Papers by Raphael M Bonelli
Clinical Neuropharmacology, 2002
Levodopa is recommended as a therapeutic approach for patients with the hypokinetic-rigid, Westph... more Levodopa is recommended as a therapeutic approach for patients with the hypokinetic-rigid, Westphal variant of Huntington's disease, but no guidelines are available for the case of nonrespondence to levodopa. In this study, however, we report a 34-year-old woman with this rare variant who showed a clear-cut improvement in motor function and depressive symptoms after treatment with pramipexole, a new dopamine agonist.
Perfektionismus by Raphael M. Bonelli Self-Improvement
Mužský narcismus : jak ho pochopit a proměnit
Suizid und Religiosität
Springer eBooks, 2014
Seit 2007 steigt in Deutschland die Suizidrate wieder an, nachdem sie nach 1980 kontinuierlich ab... more Seit 2007 steigt in Deutschland die Suizidrate wieder an, nachdem sie nach 1980 kontinuierlich abgenommen hatte. Im Jahre 2011 starben in ganz Deutschland 10.144 Menschen durch Selbsttotung, das sind 12,4 Menschen je 100.000 Einwohner. 1980 hingegen starben in der BRD noch 20,9 Personen je 100.000 Einwohner durch Selbstmord, in der DDR sogar 33,3 auf 100.000 Einwohner. Recht deutlich formuliert die WHO die Haufigkeit der Suizide: „According to WHO estimates, in the year 2000, approximately one million people died from suicide, and 10 to 20 times more people attempted suicide worldwide. This represents one death every 40 seconds and one attempt every 3 seconds, on average.“ (WHO 2000) Alle drei Sekunden wird also ein Suizidversuch durchgefuhrt, der in 7 Prozent der Falle todlich endet. Etwa 1 Mio. Menschen sterben weltweit jahrlich durch ihre eigene Hand: wesentlich mehr als durch Kriege oder durch Verkehrsunfalle. In der Europaischen Union starben nach einer Meldung der EU-Kommission aus dem Jahr 2005 jahrlich 58.000 Menschen durch Selbsttotung, im Vergleich zu 50.700 Verkehrstoten und 5350 Opfern von Gewaltverbrechen. Suizide sind in allen Landern der Erde unter den drei haufigsten Todesursachen der 15- bis 34-Jahrigen. In allen Landern sind Frauen deutlich weniger gefahrdet als Manner. Weitere bekannte Risikofaktoren neben dem mannlichen Geschlecht sind Alter (Altere mehr gefahrdet), Familienstand (Geschiedene mehr gefahrdet), Arbeitslosigkeit und Religiositat (Areligiose starker gefahrdet). Dem letzten Faktor ist dieses Kapitel gewidmet.
Huntington's disease
Handbook of Clinical Neurology, 2012
ABSTRACT Huntington's disease (HD) is an autosomal-dominant, inherited, neuropsychiatric ... more ABSTRACT Huntington's disease (HD) is an autosomal-dominant, inherited, neuropsychiatric disease which gives rise to progressive motor, cognitive, and behavioral symptoms. It affects about 1 in 10 000 individuals. The onset of symptoms typically occurs in the third or fourth decade of life, though it may appear at any age. The molecular basis of the disease is the expansion of the trinucleotide CAG in the first exon of a gene on chromosome four (4p 16.3). This gene encodes the protein huntingtin of 3136 amino acids. The normal function of huntingtin and the pathogenetic mechanisms caused by the mutant huntingtin remain incompletely characterized today. Current drug therapy has no effect on the progression of disability, and the need for any pharmacological treatment should be carefully considered. An evidence-based review of pharmacological management concluded that there is poor evidence in management of HD today. There is some evidence for treating chorea with haloperidol or fluphenazine, and less evidence for olanzapine. There is very low evidence for the treatment of other clinical problems: l-dopa and pramipexole for rigidity; amitriptyline and mirtazapine for depression; risperidone for psychosis; and olanzapine, haloperidol, and buspirone for behavioral symptoms in HD. Three substances are investigational for possible neuroprotection: coenzyme Q10, minocycline, and unsaturated fatty acids.
