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Introduction: Weight gain is a common side effect of antipsychotic and antidepressive drug therapy, difficult both to avoid and to treat. In several randomized controlled studies, add-on treatment with metformin has been demonstrated to reduce olanzapine-induced weight gain. In our department of psychiatry and psychotherapy, metformin has been used against antihistaminic-drug-induced weight gain since 2008. Objectives: Primary: To demonstrate the efficacy of metformin for prophylaxis of antihistaminic-drug-induced weight gain in a cohort of psychiatric in-patients under naturalistic conditions. Secondary: To identify side-effects of add-on metformin therapy in non-diabetic psychiatric in-patients. Methods: Retrospective case-control analysis of in-patient charts from 3400 psychiatric therapies between 2008 and 2010 at Ulm University Department of Psychiatry and Psychotherapy III. Cases were identified on the basis of metformin prescription without a diagnosis of diabetes. Controls were matched for gender, age, BMI, diagnosis, and drug treatment. Evaluation will be performed with descriptive statistics, covariance analyses and mixed models. Results: No serious side effects could be attributed to metformin therapy on the basis of the charts reviewed. Further results will be presented at the meeting. Conclusions: Metformin appears to be safe with regard to side effects in psychiatric in-patients taking anti-histaminic drugs. [ABSTRACT FROM AUTHOR]

The metalloprotein ceruloplasmin has been of interest to psychiatrists for decades following early observations of elevated serum copper, and oxidase activity, in patients with schizophrenia. While immunological methods did not confirm elevated serum ceruloplasmin concentrations in schizophrenia, low serum concentrations of ceruloplasmin are typical of Wilson''s disease, Menkes’ disease, and aceruloplasminemia making low ceruloplasmin an important marker of disease. Unfortunately, available normative values are of limited usefulness, the majority being derived from oxidase studies; very few immunoturbidimetric or nephelometric studies were performed on small samples, or did not account for known influencing factors. Therefore, the present study was planned to determine nephelometric ceruloplasmin serum concentrations in a large randomized population sample. 2,445 subjects between 12 and 65 years of age were randomly selected from a southern German town of 22,000 inhabitants. The mean ceruloplasmin serum concentration was 331±104mg/l. Ceruloplasmin serum concentration significantly correlated with gender and age and was higher by 23 mg/l on average in women than in men. There also were significant correlations with lipoprotein concentrations, but not with several other liver-associated features, parameters of metabolism, or markers of inflammation. [Copyright &y& Elsevier]

Different experimental methodologies have been used to investigate pain perception in patients with borderline personality disorder (BPD) overall showing elevated pain thresholds (PT). We assessed PT, sensorial and affective components of pain processing in BPD patients and healthy controls using repetitive peripheral magnetic stimulation (rPMS) as a novel tool for provoking controlled aversive cutaneous sensation. In 10 BPD patients and 8 healthy women we assessed PT, cutaneous sensation, emotional valence and arousal level during rPMS at different intensities on two consecutive days. Additionally, inner tension level was assessed before and after each session. We found significantly higher PT in BPD patients (91% of maximal output of stimulator, vs. 56% in controls); these measures were consistent among both days of assessment, showing a high intra-individual repeat-reliability. In BPD, PT correlated positively with motivational factors of non-suicidal self-injury (to avoid feeling of emptiness r=0.823, p=0.023; to punish oneself r=0.774, p=0.041). All stimulation intensities used were discriminated similarly in both groups. However, emotional valence and arousal level did not vary with stimulus intensity in BPD patients. Furthermore, BPD patients were found to have higher baseline levels of inner tension than controls and, as opposed to controls, they experienced subjective relief after stimulation. Besides demonstrating a distinctive pattern of affective components of pain in BPD, the present study demonstrates that rPMS is a suitable and well-tolerated method for the assessment of pain sensation. [ABSTRACT FROM AUTHOR]

Valproic acid (VPA, 2-propylvaleric acid) is originally an antiepileptic drug, which has been in use for more than 30 years in over 100 countries. The clinical application of VPA has expanded in the last years. Approval has been granted by the FDA for treatment of migraine and cluster headache in 1996, and for treatment of mania and long-term prophylaxis of bipolar affective disorder in 1995. In ongoing studies, VPA has been reported to inhibit growth of several types of cancer cells; in addition, effects on neurodegeneration, and on virus replication in HIV infection have been demonstrated potentially expanding the application of VPA in the future. Despite a good tolerability of the drug, reports of hepatotoxicty even in patients without risk factors become more frequent. We analysed all cases of VPA induced severe hepatic side effects reported to the german Federal Institute for Pharmaceuticals & Medical Products (BfArM) between 1993 and 2009. A special intention was to detect correlations with present co-medication as a crucial factor in the break-down of hepatic function. As frequent co-medications in VPA-induced hepatic side effects benzodiazepines, and antiepileptics, especially carbamazepine, lamotrigine and topiramate were found. In addition, propofol as a co-medication was found in 4 lethal cases. Different pathomechanisms of VPA hepatotoxicity and a therapeutic approach with carnitine are discussed. Current international guidelines for prevention of VPA-induced liver failure are contrasted. Weekly control of liver enzymes in the first treatment weeks might help to detect VPA-induced hepatic side effects earlier. [ABSTRACT FROM AUTHOR]

