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A Riecher-Rössler

Publications and source records attributed to A Riecher-Rössler.

At least 37 records · Page 2Linked to original sources
PubMed1997

[50 years after Manfred Bleuler. What do we know today about late-onset schizophrenia(s)?].

Since Manfred Bleuler's description of the clinical picture of late onset schizophrenia over 50 years ago, debate has persisted as to whether it is justifiable to differentiate this as a valid, independent entity from the group of classic schizophrenic disorders with early onset. As this review shows, this question cannot be answered unequivocally even now. It must rather be remarked that we have neither been able to decisively extend our knowledge since Manfred Bleuler's comprehensive contribution, nor managed to achieve a much sounder basis methodologically. The reasons for this are the international conceptual and terminological confusion that has developed around this illness group, and on the other hand the methodological limitations of the empirical studies conducted on this clinical picture so far.

Dementia↗
PubMed1997

[Psychiatric disorders and illnesses after childbirth].

After childbirth, from about a quarter up to nearly one half of all puerperae develop a short-lasting, mild affective distress, the so called blues. During the first months after delivery, about 10-15% of all young mothers suffer from a longstanding depression which is so severe that they are in need of treatment. In one or two out of 1000 women even a psychotic disorder becomes manifest. These postpartal disturbances and diseases are often not diagnosed by doctors-on the one hand because the women concerned often hide their complaints due to shame and a sense guilt regarding their supposed failure as a good mother, on the other hand because these syndromes until now have not found enough attention in German-as opposed to Angloamerican-medicine. Yet, these disorders-apart from the blues-are very serious ones with potentially severe consequences for the mother, the baby and possibly the whole family. Women with mental disorders in their family history and especially their own history are at an increased risk. They should be informed about this and, in certain cases, be treated preventively. Women with depressive and psychotic disorders are, especially in the postpartal time, in urgent need of treatment which, depending on type and severity of the disorder, should consist of psychotherapy, frequently also pharmacotherapy, and social care. Special needs of the postpartal period such as breast-feeding or the mother-infant relationship have to be considered which often requires close cooperation of the psychiatrist/psychotherapist, the gynaecologist and the pediatrician.

Depression, Postpartum↗
PubMed1995

Case management for schizophrenic patients at risk for rehospitalization: a case control study.

In many countries deinstitutionalization of psychiatric patients is accompanied by fragmentation of care, giving responsibility to an array of different services and providers. One of the possible side effects of this is an increased rehospitalization rate and length of stay. The need to coordinate the services involved for the benefit of individuals has led to the conceptual development of case management. However, despite an apparent belief in the effectiveness of case management, there is only limited scientific evidence to support this assumption. In the case control study presented we compared a group of 97 schizophrenic patients in the aftercare of case management services with a group of patients who received no outpatient care by case management services after discharge from hospital. Each patient in the case-managed group was exactly matched with a control patient with regard to diagnosis and known risk factors for rehospitalization. Additionally, we considered influencing factors that result from general health system conditions such as regional differences and different types of hospital care. Our analyses demonstrate that, during an observation period of 2.5 years, case management had neither a significant effect on the risk of rehospitalization nor on the length of time in hospital in the event of rehospitalization.

Adult↗
PubMed1995

Late-onset schizophrenia and late paraphrenia.

The term "late-onset schizophrenia" was first coined by Manfred Bleuler (1943) to describe a form of schizophrenia with an onset between the ages of 40 and 60. This concept has been adopted by German psychiatry. Until recently, British and American psychiatrists had little interest in this patient group. However, they often used the term "late-onset schizophrenia" interchangeably with late paraphrenia or as a generic term for both these diseases, even though the concept of late paraphrenia is quite different from that of late-onset schizophrenia. Late paraphrenia is a British concept that includes all delusional disorders starting after age 60. This confusion of terms and concepts is even more important now, because recent neuroimaging and neuropsychological studies suggest that an organic substrate probably exists in most cases of late paraphrenia, while only minor organic abnormalities can be found in late-onset schizophrenia. We believe it is of utmost importance to establish a clear boundary between late-onset schizophrenia and other delusional disorders in middle and old age, because the confusion in terminology and concepts is a serious impediment to comparative international research.

Adult↗
PubMed1995

Symptom assessment in casenotes and the clinical diagnosis of schizophrenia.

