Dieterich, Anja

[["dc.bibliographiccitation.firstpage","496"],["dc.bibliographiccitation.journal","Journal of General Internal Medicine"],["dc.bibliographiccitation.lastpage","502"],["dc.bibliographiccitation.volume","15"],["dc.contributor.author","Himmel, Wolfgang"],["dc.contributor.author","Dieterich, Anja"],["dc.contributor.author","Kochen, Michael M."],["dc.date.accessioned","2021-08-16T09:36:52Z"],["dc.date.available","2021-08-16T09:36:52Z"],["dc.date.issued","2000"],["dc.identifier.uri","https://resolver.sub.uni-goettingen.de/purl?gro-2/88714"],["dc.relation.orgunit","Institut für Allgemeinmedizin"],["dc.title","Will German patients accept their family physician to function as gatekeeper?"],["dc.type","journal_article"],["dc.type.internalPublication","yes"],["dc.type.subtype","original_ja"],["dspace.entity.type","Publication"]]

[["dc.bibliographiccitation.firstpage","158"],["dc.bibliographiccitation.issue","4"],["dc.bibliographiccitation.journal","Pharmacopsychiatry"],["dc.bibliographiccitation.lastpage","159"],["dc.bibliographiccitation.volume","34"],["dc.contributor.author","Sommer, M."],["dc.contributor.author","Dieterich, A."],["dc.contributor.author","Krause, C."],["dc.contributor.author","Rüther, E."],["dc.contributor.author","Wiltfang, J."],["dc.date.accessioned","2017-09-07T11:44:41Z"],["dc.date.available","2017-09-07T11:44:41Z"],["dc.date.issued","2001"],["dc.description.abstract","Mirtazapine is an antidepressive agent with proven efficacy [1] [4]. Frequent side effects include sleepiness, sedation, agitation, confusion, increased appetite, weight gain, and edema. Less frequent side-effects are orthostatic hypotension, mania, epileptic seizures, tremor, muscle-jerking, granulocytopenia, increase of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) and exanthema [2] [5]. To our knowledge, pancreatitis as a side-effect of mirtazapine has not been described before. In this communication, we will report on a case of subclinical pancreatitis in a patient with a past history of alcohol abuse. The pancreatitis was temporarily related to the combination of mirtazapine treatment and oral food, it ceased 10 days after stopping mirtazapine. There was no alcohol consumption during the entire observation period.A 54-year-old unemployed hairdresser was admitted to the Department of Psychiatry at the University of Göttingen for a severe episode of a recurrent major depressive disorder (DSM IV 296.33). He had a history of unipolar depression, with previous hospitalizations for depressive episodes in March and October of 1999. He also had a history of alcohol dependence (DSM IV 303.90) dating from adolescence with alcohol-related hallucinations (DSM IV 291.3) which were found to be responsive to pimozide in 1998. Alcohol consumption was stopped after detoxification in August, 1998. On the present admission, the treatment consisted of citalopram at 60 mg, pimozide at 1 mg, and aspirin at 100 mg. Because of the severity of the depressive episode, we decided to add mirtazapine, which had never been tried on this patient. We chose a rapid dosage increase of 15 mg per day up to 60 mg given once a day at nighttime. On day 4, an increase of lipase and pancreas-specific amylase was found after routine blood-sampling, and a further increase of these two enzymes was observed on day 5 (Fig. [1]). We stopped oral food supply that day, and pancreas enzyme serum levels returned to normal on day 7. After introduction of restricted oral food on day 8, however, enzyme serum levels increased again. Although previous reports of elevation of pancreas enzymes related to mirtazapine had not been reported either in the literature or by Organon Pharma, Inc., Munich, we decided to stop mirtazapine on day 14 despite a marked clinical improvement in the depressive symptoms. Serum levels