Search PubMed⌕ Search

Biomedical subjects

A Riecher-Rössler

Publications and source records attributed to A Riecher-Rössler.

At least 19 recordsLinked to original sources
PubMed2006

Early detection and treatment of schizophrenia: how early?

OBJECTIVE: Whereas early detection and therapy of schizophrenic psychoses until some time ago concentrated on frank schizophrenia, during the last years some centres have also started to treat patients even before a clear diagnosis could be established. This paper attempts to discuss if and when this is justified in the light of recent research. METHOD: Mini review of literature. RESULTS: The rationale for early detection and treatment of schizophrenia is based on several observations: diagnosis and treatment of schizophrenia are often seriously delayed. Consequences of the disease are severe already in the early undiagnosed phase of the disorder and early treatment seems to improve the course of the disease. It can therefore be stated quite safely that patients should be treated as early as possible. However, the question of how early has not been sufficiently answered up to now. CONCLUSION: We are at the moment in an ethical dilemma between either diagnosing and treating this disorder too late or too early. The only way and prerequisite for solving this dilemma is a more reliable identification of individuals at risk and the beginning disease process.

Diagnosis, Differential↗
PubMed2006

Radiological findings in individuals at high risk of psychosis.

OBJECTIVE: To assess the prevalence of radiological magnetic resonance imaging (MRI) findings in individuals at high risk of schizophrenia. METHODS: MRI scans from individuals at high risk of schizophrenia (HR; n = 37) were assessed by a radiologist blind to group status and compared with scans from patients with first episode psychosis (FE; n = 30), depressive controls (DC; n = 17), and healthy controls (HC; n = 26). RESULTS: There was a significantly higher proportion of radiological findings in individuals at high risk of schizophrenia (35%) and patients with first-episode psychosis (40%) than in patients with depression (18%) or healthy controls (12%). These differences were specific to findings regarded as potentially clinically significant as opposed to normal variants; however, there was no indication for medical treatment. CONCLUSIONS: The results suggest that a large proportion of those at high risk of psychosis have radiological findings on MRI scanning, and that the prevalence of radiological findings in this group is similar to that in patients with first episode psychosis.

Adolescent↗
PubMed2004

[Chronic subdural hemorrhage in a patient with suspected schizophrenia prodrome].

A patient showing "prodromal symptoms" of suspected psychosis was referred to our clinic specialized in early recognition of schizophrenia where an MRI brain scan showed a chronic subdural hemorrhage. Based on this case, it will be shown that organic brain disease, in addition to incipient schizophrenia, needs to be considered in patients with marked personality changes, social withdrawal, aggressiveness, and suspiciousness. Diagnosis of the first episode and prodromal stage of schizophrenia should include-apart from the case history as well as the psychopathological and physiological findings-certain obligatory medical examinations (EEG, cCT, or MRI) in order to identify possible organic causes and avoid misdiagnoses.

Adult↗
PubMed2003

[Estrogens and the gonadal axis. Implications for women with schizophrenia].

Estrogens significantly influence the mental states of women and probably modulate many mental diseases. Concerning schizophrenic psychoses, there is increasing evidence for a protective effect of estrogens on the one hand and gonadal dysfunction and hypoestrogenism in many women with schizophrenia on the other. This results in the urgent need to pay more attention to the gonadal axis and estrogen status in women with schizophrenia, both in research and in practice.

Antipsychotic Agents↗
PubMed2003

[Group therapy for depression during early motherhood: first results of a pilot study].

Although depression occurs frequently during early motherhood, specific psychotherapy relevant to the needs of mothers of small children is still rare. Therefore, a group therapy programme for depressive mothers with children from pregnancy up to preschool age was developed and implemented. This manualised group therapy consisted of 12 group sessions and one session with each couple. The main therapeutic method was cognitive behavioural therapy. In addition, educational and systemic therapy components were used. Five consecutive treatment groups with 31 participants were evaluated by using Beck Depression Inventory (BDI), Symptom Checklist (SCL-90-R), and several other scales. Depressive symptom decrease was significant in all groups, and mother-child interaction improved as perceived by the mothers. This newly conceptualised group therapy proved to be effective and well accepted by the participants. Further investigations such as comparing group therapy with standard therapy are necessary to confirm these preliminary results.

Adult↗
PubMed2003

Postpartum depression: do we still need this diagnostic term?