It is well known from several international studies that the incidence rates for schizophrenia, based on first-admission samples, are low in Denmark, especially in females, compared with other countries. This might be due to special diagnostic traditions in Denmark. To analyze how Danish psychiatrists reach a diagnosis of schizophrenia, a stratified subsample of 122 cases out of all 1,259 patients, aged between 12 and 64 years, with a first hospital admission in 1976 under the diagnosis of schizophrenia, paranoid psychosis, acute reactive paranoid psychosis, or casus limitaris was selected. For this subsample, psychopathological symptoms, as documented in the clinical casenotes, were rated by PSE-9 symptom lists for subsequent CATEGO analysis. The core syndrome of schizophrenia, as defined by the CATEGO class S+, showed no association with the clinical schizophrenia diagnosis compared with the other diagnoses mentioned. Also, positive symptoms of schizophrenia did not determine the diagnosis, but for typical negative symptoms such associations were indicated. Some negative symptoms also seemed to be linked to a depressive state. Furthermore, the present work indicates that using first-admission data leads to a higher age at schizophrenia onset and a lower first-admission rate in Denmark compared with Germany.

Adolescent↗
PubMed1994

[Do estrogens have an antipsychotic action?].

Within the framework of our ABC study, an epidemiological study on schizophrenia (Häfner et al., 1989, 1991 a; Riecher et al., 1991), we were able to show that the mean age at onset of the disease is 3-4 years higher in women than in men and that women have a second peak of onsets after 45 years of age. In a systematic analysis we developed and tested different psychosocial and biological explantory hypotheses. The oestrogen hypothesis could be identified in the course of this analysis as the most plausible one. According to this hypothesis (Häfner, 1987) female sex hormones enhance the vulnerability threshold for schizophrenia. In this case women from puberty to (pre-)menopause would be protected from the outbreak of the disease to a certain extent by their high physiological oestradiol production; they would, however, later "draw level" in respect of morbidity risk. Animal experiments conducted to test this hypothesis and to explain the underlying pathophysiological mechanism implied that oestradiol can modulate the sensitivity of dopamine-D2-receptors in the brain (Häfner et al., 1991 b; Gattaz et al., 1992). In the clinical study presented, we examined the validity of the oestrogen hypothesis in humans. We tested, whether the acute symptomatology of schizophrenic patients fluctuates with oestradiol serum levels during the female menstrual cycle. We examined 32 acutely admitted schizophrenic women during their hospital stay by analysing hormonal parameters and applying various rating scales for psychopathology on certain days of the cycle. A significant association emerged between oestradiol levels on the one hand, and psychiatric symptomatology, behaviour on ward, paranoid tendencies and general well-being, on the other.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

Can estradiol modulate schizophrenic symptomatology?

Using epidemiologic data, in an earlier study we formulated the hypothesis that estrogens can delay the onset of schizophrenia in females by raising the vulnerability threshold for this disease. In animal experiments, Häfner and colleagues found evidence that chronic estradiol treatment reduces the sensitivity of dopamine (D2) receptors in the brain. In the clinical study presented in this article, as a further step we examined the antipsychotic properties of estradiol in human females by testing whether schizophrenic symptomatology varies with estradiol serum levels throughout the menstrual cycle. We examined 32 acutely admitted female schizophrenia patients (Present State Examination/CATEGO diagnosis, ICD-9) with a history of regular menstrual cycles, ages 18 to 43 (mean = 30.5), during their hospital stays (3-8 weeks), analyzing hormonal parameters and applying various rating scales for psychopathology every 7 days. In all patients, estradiol serum levels were markedly reduced as compared with the normal population, and fluctuations throughout the cycle were dampened. Nevertheless, a significant association emerged between estradiol levels, on the one hand, and psychopathology scores, on the other--that is, the psychiatric symptomatology as assessed by the clinical psychiatrist (Brief Psychiatric Rating Scale, p < or = 0.01), behavior on the ward as assessed by the nursing staff (Nurses' Observation Scale for Inpatient Evaluation p < or = 0.01), paranoid tendencies and general well-being as assessed by the patients themselves (Paranoid-Depressivitäts-Skala paranoid score p < or = 0.05; Befindlichkeits-Skala p < or = 0.05). Psychopathology seems to improve when estradiol levels rise, and vice versa. These findings can be interpreted as further evidence for a protective effect of estrogens in schizophrenia, possibly due to the known anti-dopaminergic activities of these hormones.

Adolescent↗
PubMed1994

Organic factors and the clinical features of late paranoid psychosis: a comparison with Alzheimer's disease and normal ageing.

