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Biomedical subjects

A Korten

Publications and source records attributed to A Korten.

At least 19 recordsLinked to original sources
PubMed2003

Dimensional vs. categorical diagnosis in psychosis.

OBJECTIVE: To compare dimensional measures vs. categorical diagnosis of psychopathology in their prediction of disability and outcome in psychotic illness. METHOD: A community study of 980 subjects with psychotic illness was included in the Australian National Survey of Mental Health and Wellbeing. The study instrument [including the Schedules for Clinical Assessment in Neuropsychiatry (SCAN)] yielded symptom data along with Operational Criteria for Psychotic Illness (OPCRIT) diagnoses by several diagnostic schemata. Factor analysis of symptoms yielded five dimensions of psychopathology (positive symptoms, negative symptoms, dysphoria, mania and substance use). Variance in service demand and disability explained by the diagnostic schemata was compared with the variance explained by the dimensions of psychopathology. RESULTS: Dimensional measures of psychopathology explained more of the variance in service demand, dysfunctional behaviour, social adaptation and global occupation and function. Only use of support services and illness course were better predicted by categorical diagnosis. Dimensional scores explained significant extra variance when added to categorical diagnoses. CONCLUSION: Dimensional measures of psychopathology explain more variance in behaviour, disability and outcome than does categorical diagnosis in functional psychosis. Dimensions provided significant extra information not provided by diagnosis and would be a more useful basis for clinical management.

Adult↗
PubMed2001

Stroke and idiopathic Parkinson's disease: does a shortage of dopamine offer protection against stroke?

Data on the relationship between idiopathic Parkinson's disease (IPD) and stroke are conflicting. In this study, we examined the frequency of IPD in stroke patients registered in the Maastricht Stroke Registry. With the use of three different search strategies, we found eight individuals with IPD amongst a total of 1,516 stroke patients. We had expected to find approximately 30 IPD patients (relative risk 0.27; 95% confidence interval 0.11-0.53), based on IPD prevalence figures from a Dutch population-based study. We speculate that dopamine deficiency may protect against ischaemic brain damage, perhaps by reducing the effects of excitotoxicity.

Aged↗
PubMed2001

Non-disabled cases in a national survey.

BACKGROUND: Lifetime and 12-month prevalence estimates of mental disorders consistently reported in large-scale community surveys have met with deserved scepticism. A crucial variable is the extent to which people who are considered cases are also disabled by their symptoms. In a national population survey, we hypothesized that an administratively significant proportion of persons with anxiety or depressive disorders according to ICD-10 and DSM-IV would report no disability. METHODS: Interviews were sought on a nationally representative sample of people aged 18 and over across Australia. The Composite International Diagnostic Interview on laptop (CIDI-A) was used by professional survey interviewers to identify persons meeting ICD-10 or DSM-IV criteria for anxiety or depressive disorders in the previous 4 weeks, together with self-reported data on associated disability and medical consultations for the same period. RESULTS: In an achieved sample of 10,641 persons (response rate = 78%), no disability in daily life was reported by 28% of persons with an anxiety disorder and 15% with a depressive disorder by ICD-10 criteria; and by 20.4% and 13.9% respectively by DSM-IV. Non-disabled respondents had lower scores on two measures of psychological distress and markedly lower rates for having consulted a doctor for their symptoms. CONCLUSION: The ICD-10 and DSM-IV criteria for anxiety and depressive disorders, when applied to the information on symptoms elicited by the CIDI-A, inadequately discriminate between people who are and are not disabled by their symptoms. There may be a group of highly symptomatic people in the general population who tolerate their symptoms and are not disabled by them.

Adult↗
PubMed2001

The "common cause hypothesis" of cognitive aging: evidence for not only a common factor but also specific associations of age with vision and grip strength in a cross-sectional analysis.

A prominent hypothesis in cognitive aging is the existence of a common factor that is responsible for age-related deterioration in cognitive and noncognitive processes. A multiple indicators, multiple causes model was used to examine the nature of this common factor and its relationship to age, gender, and the apolipoprotein E (APOE) genotype. The common factor was modeled by using 10 indicator variables with 374 participants aged between 77.4 and 98.7 years. A latent factor was identified, with all indicators except blood pressure loading significantly. This factor could be established in 2 age strata within the sample. After controlling for the effects of gender, APOE, and level of education, direct effects of age were seen on visual functioning and grip strength. APOE was significantly associated with memory but not with the common factor. The findings suggest that a number of specific processes may operate concurrently with any common cause factor.

Aged↗
PubMed2000

Psychotic disorders in urban areas: an overview of the Study on Low Prevalence Disorders.