Sexuality in Huntington's disease
Wiener Medizinische Wochenschrift, Feb 1, 2008
Sexuality and partnership have an important influence on the quality of life of patients with chr... more Sexuality and partnership have an important influence on the quality of life of patients with chronic disorders. There are just a few studies in literature about sexuality in Huntington's disease which conclude that up to 85% men and up to 75% of women experience high levels of sexual problems, most of them having prevalent symptoms of a hypoactive sexual disorder but also increased sexual interest and paraphilia were found. There is no evidence that sexual dysfunction is mainly a specific symptom of HD and may be associated with the specific brain lesion itself or if it is chiefly related to the psychosocial factors caused by the steadily worsening of the disease. Further studies should focus on asymptomatic patients to explore sexual changes preceding neurological and motor symptoms and should incorporate partners to objectify sexual distinctive features. Investigations on the context of sexual dysfunction with depression, irritability and dementia symptoms are needed to better understand reasons for sexual changes in HD. Treatment options for HD patients with sexual disorder are only reported sporadically, guidelines can only be obtained from non-HD patients and further research is needed.
Strukturelles Neuroimaging der Basalganglien bei Schizophrenie: ein Review
Wiener Medizinische Wochenschrift, Feb 1, 2008
The basal ganglia structures have quickened interests in schizophrenia research for several reaso... more The basal ganglia structures have quickened interests in schizophrenia research for several reasons: On the one hand, schizophrenic patients are successfully treated with neuroleptics acting on dopamine receptors, which are highly concentrated in the basal ganglia structures. On the other hand, basal ganglia play an important role in higher cognitive functions such as attention, working memory and goal-directed behavior, which are impaired in schizophrenia. Magnetic resonance imaging allows non-invasive in vivo volumetric measurement of these brain structures. In this review, we studied all available papers on MRI research of the basal ganglia in schizophrenic patients. We found a possibly decreased caudate volume in first-episode schizophrenic patients, whereas studies on chronic patients mostly reveal volume increases in caudate, putamen and pallidum. Data from longitudinal studies suggest on the one hand that typical and atypical neuroleptics may produce different effects on brain morphology and on the other hand, that these changes are dynamic and might be reversible. Further studies are warranted for a better understanding of the mechanisms, which may lead to structural basal ganglia abnormalities, with medication effects demanding particular attention.
Olanzapine-associated seizure
Annals of Pharmacotherapy, 2003
TO THE EDITOR: Leflunomide is a novel agent for treatment of rheumatoid arthritis. Through Austra... more TO THE EDITOR: Leflunomide is a novel agent for treatment of rheumatoid arthritis. Through Australia’s voluntary adverse drug reaction reporting scheme, the Australian Adverse Drug Reactions Advisory Committee (ADRAC) has received 9 reports of well-documented pancytopenia in patients taking leflunomide. Using prescription data, we estimate that some 12 700 Australians have been exposed to leflunomide since its launch in January 2000, yielding an incidence of pancytopenia with leflunomide of 1 in 1411 exposures. We are aware of only 1 previously published case report of pancytopenia associated with leflunomide use.1 For the 9 reports of pancytopenia (hemoglobin <100 g/L, platelets <100 × 103/mm3, neutrophils <1.5 × 103/mm3) we have received, the median age of the patients was 66 years (range 60–80), and all but 1 were female.2 Pancytopenia developed 23–298 days after initiation of leflunomide; 4 of the 9 patients died. According to the Naranjo probability scale,3 a causal relationship between leflunomide and pancytopenia was probable in 1 of the patients, and possible in the 8 others. Of the 9 patients, 7 were taking concomitant methotrexate 7.5–12.5 mg/wk. Methotrexate has also been associated with pancytopenia in up to 2% of the patients in a reported case series4; however, this incidence may be reduced with the use of folic acid.5 Of 325 reports received by ADRAC of all types of suspected adverse reactions to leflunomide, 111 (34%) stated that methotrexate was being used concomitantly. One of the 2 patients who were taking leflunomide without methotrexate was a 66-year-old woman who developed pancytopenia 11 days after starting leflunomide and subsequently died. The other was a 65-year-old woman who developed pancytopenia 47 days after starting leflunomide. It appears that many patients taking leflunomide are also taking concomitant methotrexate, despite the absence of published evidence for increased efficacy of the combination compared with leflunomide alone. Although 7 of our 9 reports may represent an adverse reaction to methotrexate rather than leflunomide, we believe that the risk of potentially fatal pancytopenia when there is no demonstrated additional benefit argues against combined use of the drugs. Physicians and patients should be aware of this risk. Routine hematologic monitoring of patients taking leflunomide should be considered; however, in view of the variable latency between commencing leflunomide and the onset of pancytopenia, such monitoring would need to continue indefinitely.
