Changes of speech activity in depressed patients under pharmacotherapy.

The reduced speech activity of depressed patients is a consistent finding in many systematic studies. However, this and other nonverbal parameters have seldom been investigated in psychopharmacological studies. In this double-blind study, 21 retarded depressed patients were treated with amitriptyline or pirlindol over a four-week period. The speech behavior of the patients was analyzed by computer techniques, and the drug-induced changes in these variables were compared with the psychopathological effects of the treatment.

Can changes in eye-contacts predict therapeutic outcome in schizophrenic patients undergoing neuroleptic treatment? Results of a preliminary study.

The proportion of interview time spent in eye-contacts was studied before the onset of and during neuroleptic treatment in a group of 24 male schizophrenic patients. A significant increase in eye-contacts after 14 days distinguished responders to neuroleptic treatment, while a tendency towards the same effect distinguished patients treated with haloperidol from those treated with perazine. Only in the subgroup of responders was there a significant relationship between increase in eye-contacts and reduction of psychopathologic symptoms, regardless of whether these values were compared for the same treatment days or whether early changes in eye-contacts were compared with final outcome of treatment after 28 days. Since the patient subgroups were rather small, the results should still be considered preliminary. A prospective study including more parameters of visual interaction, a larger patient sample, and a longer observation period is required.

Quantitative analysis of speech behavior of depressed patients under a drug therapy.

Reduced speech activity is an important nonverbal symptom of retarded depressions. But speech patterns are also related to many other factors. Under an antidepressive drug treatment the speech behavior could be influenced not only by the therapeutic improvement but also by special pharmacological side effects. In a double-blind trial 21 endogenously depressed inpatients were treated with amitriptyline or pirlindol. Diagnostic interviews with the patients were recorded on TV-tapes on day 0, 4, 7, 14, 21 and 28. To investigate the psychopathological changes the tapes were analyzed under time-blind conditions. The AMP documented results of these ratings showed significantly better therapeutic effects in the amitriptyline-group than in the pirlindol-group. To study speech variables the tapes were computer analyzed. After 4 weeks the degree of improvement in the total group of patients was significantly correlated with the reduced length of speech pauses of both patients and interviewers. On the other hand remarkable drug influences in the course of speech variables were found. These could be interpreted as specific pharmacological effects.

A case of perazine-induced enteritis--allergy or pseudoallergy?

Almost all adverse reactions to neuroleptic drugs in the gastro-intestinal system can be explained by their peripheral cholinergic blocking action with subsequent inhibition of intestinal tone and peristalsis. As a rare condition, severe diarrhoea due to enteritis may occur. A case with this complication is presented, the etiology and pathogenetic factors are discussed.

The AMDP system for the documentation of psychiatric symptoms: course and effectivity of a training seminar.

In an AMDP training seminar on psychopathology, the possible learning effects were studied. Eighteen psychiatrists with varying levels of experience saw five video tapes of patient explorations within one and one-half days. The first and the last tape were identical. This enables a comparison of the ratings of these two tapes. The extent to which the raters agreed with regard to the frequencies of the AMDP items was examined both in relation to "present"-"absent" as well as with regard to the severity. The interrater reliability clearly increased in the course of the training. This increase was greater with the inexperienced raters than with the experienced group. The greatest change between the first and the last rating occurred between "mild" and "absent", thus indicating a threshold problem in the assessment of psychopathological symptoms.

Interrelation between changes in the EEG and psychopathology under pharmacotherapy for endogenous depression. A contribution to the predictor question.

With the predictor problem in mind, we studied in-patients with endogenous depression whether relationships exist among the EEG, the therapeutic response, and the severity of psychopathology. We found that clinically defined responders and non-responders differ in respect of their average power spectra calculated for the two occipital regions. In addition, it was shown that there is a statistically significant correlation between the EEG before treatment and the severity of AMP-documented psychopathology after a 4-week treatment period. This correlation was stronger for the left occipital region than for the right.

Reliability of the AMDP-system. A preliminary report on a multicentre exercise on the reliability of psychopathological assessment.

The AMDP-System is a documentation system for psychiatric data widely in use in the German-speaking countries. A summary of results of a multicentered study of interrater agreement of the Psychopathology Scale is presented. A new index of rater agreement was tested and the notion is discussed that the judgement of the presence and the absence of a symptom are two different processes with different reliability.

Time-blind analysis and other video-strategies in phase II trials of psychotropic drugs.

Phase-II-studies of potential psychotropic drugs present special difficulties for the investigator. They must often be performed, even in early phase II, as controlled double-blind studies because of methodological requirements. On the other side, the sample size mostly cannot be kept small, due to medical, organizational, ethical, and legal reasons. Thus, the variance of many psychological factors will easily lead to errors of the beta-type. Errors of the alpha-type are the special danger of open pilot studies in psychiatric patients. One bias of primary importance is the fact that the investigator can never remain blind as to time. Special video-techniques, developed by our psychopharmacological research group, allow to carry our time-blind analyses of normal or specially structured patient interviews. Furthermore, they provide the opportunity to expose psychopathological data obtained under normal clinical conditions to several independent raters. This procedure results in a much more standardized average rater judgement and has considerable advantages compared to documentation on conventional rating scales.

