The aim of this double-blind, placebo-controlled study was to evaluate the efficacy of intravenous magnesium sulphate (MgSO4) on the need for chlormethiazole in pure or polysubstance opiate detoxification. Forty-one inpatients suffering from pure and polysubstance opiate dependence were treated with morphine sulphate pentahydrate in a gradual detoxification program. Morphine reduction took about 11 days. Additionally, 5% MgSO4 was administered intravenously to the intervention group (Mg group, n=22) over 24 h by perfusor (150–200 mg MgSO4/h; plasma level of 2.36±0.29 mmol/l), whereas NaCl 0.9% was intravenously administered in the placebo group (n=19). In case of withdrawal symptoms (irritability, restlessness, and insomnia), patients received chlormethiazole p.o. Our hypothesis that the need for chlormethiazole would be decreased by adjunctive administration of Mg was not confirmed in our study population (2180 mg/day in the Mg group vs. 2360 mg/day in the placebo group). There was neither a difference in the quantity of chlormethiazole required nor a difference in the severity of withdrawal symptoms measured with the Wang scale between the two comparison groups. We observed that calcium plasma levels decreased and phosphate plasma levels increased significantly during intravenous therapy with Mg. Despite promising pilot studies, the administration of Mg did not enable a dose reduction of tranquilizing medication (chlormethiazole) in pure and polysubstance opiate detoxification

The aim of this double-blind, placebo-controlled study was to evaluate the efficacy of intravenous magnesium sulphate (MgSO4) on the need for chlormethiazole in pure or polysubstance opiate detoxification. Forty-one inpatients suffering from pure and polysubstance opiate dependence were treated with morphine sulphate pentahydrate in a gradual detoxification program. Morphine reduction took about 11 days. Additionally, 5% MgSO4 was administered intravenously to the intervention group (Mg group, n = 22) over 24 h by perfusor (150–200 mg MgSO4/h; plasma level of 2.36 ± 0.29 mmol/l), whereas NaCl 0.9% was intravenously administered in the placebo group (n = 19). In case of withdrawal symptoms (irritability, restlessness, and insomnia), patients received chlormethiazole p.o. Our hypothesis that the need for chlormethiazole would be decreased by adjunctive administration of Mg was not confirmed in our study population (2180 mg/day in the Mg group vs. 2360 mg/day in the placebo group). There was neither a difference in the quantity of chlormethiazole required nor a difference in the severity of withdrawal symptoms measured with the Wang scale between the two comparison groups. We observed that calcium plasma levels decreased and phosphate plasma levels increased significantly during intravenous therapy with Mg. Despite promising pilot studies, the administration of Mg did not enable a dose reduction of tranquilizing medication (chlormethiazole) in pure and polysubstance opiate detoxification

We conducted a retrospective cohort study to compare medication use patterns of a long-acting extended-release methylphenidate (Osmotic Release Oral System [OROS®] methylphenidate, CONCERTA®) and Teva-methylphenidate (methylphenidate ER-C), a generic drug determined by the Canadian regulatory authority, Health Canada, to be bioequivalent to OROS® methylphenidate.We established an OROS® methylphenidate–experienced and new-user population cohort to compare medication use patterns, including medication persistence, duration of therapy, and treatment-switching patterns. Multivariable log-binomial regression was used to adjust for confounders of the associations with persistence.In the OROS® methylphenidate–experienced cohort (n = 21,940), OROS® methylphenidate was associated with a 70% higher rate of medication persistence at 12 months relative to methylphenidate ER-C (adjusted relative risk = 1.70; 95% CI, 1.64-1.77). In the new-user cohort (n = 20,410), OROS® methylphenidate had a 58% higher rate of medication persistence relative to methylphenidate ER-C (adjusted relative risk = 1.58; 95% CI, 1.51-1.65). Median duration of therapy was significantly longer in patients taking OROS® methylphenidate compared with those taking methylphenidate ER-C, and treatment-switching occurred significantly more frequently in patients taking methylphenidate ER-C compared with those taking OROS® methylphenidate.Significant differences were observed in how the medications were used by patients in the real-world setting. Because the data sources were administrative databases, it was not possible to control for all potentially important confounding variables. Although differences in medication persistence may not directly reflect differences in treatment efficacy, the findings are important because these products are used interchangeably in a number of Canadian provinces.