returned to normal levels at day 24, and a reintroduction of unrestricted oral feeding on day 27 caused only a minor increase of serum levels lasting for 3 days. Subsequent samples revealed no abnormalities in the pancreas enzyme serum levels. Samples of AST, ALT, total bilirubin, alkaline phosphatase, gamma glutamyltransferase, C-reactive protein levels and the number of leukocytes taken on day 1 and daily between day 9 and day 34 were within normal limits. The serum ethanol was below a detectable level (< 0.02 ‰) at either sample (day 1, 9, and daily from day 13 to 34). Clinically, the patient never had any subjective complaints of abdominal pain or bowel dysfunction, and only mild pain on epigastral palpation. An abdominal ultrasound on day 6 revealed no sign of pancreatitis. Since the patient's depressive symptoms were largely improved, we decided not to administer any other antidepressive drugs. The patient was discharged on day 34, and will be seen regularly on an outpatient basis.In this patient, a subclinical elevation of pancreas enzyme serum levels was temporarily associated with mirtazapine treatment and oral food which ceased after mirtazapine was stopped. There was no clinical or biochemical evidence for current alcohol consumption. Mirtazapine is known to interact with enzymes of hepatic metabolization [2], but to our knowledge, there have been no cases of mirtazapine-related pancreatitis published as yet. A contact with the AMSP drug safety program (see Grohmann et al. [3]) revealed one previously unreported case of mirtazapine-related increase of serum lipase in a 48-year-old women with depression after a rapid dosage increase to 60 mg per day within one week. In this patient, the gamma glutamyltransferase was slightly increased; pancreas-specific amylase was not assessed. That patient also had subclinical pancreatitis, and there were no known risk factors such as alcohol abuse history. Lipase and gamma glutamyltransferase returned no normal values after mirtazapine cessation. The mechanism underlying mirtazapine-related pancreatitis remains obscure, and may not necessarily be mirtazapine-specific, since the contact to the AMSP program also revealed 2 cases of paroxetine-related pancreatitis; there are also reports of pancreatitis as a result of tricyclic antidepressant overdoses [6] [7].We hypothesize that our patient's previous alcohol abuse had caused lasting subclinical damage to his pancreas and, therefore, lowered the threshold for medication-related pancreatitis. On the basis of our observation and our literature research, we recommend pancreas enzyme serum level monitoring and slow dosage increase when introducing mirtazapine in patients with possible or known pancreas dysfunction.Fig. 1 Upper part: pancreas-specific amylase (left ordinate) and lipase (right ordinate), lower part: daily mirtazapine dose (left ordinate) and food (right ordinate). Food quality is rated as: 0 = no oral food; 1 = tea and bread; 2 = fat-free, very light food; 3 = low-fat, light food; and 4 = unrestricted oral food. Note the increase in pancreas enzyme serum levels associated with mirtazapine and oral food exposure."],["dc.identifier.doi","10.1055/s-2001-15877"],["dc.identifier.gro","3151729"],["dc.identifier.pmid","11518479"],["dc.identifier.uri","https://resolver.sub.uni-goettingen.de/purl?gro-2/8549"],["dc.language.iso","en"],["dc.notes.status","final"],["dc.notes.submitter","chake"],["dc.relation.issn","0176-3679"],["dc.title","Subclinical Pancreatitis Related to Mirtazapine - A Case Report"],["dc.type","journal_article"],["dc.type.internalPublication","yes"],["dc.type.peerReviewed","no"],["dspace.entity.type","Publication"]]

