Adrian Groh

In popular music, references to (illicit) drugs are widespread and may influence attitudes and behaviors in relation to substance use and abuse, especially among younger generations. While substance-related content in international pop and rap music has been studied extensively, the German rap scene has received comparatively little attention thus far. This study aimed to systematically analyze the lyrics of one of the most well-known German rappers, Haftbefehl (literal translation: “arrest warrant”), regarding pharmacological and toxicological references to psychotropic substances. To this end, a content analysis was performed on the lyrics of the artist’s seven studio albums released between 2010 and 2022, comprising a total of 121 songs. The lyrics were obtained from the online platform genius.com. Both explicit and contextual references to psychotropic substances were recorded and assigned to pharmacological substance classes. Also, slang terminology and contextual references to drug consumption or trafficking were documented. Descriptive statistical methods were applied to summarize the distribution of references to psychotropic substances. In addition, inferential statistical techniques were used exploratively for cross-album comparisons. A clinical trial number is not applicable. Substance-related references were highly prevalent in Haftbefehl ’s lyrics. Cocaine was the most frequently mentioned substance (being referenced in 82.6% of songs), followed by cannabis (52.9%) and alcohol (38.0%). References to μ-opioid receptor agonists (9.1%) and amphetamine-type substances (7.4%) were less prominent, while there were no references to benzodiazepines. Also, it was noted that Haftbefehl ’s lyrics contained a large variety of slang terms, particularly for cocaine. In conclusion, psychotropic substances constitute a prominent stylistic element in Haftbefehl ’s oeuvre. These findings point to the importance of rap lyrics as a cultural medium that may reflect and shape the approach to drug-related content within music-related youth culture.

The dual-hit model of schizophrenic psychoses suggests that epigenetic alterations may contribute to the disease pathogenesis. Given the significant synaptic loss in patients with schizophrenia (SZ) during puberty, we investigated DNA-methylation patterns of key synaptic target molecules: dopamine transporter (DAT), dopamine receptor D2 (DRD2), microtubule-associated protein tau (MAPT), and postsynaptic density protein 95 (PSD95). Analyses were performed in both blood and cerebrospinal fluid (CSF) samples from patients with SZ (n = 36) and healthy controls (Co) (n = 23). Due to the minimal amount of cell-free DNA available in CSF, different extraction methods were evaluated to achieve the best possible recovery. Ultimately, an adapted ethanol-glycogen precipitation protocol combined with a subsequent bead-based fusion and DNA clean-up was applied. However, despite comparable DNA concentrations obtained from Co and SZ CSF samples, only very few sequences could be obtained from CSF samples of Co, so that results concerning CSF measurements are limited to patients with SZ. In DAT, methylation was significantly higher in the blood of Co compared to both the blood and CSF of patients with SZ. In PSD95, mean methylation levels were higher in the CSF than in the blood of patients with SZ, whereas no difference was detected in the blood between SZ and Co. For MAPT and DRD2, no significant differences in mean methylation rates were observed between groups. Low sequencing success in CSF from Co, despite comparable concentrations to SZ, might point to a higher degree of fragmentation. In SZ, longer DNA fragments may be replenished more frequently. Higher central methylation of PSD95 in patients with SZ, a key regulator of glutamatergic neurotransmission, may reduce gene transcription and thus support the glutamate hypothesis of SZ, which assumes impaired glutamate receptor function. Lower DAT methylation in SZ compared to Co (with similar central and peripheral levels) could indicate a higher availability of the transporter at the synapse in SZ, resulting in a higher clearance of dopamine. This could be a compensatory mechanism concerning the hypothesis of dopaminergic hyperactivity in SZ.