Actigraphy is a quantitative method for the measurement of motor activity. In the present study, actigraphy was used to examine psychomotor correlates of brain activity. Thirty-four psychiatric patients (17 males and 17 females) with different diagnoses participated in this investigation. Directly after EEG recording, motor activity was measured with a wrist actimeter for 15 min in patients in the sitting position. The EEG was quantified by spectrum analysis, and the power spectra as well as other EEG-derived variables were correlated with actigraphic parameters. Occipital and temporoparietal β1 power was statistically significantly higher in patients with higher activity scores and lower in those with a high density of sleep (SB) or wake bouts (WB). A high density of SB or WB was also positively correlated with higher mean α power. Immobile phases measured by actigraphy were positively associated with occipital α and with frontal/frontopolar δ activity, preferentially on the side of the left hemisphere. Our results, while preliminary, suggest that short-term actigraphy may be apt to reflect central nervous system arousal.

How service employees act and speak with customers is an important part of service quality, so customer orientation (CO) and emotional labor have become critical issues in the hospitality industry. Applying the emotional labor concept to Donavan and his associates’ 2004 study about the relationship between CO and job satisfaction, this study aimed to demonstrate how the relationship is established in hospitality. Drawing on person–job fit theory from the perspective of emotional labor, this study examined different effects of emotional labor on the relationship. The findings of this study suggested that employee CO is positively related with job satisfaction and deep acting while negatively related with surface acting. This study also found that emotional labor mediates the positive relationship between CO and job satisfaction. This study did not find a moderating effect of job position on the direct relationships among CO, emotional labor, and job satisfaction. Theoretical and practical implications of the study findings are also discussed.

Ten patients with severe, therapy-resistant manic agitation received magnesium sulphate infusions with a continuous magnesium (Mg) flow of approximately 200 mg/h (4353±836 mg/day; daily monitored Mg plasma level: 2.44±0.34 mmol/l) for periods ranging from 7 to 23 days. Concomitant psychotropic treatment consisted of lithium (n=10), haloperidol (n=5) and clonazepam (n=10). During i.v. Mg treatment the mean values of the maximum dosages of neuroleptics (in chlorpromazine equivalents) and benzodiazepines (in diazepam equivalents) were significantly lower than during the last day of pretreatment (=baseline). Seven patients showed a marked improvement in the Clinical Global Impression scale. In case of bradycardia detected by the ECG monitor (n=5), Mg flow was reduced and bradycardia disappeared promptly. Mg i.v. may be a useful supplementary therapy for the clinical management of severe manic agitation. This open study needs double-blind confirmation.

