Clinical characteristics and treatment outcome in a representative sample of depressed inpatients - findings from the Munich Antidepressant Response Signature (MARS) project.

Depression is a common and often difficult-to-treat clinical condition with a high rate of patients showing insufficient treatment response and persistence of symptoms. We report the characteristics of a representative sample of depressed inpatients participating in the Munich Antidepressant Response Signature (MARS) project. Eight hundred and forty-two inpatients admitted to a psychiatric hospital for treatment of a major depressive episode, recurrent or bipolar depression were thoroughly characterized with respect to demographic factors, clinical history, and the degree of HPA-axis dysregulation evaluated by means of combined dex/CRH tests, and the predictive value of these factors for treatment outcome is investigated. 80.8% of patients responded to treatment (i.e., improvement in symptom severity of at least 50%) and 57.9% reached remission (i.e., near absence of residual depressive symptoms) at discharge after a mean treatment period of 11.8 weeks. Regression analysis identified early partial response (within 2 weeks) as the most important positive predictor for achieving remission. Previous ineffective treatment trials in the current episode and presence of a migration background are potent negative predictors for treatment outcome. In addition, remitters were characterized by a more pronounced normalization of an initially dysregulated HPA-axis. We could show that a large majority of inpatients suffering from depression benefits from antidepressant treatment during hospitalization. However, a considerable number of patients failed to achieve remission. We demonstrated that this subgroup can be characterized by a set of demographic, clinical and neuroendocrine variables allowing to predict unfavorable outcome at an early stage of treatment.

[Determining serum concentrations of the modern antipsychotic quetiapin: clinical relevance in therapeutic drug monitoring]. / Die klinische Relevanz der Serumspiegeluntersuchung des modernen Antipsychotikums Quetiapin im Rahmen eines Therapeutischen Drug-Monitorings.

OBJECTIVE: The results concerning therapeutic drug monitoring of Quetiapin concentration in 152 in-patients will be presented. METHOD: In addition to measuring the serum concentration of Quetiapin standardized patient data were collected and the clinical history assessed by the Brief Psychiatric Rating Scale (BPRS). RESULTS: A significant positive correlation of the serum concentration and the daily dosage was found. Co-medication with the CYP 3A4 inhibitor Nefazodon was associated with an increase in the serum concentration without any adverse interactions occurring. CONCLUSION: While a correlation of dosage and effect could be shown with Quetiapin, inter- and intraindividual differences could be observed. Drug monitoring therefore seems useful in clinical setting and is recommended.

[Management of the atypical antipsychotic olanzapine in a clinical environment with particular regard to therapeutic drug monitoring (TDM) in a German State hospital]. / Zum Umgang mit dem modernen atypischen Neuroleptikum Olanzapin im klinischen Alltag unter besonderer Berücksichtigung des Therapeutischen Drug-Monitorings (TDM) an einer psychiatrischen Versorgungsklinik.

OBJECTIVE: Therapeutic drug monitoring (TDM) has been established at BKH Augsburg (psychiatric district hospital) since January 2001. According to Olanzapine product information the following illustration shows the evaluation (n = 216) of various parameters of the TDM requirements of Olanzapine. METHODS: Items examined include "classification according to diagnoses", "reason for requirement", "severity of disease", "therapeutic effect" and "side-effects". In addition, serum concentration, daily dosage, clinical assessment (Brief Psychiatric Rating Scale), age, height and weight of patients will be presented. RESULTS: Clearly sick patients, 52 % of them between 20 and 30 years old, were less compliant and achieved only a moderate therapeutic effect. CONCLUSIONS: TDM is mainly assessed to control compliance. However, more specific and more personalized TDM would be more useful.