Aims: Weight gain is a serious problem with numerous psychotropic drugs including antidepressants such as mirtazapine. Drug-induced weight gain is of clinical importance with respect to subjective discomfort and treatment compliance, and may be associated with the risk for several health problems including type II diabetes. Methods: We investigated changes of weight and cortisol levels and performed glucose tolerance tests, including the assessment of insulin and c-peptide levels in 11 depressed inpatients treated with mirtazapine. Results: During treatment for up to six weeks with mirtazapine subjects gained 2.17kg on average. Unexpectedly, glucose tolerance improved during treatment. This was evidenced by a decrease in basal serum glucose levels (p=0.05) and significant decreases in 120-minutes glucose levels (p=0.048) and the area under the curve (AUC) following glucose intake (p=0.028). The improvement was only partially mirrored by insulin and cortisol levels. Conclusions: We conclude that mirtazapine improves glucose tolerance in depressed patients despite weight gain. Improved glucose tolerance during treatment with mirtazapine may be, at least in part, mediated by a reduction of the increased cortisol secretion of depressed patients. However, the exploratory nature of the present study and the limited number of subjects prohibit firm conclusions regarding causality.
Seit fünf Jahren stellen wir jährlich die Aktivitäten unseres Arbeitskreises Psychotherapie der Bundesdirektorenkonferenz in der Psychiatrischen Praxis vor. Der wiedergegründete Arbeitskreis widmet sich seit nunmehr sieben Jahren der Anwendung psychotherapeutischer Methoden im Rahmen der stationären psychiatrischen Versorgung, aber auch im Bereich von Gemeindepsychiatrie, der Tätigkeit psychiatrischer Institutsambulanzen sowie in der teilstationären Versorgung. Zu diesen Bereichen unterstützt er den Vorstand der BDK in entsprechenden psychotherapiespezifischen Fragestellungen und vertritt die Belange der Versorgungskrankenhäusern auch in der Ständigen Kommission der ärztlichen psychotherapeutischen Verbände bei der Bundesärztekammer.
Obesity is a common feature of narcolepsy. In addition, an increased occurrence of non-insulin dependent diabetes has been reported. So far, it is not known whether glucose metabolism in narcolepsy is disturbed due to, or independently of obesity.Case-control study.Sleep medicine clinic at a research institute.We studied 17 patients with narcolepsy/cataplexy compared to 17 healthy controls matched for age, sex, and body mass index (BMI).A 75-g oral glucose tolerance test was performed.Glucose tolerance was determined by computing plasma glucose curve following oral glucose challenge for 240 minutes; insulin sensitivity and insulin secretion by homeostasis model assessment and minimal model analysis.Standard outcome measures and indices of the oral glucose tolerance test did not differ between the patient group and the group of control subjects.In this study, no clinically relevant pathologic findings in the glucose metabolism of narcoleptic patients compared to weight matched controls were found. Thus, narcolepsy is unlikely to be a risk factor per se for impaired glucose tolerance or diabetes.
A bstract : Infection, inflammation, and autoimmune processes are accompanied by serious disturbances of well‐being, psychosocial functioning, cognitive performance, and behavior. Here we review those studies that have investigated the effects of experimental immunomodulation on sleep and sleepiness in humans. In most of these studies bacterial endotoxin was injected intravenously to model numerous aspects of infection including the release of inflammatory cytokines. These studies show that human sleep‐wake behavior is very sensitive to host defense activation. Small amounts of endotoxin, which affect neither body temperature nor neuroendocrine systems but slightly stimulate the secretion of inflammatory cytokines, promote non‐rapid‐eye‐movement sleep amount and intensity. Febrile host responses, in contrast, go along with prominent sleep disturbances. According to present knowledge tumor necrosis factor‐α (TNF‐α) is most probably a key mediator of these effects, although it is likely that disturbed sleep during febrile host responses involves endocrine systems as well. There is preliminary evidence from human studies suggesting that inflammatory cytokines such as TNF‐α not only mediate altered sleep‐wake behavior during infections, but in addition are involved in physiological sleep regulation and in hypnotic effects of established sedating drugs.