Mirtazapine in Suicidal Huntington's Disease
Annals of Pharmacotherapy, Mar 1, 2003
... Fernando Miranda 10 24400 Ponferrada, Spain FAX 34 987 455 300 E-mail jodsybs@telefonica. net... more ... Fernando Miranda 10 24400 Ponferrada, Spain FAX 34 987 455 300 E-mail jodsybs@telefonica. net Lucia Pantoja MD Staff Physician ... El Bierzo Ma José Romero MD Staff Physician Department of Internal Medicine Gastroenterology Service Hospital El Bierzo Ramiro López MD ...
Clinical investigation, Jul 1, 2013
The available treatment options for Huntington's disease (HD) are only symptomatic, partly with a... more The available treatment options for Huntington's disease (HD) are only symptomatic, partly with a limited symptom control and often accompanied by serious side effects. This review summarizes the current management of HD and elucidates why pridopidine might represent a turning point in the treatment of the condition. Pharmacology, clinical evidence, safety and tolerability of the drug will also be addressed. As pridopidine is a member of a new class of compounds, it opens up the field for new treatment strategies that might be more efficient in controlling motor symptoms, with fewer side effects than the treatment options currently available. In a Phase II and III study, pridopidine significantly improved motor functions in Huntington patients with an adverse-event profile comparable to that of a placebo.
Religiosität in der Psychiatrie – zum aktuellen Wissensstand
Springer eBooks, 2018
Verbitterung und Vergebung
Springer eBooks, 2014
Die lange, manchmal sogar lebenslange Dauer der Verbitterung kommt dadurch zustande, dass die Bet... more Die lange, manchmal sogar lebenslange Dauer der Verbitterung kommt dadurch zustande, dass die Betroffenen oft in einer passiven Opferrolle verharren. Insbesondere die trotzige Verbitterungsemotion fuhrt dann haufig zu einer Ablehnung aller therapeutischen Hilfsangebote: „Die Welt kann ruhig sehen, was mir angetan wurde“. Allerdings ist die Lebensrealitat, dass man manchmal Unrecht erleiden muss, leichter auszuhalten, wenn eine Vergebungsbereitschaft als personliche Ressource erarbeitet wurde. Da das Leben darin besteht, Unrecht zu erleiden und Unrecht zu tun, ist eine symmetrische Wahrnehmung essenziell fur den Erhalt der psychischen Gesundheit. Unrecht zu erleiden ist nicht leicht. Doch auch bei echtem Fremdverschulden und tatsachlich eigener Unschuld gibt es Handlungsspielraum in Form von Vergebung, die aktiv ist, wahrend Verbitterung passiv ist. Die Freiheit zum Verzeihen ist denen leichter zuganglich, die auch an sich selbst Fehler sehen.
European Neuropsychopharmacology, Oct 1, 2002
conclude that tTG may serve as a biochemical marker for acute cell death to assess the efficacy o... more conclude that tTG may serve as a biochemical marker for acute cell death to assess the efficacy of possible new anti-apoptotic drugs. We furthermore suggest that neuroleptics should be strictly limited in AD patients.