The diagnostic allocation and aetiological basis of paranoid psychoses with late onset is controversial. We examined the clinical features of patients with a diagnosis of paranoid psychosis and we compared their cranial computed tomography (CT) scans and electroencephalographic (EEG) recordings with findings from matched samples of patients with Alzheimer's disease and non-demented elderly controls. During a 5-year period, 81 patients (15 men and 66 women) with a diagnosis of paranoid psychosis and onset after age 50 were referred to our Institute. They represent 5.4% of the patients older than 50 admitted during the same period. More than half of these patients had first-rank symptoms. The ventricles, anterior and sylvian fissures of the paranoid group were larger than in non-demented controls but smaller than in Alzheimer's disease. The posterior dominant alpha EEG rhythm was slower than in normal aging and faster than in Alzheimer's dementia. If paranoid patients with first-rank symptoms were distinguished from the ones without, the former had less severe brain atrophy and faster posterior dominant rhythm, although they received higher doses of neuroleptics. This could be explained by the existence of at least 2 subgroups of late paranoid psychosis: late-onset schizophrenia and organic paranoid syndrome, the former characterized by first-rank symptoms and less severe brain atrophy, the latter by more severe EEG and CT scan changes with a closer resemblance to degenerative brain disease.

Aged↗
PubMed1994

Validation of Danish case register diagnosis for schizophrenia.

The ABC schizophrenia study aims at investigating sex differences in age of onset, symptoms and course of schizophrenic and paranoid disorders. For this purpose, we used case register data from Denmark and Mannheim and a directly examined sample of first admissions (ABC sample). The Danish case register sample included less clinical diagnoses of schizophrenia and more schizophrenia-related disorders (acute paranoid reaction, paranoid states and borderline schizophrenia) than the Mannheim data (case register and ABC sample). The problem therefore was whether the two datasets are comparable and the results are valid. For this reason a randomized, stratified sample of 116 patients was drawn from the Danish case register sample. The case notes of these 116 patients were requested from the hospitals where the patients had been treated and analyzed by means of a scoring sheet based on the Interview for the Retrospective Assessment of the Onset of Schizophrenia (IRAOS). The use of operationalized diagnoses of the CATEGO program, based on PSE items, which are integrated in IRAOS, demonstrated that the samples of the Danish and the Mannheim case registers and the directly investigated ABC sample have comparable diagnostic distributions. Possible explanations for the differences between the clinical and the CATEGO diagnoses in the Danish case register may be the frequent use of diagnoses of borderline schizophrenia and reactive psychoses (previously called psychogenic psychoses), and above all a more narrow concept of schizophrenia; in Denmark, schizophrenia is diagnosed relatively late, i.e., after the presence of enduring negative symptoms, and thus mostly after the appearance of residual state.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

Wilhelm Griesinger and the concept of community care in 19th-century Germany.

Wilhelm Griesinger, a 19th-century German physician, can be considered one of the founders of the concept of community-based care for mentally ill patients. In an era when such patients typically spent most of their lives in asylums in remote rural areas, be recommended their integration into society and proposed that short-term treatment of acutely ill patients could be carried out in asylums that were located in cities and linked to general hospitals. He believed that short-term hospitalization could be effective only if professional and natural support systems cooperated closely. Although he did not assume that all mental illnesses could be cured, he thought that most patients should be discharged from long-term treatment in remote asylums. For those unable to live without support in the community, be suggested setting up sheltered living conditions. Although his ideas about community-based care were rejected by his contemporaries in favor of a system of rural asylums, many of Dr. Griesinger's suggestions are now being put into practice.

Community Mental Health Services↗
PubMed1994

[Current status and developments in psychiatric care. A European comparison].

In most European countries several reform indicators point to a marked change in psychiatric care during the last three decades. Almost everywhere the size of psychiatric hospitals was reduced and the number of beds decreased. The development in the outpatient and complementary sector is less clear. Different European countries provide sheltered living accomodations, workshops and outpatient treatment to varying degrees. Comparably complex are financing and legal grounds of psychiatric treatment. Beside still existing institutional deficits, the negative attitude of the public toward mentally ill and psychiatric care is a serious obstacle for further implementation of community based psychiatric care.

Commitment of Persons with Psychiatric Disorders↗
PubMed1994

The epidemiology of early schizophrenia. Influence of age and gender on onset and early course.

For the investigation of the early course of schizophrenia starting from onset, the standardised Interview for the Retrospective Assessment of the Onset of Schizophrenia was developed and validated. In a representative sample of 267 first-admitted German schizophrenics of a broad diagnosis from a population of 1.5 million, the age at which different diagnostic and onset definitions were satisfied, the symptoms at the time of the interview, and the accumulation of positive and negative symptoms until first admission were assessed. Comparison between the two sexes and three age groups yielded hardly any differences in the accumulation of symptoms and their course until first admission, except for a slightly shorter period of negative symptoms in young males and a slightly longer one in older women--which contradicts prevailing opinion. At the time of the interview, no significant sex differences were found with respect to the core symptoms of schizophrenia (negative and first-rank symptoms), but clear and substantial differences emerged in disease behaviour. The significantly higher age at first onset in women is explained, on the basis of animal experiments and a clinical study, by the neuromodulatory effect of oestrogen on D2 receptors and by a higher vulnerability threshold in women.