The second generation antipsychotics clozapine and olanzapine frequently induce weight gain. Randomized studies investigating abnormal eating behavior (food craving, binge eating) possibly associated with weight gain are lacking. Thirty patients with schizophrenia, schizophreniform, or schizoaffective disorder were included in this randomized, double-blind, parallel study comparing abnormal eating behavior using a standardized scale, clinical efficacy using the Brief Psychiatric Rating Scale0-6 and Clinical Global Impression-Severity scale, and tolerability of clozapine and olanzapine. In both treatment groups, the number of patients reporting food craving, binge eating, or both increased over time. The likelihood to experience food craving at any time during drug treatment showed a trend (P = 0.068) to be higher in the olanzapine group (48.9%) compared with the clozapine group (23.3%). The likelihood to experience binge eating at any time during drug treatment was numerically but not statistically significantly higher in the olanzapine group (16.7%) than in the clozapine group (8.9%). In both groups, significant baseline-to-end point improvements of clinical symptoms (Brief Psychiatric Rating Scale0-6: clozapine, 36.6 ± 8.8 to 15.9 ± 13.7; olanzapine, 36.7 ± 9.9 to 19.1 ± 13.8) and severity of illness (Clinical Global Impression-Severity scale: clozapine, 4.7 ± 0.6 to 2.5 ± 1.5; olanzapine, 4.5 ± 0.6 to 2.3 ± 1.2) were observed. These improvements did not differ significantly between groups. Olanzapine was more tolerable than clozapine; adverse events occurred significantly (P < 0.01) less frequently than in the clozapine group. These results suggest that both clozapine and olanzapine can induce food craving and binge eating, however, olanzapine possibly to a greater extent. Findings on clinical efficacy and safety are in accordance with previous reports.
Auch in der stationär-psychiatrischen Versorgung gewinnen psychotherapeutische Methoden zunehmend an Bedeutung. Die Durchführung von methoden- und störungsspezifischer Psychotherapie erfolgt sowohl im (teil-)stationären wie auch im ambulanten Sektor der Kliniken durch ärztliche wie psychologische Mitarbeiter und Mitarbeiterinnen und ist zudem ein umfangreicher Baustein der Aus- und Weiterbildung für die unterschiedlichen Berufsgruppen. Die Bundesdirektorenkonferenz widmet sich diesem Thema seit Jahren und hat das entsprechende Engagement in den letzten drei Jahren durch die Neugründung ihres Arbeitskreises Psychotherapie weiter intensiviert. Gemäß der Satzung der Bundesdirektorenkonferenz dient dieser Arbeitskreis darüber hinaus der fachlichen Unterstützung des Vorstandes der BDK in psychotherapiespezifischen Fragen.
Dehydroepiandrosterone (DHEA) and DHEA sulphate (DHEAS) inhibit T-helper lymphocyte type 2 immune reactions and exert anti-inflammatory effects in some chronic inflammatory diseases. Both DHEA and, in particular, DHEAS levels are dramatically decreased in chronic inflammatory diseases whereas cortisol levels remain stable or are elevated. However, the time course of cortisol relative to DHEA production is not known. We tested whether administration of endotoxin to healthy male subjects can induce an early predominance of cortisol relative to DHEA and DHEAS. It is demonstrated that endotoxin induces a dose-dependent increase of cortisol in relation to DHEA (no effect at 0.2 ng endotoxin/kg body weight (b.w.), clear effect at 0.4 and 0.8 ng/kg b.w., p<0.05) and DHEAS (tested at 0.4 ng/kg b.w., P=0.014). The increase of cortisol relative to DHEA appears 4 h after endotoxin injection and 2 h after a strong increase of interleukin (IL)-6 relative to tumour necrosis factor (TNF). In addition, an increase of cortisol relative to 17OH-progesterone was observed. The ratio of serum IL-6/TNF was positively correlated with the ratio of serum cortisol/DHEA (R(Rank)=0.472, P=0.041) and serum cortisol/17OH-progesterone (R(Rank)=0.514, P=0.048). In conclusion, dissociation of cortisol relative to DHEA, DHEAS or 17OH-progesterone appears very early during a systemic inflammatory response which is associated with an increase of IL-6 relative to TNF. As in chronic inflammatory diseases, during an acute inflammatory response with endotoxin, these physiological hormone changes are probably necessary to achieve adequate cortisol levels at the expense of adrenal androgens.
