Pharmacokinetics of alprazolam in elderly patients with multiple diseases.

The pharmacokinetics of alprazolam (1 mg p.o.) were investigated (using a new developed HPLC-assay) in 10 multimorbid elderly patients (five female, five male; mean age 72.8 +/- 8.2 years, creatinine clearance 63.6 +/- 25.9 ml/min, weight 68.9 +/- 13.9 kg). Compared with young and elderly volunteers from other studies peak plasma concentrations of alprazolam were decreased while peak time and elimination half-life were increased. 'Second peak' plasma levels (correlated with age and creatinine clearance) occurred in eight of 10 elderly patients. The variability associated with the pharmacokinetic parameters in the multimorbid elderly patients was far greater than that observed in young and old healthy volunteers. Mean alprazolam concentrations in multimorbid patients aged 72 years or more were elevated as compared to 'younger' patients (age range: 63-71 years). Dose reduction should be considered in the older multimorbid patients.

[Assessment of curriculum by medical students: comparison of participants and non-participants in voluntary anamnesis groups. An empirical study]. / Einschätzung von Unterrichtsformen durch Medizinstudenten: Vergleich von Teilnehmern und Nichtteilnehmern an freiwilligen Anamnesegruppen. Eine empirische Untersuchung.

A representative sample of medical students (n = 121) was given a questionnaire to assess parts of their medical education (lectures, seminars, clerkships) and to design a subjectively ideal timetable, which was compared with the real faculty program. Overall traditional lectures received a low rating (n = 0.17) and individual studies with the textbooks a high rating (n = 0.53). The information given in programs in psychiatry and psychosomatics in significantly less motivating than information to be learned in other medical subjects. This is surprising because the ground work for training in the doctor-patient relationship should be in these fields. Students with former group experience (participation in peer groups on history taking (wish to have more practically oriented education compared with the students without group experience. It is not clear whether the important factor is participation in group experience before starting medical school. (64% of the participants had group experience in the first group as opposed to only 45% of the other group). This information should be taken into consideration when reforming medical school programs.

Change in symptomatology of melancholic depression over two decades. Core symptoms and culturally determined symptoms.

The psychopathology of 183 patients with melancholic depression first admitted to our department in 1969 and 1970 was compared with that of 184 patients first admitted in 1989 and 1990. A multivariate statistical analysis was performed. The main results were as follows: A socioculturally invariable core syndrome of melancholia comprising psychomotor inhibition and vegetative disturbances can be identified. The contents of depressive thinking are, at least in part, culturally determined and vary with value changes in society. Paralleles to social change could be shown in particular for feelings of guilt and a concern with self-realization.

[Suicidal acts in advanced age]. / Suizidhandlungen im Alter.

Geriatric suicides and attempted suicides differ from those of other age groups in a number of major characteristics: the suicide rate increases with age, while attempted suicides decrease; the lethality of the method selected increases with advancing age; the motivations of the elderly differ from those of younger suicides; psychiatric problems are more severe in the aged. Our own investigations were based on the data on suicide in West Germany collected between 1979 and 1987. Possible explanations for these findings are discussed, and conclusions drawn on how to prevent suicide and how to treat attempted suicides in the aged.

[The need and actually successful work-related rehabilitation measures for first-admission psychiatric patients]. / Uber den Bedarf und die tatsächlich erfolgten berufsbezogenen Rehabilitationsmassnahmen bei ersteingewiesenen psychiatrischen Patienten.

Presented are the findings of a follow-up study of 258 psychiatric patients who had for the first time been admitted to inpatient psychiatric treatment in 1979. Using standardized forecasting instruments, the patients themselves, their treating physician, and a member of the care staff were asked to give their views of the patient's occupational outlook, his chances for resettlement, and the need for vocational rehabilitation services following discharge. The needs statements made at discharge are contrasted with the vocational and job-related rehabilitation measures actually initiated and carried out in the year following discharge; additionally, the patients' vocational situation at discharge is compared with their situation twelve months later, and the course of the rehabilitation measures provided is described. Along with the discrepancies between needs statements and amount of vocational rehabilitation services actually initiated and carried out, the empirical findings point to a non-specific, dispersive approach to providing rehabilitation services. The possible causes for this discrepancy between needs and service provision, with its rather serious implications, as well as the doubtful effectiveness of the rehabilitation services provided are discussed, practice-related consequences are outlined.

[Familial stresses as a sequel of psychiatric diseases in a relative. Results of an interview with relatives]. / Familiäre Belastungen als Folge psychischer Erkrankung eines Angehörigen. Ergebnisse einer Angehörigenbefragung.

The results of interviews with relatives of 179 patients committed to psychiatric treatment are reported. The relatives were interviewed in 1980, one year after discharge of the patient--who had been hospitalized for psychiatric problems for the first time--usually in the family setting. Our main interest was to investigate the concern of the relatives induced by the illness of a family member, and to take stock of the nature and extent of family stress at a relatively early stage of a psychiatric illness. We also wished to know what support the relatives had received, and from what sources, and from what other sources they would have wished such support. The results confirm what other investigators have suggested, i.e that community-centred care apparently leads to an increase in family stress, and that outpatient services and facilities have, to date, played a very minor role in overcoming the problems in the families of psychiatric patients.

[After care behavior of first-admission psychiatric patients during the year after their discharge]. / Das Nachsorgeverhalten ersteingewiesener psychiatrischer Patienten im Jahr nach ihrer Entlassung.

228 patients who had been admitted for the first time to a psychiatric hospital were questioned one year after their discharge in respect of the use they made of the medical and non-medical facilities or institutions. The article describes the actual state of affairs in the after-care behaviour of the psychiatric patients, and goes into details with regard to the diagnosis-specific differences in their behaviour. It is especially in this group of patients that a great demand exists with regard to treatment facilities. 90% of the patients have some kind of contact with our health system, and almost 3/4 have undergone treatment for mental disturbances. The main burden of medical outpatient follow-up of psychiatric patients continues to rest with the family physicians. This is equally true for almost all groups of diagnosed diseases. The patients with schizophrenic psychoses represent the only difference, since they will tend to preferably look up a neurologist for the treatment of their mental complaints.

[Freedom and voluntary death: suicide as ideology]. / Freiheit und Freitod: Suicid als Ideologie.

Voices have been increasing in the last years, demanding the right of men to choose time and way of ending his life, thus asking consequently the liberty for mankind of killing themselves. The most important of these ideas are explained in connection with their philosophical, psychological and sociological background and confronted with the results of modern suicide research. The outcome of this review gives, however, no reason for changes in the previous and successful ways of suicide prevention.

[Pathogenetic model-theories of endogenous psychoses (author's transl)]. / Modelle endogener Psychosen

The multiplicity of frequently conflicting views in the psychiatry of today inspires the wish for a uniform way thinking about the thorough knowledge and the many hypotheses that have become almost boundlessly vast. Such ideas of models as have played a part for quite some time in the mathematical and natural sciences, and of late in the sociology, are also to be found in the field of psychiatry, without however always being called so expressis verbis. Guided by the historical development an attempt has been made to expose model-like ideas about the etiology and pathogenesis of endogenic psychoses, first of all of schizophrenia, as they have become decisive for modern psychiatry. It appears that in the abbreviation of the "model" the basis for a discussion already overdue is to be found.