Introduction/objectives/aims: Gynecomastia and hypogonadism can occur during treatment with a range of antidopaminergic drugs and is most likely to a medication induced increase in serum prolactin levels. However there is little evidence for an association between antidepressants and hypogonadism. Methods: We report the case of a 23 year old male with a 3 year history of bulimia nervosa and recurring depression who had been treated with duloxetine for a period of 6 months during which he developed pronounced bilateral gynocomastia. Since serum prolactine and serum testosterone levels were normal and duloxetin was initially not considered causative, the drug was continued and bilateral gynecomastia was performed. 4 months later the patient again experienced tension and swelling in the breast. Results: The endocrinologic exams revealed reduced serum testosterone levels and reduced testicular volume. Body weight was 63kg, height 176cm and a neurological exam, including olfactory testing and MR brain imaging was normal. Hypogonadotropic hypogonadism was diagnosed. Discussion: Increased prolactin levels under antipsychotic medications are not uncommon. Some rare instances of gynecomastia have been reported under fluoxetine and venlafaxine, always associated with increased serum prolactin levels. In the present case the close tempral relationship between initiation of duloxetine and the development of gynecomastia and the recurrence under continued medication and resolution after termination of the medication suggests a possible causal relationship. The normal prolactin levels argue against anvolvement of prolactin in the pathogenesis. We suspect a prolactine independent mechanism. [ABSTRACT FROM AUTHOR]

Allogeneous hematogenic stem cell transplantation (HSCT) is a curative therapeutic strategy for numerous benign and malignant hematologic diseases. The transplantation procedure is characterized by significant physical, social and psychological stressors, especially for the graft recipient. This can lead to depression and anxiety. Every HSCT represents a potential risk for transmission of known and unknown diseases. Hematologically transmissible diseases of the donor therefore are considered a contraindication. Recent animal experiments have demonstrated that psychiatric diseases can transmitted via HSCT from donor to recipient. So far there are no such observations in human patients. Here we report the case of a 33 year old male patient who, because of a rare chronic hypoplastic congenital aenemia, underwent HSCT. The BM donor was the brother of the patient and suffered from recurrent depressive disorder. Because of the short stature resulting from his underlying hematologic disease the patient had been in psychotherapy form several years. Depressive episodes had not been observed during this time. 10 weeks post HSCT the patient experienced a depressed mood and recurring anxiety attacs. The initiation of antidpressant medication was considered but not started due to the mild symptomatology. While depressive symptoms after HSCT are not infrequent because of the multiple stressors outlined above, we argue that in the light of the recent animals studies on the transmission of psychiatric disease via hematopoeitic stem cells in the present constellation a hematologic transmission of the mood disorder can also be condsidered. Acknowledment: To the colleagues of the Department of Pediatrics. [ABSTRACT FROM AUTHOR]

The treatment of psychiatric disorders during pregnancy poses a challenge particularly regarding limited pharmacological possibilities. Repetitive transcranial magnetic stimulation (rTMS) and electroconvulsive therapy (ECT) have been described to be successful in few single cases but, however, literature lacks of guidelines. In order to contribute to the pool of empirical data that is necessary to create evidenced based recommendations we present a case of successful treatment of major depression with ECT in a 35.year old pregnant patient with non-response to rTMS. [ABSTRACT FROM AUTHOR]

Selfmutilation (SM) is a common phenomenon among patients with psychiatric disorders and has been reported frequently in patients with schizophrenia, personality disorders and occasionally with transsexuality. Several psychotropic agents, as alocohol or amphetamines, are able to induce intoxications during which SM is performed. Though SM related to psychotropic agents is probably a frequent phenomenon, literature lacks of systematic approaches and just provides single case reports. In this context we performed a systematic literature search and identified published cases of psychotropic substance induced selfmutilating behaviour (PSISM). Assessment of these cases shows that the typical patient that is on risk to develop PSISM is male, in the middle age and with a previous history of multiple substance abuse. Most frequent agents involved in PSIMS belong to the amphetamine group. [ABSTRACT FROM AUTHOR]

Delusional parasitosis (DP) is a rare psychiatric disorder, predominantly observed in middle aged and elderly patients. It can manifest itself as an isolated delusional disorder (primary DP), as a symptom of another psychiatric disorder or as an organic or toxic psychosis. The typical antipsychotic pimozide was traditionally considered to be the gold standard for treating DP. Compared with pimozide, atypical antipsychotics have many advantages in terms of tolerability, but their effectiveness has only been shown in a few case reports, which do not differentiate between primary and other forms of DP. We present the case of a 77-year-old woman with primary DP who responded markedly to the atypical antipsychotic olanzapine (2.5 mg daily). She was treated in a psychiatric outpatient department with a follow-up period of 3.5 years. This is the first report of a successful olanzapine mono-therapy in primary DP in such a setting and the longest follow-up period ever reported. The need for maintenance treatment was demonstrated. Olanzapine in age-adapted doses should be considered as an alternative treatment. This paper also provides a review of all published cases in which primary DP was treated with atypical antipsychotics.

Background: Repetitive transcranial magnetic stimulation (rTMS) has been proposed as a new treatment option for depression. Previous studies were performed with low sample sizes in single centres and reported heterogeneous results., Aims: To investigate the efficacy of rTMS as augmentative treatment in depression., Method: In a randomised, double-blind, sham-controlled multicentre trial 127 patients with moderate to severe depressive episodes were randomly assigned to real or sham stimulation for 3 weeks in addition to simultaneously initiated antidepressant medication., Results: We found no difference in the responder rates of the real and the sham treatment groups (31% in each) or in the decrease of the scores on the depression rating scales., Conclusions: The data do not support previous reports from smaller samples indicating an augmenting or accelerating antidepressant effect of rTMS. Further exploration of the possible efficacy of other stimulation protocols or within selected sub-populations of patients is necessary.