Patients suffering from schizophrenic psychosis show reduced synaptic connectivity compared to healthy individuals, and often, the use of cannabis precedes the onset of schizophrenic psychosis. Therefore, we investigated if different types of cannabinoids impact methylation patterns and expression of schizophrenia candidate genes concerned with the development and preservation of synapses and synaptic function in a SH-SY5Y cell culture model. For this purpose, SH-SY5Y cells were differentiated into a neuron-like cell type as previously described. Effects of the cannabinoids delta-9-THC, HU-210, and Anandamide were investigated by analysis of cell morphology and measurement of neurite/dendrite lengths as well as determination of methylation pattern, expression (real time-qPCR, western blot) and localization (immunocytochemistry) of different target molecules concerned with the formation of synapses. Regarding the global impression of morphology, cells, and neurites appeared to be a bit more blunted/roundish and to have more structures that could be described a bit boldly as resembling transport vesicles under the application of the three cannabinoids in comparison to a sole application of retinoic acid (RA). However, there were no obvious differences between the three cannabinoids. Concerning dendrites or branch lengths, there was a significant difference with longer dendrites and branches in RA-treated cells than in undifferentiated control cells (as shown previously), but there were no differences between cannabinoid treatment and exclusive RA application. Methylation rates in the promoter regions of synapse candidate genes in cannabinoid-treated cells were in between those of differentiated cells and untreated controls, even though findings were significant only in some of the investigated genes. In other targets, the methylation rates of cannabinoid-treated cells did not only approach those of undifferentiated cells but were also valued even beyond. mRNA levels also showed the same tendency of values approaching those of undifferentiated controls under the application of the three cannabinoids for most investigated targets except for the structural molecules (NEFH, MAPT). Likewise, the quantification of expression via western blot analysis revealed a higher expression of targets in RA-treated cells compared to undifferentiated controls and, again, lower expression under the additional application of THC in trend. In line with our earlier findings, the application of RA led to higher fluorescence intensity and/or a differential signal distribution in the cell in most of the investigated targets in ICC. Under treatment with THC, fluorescence intensity decreased, or the signal distribution became similar to the dispersion in the undifferentiated control condition. Our findings point to a decline of neuronal differentiation markers in our in vitro cell-culture system under the application of cannabinoids.

Objective: To investigate the frequency and characteristics of adverse drug reactions (ADRs) that occurred on the gerontopsychiatric ward of Hannover Medical School over a 6-year period. Design: Retrospective monocentric cohort study. Results: Six hundred thirty-four patient cases (mean age 76.6 ± 7.1 years; 67.2% female) were analysed. In total, 92 ADRs in 56 patient cases were registered in the study population. The overall ADR prevalence, the ADR prevalence upon hospital admission, and the ADR prevalence during hospitalisation were 8.8%, 6.3%, and 4.9%, respectively. The most frequent ADRs were extrapyramidal symptoms, alterations in blood pressure or heart rate, and electrolyte disturbances. Of note, two cases of asystole and one case of obstructive airway symptoms related to general anaesthesia in the context of electroconvulsive therapy (ECT) were detected. The presence of coronary heart disease was associated with an increased risk of ADR occurrence (odds ratio (OR) 2.92, 95% confidence interval (CI) 1.37–6.22), while the presence of dementia was associated with a decreased risk of ADR development (OR 0.45, 95% CI 0.23–0.89). Conclusions: Type and prevalence of ADRs in the present study were largely in accordance with previous reports. By contrast, we did not observe a relationship between advanced age or female sex and ADR occurrence. We detected a risk signal for cardiopulmonary ADRs related to general anaesthesia in the context of ECT that warrants further investigation. Elderly psychiatric patients should be carefully screened for cardiopulmonary comorbidities before initiation of ECT.

BackgroundThis study sought to investigate the frequency and characteristics of duplicate prescriptions (DPs) in elderly psychiatric inpatients using a novel categorisation of DPs that differentiates between appropriate duplicate prescriptions (ADPs) and potentially inappropriate duplicate prescriptions (PIDPs). MethodsThe study was conducted as a monocentric retrospective cross-sectional pilot study on the gerontopsychiatric ward of the Department of Psychiatry, Social Psychiatry and Psychotherapy of Hannover Medical School, a large university hospital in northern Germany. The outcome measures were the nature and frequency of PIDPs compared with the frequency of ADPs. ResultsFor 92 individual patients a total of 339 medication chart reviews were conducted between April 2021 and February 2022. The median age of the study population was 73 years (interquartile range (IQR) 68-82 years); 64.6% were female. Patients' medications comprised a median of eight drugs (IQR 6-11 drugs) and 43.1% of the study population were exposed to at least one PIDP (at least one grade-1 PIDP: 39.5%; at least one grade-2 PIDP: 5.0%; at least one grade-3 PIDP: 1.5%). Sedatives were most frequently responsible for grade-1 and grade-2 PIDPs, while grade-3 PIDPs were elicited exclusively by analgesics. Nearly half of the study population (49.0%) displayed at least one ADP. ConclusionEven though the clinical implications of PIDPs are not fully established to date, we recommend that physicians who treat elderly psychiatric patients pay special attention to PIDPs, especially PIDPs elicited by sedatives. Termination of PIDPs may prevent adverse drug reactions and save healthcare expenditures.