OBJECTIVE: This paper reports on a study designed within the framework of the National Survey of Mental Health and Wellbeing to: estimate the prevalence of psychoses in urban areas of Australia; identify profiles of symptomatology, impairments and disabilities; collect information on services received and needed; and explore quality of life issues in a broadly representative sample of people with psychotic illnesses. METHOD: The study was conducted over four areas in the Australian Capital Territory, Queensland, Victoria and Western Australia, as a two-phase survey: (i) a census and screening for psychosis of all individuals who made contacts with mental health services during a period of 1 month in 1997; and (ii) interviews with a stratified random sample (n=980) of the screen-positive individuals (n=3800) using a standardised instrument. RESULTS: The point prevalence (1 month) of psychotic disorders in the urban population aged 18-64 is in the range of 4-7 per 1000 with a weighted mean of 4.7 per 1000. People with psychotic disorders experience high rates of functional impairments and disability, decreased quality of life, persistent symptoms, substance-use comorbidity and frequent side effects of medication. Although the utilisation of hospital-based and community mental health services, as well as of public and non-governmental helping agencies, is high, the majority live in extreme social isolation and adverse socioeconomic circumstances. Among the many unmet needs, the limited availability of community-based rehabilitation, supported accommodation and employment opportunities is particularly prominent. CONCLUSIONS: The so-called 'low-prevalence' psychotic disorders represent a major and complex public health problem, associated with heavy personal and social costs. There is a need for a broad programmatic approach, involving various sectors of the community, to tackle the multiple dimensions of clinical disorder, personal functioning and socioeconomic environment that influence the course and outcome of psychosis and ultimately determine the effectiveness of service-based intervention.

Activities of Daily Living↗
PubMed2000

Characterising psychosis in the Australian National Survey of Mental Health and Wellbeing Study on Low Prevalence (psychotic) Disorders.

OBJECTIVE: This study examines the factorial structure of symptoms and signs in psychosis in data from the Study on Low Prevalence (psychotic) Disorders which is part of the National Survey of Mental Health and Wellbeing, Australia 1997-1998. METHOD: The present study examined a wide variety of symptoms taken from the Schedules for Clinical Assessment in Neuropsychiatry items and the substance use items in the Diagnostic Interview for Psychosis, an instrument specially constructed for the national study. The instrument was applied to 980 community and hospital subjects with a wide range of psychotic illness diagnoses. The data were factor analysed and scales of 'domains of psychopathology' derived. RESULTS: The data were best fitted by five principal factors ('domains') which can be approximately labelled dysphoria, positive symptoms, substance use, mania and negative symptoms/incoherence. These factors together explained 55.4% of variance in symptoms. Solutions with more numerous factors did not improve the representation. CONCLUSION: The five domains successfully characterise a large part of the variance in psychopathology found in the present study of low prevalence (psychotic) disorders. The approach allows sufferer's symptom range and severity to be well expressed without multiple comorbid diagnoses or the limits imposed by categorical diagnosis. Knowledge of alternative dimensional representations of psychopathology may usefully complement our use of categories, enhance awareness of symptoms and ensure that important psychopathology is heeded in practice and research.

Adult↗
PubMed2000

Efficacy of continuing advocacy in involuntary treatment.

OBJECTIVE: The effectiveness of an experimental model of personal advocacy for involuntarily hospitalized psychiatric patients was examined. In the model, a personal advocate represented the needs and best interests of patients throughout the period of involuntary hospital treatment. METHODS: The sample consisted of 105 involuntarily hospitalized psychiatric inpatients in Canberra, Australia. Fifty-three consecutive patients received personal advocacy, which started soon after they entered the hospital and lasted through the commitment process to the time of discharge from involuntary care. The outcome of this group was compared with that of 52 consecutive patients in a control group who received routine rights advocacy from hospital entry through the commitment hearing only. RESULTS: The experimental and control groups were similar in demographic characteristics, diagnosis, and severity of illness. At the start of hospital care, satisfaction with care was similar in both groups; however, it improved significantly in the experimental group while it declined in the control group. Aftercare attendance was significantly better in the experimental group. The experimental subjects' risk of involuntary rehospitalization was less than half the risk of control subjects, and community tenure was significantly increased. Clinical staff reported that the experimental advocacy facilitated management of patients. CONCLUSIONS: Compared with routine rights advocacy, the experimental advocacy based on patients' needs and best interests, which was maintained throughout the patients' involuntary hospitalization, significantly improved patients' and staff members' experience of involuntary treatment. Better compliance with aftercare among patients receiving personal advocacy led to a statistically and economically significant reduction in rehospitalization.