Nel 1999 alcuni psichiatri genovesi iniziarono a operare come consulenti psichiatri per conto del Dipartimento di Salute Mentale (DSM) nel carcere di Marassi, il maggiore istituto penitenziario della Liguria. Negli anni successivi l’interesse dei DSM della regione e della Sezione ligure della Società Italiana di Psichiatria nei confronti dell’assistenza psichiatrica negli istituti di pena è andato crescendo e, contemporaneamente, si è cominciato a ragionare sulla chiusura degli Ospedali Psichiatrici Giudiziari (OPG).L’intreccio tra mondo della psichiatria e mondo della giustizia è diventato sempre più stretto e oggi emergono questioni prioritarie: l’organizzazione dell’assistenza psichiatrica in ambiente carcerario; la presa in carico presso il Centro di Salute Mentale e i Centri Diurni di soggetti con problemi di salute mentale che scontano la pena o la misura di sicurezza al domicilio; il trattamento in struttura residenziale psichiatrica come misura alternativa all’OPG o al carcere; la progettazione di una struttura regionale in grado di accogliere i soggetti prosciolti per infermità di mente con pericolosità sociale elevata nel momento in cui sarà chiuso l’OPG.In 1999 a group of psychiatrists of Mental Health Department of Genoa started building up a psychiatric liaison service to the Marassi Institute, the largest prison of Liguria. Over the years, the interest on the issue of forensic psychiatry has been increasing in the Ligurian Mental Health Departments as well as in the meetings of Ligurian Section of Italian Psychiatric Society. At the same time all the aforementioned subjects begun to argue about the shutdown of the forensic hospitals.In the subsequent years the real world psychiatric practice have become increasingly interwoven with legal issues, and nowadays the main questions to address in this field are: the organization of psychiatric care in prisons; the organization of care in the Mental Health Center and Day Hospitals for mentally ill offenders serving their sentence at home; the organization of care in residential facilities as an alternative measure to forensic hospital or imprisonment; the planning of a regional facility, after the shutdown of the forensic hospitals, to admit patients deemed incompetent to proceed by reason of mental insanity, but still at risk of future violence.

Durch die Entwicklung des SPECT (Single-Photonen-Emissions-Computerized Tomographie) und neuer Radioliganden wurde der Neurologie und Psychiatrie die Möglichkeit eröffnet, die Hirndurchblutung und Hirnrezeptoren routinemäßig dreidimensional darzustellen. Mit der SPECT Methode ist es gelungen funktionelle Veränderungen des Gehirns von psychiatrischen Erkrankungen darzustellen, wie z. B. Schizophrenie, Depression, Angsterkrankungen und Substanzmißbrauch. Bei Substanzabhängigkeit liegen im Gegensatz zu anderen psychiatrischen Krankheitsbildern nur wenige SPECT-Untersuchungen vor. Volkow’s Konklusion einer MRI Untersuchung bei Patienten mit multiplen Substanzmißbrauch war, daß der toxische Effekt von Drogen zu pathologischen morphologischen Befunden, wie einer Demyelinisierung der weißen Substanz führe (Volkow 1988). Die metabolische Auswirkung einer einzelnen Gabe von Morphium auf den cerebralen Bluffluß wurde bei einer PET-Studie von London beschrieben, wobei ein signifikant reduzierter Bluffluß im gesamten Gehirn gefunden werden konnte (London 1990). Interessanterweise erwies sich in dieser Untersuchung, daß der cerebrale Blutfluß im rechten temporalen Cortex signifikant geringer ist als im linken. Eine Untersuchung von Danos an 40 Patienten, die an einer polytoxikomanen Drogenabhängigkeit (incl. Heroin) erkrankt waren, ließen signifikant häufigere Hypoperfusionen rechts-temporal erkennen, die bei einigen Patienten auch nach einer etwa 3 Monate bestehenden Abstinenz noch nachzuweisen waren (Danos 1994).