OBJECTIVE: The diagnostic term 'postpartum depression' is still widely used. This paper attempts to discuss if this is still justified in the light of recent research. METHOD: Comprehensive review of literature. RESULTS: Postpartum depression is not a specific entity in terms of having a specific aetiology. Rather, giving birth to a child with all its biological and psychosocial consequences seems to act as a major stressor, which - within a general vulnerability-stress model - can trigger the outbreak of the disease in predisposed women. Nevertheless, it might still be justified to continue the use of this diagnostic term, as depression in early motherhood confronts us with specific needs. Thus, help-seeking is often delayed due to shame and stigma, and diagnosis is often missed due to misinterpretation of symptoms. Services often do not meet these women's needs adequately, as they do not take into account their specific situation, problems and fears. Untreated, postpartum depression can have especially severe long-term consequences, not only for the mother but also for the child and the whole family. Therefore, special attention and special treatment is necessary. This necessitates modifications of our pharmacological, non-pharmacological and psychotherapeutic treatment and also provision of new low-threshold mother-infant services. CONCLUSION: Although postpartum depression is not a specific entity from an aetiological point of view, the diagnostic term [as 'specifier', as in the Diagnostic and Statistical Manual (DSM)-IV)] should not be abandoned, as depression in the postpartum period confronts us with specific needs for care.

Adult↗
PubMed2003

Neuropsychological and neurophysiological findings in individuals suspected to be at risk for schizophrenia: preliminary results from the Basel early detection of psychosis study - Früherkennung von Psychosen (FEPSY).

OBJECTIVE: Our study aims to establish a scientific basis for the very early detection of patients at risk for schizophrenia during the nonspecific prodromal phase of the disorder and to predict its outbreak. METHOD: A multidomain approach is used. After screening, approved psychopathological, neurophysiological, neuropsychological and neuroradiological investigations are used to assess a sample of individuals suspected to be at risk for schizophrenia. RESULTS: Neuropsychological and fine motor functioning tests as well as eye movement measurements showed statistically significant differences (P<0.01) between individuals suspected to be at risk for schizophrenia and healthy controls. CONCLUSION: Individuals suspected to be at risk for schizophrenia show specific impairments in various investigations including neuropsychological and fine motor functioning tests as well as eye movement measurements. A set of methods sensitive to even subtle changes in normal functioning may prove useful in predicting the subsequent outbreak of schizophrenia.

Adult↗
PubMed2002

Oestrogen effects in schizophrenia and their potential therapeutic implications--review.

Increasing evidence from clinical as well as from epidemiological and basic research shows that oestrogens exert protective effects in schizophrenia. A brief overview of these protective effects will be provided, and potential therapeutic implications will be discussed. If these effects are confirmed, they could have important implications for prophylaxis and treatment. For instance, consideration would need to be given to oestrogen replacement in peri- and postmenopausal women with schizophrenia, adjunct oestrogen therapy in women with oestrogen deficiency syndromes, cycle-modulated neuroleptic therapy in women with frequent perimenstrual relapses, and/or emphasis on prolactin-sparing atypical neuroleptics in women with hypoestrogenism. Further research is urgently needed since there may be direct therapeutic benefits for women.

Antipsychotic Agents↗
PubMed2001

[Schizophrenia and delusions in middle aged and elderly patients. Epidemiology and etiological hypothesis].

Knowledge of the similarities and differences between early- and late-onset schizophrenia and between late-onset schizophrenia and paranoid disorder of old age and very old age is fragmentary. We compared diagnosis, subtypes, syndromes and symptoms between first-episode schizophrenia (ICD-9: 295) and paranoid disorder (ICD-9: 297, 298.3/4.) over the life cycle in a population-based (N = 232) and a clinical first-admission sample (N = 1109). Apart from different age patterns of the sexes only two symptom groups were significantly different between early- and late-onset illness: paranoid and systematic delusions showed a linear increase, symptoms of disorganisation a linear decrease over the life cycle. Clearly different between early- and late-onset illness were the neurobiological and psychological risk factors, suggesting that both neurodevelopmental and neurodegenerative disorder causes psychopathology typical of schizophrenia. Late- (40 to 60) and very-late-onset (over 60) cases of both groups of illness showed the same symptom profiles, merely the number of symptoms being higher in the group diagnosed with schizophrenia. Age was the only factor significantly contributing to a clinico-diagnostic differentiation of schizophrenia from paranoid disorder beyond age 40.

Adolescent↗
PubMed2000

Gender aspects in schizophrenia: bridging the border between social and biological psychiatry.

