störungen mit der höchsten Prävalenz in der erwachsenen Allgemeinbevölkerung. Die Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS) zählt zu den häufigsten psychischen Störungen bei Kindern und Jugendlichen und persistiert bei einem Teil der Patienten bis in das Erwachsenenalter. Das Vorliegen von ADHS im Kindes- und Jugendalter ist zudem ein stabiler Prädiktor für den Konsum von Tabak, Alkohol und illegalen Suchtmitteln im Erwachsenenalter. Die Problematik einer integrierten Therapie von erwachsenen Patienten mit der Komorbidität ADHS und SUD zählt zu den zentralen Herausforderungen in der klinischen Versorgung dieser Patientengruppe. Das Ziel dieser Übersichtsarbeit sind die Darstellung und Diskussion der Komorbidität von ADHS und SUD bei erwachsenen Patienten anhand der aktuellen Literatur sowie die Ableitung der Implikationen für eine adäquate Diagnostik und Therapie. Des Weiteren werden die Prävalenzen komorbider Störungen, die Herausforderungen der (Differenzial-)Diagnostik durch Symptomüberschneidungen und Ausblicke für eine integrierte psychiatrisch-psychotherapeutische Behandlung von ADHS und substanzbezogenen Störungen dargestellt.</jats:p
Are Persons Treated with Antidepressants and/or Antipsychotics Possibly Better Protected against Severe COVID 19?
No full textOccipital event-related potentials to addiction-related stimuli in detoxified patients with alcohol dependence, and their association with three-month relapse
No full textBackground: Understanding the biological underpinnings of relapse in alcohol dependency is a major issue in addiction research. Based on recent evidence regarding the relevance of occipital visual evoked response potentials (ERPs) in addiction research, and its significance for relapse research, we assessed occipital ERPs to alcohol- and non-alcohol-related stimuli in recently detoxified patients and controls.MethodsThirty recently detoxified patients with alcohol addiction, and 31 healthy control subjects, were assessed in a Go and a NoGo condition, each using three visual stimuli: tea, juice and beer. In the “Go” condition, subjects had to respond to the juice (12.5 %) and the beer stimulus (12.5 %), and ignore the tea picture (75 %). In the “NoGo” condition, subjects had to respond to the tea picture (75 %) and ignore the juice and the beer picture (12.5 % each). The subjects’ EEGs were analyzed with regard to the occipital P100 and N170 ERP components. Patients were then evaluated for relapse 3 months after this initial assessment.ResultsP100 amplitudes differed between conditions and between stimuli, and we found a condition x electrode interaction. However, none of these P100 results involved group or relapse-status effects. N170 amplitudes in patients were elevated as compared to controls. Additionally, patients’ heightened N170 amplitudes in response to the alcohol-related (beer) stimulus were found only under the NoGo condition, where subjects had to react to the frequent tea stimulus and ignore the beer and the juice stimuli, thus resulting in a condition x stimulus x group interaction. Patients reporting relapse in a 3-month follow-up assessment showed larger NoGo N170 alcohol cue-related ERP amplitudes and increased depression scores as compared to patients who stayed abstinent. Depression was related to shortened P100 latencies in patients, but unrelated to the N170 NoGo cue-reactivity effect.ConclusionsOur results indicate a sensitivity of occipital ERPs to addiction-related stimuli when these act as non-targets. Recently detoxified patients may be vulnerable to addiction-related cues when these occur outside the focus of directed attention, thereby circumventing intentional control processes. Furthermore, ERPs to addiction-related stimuli may be useful as a predictor of abstinence success in recently detoxified patients
Impact of dementia-landscaped therapy garden on psychological well-being– A pilot study
No full textAbstract Non-pharmacological interventions are increasingly recognized as first-line therapies for managing dementia symptoms alongside pharmacologic strategies. Among these, therapy gardens and horticultural interventions have emerged as promising adjunctive approaches. This pilot study aimed to evaluate the effects of a six-month dementia-friendly therapy garden intervention on psychological well-being, specifically depression levels, and to determine whether baseline dementia severity predicts treatment success. The study was conducted in a real-world setting, with a final sample of 28 dementia patients. Unlike previous studies, this intervention incorporated multimodal stimulation, including sensory, motor, and cognitive elements. Results indicated a significant reduction in depression, as measured by the Montgomery-Åsberg Depression Rating Scale (MADRS) after six months of intervention ( p <.05). However, depression scores assessed using the Hamilton Depression Rating Scale (HAM-D) showed only a trend toward improvement but did not reach statistical significance. No improvements were observed at the three-month mark, suggesting that sustained engagement is necessary for measurable benefits. Cognitive function, as assessed by dementia severity, did not show significant improvement, and dementia severity at baseline was not a significant predictor of treatment response. These findings underscore the potential of dementia-friendly therapy gardens to provide meaningful psychological benefits by significantly reducing depression over time. Notably, even individuals with more advanced dementia benefited, challenging the prevailing notion that non-pharmacological interventions are primarily effective in early disease stages. These results highlight the need for further research on the long-term effects and mechanisms underlying garden-based interventions in dementia care