Depresif semptomlar ve dini/manevi pratikler tum dunyada yaygindir, fakat bunlarin kesisim noktas... more Depresif semptomlar ve dini/manevi pratikler tum dunyada yaygindir, fakat bunlarin kesisim noktasi genel ruh sagligi uzmanlarinin nispeten cok az ilgisini cekmektedir. Bu makale son elli yil suresince (1962’den 2011’e kadar) dini /manevi baglanma (involvement)* ile depresif semptomlar ya da bozukluklar arasindaki iliskileri inceleyen nicel arastirmalari gozden gecirmekte ve bir sentez yapmaktadir. Şu anda en azindan 444 arastirma nicel olarak bu iliskileri incelemistir. Bunlarin % 60’indan fazlasi, daha fazla dindar / manevi yasantisi olanlarda daha az depresyon ve depresyondan daha hizli bir sekilde iyilesmenin var oldugunu ya da dini/manevi bir mudahaleye karsilik olarak depresyon siddetinde bir azalma oldugunu ortaya koymaktadir. Buna karsilik arastirmalarin sadece % 6’si daha fazla depresyonu ortaya koymaktadir. Metodolojik olarak en titiz olan 178 arastirmadan 119’u (% 67), din / maneviyat ile depresyon arasinda ters iliski oldugunu ortaya cikarmistir. Dini inanclar ve pratikle...
Transient hypoglycemic abducens palsy
PubMed, May 1, 2004
Since 1928, among the thousands of patients treated for insulinoma, only 32 cases with peripheral... more Since 1928, among the thousands of patients treated for insulinoma, only 32 cases with peripheral neuropathy have been reported. None of these described an affection of the cranial nerves. We present a 56 old woman, who suffered from chronic hyperinsulinism due to an insulinoma. For ten years, the patient has developed progressively marked hypoglycemic attacks of up to 20 mg/dl. Recently we have observed the development of a paresis of the right abducens nerve lasting for 6 weeks.
Medical Hypotheses, Oct 1, 2001
Advances in neuroradiological and neurosurgical techniques have lead to a growing interest in fun... more Advances in neuroradiological and neurosurgical techniques have lead to a growing interest in functional neurosurgical interventions for medically intractable movement disorders. The majority of these procedures are performed in patients with hypokinetic movement disorders, especially Parkinson's disease. However, relatively few interventions were done in hyperkinetic disorders such as Huntington's disease (HD), mainly owing to the lack of an adequate target nucleus. We have recently described the case of a reversible chorea in a genetically confirmed HD patient. We subsequently identified a marked bilateral degeneration of the substantia nigra as the probable reason for choreatic cessation. We therefore suggest that primary striatal atrophy causing hyperkinesia and secondary substantia nigra atrophy favouring hypokinesia were balanced in this patient, thus resulting in a close-to-physiologic GABAergic basal ganglia output. We postulate that deep brain stimulation of the substantia nigra pars compacta may ameliorate hyperkinesia in choreatic movement disorders, thus representing the first effective therapy in Huntington's chorea. Several lines of evidence in recent neurophysiological research support our hypothesis and are discussed below.
Journal of Neurology, Nov 1, 2001
High-dose olanzapine in Huntington??s disease
International Clinical Psychopharmacology, Mar 1, 2002
The few reports available on olanzapine in Huntington&#39;s disease (HD) are insufficiently d... more The few reports available on olanzapine in Huntington&#39;s disease (HD) are insufficiently documented and/or insufficiently dosed. We describe a 30-year-old woman with genetically confirmed HD who presented with severe chorea. She was not able to eat or dress without help and did not respond to haloperidol; the motor scale of the Unified HD Rating Scale (UHDRS-I) revealed 65 of a possible 124 points. After admission, we treated the patient with a high dose of olanzapine (30 mg daily). The chorea almost ceased in the next 2 days, she was able to eat and walk without assistance (UHDRS-I of 21 points), and fine motor tasks improved, as well as gait and eye movements. This effect lasted for 5 months. We conclude that high-dose olanzapine appears to be useful in grave choreatic attacks.
European Journal of Neurology, Mar 1, 2002
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Papers by Raphael M Bonelli