Das Antiepileptikum Vigabatrin wurde 1977 als ein spezifischer irreversibler Hemmstoff der γ-Aminobuttersäure-Aminotransferase entwickelt (Lippert et al. 1977).

In a single blind study the antiepileptic effects and safety of vigabatrin--a new anticonvulsant drug selectively inhibiting GABA-transaminase--was investigated in therapy resistant epilepsy, along with its central effects objectivated by mapping of EEG and event-related potentials (ERP). In addition to their current antiepileptic therapy, 10 patients with complex partial seizures (CP) (4 male, 6 female), aged between 22 and 57 years received placebo for 1 month, subsequently 2 g vigabatrin for 2 months and thereafter a titrated optimal dosage vigabatrin for another 2 months. Clinical investigations were carried out at the afore-mentioned periods, neurophysiological ones pre and post 2 months vigabatrin. After 2 months vigabatrin, 5 out of 10 patients had a 50% or greater decrease in CP frequency, after another 2 months 7 out of 10. The median number of CP per months decreased from 5.5 to 3.75 (p < 0.05) to 2.0 (p < 0.01), respectively. No clinically relevant side effects and laboratory changes were noted. EEG mapping showed decreased fast alpha and slow beta power and increased delta-theta frequency variability, reflecting most likely a decreased CP disposition. ERP mapping showed slightly increased N1 and P2 as well as reduced P300 amplitudes. Unchanged P300 latency indicated no delayed stimulus evaluation time after vigabatrin therapy.

Das neue Antiepileptikum Vigabatrin hat eine außerordentliche Bedeutung in der klinischen Epilepsie-Therapie erlangt. 1977 wurde die Gamma-Aminobuttersäure analoge Substanz Gamma-vinyl-GABA (GVG, Vigabatrin) als ein spezifischer irreversibler Hemmstoff der Gamma-Aminobuttersäure-Aminotransferase identifiziert [1].

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.

Reports on neuropsychological assessment and psychopathological symptoms in HIV-1 patients are rather different. The aim of the study was to assess frequency and extent of noopsychic changes and psychopathological symptoms in HIV-1 patients of different risk groups. Of the 77 patients being included in the study 35 patients belonged to risk group 1, 42 to risk group 2. The patient groups were compared to a control-group of healthy volunteers (n = 50) and to a control-group of HIV-negative i.v. drug-addicts (n = 31). The psychometric test battery included Raven and MWT Test, Benton Test, numerical memory Test, ARG Test. Personality variables were assessed by MMPI, Psychopathology by AMDP-System, Hamilton Depression Scale, Wellbeing Scale (von Zerssen), STAI 1 and 2 and BPRS. Patients of risk group 1 showed significantly less impairment of noopsychic performance than patients of risk group 2. Risk group 1 showed only in the Benton Test significant impairment compared to healthy volunteers while risk group 2 in most of the tests was impaired. Risk group 2 did not show impairment compared to the control-group of seronegative drug users. Depressive syndromes mainly in risk group 2 showed a significant influence on the noopsychic performance.

Reports available on the extent and incidence of cognitive deficits in human immunodeficiency virus (HIV-1) patients are variable. To assess the influence of drug abuse and psychiatric symptoms on the extent of the cognitive deficit, we examined 42 drug-addicted HIV-1 patients and compared them with a group of seronegative drug addicts (n = 31) as well as with a group of healthy controls (n = 50), using a psychometric test battery and standardized psychiatric scales. We found no significant difference in the extent and incidence of cognitive deficits in the group of HIV-1 patients as compared with the seronegative drug addicts. Both groups, however, differed from the normal population group. Remarkable depressive symptoms were found in the HIV-1 infected patient group. We assume that long-term drug abuse contributes markedly to the cognitive deficit of HIV-1 patients, which is further influenced by depressive symptoms.

Reports on neuropsychological assessment and psychopathological symptoms in HIV-1 patients are rather different. The aim of the study was to assess frequency and extent of noopsychic changes and psychopathological symptoms in HIV-1 patients of different risk groups. Of the 77 patients being included in the study 35 patients belonged to risk group 1, 42 to risk group 2. The patient groups were compared to a control group of healthy volunteers (n = 50) and to a control group of HIV-negative i. v. drug addicts (n = 31). The psychometric test battery included Raven and MWT Test, Benton Test, numerical memory Test, ARG Test. Personality variables were assessed by MMPI, Psychopathology by AMDP-System, Hamilton Depression Scale, Wellbeing Scale (von Zerssen), STAI 1 and 2 and BPRS. Patients of risk group 1 showed significantly less impairment of noopsychic performance than patients of risk group 2. Risk group 1 showed only in the Benton Test significant impairment compared to healthy volunteers while risk group 2 in most of the tests was impaired. Risk group 2 did not show impairment compared to the control group of seronegative drug users. Depressive syndromes mainly in risk group 2 showed a significant influence on the noopsychic performance.