The efficacy of the dopamine D(2)/D(3) antagonist tiapride in maintaining abstinence: a randomized, double-blind, placebo-controlled trial in 299 alcohol-dependent patients
No full textIn this investigation, the hypothesis was tested whether the selective dopamine D(2)/D(3) receptor antagonist tiapride is effective in maintaining abstinence after detoxification in alcohol-dependent patients. The rationale of the study was based on the relevance of the dopaminergic system for addictive behaviour as well as some preliminary studies. A multi-centre, randomized, double-blind, placebo-controlled, parallel-group study was conducted. A total of 299 detoxified alcohol-dependent patients (ICD-10: F10.2) received either tiapride (300 mg/d) or placebo over a 24-wk study period. Subjects with severe comorbid psychiatric disorder such as schizophrenia or Wernicke-Korsakoff syndrome were excluded. Primary outcome variable was the time to first relapse with relapse defined as any alcohol consumption after detoxification. Data analysis was done with Kaplan-Meier estimates with log-rank test (one-sided, p < 0.05). Tiapride was not superior to placebo in maintaining abstinence. The time to first relapse was 71 d in the tiapride group and 92 d in the placebo group (log-rank test, p = 0.9895). Relapse rate was higher in the intervention group (54.4%) than in the control group (40.7%). Like the dopamine antagonist flupenthixol, tiapride was not effective in maintaining alcohol abstinence. Regarding the high success rate in the placebo group the influence of psychosocial treatment in studies investigating drug effects on the course of alcohol dependence has to be considered
Assessment of recommendations for low-risk use of alcohol, cannabis, gambling and gaming: state of knowledge
No full textThe impact of drug associated cues on decision making behavior - a study with an modified version of the Iowa Gambling Task
No full textOpiatabhängige sind im Treffen funktionaler Entscheidungen beeinträchtigt. Sie entscheiden sich für den kurzfristig belohnenden Substanzkonsum, obwohl dieser langfristig negative Konsequenzen hat. Es gibt bislang keine Untersuchung, die das Entscheidungsverhalten verschiedener Behandlungsgruppen opiatabhängiger Patienten vergleicht. In einer Studie mit 81 Opiatabhängigen (39 kurz vor Abschluss einer Entzugsbehandlung, 42 stabil Substituierte) wurde das Entscheidungsverhalten von Entzugspatienten und Substitutionspatienten verglichen. Mittels einer modifizierten Version der Iowa Gambling Task (IGT) mit suchtrelevanten Reizen wurde das Entscheidungsverhalten unter Ambiguität erfasst. Zudem wurde Entscheidungsverhalten unter Risikobedingungen mittels Game of Dice Task (GDT) erfasst. Es zeigte sich, dass Substituierte signifikant bessere Leistungen in der modifizierten IGT erzielten als Entzugspatienten (p=.01) sowie signifikant weniger Suchtdruck beim Anblick von Suchtreizen verspürten (p<.01). In der Ambiguitätsphase der modifizierten IGT bestand kein signifikanter Unterschied zwischen den Gruppen (p=.99), im letzten Abschnitt, nach Lernprozess, signifikant bessere Leistungen der Substitutionsgruppe (p<.01). Weiter zeigten Entzugspatienten in der GDT ein signifikant riskanteres Entscheidungsverhalten als Substitutionspatienten (p<.001). Die Ergebnisse zeigen mögliche Erklärungsansätze für die hohe Rückfallrate nach abgeschlossenen Entzugssyndrombehandlungen ohne Anschlussbehandlung. Weiter legen die Ergebnisse nahe, dass eine stabile Substitutionstherapie funktionale Entscheidungen sowie Craving positiv beeinflusst.People with an opiate dependency are impaired in functional decision making. They choose the short-term rewarding abuse, without considering long-term negative consequences. Momentary there is no study comparing the decision making behavior of different treatment groups of opiate-dependent patients. In a study with 81 opiate addicts (39 just before completion of a withdrawal of opiates, 42 stable substitutes) the decision making behavior of withdrawal patients and substitution patients has been compared. By means of a modified version of the Iowa Gambling Task (IGT) with addiction relevant stimuli, the decision making behavior has been recorded under ambiguity. In addition, decision making behavior has been recorded using the Game of Dice Task (GDT) under risk conditions. The results have represented that substitutes significantly improved performance in the modified IGT as withdrawal patients (p = .01) as well as significantly less addictive pressure at the sight of pictures, illustrating motives that are associated with drug abuse (p <.01). In the ambiguity phase of the modified IGT, there has been no significant difference between the groups (p = .99) and significantly better performances of the substitution group during the last phase (p <.01) after the learning process. Furthermore, withdrawal patients in the GDT showed a significantly riskier decision making behavior than substitution patients (p <.001). Possible explanatory approaches for the high rate of relapse after completed withdrawal syndrome treatment without follow-up treatment can be concluded. Moreover, the results suggest that stable substitution therapy positively affects functional decisions as well as craving
Diversion and Abuse of Prescribed Methylphenidate – A Survey of an Outpatient Clinic for Adult Persons with ADHD
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