Effect of deployment related experiences on sleep quality of German soldiers after return from an International Security Assistance Force (ISAF) mission to Afghanistan.

The aim of the present study was to investigate the effect of experiencing potentially traumatic events during deployment on post-deployment sleep quality as measured by the Pittsburgh Sleep Quality Index (PSQI) and the Addendum for Post-Traumatic Stress Disorder (PTSD) of the Pittsburgh Sleep Quality Index (PSQI-A). Deployment related experiences were quantified on a standardised list of the Mental Health Advisory Team of the U.S. armed forces. The original sample consisted of 118 soldiers of the German armed forces who were deployed to Afghanistan for six months. The present analyses focused on data assessed after deployment (n = 70) and in a three-month follow-up (n = 51). Results indicate that immediately after return experiences during deployment had an independent significant effect on sleep quality but not three months later. Immediately after return depressive and stress symptoms significantly affected sleep quality while three months later somatic symptoms were significant. At both time points sleep prior to deployment was a significant predictor of sleep quality following deployment. Given the importance of sleep quality prior to deployment as a known independent risk factor for newly occurring mental disorders after deployment, these results underline the need to improve sleep quality already at an early stage.

Sleep quality of German soldiers before, during and after deployment in Afghanistan-a prospective study.

In this prospective study, subjective sleep quality and excessive daytime sleepiness prior to, during and after deployment of German soldiers in Afghanistan were examined. Sleep quality (Pittsburgh Sleep Quality Index; PSQI) and daytime sleepiness (Epworth Sleepiness Scale; ESS) were assessed in 118 soldiers of the German army, who were deployed in Afghanistan for 6 months (deployment group: DG) and in 146 soldiers of a non-deployed control group (CG) at baseline. Results of the longitudinal analysis are reported, based on assessments conducted prior to, during the deployment and afterwards in the DG, and in the CG in parallel. Sleep quality and daytime sleepiness in the DG were already impaired during the predeployment training phase and remained at that level during the deployment phase, which clearly indicates the need for more attention on sleep in young soldiers, already at this early stage. The percentage of impaired sleepers decreased significantly after deployment. Programmes to teach techniques to improve sleep and reduce stress should be implemented prior to deployment to reduce sleep difficulties and excessive daytime sleepiness and subsequent psychiatric disorders.

[Characteristics of psychiatric patients in the accident and emergency department (ED)]. / Charakteristik psychiatrischer Patienten in der Notaufnahme.

OBJECTIVE: To obtain data and results concerning the acute treatment of psychiatric patients within a general ED. METHODS: Retrospective examination of psychiatric cases treated in the ED of the Hannover Medical School in the year 2002. Patient characteristics were evaluated concerning diagnosis, technical examinations, therapeutic steps and data relating to the length of stay and patterns of usage of emergency services. RESULTS: 2069 psychiatric patients were seen in the ED. Additionally 563 psychiatric consultations were requested. Accordingly, psychiatry is the fourth most frequented discipline within the ED. 51.6 % of the patients were male, the average age was 43.5 years. Acute alcohol intoxication was the most frequent diagnosis with 20.2 %, followed by paranoid schizophrenia in 14.2 % and acute adjustment disorder in 6.7 % of the patients. Suicidal behaviour was present in 12.1 %. CONCLUSIONS: Psychiatric patients represent a large part of the general interdisciplinary ED. Data may support quality assurance and service planning.

Aripiprazole augmentation of clozapine in treatment-resistant schizophrenia: a clinical observation.

BACKGROUND: Therapeutic options for patients with treatment-resistant schizophrenia are limited, and combination treatment with atypical antipsychotic drugs is an often used strategy. We tested the hypothesis that the combination of aripiprazole and clozapine would lead to an improvement in this patient group. METHODS: Eleven patients with treatment-resistant schizophrenia participated in this clinical trial and received a combination of aripiprazole and clozapine. Patients had to have remained on a stable dose of clozapine for at least 6 months in order to ensure a reasonable opportunity to respond to clozapine monotherapy. Clinical status was evaluated at baseline and at 3 months' follow-up using the Brief Psychiatric Rating Scale (BPRS). RESULTS: All patients completed 3 months' combination treatment. There was a significant reduction in the mean BPRS score in seven patients (63.6%) over the 3 months of combination treatment. Augmentation with aripiprazole in clozapine-treated patients did not result in a corresponding increase in adverse effects. Use of the combination allowed a significant reduction in the daily dose of clozapine. CONCLUSIONS: Combined application of clozapine and aripiprazole is in accordance with a neurobiological rationale and appears to be safe and well tolerated without increased risk of adverse effects.