Pfersmann, D.; Resinger-Kepl, E.; Brandstätter, N.; Stamenkovic, M.; Mahler, E.; Werdenich, W. Author Information

The methadone maintenance therapy still stays controversai, pro- and contra aspects are discussed as well. Besides scientific — medical, social — psychological aspects also economical (“economy of drug use”) are pointed out and become more and more of interest. According to the latter costs have been listed for the consumption of drugs, the court, long time arrest and the costs for rehabilitation and prevention of crime. An alternative which makes sense is the long time therapy in an outpatient department with a dosage, which is adapted gently to the patient. In accordance with Haas (1) especially the methadone maintenance therapy in this group of patients is working palliative for an unlimited period of time.

The habituation of the electrodermal reaction (EDR) is one of the most used variables among psychophysiological indicators in investigations in men. In our department a specific computer assisted technique for measuring habituation, mean amplitude, area underneath the line and "emotional reflection" was developed. 15 acoustic stimuli (500 Hz tone at 72 db intensity lasting for 500 msec) are presented to the patient. The habituation criterion is reached when there are no reactions to 3 consecutive stimuli. Since the first reports in 1981 AIDS has become an expanding major public health problem. Therefore the aim of our investigation was to study electrodermal activity in AIDS-patients, especially the habituation of the EDR. 37 addicted AIDS-patients participated in the study voluntarily and were compared to 30 drug addicted HIV-negative patients, 30 homosexual AIDS-patients and 20 healthy normals. Furthermore the patients were divided according to the stages of their disease. The drug addicted AIDS-patient group habituated earlier than the addicted HIV-negative group, the healthy normals, and the homosexual patients. The drug dependent AIDS-patients were more psychovegetatively suppressed. As compared to the healthy normals and addicted HIV-negative patients the homosexual AIDS-patients differed in emotional reflection; they showed a higher degree of excitement, while in drug dependent AIDS-patients a lower emotional reflection was found. Concerning emotional intensity similar results were obtained. Differences in the mean amplitudes reached the level of statistical significance between homosexual AIDS-patients and the healthy normals and addicted HIV-negative patients respectively. Within as well as between both groups differences concerning stage III and IV could be observed.(ABSTRACT TRUNCATED AT 250 WORDS)

The rapid spread of HIV infection among intravenous drug abusers plays an increasing role in the AIDS epidemic. In this context the Austrian government changed politics and introduced a methadone maintenance program 1987, to reach more intravenous drug addicts and to stop intravenous drug abuse of this clients. 119 intravenous drug users were anonymously tested for HIV antibodies between April 18 and May 17, 1988 at the out-patient clinic of the Psychiatric University clinic of Vienna and were examined by means of a standardized questionnaire. The data are discussed in respect of the benefits of a methadone maintenance program to decrease HIV-infection among intravenous drug abusers in Vienna.

To date, no satisfying solution has been found to the problem of how to avoid the distressing withdrawal symptoms accompanying opiate detoxification. By administering staggered doses of naloxone to the patient while under tiapride (Delpral-R), the various discomforts were satisfactorily reduced and the detoxification syndrome could be limited to 50 hours. This study covers 15 patients who had an average addiction history of more than 7 1/e years, and who underwent inpatient rapid opiate withdrawal treatment lasting an average of five days.

It has been reported that the acquired immune deficiency syndrome can present neuropsychiatric symptoms of major depressive disorders, adjustment disorder with depressed mood and organic brain syndromes with affective, delusional and demented features. The aim of the present study was to determine deficits in performance and to measure psychophysiological variables in drug addicted AIDS-patients. 28 drug addicted AIDS-patients and 17 homosexual AIDS-patients participated in the study voluntarily and were compared to healthy normals. 18 patients belonged to stage III, 27 to stage IV. Performance was measured by numerical memory test, Benton test, Alphabetic reaction test and computer-assisted rigidity test. Psychophysiological parameters were evaluated by computer-assisted "static" and "dynamic" pupillometry, computer-assisted measurements of skin conductance-level, -reaction and habituation; and critical flicker frequency analyses. Performance in drug addicted AIDS-patients differed from controls and especially from healthy normals within a minimal range ("Denivellierungssyndrom"--decline of level of performance). No AIDS-dementia could be objectivated. Furthermore drug-dependent AIDS-patients demonstrated autonomous desactivation, reduced pupillary reagibility and suppressed vegetative irritability.