Adult↗
PubMed2000

The Australian National Survey of Mental Health and Well-Being. Common psychological symptoms and disablement.

BACKGROUND: The mental health of populations can be represented by case prevalence rates and by symptom scales. Scales have the advantage of identifying sub-syndromal levels of distress, which may be common and associated with considerable disability. AIMS: To examine the distribution of common psychological symptoms and associated disablement in the Australian population. METHOD: A household sample of 10,641 individuals representative of the adult population of Australia was interviewed using the Composite International Diagnostic Interview and completed scales measuring recent symptoms and disablement. RESULTS: Symptom scales showed similar associations with socio-economic variables as did diagnoses, although only a small amount of variance in symptom levels was explained by these variables. Considerable disablement was associated with symptom levels indicating distress but not reaching levels for formal diagnoses of anxiety or depression. CONCLUSIONS: Symptom scales provide parsimonious measures of psychological distress and are appropriate for use in large-scale surveys of mental health and disablement.

Adolescent↗
PubMed1998

Sex differences in the prevalence and detection of depressive and anxiety disorders in general health care settings: report from the World Health Organization Collaborative Study on Psychological Problems in General Health Care.

BACKGROUND: Understanding the relevance of biological and social factors to sex differences in the prevalence and detection of depressive and anxiety disorders has been impaired by the lack of standardized research methods across cultures. METHOD: Prevalence rates of depressive and anxiety disorders were assessed using a 2-stage design from 26,969 patients attending for primary care in 15 centers from 4 continents. Logistic regression analysis was used to examine sex differences in prevalence and detection across centers. RESULTS: Odds ratios for women compared with men of current depression (1.60; 95% confidence interval [CI], 1.37-1.86) and agoraphobia or panic (1.63; 95% CI, 1.18-2.20) were consistent across centers. The odds ratio for generalized anxiety varied among centers: 3 groups of centers were identified with odds ratios of 0.46 (95% CI, 0.27-0.78), 1.34 (95% CI, 1.08-1.66), and 3.09 (95% CI, 1.60-5.89). There was no sex difference in the detection of depressive and anxiety disorders by physicians across centers. CONCLUSIONS: The absence of a sex-by-center effect for current depression and agoraphobia or panic disorder is consistent with biological and psychosocial factors, either interacting or working alone, that have a similar final effect across cultures. It does not support the idea that sex differences in prevalence are caused by local psychosocial factors that vary from country to country. The variation in the odds ratio for generalized anxiety disorder offers some support to the idea that there are local differences between the centers contributing to the sex difference in rates. Patients' sex does not appear to affect the likelihood of current depression and anxiety being detected by primary care physicians.

Agoraphobia↗
PubMed1996

Activity levels and cognitive functioning in an elderly community sample.

The influence of self-reported and informant-reported activity levels on Crystallized Intelligence, Fluid Intelligence, Memory and the Mini-Mental State Examination was investigated in a sample of 858 community-dwelling elderly subjects. Both self-reported and informant-reported activity levels explained variance beyond that accounted for by sex, sensory functioning, activities of daily living, medical conditions, current health problems and education. Age accounted for additional variance once activity and the other contextual variables were entered. Interaction effects indicated that inactivity was associated with poorer performance on fluid intelligence in older rather than younger elderly subjects and that inactivity was predictive of poor crystallized intelligence at younger ages. Higher informant-rated activity levels moderated the effects of education, so that higher activity offset effects associated with low education on memory tasks. The mount of variance explained by activity levels was modest.

Activities of Daily Living↗
PubMed1995

Progress toward achieving a common language in psychiatry, II: Results from the international field trials of the ICD-10 diagnostic criteria for research for mental and behavioral disorders.

OBJECTIVE: In preparing for the publication of ICD-10, the Division of Mental Health of the World Health Organization developed several versions of chapter V, which deals with mental and behavioral disorders. The version for research purposes is called the Diagnostic Criteria for Research (ICD-10 DCR) and gives operational criteria for the diagnosis of mental disorders. This article describes the results of international field trials undertaken to evaluate the draft criteria and refine them further. METHOD: Data were obtained to assess interrater agreement, the confidence with which diagnoses could be made, and the ease of use of the criteria. Additional substudies examined the concordance between ICD-10 DCR, ICD-10 Clinical Descriptions and Diagnostic Guidelines, and other national classification systems (e.g., DSM-IV). The field trials were carried out at 151 clinical centers in 32 countries by 942 clinician/researchers who conducted 11,491 individual assessments of patients. Results for cases assessed by at least two raters are reported here. RESULTS: Most clinician/researchers found the criteria to be explicit and easy to apply. Interrater agreement was high for most diagnostic categories. For some categories, such as those dealing with certain polymorphic psychotic disorders or milder forms of affective disorders, the criteria were rated as somewhat difficult to use, and reliability was lower. Comparison of the results of these field trials with those of the ICD-10 Clinical Descriptions and Diagnostic Guidelines demonstrated that there are increases in interrater agreement when the operational criteria are used. CONCLUSIONS: The use of internationally accepted research criteria enhances the reliability of diagnosis of mental disorders made in research settings worldwide.