[["dc.bibliographiccitation.firstpage","496"],["dc.bibliographiccitation.issue","7"],["dc.bibliographiccitation.journal","Journal of General Internal Medicine"],["dc.bibliographiccitation.lastpage","502"],["dc.bibliographiccitation.volume","15"],["dc.contributor.author","Himmel, Wolfgang"],["dc.contributor.author","Dieterich, Anja"],["dc.contributor.author","Kochen, Michael M."],["dc.date.accessioned","2018-11-07T10:41:38Z"],["dc.date.available","2018-11-07T10:41:38Z"],["dc.date.issued","2000"],["dc.description.abstract","OBJECTIVE: Looking to the experience in the United States with managed care and the possible introduction of gatekeeping in the near future in Germany, we performed a population-based survey to examine preferences for future gatekeeping arrangements. DESIGN: Cross-sectional telephone survey. SETTING: Four health districts in Thuringia (formerly East Germany) and Lower Saxony (formerly West Germany). PARTICIPANTS: Out of a random sample of 644 adults in the 4 districts, 415 persons (64.4%) took part in the survey. MEASUREMENTS AND MAIN RESULTS: Using multiple logistic regression, we analyzed associations between preferences for gatekeeping arrangements and patient satisfaction, insurance status, and sociodemographic characteristics. Seventy-four percent of respondents valued first-contact care, especially older people (odds ratio [OR], 4.3; 95% confidence interval [95% CI], 2.0 to 9.3), people who were very satisfied with the relationship with their family physician (OR, 2.7; 95% CI, 1.6 to 4.8) and members of sickness funds in contrast to privately insured persons (OR, 2.4; 95% CI, 1.2 to 5.2). The family physician's influence in coordinating the use of specialist services was appreciated by 86%, more often by members of sickness funds (OR, 5.9; 95% CI, 2.4 to 14.3), people who were very satisfied with their doctor's professional competence (OR, 3.2; 95% CI, 1.6 to 6.3) and older persons (OR, 2.9; 95% CI, 1.1 to 7.7). CONCLUSIONS: A vast majority of the German population would accept their family physician as entry point and as coordinator of all other health services. Since patient satisfaction, among other reasons, strongly influenced preferences for gatekeeper arrangements, family physicians themselves may be able to promote primary care health services."],["dc.identifier.doi","10.1046/j.1525-1497.2000.10016.x"],["dc.identifier.isi","88302700009"],["dc.identifier.pmid","10940137"],["dc.identifier.uri","https://resolver.sub.uni-goettingen.de/purl?gro-2/46588"],["dc.notes.status","zu prüfen"],["dc.notes.submitter","Najko"],["dc.relation.issn","0884-8734"],["dc.title","Will German patients accept their family physician as a gatekeeper?"],["dc.type","journal_article"],["dc.type.internalPublication","yes"],["dc.type.peerReviewed","yes"],["dspace.entity.type","Publication"]]

[["dc.bibliographiccitation.firstpage","1"],["dc.bibliographiccitation.issue","26"],["dc.bibliographiccitation.journal","GMS Zeitschrift für medizinische Ausbildung"],["dc.bibliographiccitation.lastpage","17"],["dc.contributor.author","Simmenroth-Nayda, Anne"],["dc.contributor.author","Bachmann, Cadja"],["dc.contributor.author","Hölzer, Henrike"],["dc.contributor.author","Dieterich, Anja"],["dc.contributor.author","Fabry, Götz"],["dc.contributor.author","Langewitz, Wolf"],["dc.contributor.author","Lauber, Heike"],["dc.contributor.author","Ortwein, Heiderose"],["dc.contributor.author","Pruskil, Susanne"],["dc.contributor.author","Schubert, Sebastian"],["dc.contributor.author","Sennekamp, Monika"],["dc.contributor.author","Silbernagel, Waltraud"],["dc.contributor.author","Scheffer, Simone"],["dc.contributor.author","Kiessling, Claudia"],["dc.date.accessioned","2019-07-10T08:13:28Z"],["dc.date.available","2019-07-10T08:13:28Z"],["dc.date.issued","2009"],["dc.description.abstract","Zielsetzung: Ziel des Projekts ist es, ein longitudinales Modell-Curriculum „Kommunikative und soziale Kompetenzen“ für die medizinische