[Interhemispheric transfer and its implications for neurology and psychiatry]. / Der interhemispherielle Transfer und seine Relevanz in der Neurologie und Psychiatrie.

The corpus callosum (CC) is the brain's most important connection between cortical areas of both hemispheres. Due to the hemispheric lateralisation of brain function, information transfer between both hemispheres is vital for an optimal performance in tasks, in which several psycho-motor functions have to be integrated. Dysfunction of the CC can lead to deficits in neuropsychological tasks and could contribute to pathologies underlying psychiatric illnesses. In this review the normal and abnormal development of the CC as well as its macro- and microscopic anatomy will be outlined. Then the detrimental effects of operative callosomy on different modalities, e. g. on vision, the somatosensory and the auditory system, will be discussed. Two electrophysiological methods will be introduced, with which interhemispheric communication can be studied: hemispheric transfer in rapid visuo-motoric tasks (CUD) and transcallosal inhibition (TI), a phenomenon which occurs in a special paradigm of transcranial magnetic stimulation. A first study found TI to be reduced in unmedicated schizophrenic patients. This suggests that an inhibition between motor cortices could be reduced in schizophrenic patients. Further results of other studies, which have analysed the CC and interhemispheric transfer in schizophrenic patients, will be introduced and discussed. In future experiments, the contribution of dysfunctions of transcallosal transfer to psychopathological symptoms and neuropsychological deficits in schizophrenia should be studied.

[The role of depression in rehabilitation of geriatric patients with hip fracture]. / Depression bei geriatrischen Patienten mit hüftgelenksnahen Frakturen und deren Auswirkung auf den Rehabilitationsverlauf.

The effect of depression on the rehabilitation course of 64 geriatric inpatients with hip fracture was examined. At the beginning of treatment 38.5% had a depressive disorder according to GDS-15. After 3 weeks it was still 32%, although in 7 patients the GDS-score had decreased. Additionally, 18% had a cognitive disorder (MMSE<24). There was a correlation between depression and Barthel-Index at the start of treatment (58.4; SD 14.7 vs 48.3; SD 21.8; ANOVA; p<0.01), Barthel-Index at discharge (86.1; SD 13.1 vs 75.0; SD 25.11; ANOVA; p<0.01), mobility measured by timed "Up and Go" (Chi(2); p<0.01) and the number of prescribed drugs, as equivalent for severity of somatic diseases. Treatment of depression was inadequate in the beginning and at follow-up. Treated patients had a better outcome than untreated.

Survival of AIDS patients with primary central nervous system lymphoma is dramatically improved by HAART-induced immune recovery.

OBJECTIVE: To evaluate the impact of immune recovery induced by highly active antiretroviral therapy (HAART) on the survival of AIDS patients with primary central nervous system lymphoma (PCNSL). METHODS: In a multicentric retrospective analysis, 29 HIV-infected patients with histologically confirmed PCNSL were identified. To evaluate median survival, Kaplan-Meier statistics were used. To explore the effects of different variables on survival, a Weibull accelerated failure time regression analysis was performed. RESULTS: Median age at manifestation of PCNSL was 39.1 years and median CD4 cell count was 11 x 10(6) cells/l. Seventy per cent of the patients had had a prior AIDS-defining illness. Cranial radiation (CR) was given to 12 out of 29 patients. Six patients were treated with HAART. Survival time of these patients and of the patients treated with CR alone differed significantly from those receiving neither CR nor HAART (median Kaplan-Meier survival estimate: 1093, 132, and 33 days, respectively). In the multivariate regression model, HAART and CR were identified as the only variables independently associated with prolonged survival. HAART versus no HAART and CR versus no CR increased the time to event by a factor of 6.1 (95% confidence interval, 2.4-16.0; P = 0.0002) and 3.1 (95% confidence interval, 1.5-6.3; P = 0.002), respectively. Four out of six patients on HAART showed a marked immune recovery and survived for more than 1.5 years, with two patients still alive. CONCLUSION: Data from this cohort indicate that immune recovery induced by HAART leads to dramatic improvement in survival of patients with AIDS-associated PCNSL. These findings may have important implications for future treatment strategies.

Serum cholesterol in patients with obsessive compulsive disorder during treatment with behavior therapy and SSRI or placebo.

OBJECTIVE: Patients with panic disorder are reported to have elevated cholesterol levels. There is also some evidence that cholesterol elevation is not so much a specific condition in panic disorder but is generally associated with anxiety. So far, there is little data on cholesterol levels in patients with obsessive compulsive disorders (OCD) which is also classified as anxiety disorder. METHOD: Thirty-three patients with OCD participated in the study. Serum cholesterol was measured as pretreatment and at the end of a ten-week treatment-period. All patients received behavior therapy and, in a double-blind fashion, fluvoxamine or placebo. Severity of OCD was assessed by the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). RESULTS: Pretreatment cholesterol values of OCD patients were compared with cholesterol levels of thirty panic disorder patients and thirty normal controls. OCD patients had elevated cholesterol levels comparable with those of panic disorder patients. Cholesterol levels decreased significantly from pre- to posttreatment. OCD patients with high cholesterol levels (> or = 240 mg/dl, n = 7) could make best use of the treatment whereas patients with desirable cholesterol levels (< 200 mg/dl, n = 11) did not change their cholesterol during treatment. CONCLUSIONS: Our data support the assumption that not only panic disorder but also other anxiety disorders, e.g., obsessive compulsive disorders, may be associated with serum cholesterol elevations. Effective treatment (behavior therapy and/or treatment with a selective serotonin reuptake inhibitor [SSRI]) seems to decrease cholesterol levels, especially in patients with pathological cholesterol elevations.