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  • 2000-2004  (2)
  • Key words Bipolar depression  (1)
  • Schizophrenia  (1)
  • 1
    ISSN: 1433-0407
    Keywords: Schlüsselwörter Psychopharmakologie ; Suizid ; Schizophrenie ; Risikofaktoren ; Psychopathologie ; Keywords Psychopharmacology ; Suicide ; Schizophrenia ; Risk facotrs ; Psychopathology
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract For all 5.352 patients treated for schizophrenia at the Psychiatric Hospital of the University of Munich in 1981 and 1992, detailed routine and data processing-assisted documentations were made of the psychopharmacological therapies. Nineteen of the patients committed suicide while undergoing inpatient treatment; the control group consisted of all other patients (n=5.333). More than 77 sociodemographic and anamnestic variables as well as 195 items from the admission summaries were taken into account while comparing the groups. Furthermore, the pharmacological data were classified according to drug groups and comparison was based on the mean frequency of prescription of each group. We analyzed the mean number of prescriptions for neuroleptics, tranquilizers, and antidepressants, which were further differentiated into sedating and nonsedating types. For frequently administered drugs, mean daily doses were also compared. Bivariate analysis of the data suggests that the suicide cases presented depressive signs, symptoms, and tendencies already present on admission more frequently than with controls; the same applies to previously attempted suicides. Discriminating analysis showed that the variables “feeling of loss of feelings,“ thought insertion,”“visible depression,”“free-floating anxiety,”“suicidal tendencies,” and “previously attempted suicide” have the greatest predictive value with respect to suicide, in descending order. No differences in psychopharmacological treatment between suicides and controls were found, apart from a significantly higher percentage of antidepressive treatments and a higher mean number of antidepressant prescriptions for the suicides.
    Notes: Zusammenfassung Bei allen 5.352 im Zeitraum 1981–1992 in der Psychiatrischen Klinik der Universität München stationär aufgenommenen schizophrenen Patienten wurde systematisch sowohl eine Routinedokumentation mit dem AMDP-System als auch eine computergestützte Dokumentation der pharmakologischen Behandlung durchgeführt. 19 dieser Patienten suizidierten sich während des stationären Aufenthaltes, wobei die Kontrollgruppe aus allen übrigen Patienten gebildet wurde (n=5.333). In den Gruppenvergleich gingen alle soziodemographischen und krankheitsanamnestischen Variablen sowie alle Items des AMDP-Aufnahmebefundes ein. Ferner wurden die pharmakologischen Daten nach Medikamentengruppen zusammengefasst und hinsichtlich der Verordnungshäufigkeiten der jeweiligen Pharmakagruppen verglichen. Die bivariate Auswertung zeigte neben häufigeren Suizidversuchen in der Vorgeschichte ein bei den säteren Suizidenten bereits bei Aufnahme häufiger vorliegendes depressiv-suizidales Syndrom, wobei diskriminanzanalytisch in absteigender Reihenfolge die Variablen “Gefühl der Gefühllosigkeit”, “Gedankeneingebung”, “beobachtete Depression”, “frei flottierende Angst”, “Suizidalität” und “Suizidversuch in der Vorgeschichte” die größte prädiktive Kraft in Richtung Suizid entfalteten. Mit Ausnahme einer signifikanten Erhöhung sowohl des prozentualen Anteils der antidepressiv behandelten Patienten als auch der mittleren Anzahl der Antidepressivaverordnungen in der Suizidgruppe fanden sich keine Anhaltspunkte für eine zwischen den beiden Gruppen wesentlich differierende psychopharmakologische Behandlung.
    Type of Medium: Electronic Resource
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  • 2
    Electronic Resource
    Electronic Resource
    Springer
    European archives of psychiatry and clinical neuroscience 250 (2000), S. 57-68 
    ISSN: 1433-8491
    Keywords: Key words Bipolar depression ; Tricyclic antidepressants ; Selective serotonin re-uptake inhibitors ; Drug treatment of acute bipolar depression
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract This paper gives a critical review of recommendations concerning the drug treatment of acute bipolar depression. The suggestions of different guidelines and consensus papers, especially in US-American and Canadian psychiatry, have a strong tendency against antidepressants in bipolar depression; they prefer mono-therapy with mood stabilizers and, in the case of co-medication with mood stabilizers and antidepressants in severe depression, to withdraw the antidepressant as early as possible. The intention of this restrictive use is to avoid the risk of mania and the risk of rapid cycling induced by antidepressants. However, apparently the risk of suicidal acts, which is as prominent in bipolar depression as in unipolar depression, has been totally neglected. Furthermore, the fact that none of the mood stabilizers have proven their antidepressive efficacy leads not only to the risk of depression-related suicidal behavior but also to the risk of chronicity of depressive symptoms due to undertreatment. Altogether the view expressed in some guidelines and consensus papers appears not well balanced. Furthermore, the fact that apparently the selective serotonin re-uptake inhibitors and possibly some other modern antidepressants have only a low risk of inducing a switch to mania should stimulate a rewriting of the guidelines on drug treatment in acute bipolar depression in a less restrictive way concerning the use of antidepressants.
    Type of Medium: Electronic Resource
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