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Both monoamine oxidase A (MAOA) and dopamine D2 receptor (DRD2) genes have been considered as candidate genes for antisocial personality disorder with alcoholism (Antisocial ALC) [Parsian, A., 1999. Sequence analysis of exon 8 of MAO-A gene in alcoholics with antisocial personality and normal controls. Genomics. 45, 290–295.; Samochowiec, J., Lesch, K.P., Rottmann, M., Smolka, M., Syagailo, Y.V., Okladnova, O., Rommelspacher, H., Winterer, G., Schmidt, L.G., Sander, T., 1999. Association of a regulatory polymorphism in the promoter region of the monoamine oxidase A gene with antisocial alcoholism. Psychiatry. Res. 86, 67–72.; Schmidt, L.vG., Sander, T., Kuhn, S., Smolka, M., Rommelspacher, H., Samochowiec, J., Lesch, K.P., 2000. Different allele distribution of a regulatory MAO-A gene promotor polymorphism in antisocial and anxious-depressive alcoholics. J. Neural .Transm. 107, 681–689.]. However, the association between alcoholism and MAOA or DRD2 gene has not been universally accepted [Lee, J.F., Lu, R.B., Ko, H.C., Chang, F.M., Yin, S.J., Pakstis, A.J., Kidd, K.K., 1999. No association between DRD2 locus and alcoholism after controlling the ADH and ALDH genotypes in Chinese Han population. Alcohol. Clin. Exp. Res. 23, 592–599.; Lu, R.B., Lin, W.W., Lee, J.F., Ko, H.C., Shih, J.C., 2003. Neither antisocial personality disorder nor antisocial alcoholism association with MAOA gene among Han Chinese males in Taiwan. Alcohol. Clin. Exp. Res. 27, 889–893.]. Since dopamine is metabolized to 3,4-dihydroxyphenyl-acetaldehyde (DOPAL) via monoamine oxidase (MAO) [Westerink, B.H., de Vries, J.B., 1985. On the origin of dopamine and its metabolite in predominantly noradrenergic innervated brain areas. Brain. Res. 330, 164–166.], the interaction between MAOA and DRD2 genes might be related to Antisocial ALC.The present study aimed to determine whether Antisocial ALC might be associated with the possible interactions of DRD2 gene with MAOA gene. Of the 231 Han Chinese subjects who were recruited for the study, 73 participants were diagnosed with Antisocial ALC and 158 subjects were diagnosed with antisocial personality disorder without alcoholism (Antisocial Non-ALC). The DRD2 TaqI A and MAOA-uVNTR (variable number of tandem repeat located upstream) polymorphisms were not found to be associated with Antisocial ALC. However, an association between DRD2 TaqI A polymorphisms and Antisocial ALC was shown only after stratification for the MAOA-uVNTR 4-repeat polymorphism. Additionally, after multiple logistic regressions, we found that, under stratification of MAOA-uVNTR 4-repeat polymorphism and in comparison with the DRD2 A1/A1 genotype as a reference group, the DRD2 A1/A2 genotype has a possible protective effect against alcoholism in individuals with antisocial personality disorder (ASPD). We concluded that the possible interactions between MAOA-uVNTR polymorphism and DRD2 TaqI A polymorphism might be related to Antisocial ALC among Han Chinese men in Taiwan.

The renal handling of beta2-microglobulin in the dog. The renal extraction of beta2-microglobulin (β2M) was investigated under steady-state conditions achieved by constant infusion of human β2M. Fifteen animal experiments were conducted. Beta2 microglobulin was infused at rates ranging from 51 to 269 µg/min. The renal arterial and venous blood levels remained constant throughout the study period. The data showed that renal extraction of β2M exceeded the rate of filtration at all levels of β2M delivered to the kidney. The tubular uptake of filtered β2M increased linearly as did the extraglomerular extraction throughout the range investigated. There was no evidence that either mechanism was saturated. The fractional excretion of β2M (FE β2M) increased linearly with the fractional excretion of filtered water (FE H2O). The results are interpreted to indicate that β2M is extracted from renal blood by glomerular filtration and, in addition, by a mechanism independent of glomerular filtration rate (GFR). Under the conditions existing in these experimental animals, the linear relationship between FE β2M and FE H2O is evidence to suggest that factors affecting proximal tubular water reabsorption also affect β2M reabsorption.L'élimination rénale de la bêta2 microglobuline chez le chien. L'extraction rénale de la bêta2 microglobuline (β2M) a été étudiée dans des conditions d'équilibre obtenues par perfusion continue de β2M humaine. Quinze expériences animales ont été entreprises. La bêta2 microglobuline a été perfusée à des débits de 51 à 269 µg/min. Les concentrations sanguines artérielles et veineuses rénales sont restées constantes tout au long de l'étude. Les résultats indiquent que l'extraction rénale de β2M a dépassé le débit de filtration pour toutes les quantités de β2M délivrées aux reins. La captation tubulaire de la β2M filtrée s'est élevée linéairement, de même que l'extraction extraglomérulaire, pour l'ensemble des débits étudiés. Il n'y a pas eu d'indice de saturation d'un des deux mécanismes. L'excrétion fractionnelle de β2M (FE β2M) s'est élevée linéairement avec l'excrétion fractionnelle de l'eau filtrée (FE H2O). Ces résultats indiquent que la β2M est extraite du sang rénal par filtration glomérulaire, et, en plus, par un mécanisme indépendant du débit de filtration glomérulaire (GFR). Dans les conditions existant chez ces animaux expérimentaux, la relation linéaire entre FE β2M et FE H2O est une preuve de ce que les facteurs modifiant la réabsorption tubulaire proximale de l'eau modifient aussi la réabsorption de β2M.