Ausbildung zur Diskussion zu stellen. Vorgehen und Ergebnisse: Auf einem 2-tägigen Workshop wurde interfakultär und interdisziplinär auf der Grundlage des „Basler Consensus Statements: Kommunikative und soziale Kompetenzen im Medizinstudium“ ein Curriculum entwickelt, das deutschsprachigen Fakultäten bei der Planung und Implementierung als Vorlage dienen kann. Das Modell lässt sich als Gesamt-Curriculum oder in Teilmodulen implementieren. Es kann auch bei der Umstellung auf Bachelor- und Masterstudiengänge genutzt werden. Das longitudinale Modell-Curriculum weist neben 131 definierten Ausbildungszielen geeignete didaktische Konzepte und Prüfungsformate auf und gibt Vorschläge, zu welchem Zeitpunkt die verschiedenen Fächer die entsprechenden Lernziele vermitteln können. Fazit: Mit diesem longitudinalen „Modell-Curriculum Kommunikative und Soziale Kompetenzen“ liegt für den deutschen Sprachraum erstmalig ein curriculares Instrument vor, das breite Anwendung an einer Vielzahl deutscher, österreichischer und schweizerischer Fakultäten finden und eine Umsetzung des Bologna-Prozesses auch fakultätsübergreifend vereinfachen kann."],["dc.identifier.fs","568395"],["dc.identifier.purl","https://resolver.sub.uni-goettingen.de/purl?gs-1/5966"],["dc.identifier.uri","https://resolver.sub.uni-goettingen.de/purl?gro-2/61254"],["dc.language.iso","de"],["dc.notes.intern","Merged from goescholar"],["dc.relation.issn","1860-3572"],["dc.relation.orgunit","Institut für Allgemeinmedizin"],["dc.relation.orgunit","Universitätsmedizin Göttingen"],["dc.rights","Goescholar"],["dc.rights.uri","https://goescholar.uni-goettingen.de/licenses"],["dc.subject.ddc","610"],["dc.title","Longitudinales, Bologna-kompatibles Modell-Curriculum \"Kommunikative und Soziale Kompetenzen\": Ergebnisse eines interdisziplinären Workshops deutschsprachiger medizinischer Fakultäten"],["dc.type","journal_article"],["dc.type.internalPublication","yes"],["dc.type.subtype","original_ja"],["dc.type.version","published_version"],["dspace.entity.type","Publication"]]

[["dc.bibliographiccitation.firstpage","250"],["dc.bibliographiccitation.issue","5"],["dc.bibliographiccitation.journal","European Archives of Psychiatry and Clinical Neuroscience"],["dc.bibliographiccitation.lastpage","252"],["dc.bibliographiccitation.volume","252"],["dc.contributor.author","Sommer, M."],["dc.contributor.author","Dieterich, Anja"],["dc.contributor.author","Ruther, Eckart"],["dc.contributor.author","Paulus, Walter J."],["dc.contributor.author","Wiltfang, J."],["dc.date.accessioned","2018-11-07T09:58:09Z"],["dc.date.available","2018-11-07T09:58:09Z"],["dc.date.issued","2002"],["dc.description.abstract","Electroconvulsive therapy (ECT) is a powerful antidepressive treatment, but its mechanism of action remains poorly understood. To clarify the influence of ECT on corticospinal tract excitability we tested the motor threshold, the motor evoked potential (MEP) input/output curve, and the intracortical excitability using transcranial magnetic stimulation in a depressed patient before and after successful treatment with ECT. Resting motor thresholds were increased bilaterally after treatment, and the input/output curve less steep. These results point to a decreased excitability of the corticospinal motor tract after successful ECT."],["dc.identifier.doi","10.1007/s00406-002-0387-0"],["dc.identifier.isi","000180340900010"],["dc.identifier.pmid","12451468"],["dc.identifier.uri","https://resolver.sub.uni-goettingen.de/purl?gro-2/37315"],["dc.notes.status","zu prüfen"],["dc.notes.submitter","Najko"],["dc.relation.issn","0940-1334"],["dc.title","Increased transcranial magnetic motor threshold after ECT - A case report"],["dc.type","journal_article"],["dc.type.internalPublication","yes"],["dc.type.peerReviewed","yes"],["dspace.entity.type","Publication"]]