Purpose: To determine the nature and frequency of duplicate prescriptions (DPs) in the emergency department (ED) by utilization of a novel categorization of DPs which differentiates between appropriate DPs (ADPs) and potentially inappropriate DPs (PIDPs). Methods: In this retrospective cohort study, adult patients who presented to the ED for internal medicine of a large university hospital in northern Germany in 2018 and 2019 were screened for the presence of DPs. Descriptive statistical methods were used to characterize the nature and frequency of PIDPs compared to the frequency of ADPs. Results: A total of 4208 patients were enrolled into the study. The median age of the study population was 63 years (interquartile range (IQR) 48–77), 53.9% were female. The patients took a median of 5 drugs (IQR 3–9). 10.9% of the study population were affected by at least one PIDP (at least one grade-1 PIDP: 6.1%; at least one grade-2 PIDP: 4.5%; at least one grade-3 PIDP: 1.1%). Non-opioid analgesics accounted for the majority of grade-1 PIDPs, while inhalatives were most frequently responsible for grade-2 and grade-3 PIDPs. Nearly half of the study population (48.6%) displayed at least one ADP. Conclusion: PIDPs pose a frequent pharmacological challenge in the ED. The medication review should comprise a systematic screening for PIDPs with a particular focus on non-opioid analgesics and inhalatives. ADPs were detected more frequently than PIDPs, questioning the predominant notion in the medical literature that DPs are exclusively deleterious.

Apart from Alzheimer’s disease (AD), no biomarkers for the differential diagnosis of dementia have been established to date. Inflammatory processes contribute to the pathogenesis of dementia subtypes, e.g., AD or frontotemporal dementia (FTD). In the context of cancer or cardiovascular diseases, white blood cell (WBC) populations and platelet counts, as well as C-reactive protein (CRP), have emerged as biomarkers. Their clinical relevance in dementia, however, is currently only insufficiently investigated. In the present study, hematological and inflammatory parameters were measured in the peripheral blood of 97 patients admitted to the gerontopsychiatric ward of Hannover Medical School, a university hospital in Germany, for dementia assessment. The study population comprised 20 non-demented, depressed patients (control group) and 77 demented patients who were assigned to five different groups based on their underlying dementia etiology: AD, n = 33; vascular dementia, n = 12; mixed dementia, n = 21; FTD, n = 5; and Korsakoff syndrome, n = 6. We observed neither statistically significant differences regarding total WBC populations, platelet counts, neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio, nor CRP levels between the control group and the five dementia groups. CRP levels tended to be higher in patients with Korsakoff syndrome than in the control group and in AD patients. Thus, CRP could possibly play a role in the differential diagnosis of dementia. This should be investigated further in future prospective studies with larger sample sizes. WBC and platelet counts, by contrast, do not appear to be suitable biomarkers in the differential diagnosis of dementia.