Zur Durchführung eines Opiatentzuges gibt es unterschiedliche Methoden: Zum einen die abrupte Entzugsbehandlung, die darin besteht, daß die Suchtmittelzufuhr abrupt unterbrochen wird und die entstehenden Beschwerden mit geeigneten Medikamenten unterdrückt werden. Dies kann z. B. mit Neuroleptika, Tranquilizern, Clonidin, Akupunktur, Guanfazin, Antidepressiva, Delta-sleep-inducing Peptide erreicht werden. Eine andere Methode, die schrittweise Entzugsbehandlung, besteht darin, daß das Suchtmittel selbst oder ein Ersatzstoff, wie z. B. Methadon bei langsamer Dosisreduktion verabreicht wird [2]. Diese Formen des Entzugs wurden schon 1938 von Kolb und Himmelsbach beschrieben [1]. Neuere Methoden, die von uns angewendet werden, sind induzierte Entzugsbehandlungen bei Opiatsüchtigen durch Provokation des Entzugssyndroms mittels des kompetitiven Opiatantagonisten Naloxon. Zum einen kam 1. der fraktionierte Kurentzug und 2. der Narkoseultrakurzentzug zur Anwendung.

Das zentrale Nervensystem und das Immunsystem wurden sehr lange als zwei unabhängige Einheiten betrachtet. Solomon et al. beschrieben die Interaktion von Emotionen, Immunität und Erkrankung [4]. Psychologische Faktoren wie Streß und Trauer spielen eine bedeutende Rolle bei Immunfunktionen [1]. Natural-Killer-Zellen spielen eine wichtige Rolle in der Abwehr gegen Virusinfektionen, der Entwicklung von Neoplasmen und der Kontrolle für Antikörperproduktion bei B-Zellen [2]. Immunologische Untersuchungen bei psychiatrischen Erkrankungen liegen für Depressionen, Schizophrenie, Autismus, Alkoholabhängigkeit vor, wenige bei Drogenmißbrauch mit Opiaten, und wenn, dann fast ausschließlich im Zusammenhang mit HIV-Infektionen [3]. HIV-positive opiatabhängige Patienten zeigen eine reduzierte Natural-Killerzell-Aktivität. Untersuchungen bei methadonsubstituierten Patienten liegen kaum vor, bzw. ist nicht klar, ob es sich bei jenen Arbeiten um rein methadonsubstituierte Patienten handelt, oder ob eine Mischabhängigkeit mit anderen Substanzen (etwa Barbituraten, Benzodiazepine, Kokain) gegeben ist. Vorarbeiten von Nair et al. etwa zeigen, daß die Natural-Killerzell-Aktivität und antikörperabhängige Zytotoxizität bei Patienten mit einem intravenösen Opiatmißbrauch herabgesetzt ist [3]. Allerdings wurden bei dieser Untersuchung Patienten inkludiert, die akut an somatischen Problemen erkrankt sind und die ebenso eine Polytoxikomanie aufwiesen.