[The use of TV-technique for a quantitative evaluation of the longitudinal psychopathological profile (author's transl)]. / Quantifizierende Beurteilung des psychopathologischen Längsschnittprofils mit Hilfe audiovisueller Aufzeichungen.

19 depressed patients were treated with viloxazine (n = 9) or amitriptyline (n = 10) in a double-blind trial. TV-tapes produced for each patient on day 0, 10 and 20 were analyzed with respect to the global intensity of depression and to 4 other verbal or averbal psychopathological parameters by 4 independent raters under the condition of a time-blind analysis. Global intensity of depression, prosodic, depressive contents of experience, and psychomotoric inhibition were found decreased between day 0 and day 10 for the viloxazine group, and between day 10 and day 20 for the amitriptyline-group. The accuracy of judgement of agitation was the lowest one.

[Synopsis of psychopathological, electroencephalographical, and pharmacokinetic variables during antidepressive treatment with viloxazine (author's transl)]. / Synopsis psychopathologischer, elektroenzephalographischer und pharmakokinetischer Parameter unter einer antidepressiven Therapie mit Viloxazin.

In order to achieve a more differentiated assessment of the profile and time course of treatment with a new antidepressant drug, several psychiatric, neurophysiological, and biochemical parameters were examined in a double-blind study (viloxazine versus amitriptyline). Special attention was directed to the use of a time-blind audiovisual technique. The TV technique allowed to demonstrate an earlier onset of the therapeutic effect under viloxazine, which is in good agreement with the cross-sectional and longitudinal profile of viloxazine as regards pharmacokinetics and EEG.

[New strategies in psychiatric diagnosis through the use of audio-visual technics. 2. Importance of verbal and non-verbal information for assessment of depressive patients]. / Neue Strategien psychiatrischer Urteilsbildung durch Anwendung audio-visueller Techniken. 2. Mitteilung: Zur Bedeutung verbaler und averbaler Informationen für die Beurteilung depressiver Patienten

Sections of 150 seconds duration were taken on a random basis out of TV stored interviews of day 0, 10 and 20 of a double-blind antidepressive drug trial. Not identical sections were selected for the isolated audio and video channel and for the combined presentation in such a way that for each of the 20 patients three times three parts were presented for evaluation. It was the two rater's task to rank each patient's tapes in terms of the degree of depression. They were blind regarding the day of recording the interview (day 0, 10 or 20). The best results were reached with the combined presentation of the audio-video-channel while each channel taken seperately rendered less diagnostic information. The raters evaluated the material in two different modifications: a) Video, audio and than audio-video-channel or b) audio, video and audio-video-channel. The first version (a) was evaluated in a better way than the second one with respect to the content of diagnostic information. Furthemore we found that the evaluation of the visual information became less safe if the audio presentation preceded as in version b.

[New diagnostic strategies in psychiatry by means of video-technique. I. The use of time-blind video analysis for the evaluation of antidepressant drug trials (author's transl)]. / Neue Strategien psychiatrischer Urteilsbildung durch Anwendung audio-visueller Techniken. 1. Mitteilung: Verlaufsuntersuchung einer antidepressiven Therapie durch vergleichende und zeitblinde Auswertung von Fernsehaufnahmen

The use of audio-video methods allowed the decrease of subjective factors influencing ratings of psychopathological phenomina. TV-stored interviews, recorded at separate days, may be compared almost simultaneously. In this study a rating of severity of depression was made of patients under antidepressive medication on days 0, 10, 20. (Mianserin was compared with Amitriptyline in a double-blind-trial). This method rendered it possible to detect significant differences between therapeutic profiles over time. The same result was reached independently by both investigators. The judgement of depression was based on a global impression and not on the evaluation of isolated psychopathological symptoms. No absolute measurement of depression was possible. The described method of a time-blind-analysis of TV-stored interviews constitutes a considerable progress in the assessment of a drug's profile in time, particularly if rating-scales are used in the same manner.

Time-blind analysis of TV-stored interviews. An objective method to study antidepressive drug-effects.

A new method of evaluating the time course of an antidepressive drug effect is described. It has the advantage that the rater is "blind" as to the duration of the treatment (time-blind analysis). TV-stored tapes of interviews recorded during the drug trial were presented in a randomized sequence to raters who ranked each patient's tapes in terms of the degree of depression shown during the interview. Patients treated with Amitriptyline showed a continuous amelioration of depression throughout the drug trial while those treated with Mianserin showed an amelioration of depression that was not constant in time.