Possible criteria for inpatient psychiatric admissions: which patients are transferred from emergency services to inpatient psychiatric treatment?

BACKGROUND: Patients with psychiatric problems often seek help and assistance in hospital emergency departments. An important task of emergency room staff is to decide whether such patients need to be admitted or whether they can be treated on an outpatient basis. METHODS: Psychiatric treatments given in the Central Interdisciplinary Emergency Department (CED) at the Medical University of Hannover (MHH) in 2002 were analysed. RESULTS: Of a total of 2632 patients seeking psychiatric help, 51.4% were admitted for inpatient treatment. Patients with dementia syndromes were admitted more frequently than patients with other psychiatric diseases. Suicidality was often the reason for admission. Accompanied patients were less likely to be hospitalised, unless a care-order was in force. Restraining measures and acute medication also had an impact on the rate of admissions. CONCLUSION: The results may help psychiatrists in the emergency department to make a more effective decision regarding inpatient admission in the interest of the individual patient.

Cytochrome P-450 2D6 and 2C19 polymorphisms and length of hospitalization in psychiatry.

We evaluated whether cytochrome P450 (CYP) poor metabolizer polymorphisms of CYP2D6 and CYP2C19 are relevant for the outcome (measured by length of hospitalization) during treatment with psychotropic medications in patients with depression or schizophrenia. 229 patients were genotyped by real-time PCR hybridization probe melting curve technique for CYP2C19*2, CYP2D6*3, *4, and *6, respectively. The gene deletion CYP2D6*5 was analyzed by a long PCR method. Detailed clinical information was obtained from 53 subjects. Patients genotyped homozygous or heterozygous for those CYP2D6 and CYP2C19 poor metabolizer alleles were treated for a longer time in hospital (median 57.5 vs. 40.0 days). Psychiatric patients might benefit from CYP genotyping, the duration of stay as inpatient might be reduced by a priori selection of the appropriate drug for the individual patient.

Psychiatric patients turnaround times in the emergency department.

BACKGROUND: To analyze the turnaround times of psychiatric patients within the Emergency Department (ED) from registration to discharge or hospitalization in a University Hospital in 2002. METHODS: Data from a one-year period of psychiatric admissions to the emergency service at a University Hospital were monitored and analyzed focused on turnaround times within the ED. Information on patients variables such as age, sex, diagnosis, consultations and diagnostic procedures were extracted from the patients' charts. RESULTS: From 34.058 patients seen in the ED in 2002, 2632 patients were examined by psychiatrists on duty. Mean turnaround time in the ED was 123 (SD 97) minutes (median 95). Patients to be hospitalized on a psychiatric ward stayed shorter within the ED, patients who later were admitted to another faculty, were treated longer in the ED. Patients with cognitive or substance related disorders stayed longer in the ED than patients with other psychiatric diagnoses. The number of diagnostic procedures and consultations increased the treatment time significantly. CONCLUSION: As the number of patients within the examined ED increases every year, the relevant variables responsible for longer or complicated treatments were assessed in order to appropriately change routine procedures without loss of medical standards. Using this basic data, comparisons with the following years and other hospitals will help to define where the benchmark of turnaround times for psychiatric emergency services might be.

Combination of clozapine and ziprasidone in treatment-resistant schizophrenia: an open clinical study.

OBJECTIVES: Therapeutic options for patients with treatment-resistant schizophrenia are limited. In such patients, combined application of atypical antipsychotic drugs is an often-used strategy. The authors tested the hypothesis that the combination of ziprasidone and clozapine would lead to an improvement in this patient group. METHODS: Nine patients with treatment-resistant schizophrenia participated in this open clinical trial and received a combination regimen of ziprasidone and clozapine. Patients had to have remained on a stable dose of clozapine for at least 6 months to ensure a reasonable opportunity to respond to clozapine monotherapy. Clinical status was evaluated at baseline, and at 3 and 6 months' follow-up using the Brief Psychiatric Rating Scale (BPRS). RESULTS: All patients completed the 6-month combination treatment. The mental state of 7 patients (77.8%) was improved and there was a significant reduction in the mean BPRS score over the 6 months treatment. The coadministration of ziprasidone in clozapine-treated patients did not result in a corresponding increase in side effects. The combination allowed a 18% reduction of the daily clozapine dose. CONCLUSION: The combined application of clozapine and ziprasidone follows a neurobiologic rationale and appears to be safe and well tolerated without increasing the risk of side effects.

Oxidative stress during treatment with first- and second-generation antipsychotics.