Adolescent↗
PubMed1994

Common mental disorders and disability across cultures. Results from the WHO Collaborative Study on Psychological Problems in General Health Care.

OBJECTIVE: To examine the impact of common mental illness on functional disability and the cross-cultural consistency of this relationship while controlling for physical illness. A secondary objective was to determine the level of disability associated with specific psychiatric disorders. DESIGN: A cross-sectional sample selected by two-stage sampling. SETTING: Primary health care facilities in 14 countries covering most major cultures and languages. PATIENTS: A total of 25,916 consecutive attenders of these facilities were screened for psychopathology using the General Health Questionnaire (96% response). Screened patients were sampled from the General Health Questionnaire score strata for the second-stage Composite International Diagnostic Interview administered to 5447 patients (62% response). MAIN OUTCOME MEASURES: Patient-reported physical disability, number of disability days, and interviewer-rated occupational role functioning. RESULTS: After controlling for physical disease severity, psychopathology was consistently associated with increased disability. Physical disease severity was an independent, although weaker, contributor to disability. A dose-response relationship was found between severity of mental illness and disability. Disability was most prominent among patients with major depression, panic disorder, generalized anxiety, and neurasthenia; disorder-specific differences were modest after controlling for psychiatric comorbidity. Results were consistent across disability measures and across centers. CONCLUSIONS: The consistent relationship of psychopathology and disability indicates the compelling personal and socioeconomic impact of common mental illnesses across cultures. This suggests the importance of impairments of higher-order human capacities (eg, emotion, motivation, and cognition) as determinants of functional disability.

Adolescent↗
PubMed1994

Symptom profiles of psychiatric disorders based on graded disease classes: an illustration using data from the WHO International Pilot Study of Schizophrenia.

The Grade of Membership (GoM) model is a classification procedure which allows a person to be a member of more than one diagnostic class. It simultaneously quantifies the degrees of membership in classes while generating the discrete symptom profiles or 'pure types' describing classes. The model was applied to the symptomatology, history, and follow-up of 1065 cases in the WHO International Pilot Study of Schizophrenia. The model produced an eight diagnostic class or 'pure type' solution, of which five were related to the diagnostic concepts of schizophrenia and paranoid disorder, two types were affective disorders, and one asymptomatic type. A subtype of paranoid schizophreniform disorder found primarily in developing countries was identified. There was a strong association between pure types and the original clinical and computer generated (CATEGO) diagnoses. A GoM based psychiatric classification might more clearly identify core disease processes than conventional classification models by filtering the confounding effects of individual heterogeneity from pure type definitions.

Adult↗
PubMed1992

The International Pilot Study of Schizophrenia: five-year follow-up findings.

A five-year follow-up of the patients initially included in the International Pilot Study of Schizophrenia was conducted in eight of the nine centres. Adequate information was obtained for 807 patients, representing 76% of the initial cohort. Clinical and social outcomes were significantly better for patients in Agra and Ibadan than for those in the centres in developed countries. In Cali, only social outcome was significantly better.

Activities of Daily Living↗
PubMed1990

Relatives' expressed emotion and the course of schizophrenia in Chandigarh. A two-year follow-up of a first-contact sample.

A two-year follow-up was conducted of a subsample of the Chandigarh cohort of first-contact schizophrenic patients from the WHO Determinants of Outcome project. The patients were those living with family members who had been interviewed initially to determine their levels of expressed emotion (EE). The interview was repeated for 74% of the relatives at one-year follow-up. A dramatic reduction had occurred in each of the EE components and in the global index. No rural relative was rated as high EE at follow-up. Of the patients included in the one-year follow-up, 86% were followed for two years. In contrast to the one-year findings, the global EE index at initial interview did not predict relapse of schizophrenia over the subsequent two years. However, there was a significant association between initial hostility and subsequent relapse. The better outcome of this cohort of schizophrenic patients compared with samples from the West is partly attributable to tolerance and acceptance by family members.

Attitude to Health↗