Psychische Erkrankungen in der Lebensspanne ... - DGPPN

Topic 4 G Affektive Störungen, F3 // Affective disorders, F3
Discussion / Results: First results of the ongoing study (N=55)
confirm the high response rates of acute ultrabrief unilateral ECT
in severely depressed patients (67 %). In addition, the use of protocolized
continuation therapies markedly reduces relapse rates (25 %
relapse overall) while the two combination groups have siginificantly
lower relapse rates than the antidepressant treatment-alone
group. Concerning cognition, analyses comparing cognitive performance
during continuation treatment indicate that verbal and
visual short- and long-term memory are either not impaired or
even improved in all three continuation groups. Regarding autobiographical
memory, the C-ECT group performances even better
than the two other groups pointing out that there might be no cumulative
cognitive deficits following C-ECT. Although these are
only preliminary results, it seems that combining antidepressant
treatment with either C-ECT or C-CBT in the continuation phase
are highly successful to prevent relapse in ECT responders.
004
Intermittierende transkranielle Kortexstimulation (rTMS und
tDCS) für die Akut- und Langzeittherapie von Depressionen
Frank Padberg (Psychiatrie und Psychotherapie, LMU München)
M. Holzer, D. Keeser, U. Palm, M. Riedel, H.-J. Möller, O. Pogarell
Einleitung: Im Gegensatz zur tiefen Hirnstimulation einerseits,
bzw. einer pharmakologischen Stimulation zeichnen sich transkranielle
Kortexstimulationsverfahren (repetitive transkranielle Magnetstimulation
– rTMS und transkranielle Gleichstromstimulation
– tDCS) und auch die Elekt-rokonvulsionstherapie (EKT) durch
die intermittierende Stimulationsform aus. Deshalb sind die Dauer
der Post-Stimulationseffekte, ihre Summation über die Zeit und Interferenz
zwischen einzelnen Stimulationsserien von besonderer
Bedeutung, allerdings noch wenig unter-sucht. Erste Anhaltspunkte
können hier die klinischen Erfahrungen zu Dauer und Abklingen
der Behandlungseffekte, aber auch Untersuchungen zur Erhaltungstherapie
geben.
Methode: Ausgehend von Studien zur Dauer der Post-Stimulationseffekte
bei rTMS und tDCS und zu neuroplastischen Veränderungen
nach transkranieller Kortexstimulation sollen die bisherigen
Erfahrungen mit rTMS und tDCS in der Akut- und
Langzeittherapie von Depressionen disku-tiert werden. Dies geschieht
zum einen anhand eines Literaturüberblicks, zum anderen
auf der Basis eigener kasuistischer Erfahrungen.
Diskussion / Ergebnisse: Bislang fehlen noch größere systematische
Untersuchungen zum Aufbau und zur Stabilität antidepressiver
Effekte über die Zeit sowie zu Erhaltungstherapieansätzen,
zumeist liegen Kasuistiken, kleinere Fallserien und Follow-Up-
Untersuchungen zu größeren placebokontrollierten Akutstudien
vor. Die bisherigen Daten sprechen dafür, dass die Effekte der
Akutbe-handlung mit TMS und tDCS vorübergehend sind und innerhalb
weniger Wochen abklingen. Eine wiederholte Anwendung
von Stimulationssequenzen im Sinne einer Erhaltungstherapie –
analog zur Erhaltungs-EKT – erscheint auf der Basis erster Erfahrungen
durchaus vielver-sprechend. Von besonderem Interesse
sind jedoch methodische Weiterentwicklungen, z. B. die sog. Theta-
Burst-Stimulation (TBS) mit dem Ziel, die Post-Stimulationseffekte
zu verlängern, um so eine Optimierung der Wirkung über die Zeit
zu erreichen.
Freitag, 27. 11. 2009, 08.30 – 10.00 Uhr, Saal 5
S-101 Symposium
Mood disorders as glial disorders
Vorsitz: M. Schroeter (Leipzig), P. Falkai (Göttingen)
001
Glial Pathology in Mood Disorders – Serum Markers
Matthias Schroeter (MPI, Kognitive Neurologie, Leipzig)
Introduction: Recently, it was shown by histopathological studies
that mood disorders are characterized by disease-specific glial
patho logy.
Method: To validate this hypothesis in vivo we measured serum
levels of the neuronal marker neuron-specific enolase and S100B, a
protein expressed in astro- and oligodendroglia in the human brain,
in patients with major depressive disorder and age- and gendermatched
control subjects. Furthermore, we conducted a systematic,
quantitative meta-analysis of all published studies on S100B involving
193 patients suffering from mood disorders and 132 healthy
control subjects by calculating effect sizes.
Discussion / Results: S100B was elevated at admission and discharge
in the patients with major depression compared with control
subjects, whereas there were no significant differences for neuron-specific
enolase. During treatment S100B decreased slightly,
although this effect was not significant. It had no significant impact
on neuron-specific enolase. The meta-analysis revealed that serum
levels of S100B are consistently elevated in mood disorders during
acute major depressive or manic episodes. Additionally, it demonstrated
that serum S100B decreases during antidepressive treatment
reliably if clinical improvement is sufficient. In conclusion, S100B
may represent a biomarker for mood disorders, particularly major
depression, and their treatment. Together with unaltered levels of
neuron-specific enolase, our results support in vivo the histopathologically
generated hypothesis of disease-specific glial pathology in
mood disorders. References Schroeter et al. (2009) Psychiatry Res
167:66-72. Schroeter & Steiner (2009) Mol Psychiatry 14:235-7.
002
Glial Pathology in Mood Disorders – Cell Culture Models and Post
Mortem Studies
Johann Steiner (Universitätsklinikum Magdeburg, Psychiatrie und
Psychotherapie)
H.-G. Bernstein, G. Keilhoff, B. Bogerts
Introduction: As recently reviewed (Rajkowska G & Miguel-
Hidalgo JJ; 2007), a decreased density of GFAP+ astrocytes has
been ob served in the prefrontal cortex and hippocampus of younger
(≤ 45 years old) depressed subjects. Moreover, a diminished expression
of other astrocyte-related proteins (glial glutamate transporter
/ glutamine synthetase) and a reduced density of oligodendrocytes
were observed. These findings may be related to an altered
expression of S100B by glial cells, since elevated levels of this protein
have been observed in previous serum studies (meta-analysis:
Schroeter ML & Steiner J; 2009).
Method: The density of S100B-immunopositive astrocytes and
oligodendrocytes was assessed in the hippocampus of 17 depressed
patients and 16 matched healthy controls from the Magdeburg
brain collection. In addition, synthesis and release of S100B were
analyzed in C6 and OLN-93 cell cultures with particular focus on
the influence of glucose supply.
Discussion / Results: The density of S100B-positive astrocytes was
reduced in the hippocampus of depressed patients. Synthesis and
release of S100B was increased by deficient energy supply of glial
cells (Steiner J et al.; 2008). This finding is discussed in the context
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