Ziel der Studie Neben der Vermittlung von theoretischen und klinisch-praktischen Fähigkeiten sollte die Weiterentwicklung der individuellen moralischen Kompetenz ein weiteres Kernanliegen im Studium der Humanmedizin sein. Untersuchungen zeigen allerdings, dass die moralische Kompetenz bei Medizinstudierenden im Verlauf des Studiums stagniert oder sogar abnimmt. Die vorliegende Querschnittstudie untersuchte daher die moralische Kompetenz von Medizinstudierenden zu Beginn des Studiums (d. h. im ersten Fachsemester) sowie im Praktischen Jahr (PJ) sowie die Auswirkungen von Testosteron als Neurohormon auf die moralische Urteilsfähigkeit. Methodik Im Rahmen einer Querschnittstudie wurden mittels des Moralischen Kompetenz Tests (MKT) nach Lind die moralische Urteilsfähigkeit von 24 Erstsemesterstudierenden und 16 PJ-Studierenden der Medizinischen Hochschule Hannover erfasst und ausgewertet. Der Testosteron-Serumspiegel der Studienteilnehmenden wurde statistisch in Beziehung zu den MKT-Ergebnissen gesetzt. Ergebnisse Es zeigten sich keine signifikanten Unterschiede zwischen Erstsemester- (Mittelwert (M)±Standardabweichung (SD): 13,16±8,21) und PJ-Studierenden (M±SD: 11,24±8,07) im Hinblick auf die mittels des MKT gemessene moralische Kompetenz (p=0,36). Ein höherer Testosteron-Serumspiegel zeigte keine statistisch signifikante Korrelation mit der moralischen Kompetenz (r=–0,09, p=0,58). Schlussfolgerung Unsere Ergebnisse zeigen keinen klaren Trend, ob die moralische Kompetenz bei Medizinstudierenden in fortgeschrittenen Studiensemestern geringer ist als zu Beginn des Studiums und ob die moralische Kompetenz durch das Neurohormon Testosteron beeinflusst wird. Dennoch erscheint es sinnvoll, moralische Kompetenztrainings für Medizinstudierende frühzeitig, kontinuierlich und möglichst individuell gestaltet während des Medizinstudiums zu implementieren (und in weiterführenden Untersuchungen zu evaluieren), um einer Stagnation bzw. Rückentwicklung der moralischen Urteilsfähigkeit präventiv zu begegnen. Objective In addition to teaching theoretical and clinical-practical skills, the development of individual moral competence should be another core concern in medical school. However, research suggests that moral competence in students of human medicine stagnates or even declines during the course of medical school. Therefore, the present cross-sectional study investigated the moral competence of medical students at the beginning of their studies and during their practical year, as well as the effects of testosterone as a neurohormone on moral judgment. Methods By means of a cross-sectional study, the moral judgment ability of 24 first-year and 16 practical year students of Hannover Medical School was recorded and evaluated with the Moral Competence Test (MCT) according to Lind. The testosterone serum level of the study participants was statistically related to the MCT results. Results No significant differences between first-year (mean±standard deviation (SD): 13.16±8.21) and practical year students (mean±SD: 11.24±8.07) with regard to moral competence as per the MCT were identified (p=0.36). Higher serum testosterone levels did not show a statistically significant correlation with moral competence (r=–0.09, p=0.58). Conclusion Our results do not show a clear trend whether moral competence is lower in medical students in advanced semesters compared to the beginning of medical school and whether moral competence is influenced by the neurohormone testosterone. Nevertheless, it seems reasonable to implement moral competence training for medical students early, continuously, and as individually designed as possible during medical school (and to evaluate it in further studies) in order to preventively counteract stagnation or regression of moral judgment. ^* geteilte Erstautorenschaft Received: 11 September 2021 Accepted: 17 August 2022 Article published online: 04 October 2022 © 2022. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

Adverse drug reactions (ADRs) constitute a frequent cause of hospitalization in older people. The risk of ADRs is increased by the prescription of potentially inappropriate medications for older people (PIMs). The PRISCUS list and the FORTA classification represent established tools to detect PIMs. The aim of the present study was to examine the prevalence and characteristics of PIM prescriptions on the gerontopsychiatric ward of a university hospital in Germany. To this aim, medication charts of 92 patients (mean age 75.9 ± 7.7 years; 66.3% female) were analyzed on a weekly basis until patient discharge by utilization of the PRISCUS list and the FORTA classification. Overall, 335 medication reviews comprising 2363 drug prescriptions were analyzed. 3.0% of the prescribed drugs were PIMs according to the PRISCUS list, with benzodiazepines and Z-drugs accounting for nearly half (49.3%) of all PIM prescriptions. 30.4% of the patients were prescribed at least one PRISCUS-PIM, while 43.5% of the study population took at least one FORTA class D drug. A considerable proportion of gerontopsychiatric patients were affected by PIMs; however, the overall number of PIM prescriptions in the study population was low. Further improvements in the quality of prescribing should target the use of sedating agents such as benzodiazepines and Z-drugs. Physicians should be aware of discrepancies between the PRISCUS list and the FORTA classification.