Adolescent↗
PubMed1994

[Psychiatric rehabilitation of chronic psychiatric and mentally handicapped patients].

Since the beginning of psychiatric reforms, all efforts for the chronically mentally ill have been directed toward a life in dignity in the community. Only in the eighties have such measures been integrated into the concept of psychiatric rehabilitation. In connection with the development of new rehabilitative strategies, this indicates a change in the attitudes toward mentally ill persons. The newly developed measures are directed toward the psychological impairment and the social disability. Today, the obstacles in psychiatric rehabilitation are based mainly on the discrimination against chronically mentally ill compared to physically disabled persons.

Activities of Daily Living↗
PubMed1993

Schizophrenia and oestrogens--is there an association?

Some early psychiatrists already believed that schizophrenic disorders were associated with a disturbed balance of sexual hormones. This belief was based on the observation of a. an "insufficient functioning of the sexual glands" with so-called "hypoestrogenism", and b. an influence of ovarian function on schizophrenic psychoses. As this review shows, there are findings from recent research which seem to confirm that estrogens may have a protective effect in schizophrenia. There are also occasional hints at a possible "hypoestrogenism" in schizophrenia. In our own epidemiological, clinical and animal studies the hypothesis of a protective effect of oestrogens was for the first time systematically examined and confirmed. Oestrogens seem to modulate the sensitivity of D2-receptors in the brain, and clinically they seem to have a neuroleptic-like effect. These findings may have important implications for the prevention and therapy of schizophrenic disorders. Furthermore, our findings indicate the need to reinvestigate the question of a disturbed balance of sexual hormones in schizophrenic disorders. Further research on the role of oestrogens in schizophrenic disorders could in our opinion contribute to understanding the still unclear, possibly aetiologically heterogeneous pathogenetic mechanism of schizophrenic psychoses.

Age Factors↗
PubMed1993

Generating and testing a causal explanation of the gender difference in age at first onset of schizophrenia.

Motivated by the lack of knowledge of the pathophysiological processes underlying the manifestation of symptoms in schizophrenia, we have worked out a systematic search strategy. Since epidemiological distribution patterns consistently deviating from expected values provide valuable indications of causal relationships, we chose the higher age of females at first admission for schizophrenia, first reported by Kraepelin and since then confirmed in over 50 studies, as the basis for our study. This unexplained epidemiological finding was replicated on Danish and Mannheim case-register data by systematically controlling for selection and diagnostic artefacts and by testing alternative explanations at the individual stage of the study. To check whether the difference in age at first admission was determined by a difference in age at onset, a representative sample of 267 first-admitted patients with non-affective functional psychosis was examined by using an interview for the retrospective assessment of the onset of schizophrenia (IRAOS) designed for this purpose. Any of the definitions of first-ever onset applied--first sign of mental disorder, first psychotic symptom, first acute episode--led to a significant age difference of 3.2 to 4.1 years between the sexes. The distribution of onsets across the life cycle showed a later increase and a second, lower peak between the ages of 45 and 54 years among females compared with males. The lifetime risk for schizophrenia was equal for males and females. After testing the plausibility of psychosocial versus biological explanations we hypothesized that due to the effect of oestrogens the vulnerability threshold for schizophrenia is elevated in females until the menopause. Animal experiments and post mortem analyses showed that chronic oestrogen applications significantly shortened dopamine-induced behaviour and reduced D2 receptor sensitivity in the brain. The applicability of this pathophysiological mechanism to human schizophrenia was tested on acutely schizophrenic females with normal menstrual cycles. A significant negative correlation was found between measures of symptomatology and plasma oestrogen levels. The manifestation of symptoms in schizophrenia appears to be influenced by a sufficiently sensitive D2 receptor system in the brain, blocked by neuroleptics and modulated by oestrogens.

Age Factors↗
PubMed1993

Compulsory admission of psychiatric patients--an international comparison.

The frequency of compulsory admissions to psychiatric hospitals varies considerably between countries and regions. However, the differences are partly artificial, as the figures available are not fully comparable; this is mainly owing to differing definitions of "compulsory" and the methodological shortcomings of most studies in this field. In addition, there are also clear real differences, most of which result from different legislation and administrative regulations. Characteristics of the patient that influence the risk of compulsory admission include diagnosis and certain sociodemographic and social factors. Most studies, however, are based on highly selected populations. Furthermore, the results depend heavily on the commitment frequency of a country and therefore eventually also on the restrictiveness of legislation. The lack of methodologically sound studies, internationally comparable data and internationally published information is regrettable, as international comparison and discussion would certainly be valuable, especially for countries that are in the process of re-evaluating their commitment criteria and mental health legislation.

Commitment of Persons with Psychiatric Disorders↗