OBJECTIVE: This paper tries to show that gender differences in mental diseases are a valuable paradigm for research into the interplay between biological and psychosocial factors--not only regarding pathogenetic mechanisms, but also concerning therapeutic approaches. METHOD: Based on relevant literature, this topic is highlighted using schizophrenia as an example. RESULTS: Schizophrenic disorders show a later age of onset in women and a slightly better course, especially in young women. As to pathogenesis, there is some evidence that the age difference might be due at least partly to the female sex hormone oestradiol being a protective factor. Differences in course might also have to do with this biological factor, but at the same time with the psychosocial advantages of a higher age of onset and other psychosocial factors. Concerning therapy, these gender differences have important implications for pharmacotherapy, but also psychotherapy and social measures. CONCLUSION: A gender-sensitive approach in psychiatry improves our understanding of mental illness and our therapeutic strategies and at the same time illustrates that comprehensive psychiatry cannot be practised in artificially separated 'drawers' called 'biological psychiatry', on one hand, and 'social psychiatry' on the other.

Adult↗
PubMed2000

[Not Available].

A gender-sensitive psychiatry and psychotherapy takes into account the characteristics of mental disorders in both genders, in diagnostics as well as in therapy. It thereby not only contributes to quality assurance in our practical work, but also to patient-satisfaction. Teaching and training in this area have, so far, been neglected in German speaking countries, and research is also mainly done in Angloamerican countries. But especially in this area, findings cannot easily be transferred from one culture to another. Furthermore, research on gender differences and influencing factors - biological, psychological and social ones - as well as their interactions are of outstanding importance for research on mental disorders in general.

Gender↗
PubMed1998

The ABC Schizophrenia Study: a preliminary overview of the results.

The ABC Schizophrenia Study, a large-scale epidemiological and neurobiological research project commenced in 1987, initially pursued two aims: (1) to elucidate the possible causes of the sex difference in age at first admission for schizophrenia and (2) to analyse the early course of the disorder from onset until first contact and its implications for further course and outcome. First, transnational case-register data (for Denmark and Germany) were compared, second, a population-based sample of first-episode cases of schizophrenia (n = 232) were selected and third, the results obtained were compared with data from the WHO Determinants of Outcome Study by using a systematic methodology. A consistent result was a 3-4 years higher age of onset for women by any definition of onset, which was not explainable by social variables, such as differences in the male-female societal roles. A sensitivity-reducing effect of oestrogen on central D2 receptors was identified as the underlying neurobiological mechanism in animal experiments. Applicability to humans with schizophrenia was established in a controlled clinical study. A comparison of familial and sporadic cases showed that in cases with a high genetic load, the sex difference in age of onset disappeared due to a clearly reduced age of onset in women, whereas in sporadic cases it increased. To analyse early course retrospectively, a semistructured interview, IRAOS, was developed. The early stages of the disorder were reconstructed in comparison with age- and sex-matched controls from the same population of origin. The initial signs consisted mainly of negative and affective symptoms, which accumulated exponentially until the first episode, as did the later emerging positive symptoms. Social disability appeared 2-4 years before first admission on average. In early-onset cases, social course and outcome, studied prospectively over 5 years, was determined by the level of social development at onset through social stagnation. In late-onset cases, decline from initially high social statuses occurred. Socially negative illness behaviour contributed to the poor social outcome of young men. Symptomatology and other proxy variables of the disorder showed stable courses and no sex differences. Further aspects tested were the sequence of onset and the influence of substance abuse on the course of schizophrenia, primary and secondary negative symptoms, structural models and symptom clusters from onset until 5 years after first admission.

Adolescent↗
PubMed1998

The course of schizophrenic psychoses: what do we really know? A selective review from an epidemiological perspective.

There is only a limited amount of definite knowledge on the course of schizophrenic psychoses, although 100 years have passed since they were first described by Kraepelin as "Dementia praecox". The main reason for this is that most studies done thus far suffer from more or less serious methodological shortcomings: samples were often highly selective; investigations were often not direct, not prospective and almost never continuous, which would be of utmost importance in an episodic disease such as schizophrenia; assessments in older studies were neither standardized nor tested for validity or reliability; in more recent studies they were often not conducted by experienced psychiatrists; patients who refused to participate or who died during the study period were widely neglected. Nevertheless, we have learned that schizophrenic psychoses do not have a steadily deteriorating course ending in "dementia". On the contrary, the course of these psychoses seems very heterogeneous. Due to their methodological shortcomings, studies done thus far even seem to have underestimated heterogeneity by partly neglecting patients with very good outcome, on the one hand, and very poor outcome, on the other hand.