Neurotoxicity of first-generation antipsychotics (FGAs) may be involved in lipid peroxidation, which is the pathogenesis of extrapyramidal symptoms, including tardive dyskinesia (TD). Blood samples at day 0, 7, and 21 drawn from patients taking antipsychotics were analyzed for malondialdehyde (MDA) in plasma, a marker of lipid peroxidation, by high-performance liquid chromatography. Of 115 patients enrolled, 92 patients completed the study. Most MDA levels were within normal ranges (<1.0 micromol/liter). Malondialdehyde levels in patients receiving clozapine (p = 0.002), quetiapine (p = 0.003), amisulpride (p = 0.008), and risperidone (p = 0.008) were significantly lower than within the first generation antipsychotic group. The authors conclude that lipid peroxidation is significantly higher in treatment with FGAs.

N-terminal fragment of B-type natriuretic peptide (NT-proBNP), a marker of cardiac safety during antipsychotic treatment.

BACKGROUND: The potential cardiotoxicity of antipsychotic drugs is well known. The N-terminal fragment of B-type natriuretic peptide (NT-proBNP) is considered to be a possible biomarker in clinical practice for the diagnosis and prognosis in patients with suspected heart failure. This pilot evaluation tests the influence of antipsychotic drugs on NT-proBNP concentration in view of the hypothesis that NT-proBNP could be used as marker for the tolerability and safety of antipsychotic medications. METHODS: On a routine basis, patient's blood samples were examined for NT-proBNP on days 0, 7 and 21 after initiation of a new antipsychotic monotherapy. All plasma samples were analysed for NT-proBNP using an electrochemiluminiscence immunoassay "ECLIA" (proBNP kit, Roche Diagnostics, Mannheim, Germany) on an Elecsys 2010 analyser. RESULTS: A difference was found in NT-proBNP values at day 0 between patients younger versus older than 40 years. Also women had comparatively lower NTproBNP on days 7 and 21. Smokers' levels of NT-proBNP values decreased more from day 0 to day 7. CONCLUSION: Our results suggest that antipsychotic medication influences the plasma concentration of NT-proBNP, suggesting a possible method to identify high-risk-patients for cardiovascular adverse effects due to antipsychotic medication. Larger studies should further test this hypothesis.

Creutzfeldt-Jakob disease and homocysteine levels in plasma and cerebrospinal fluid.

BACKGROUND: There is evidence that homocysteine contributes to various neurodegenerative disorders. OBJECTIVE: To assess the values of homocysteine in patients with Creutzfeldt-Jakob disease (CJD) in both cerebrospinal fluid (CSF) and plasma. STUDY DESIGN: Case control study. Total homocysteine was quantified in CSF and plasma samples of CJD patients (n=13) and healthy controls (n=13). RESULTS: Mean values in healthy controls: 0.15 micromol/l +/- 0.07 (CSF) and 9.10 micromol/l +/- 2.99 (plasma); mean values in CJD patients: 0.13 micromol/l +/- 0.03 (CSF) and 9.22 micromol/l +/- 1.81 (plasma). No significant differences between CJD patients and controls were observed (Mann-Whitney U, p >0.05). CONCLUSIONS: The results indicate that the CSF and plasma of CJD patients showed no higher endogenous levels of homocysteine as compared to normal healthy controls. These findings provide no evidence for an additional role of homocysteine in the pathogenetic mechanisms underlying CJD neurodegeneration.

[Involuntary Hospitalisations in 2000 According to German "PsychKG" in the City of Hannover]. / Unterbringungen nach (section sign) 18 NPsychKG in der Landeshauptstadt Hannover -- oder: die Wirkung der Versorgungsgeografie auf Patienten und Professionelle.

OBJECTIVE: To examine for one year which psychiatric services are involved in involuntary hospitalisations according to PsychKG (German law concerning psychiatric practice) in the City of Hannover. METHOD: All available data within the health administration of the former city and former county of Hannover of compulsory admissions in the year 2000 were evaluated. RESULTS: In 2000, 524 patients were involuntary admitted to psychiatric hospitals according to the data of the health administration of the city of Hannover. The two major diagnoses were schizophrenia or substance addiction of involuntarily admitted patients, most hospitalisation were documented for Fridays, the most frequent time was between 9 and 1 hour p. m. The services in Hannover which dealt most with involuntary admissions were the either physicians of "KV" (Kassenarztliche Vereinigung, the German physicians organisation who is in charge of the treatment of all patients for non-private health insurances) or the physicians of the psychiatric departments of the Hannover Medical School. CONCLUSIONS: The major provider of psychiatric assistence for compulsory admissions within the City of Hannover are the physicians of the KV and the psychiatric departments of the Hannover Medical School.