Christian Lange-Asschenfeldt

Background: Increased expression of the astroglial Ca2+ -binding protein S100B has been observed in various neurodegenerative diseases and also seems to play a role in the unfolding of pathophysiological events at early stages of Alzheimer’s disease

We compared the acute effect of typical (haloperidol) and atypical (aripiprazole, clozapine, olanzapine) antipsychotic drugs (APDs) on spontaneous electrophysiological activity of in vitro neuronal networks cultured on microelectrode arrays (MEAs). Network burst analysis revealed a “regularizing” effect of all APDs at therapeutic concentrations, i.e., an increase of network-wide temporal synchronization. At supratherapeutic concentrations, all APDs but olanzapine mediated a decrease of burst and spike rates, burst duration, number of spikes in bursts, and network synchrony. The rank order of potency of APDs was: haloperidol > aripiprazole > clozapine > olanzapine (no suppression). Disruption of network function was not due to enhanced cell death as assessed by trypan blue staining. APDs promoted distinct concentration-dependent alterations yielding acute effect fingerprints of the tested compounds. These effects were rather characteristic for individual compounds than distinctive for typical vs. atypical APDs. Thus, this dichotomy may be of value in distinguishing clinical features but has no apparent basis on the network or local circuitry level.

Posterior cortical atrophy (PCA) is a rare form of dementia primarily characterized by slowly progressing deterioration of visual processing corresponding to atrophy in the posterior parietal and occipital cortices with less prominent memory loss than are usually seen in other forms of dementia such as Alzheimer’s Disease (AD). In the present case report, we describe longitudinal data over a period of 11 years regarding clinical and neuropsychological impairments and their relation to the location and extent of cortical changes related to higher order visual processing in a patient with posterior cortical atrophy. In our patient, visual processing deficits concerning space, motion and object perception emerged at the age of 50 and continued to worsen. By the age of 58, while the perception of contrast, color and figure-ground separation appeared undisturbed the patient exhibited pronounced dorsal- and ventral-related visual deficits, which continued to worsen with age. The patient’s MRI scans over the course of the disease revealed increasing circumscribed and bilateral atrophy of the parietal and occipital cortices, with a right-sided predominance. The specific localization of cortical atrophy, the slow progression characterized by visual processing deficits and relatively preserved memory were the main criteria for the diagnosis of posterior cortical atrophy. The case report also highlights the importance of an early extensive neurological and neuropsychological evaluation of visual deficits that occur without the presence of ophthalmological disease.

Chronische Schizophrenie, Depression, bipolare Störungen und andere chronische psychische Erkrankungen mit Beginn in Jugend oder jungem Erwachsenenalter werden oft als „severe mental illness“ (SMI) bezeichnet. Altwerden mit einer SMI ist vergesellschaftet mit verschiedenen psychosozialen, physiologischen und medizinischen Besonderheiten mit potenziellem Einfluss auf die Psychopharmakotherapie (PPT).

Weight gain among psychiatric inpatients is a widespread phenomenon. This change in body mass index (BMI) can be caused by several factors. Based on recent research, we assume the following factors are related to weight gain during psychiatric inpatient treatment: psychiatric medication, psychiatric diagnosis, sex, age, weight on admission and geographic region of treatment. 876 of originally recruited 2328 patients met the criteria for our analysis. Patients were recruited and examined in mental health care centres in Nigeria (N = 265), Japan (N = 145) and Western-Europe (Denmark, Germany and Switzerland; N = 466). There was a significant effect of psychiatric medication, psychiatric diagnoses and geographic region, but not age and sex, on BMI changes. Geographic region had a significant effect on BMI change, with Nigerian patients gaining significantly more weight than Japanese and Western European patients. Moreover, geographic region influenced the type of psychiatric medication prescribed and the psychiatric diagnoses. The diagnoses and psychiatric medication prescribed had a significant effect on BMI change. In conclusion, we consider weight gain as a multifactorial phenomenon that is influenced by several factors. One can discuss a number of explanations for our findings, such as different clinical practices in the geographical regions (prescribing or admission strategies and access-to-care aspects), as well as socio-economic and cultural differences.

Zusammenfassung: Einleitung Psychopharmaka sind gut bekannte Auslöser klinisch bedeutsamer Blutdruckänderungen. Unser Ziel war es, Rangreihen für das Risiko einer Psychopharmaka-assoziierten arteriellen Hyper- bzw. Hypotonie zu erstellen. Methoden Es wurden für 105 in Deutschland in der Erwachsenenpsychiatrie zugelassene Psychopharmaka sämtliche in der Roten oder Gelben Liste online verfügbaren 784 Fachinformationen (FI) ausgewertet und die dort standardisiert genannten Risiken einer Blutdrucksteigerung oder -senkung extrahiert. Ergebnisse Für blutdrucksteigernde Effekte hatte Atomoxetin laut FI das höchste Risiko („sehr häufig“, > 10 %) und 15 weitere Psychopharmaka waren in der Kategorie „häufig“ (> 1 %): Duloxetin, Milnacipran, Venlafaxin, Bupropion, Citalopram, Tranylcypromin (v. a. bei Diätfehlern), Reboxetin, Methylphenidat, Clozapin, Paliperidon, Risperidon, Buprenorphin+Naloxon, Memantin, Galantamin und Rivastigmin. Umgekehrt waren mit Amitriptylin, Tranylcypromin, Chlorprothixen, Flupentixol, Levomepromazin, Olanzapin und Trimipramin 7 Stoffe „sehr häufig“ als mit blutdrucksenkenden Effekten assoziiert beschrieben, weitere 25 „häufig“. Für viele andere Psychopharmaka war kein Hypertonie- bzw. Hypotonie-Risiko dokumentiert. Nebenbefundlich fanden sich in den FIs verschiedener Hersteller zu einer Substanz teils erhebliche Unterschiede (z. B. bei Citalopram), sodass für viele Stoffe keine eindeutige Risikozuordnung bestand. Diskussion Gemäß den FIs weisen viele Psychopharmaka ein Hypertonie- und stärker noch ein Hypotonie-Risiko auf. Nur vereinzelt zeigten sich Gruppeneffekte, z. B. Blutdruckerhöhung durch noradrenerge Antidepressiva. Gängige Tabellen zu medikamentösen Ursachen der arteriellen Hypertonie sind im Bereich Psychopharmaka revisionswürdig. Unsere Rangreihen dienen der Auswahl geeigneter Psychopharmaka bei Patienten mit bekanntem Hypertonus bzw. Synkopenneigung und bei Blutdruckentgleisungen unter Psychopharmaka. Für eine definitive Risikobewertung sind allerdings kontrollierte Studien nötig.