Humans↗
PubMed1998

Is schizophrenia a disorder of all ages? A comparison of first episodes and early course across the life-cycle.

BACKGROUND: The heterogeneity of schizophrenic and delusional syndromes by age of onset has frequently been discussed. METHODS: The age distribution of symptoms and 5 year course was studied in a population-based first-episode sample admitted to 10 psychiatric hospitals before the age of 60 (N = 232) and in a clinical sample without age limit of consecutive first admissions to a single hospital (N = 1109), both samples with broadly diagnosed schizophrenia. RESULTS: Early-onset patients, particularly men, presented more non-specific symptoms and higher PSE-CATEGO total scores than late-onset patients. In men, symptom severity decreased with increasing age of onset. In women, it remained stable except for an increase of negative symptoms with late-onset. Only a few symptoms changed markedly with age: disorganization decreased, while paranoid and systematic delusions increased steeply across the whole age of onset range. Pronounced age- and sex-differences emerged in illness behaviour, socially negative behaviour and substance abuse. Within the group of late-onset psychoses there were continuous transitions in symptom profiles and no discrimination between schizophrenia and paranoid psychosis or late paraphrenia. The main determinant of social course was onset level of social development. Early-onset patients did not improve in social status, while late-onset patients, prior to retirement, suffered considerable decline in social status. CONCLUSIONS: Gender differences in age at onset and in age trends in symptom severity support the hypothesis of a mild protective effect of oestrogen. Social course results from an interplay between biological factors (age at onset and functional impairment) and development factors (level of social development at onset and illness behaviour).

Adolescent↗
PubMed1998

Causes and consequences of the gender difference in age at onset of schizophrenia.

The ABC (age, beginning, course) schizophrenia study was commenced in 1987 to generate and test hypotheses about pathogenic aspects of schizophrenia. One of the main branches of the study focused on how gender influences the age distribution of onset, symptomatology, illness behavior, and early course in schizophrenia. Proceeding from one of the rare, strikingly deviating, consistent findings--the gender difference in age at first admission--we launched a systematic search for explanations by generating and testing hypotheses in a series of substudies. We moved from the epidemiological to the neurobiological and finally to the clinical level. The present article is an attempt to provide a brief overview of the individual stages of the ABC study and the different levels of investigation involved in formulating and testing the estrogen hypothesis in animal experiments and in demonstrating its applicability to human schizophrenia. From these results, three hypotheses were formulated and tested on data from an ABC study sample of 232 first-episode cases of schizophrenia. The analyses described here represent the latest stages of the ABC study.

Adolescent↗
PubMed1998

[The course of schizophrenic illnesses].

There is only a limited amount of safe knowledge on the course of schizophrenic psychoses, although 100 years have passed since their first description as "Dementia praecox". 2 main reasons may account for this: On the one hand most studies suffer from more or less serious methodological shortcomings, which do not allow to generalize the results. On the other hand schizophrenic psychoses are possibly not one homogeneous disease with one uniform etiology and a relatively uniform course, but rather a group of diseases with hetereogenous causes and therefore hetereogenous courses as well.

Female↗
PubMed1997

What do we really know about late-onset schizophrenia?

Actual knowledge on classical late-onset schizophrenia, i.e. the schizophrenic disorders with onset after age 40 years, is reviewed regarding incidence, symptomatology and course. As is shown, sound empirical knowledge is scarce. Reasons for this are, on the one hand, the conceptual and terminological confusion which has occurred internationally regarding this illness group, and, on the other hand, the methodological limitations of the empirical studies conducted on this clinical picture thus far. If we only draw on classical late-onset schizophrenia, as originally defined by Bleuler, and primarily on methodologically sound studies, as well as on own studies, we can nevertheless conclude that the term "late-onset schizophrenia" could be omitted. Late-onset schizophrenia does not seem to be a distinct entity, but instead seems to belong to the same illness group as classical schizophrenia with earlier onset. Slight differences in symptomatology and course are probably due to unspecific influences of age. The markedly higher proportion of women among late-onset cases, as well as our finding that symptomatology and course of late-onset women are comparably poor, could possibly be explained by an effect of the female sex hormone oestradiol.

Age of Onset↗