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Biomedical subjects

A Rohde

Publications and source records attributed to A Rohde.

At least 37 records · Page 2Linked to original sources
PubMed1993

[Psychoses in puerperium: symptoms, course and long-term prognosis].

86 women who suffered from a psychotic disorder for the first time in their life within 6 weeks after parturition, were investigated regarding sociodemographic and gynaecological parameters, time of onset and initial symptomatology, psychopathological symptoms during hospitalisation, treatment and short-term outcome of the illness. The majority of patients became ill after the first (75%), full-term normal (63%) delivery and within the first two postpartum weeks (78%). The most frequent initial symptoms were anxiety, restlessness, depressive mood, sleep disturbances, behaviour disturbances, catatonic excitement, delusions and hallucinations. By the time of follow-up investigation, 16 women had died; 61 women were investigated on average 25.6 years after onset (minimum 12, maximum 41 years), using standardised instruments of evaluation. Nearly two-thirds of the patients had suffered re-manifestation of psychotic disorder during a long-term course (64%). The frequency of re-manifestations of illness after additional pregnancies and deliveries was found to be 1:4, which is also known to be the expected frequency during the course of other psychotic disorders. These results do not justify the global recommendation to avoid additional pregnancies or carry out an interruption of pregnancy, if the patient has a history of postpartum psychosis. The climacteric period also seems to be a vulnerable phase for the re-manifestation of illness. Nearly 3/4 of the investigated women displayed no disturbances in any of the evaluated dimensions (psychopathological, psychological, psychosocial status) at the time of follow-up.

Adult↗
PubMed1993

Factors influencing the long-term outcome of schizoaffective disorders.

Factors influencing the long-term outcome of schizoaffective disorders were investigated in 101 patients with a mean duration of illness of 25.5 years. Univariate statistical analyses and stepwise multiple discriminance analyses were applied. The most important factors influencing the development of persisting psychosocial alterations proved to be the absence of pure melancholic episodes during course and life events at onset, and the presence of first rank schizophrenic symptoms, schizomanic-depressive mixed episodes, higher number of episodes and higher annual frequency of episodes. The most relevant factors influencing the development of negative social consequences due to the illness were found to be an asthenic/low self-confident premorbid personality and the higher number of episodes and cycles. There are only partial similarities with schizophrenic or affective disorders.

Adult↗
PubMed1993

[Prognosis of puerperal psychoses: follow-up and outcome after an average of 26 years].

61 women, who became ill for the first time in their life within 6 weeks after childbirth were investigated after a mean of 25.6 years (minimum 12, maximum 41 years), using various standardised instruments of evaluation. A total of 39 Patient (63.9%) had had a recurrence of illness, the average number of further episodes being 4.8. 31 of the women had had additional pregnancies and deliveries, and 8 of these (25.8%) had suffered another postpartum psychosis. 23.5% of the patients who had reached or passed the climacteric became ill again in close connection with that time (first time after the postpartum psychosis or first time after a relapse-free interval of more than 12 years). 72.1% of the patients were symptom-free at the time of follow-up, only 17 (27.9%) showed persisting alterations (13.1% "adynamic-deficient syndrome", 9.8% "slight asthenic insufficiency syndrome", 4.9% "chronic subdepressive syndrome"). Considering also the findings according to the Global Assessment Scale (GAS) and Disability Assessment Schedule (WHO/DAS) the long-term outcome was found to be favourable in the majority of cases, with regard to the frequency and intensity of disability and persisting alterations.

Adolescent↗
PubMed1992

Schizoaffective disorders with and without onset in the puerperium.

The premorbid and sociodemographic features, long-term course and long-term outcome (on average 23.8 resp. 26.8 years after onset of illness) were compared in 30 female schizoaffective patients with onset of their illness during the puerperium and 60 female schizoaffective patients with onset at other times. The majority of premorbid and sociodemographic variables as well as course parameters were similar in the two groups. Most of the few differences (in age at first manifestation, marital state at onset, presence of stable heterosexual relationship before onset, acuteness of onset, presence of life events) are closely connected with the inclusion and exclusion criteria applied for the puerperal disorders (exclusion of patients with preexisting illness or psychiatric symptoms during pregnancy, inclusion only if onset was within 6 weeks of parturition). The puerperal schizoaffective disorders began more frequently with a schizomanic episode and less frequently with a schizodepressive episode than did the non-puerperal schizoaffective disorders, a finding which perhaps reflected the "pathoplastic" role of the puerperium on psychotic disorders. Several significant differences were found regarding the long-term outcome (frequency of persistent alterations, level of global functioning and disability, non-achievement of the expected social development, loss of autarky), confirming earlier findings that puerperal disorders generally have a better outcome than other psychotic disorders.

Adolescent↗
PubMed1992

Validity of the negative/positive dichotomy for schizophrenic disorders under long-term conditions.

A total of 148 patients fulfilling the DSM-III symptomatological criteria of schizophrenia were classified according to Andreasen's criteria of positive, negative and mixed symptomatology. After excluding cases of permanent hospitalisation and patients with monoepisodic course the remaining 100 patients had a total of 458 episodes. Of these episodes, 213 were identified as positive, 134 as negative and 111 as mixed. During the course of illness the proportion of negative episodes increased and the proportion of positive episodes decreased. The great majority of the patients (76%) had a bimorphous course, i.e. one showing both types of schizophrenic symptomatology, positive and negative. Only 6% of the patients had only negative episodes, and only 18% had only positive episodes. The shift from one type of episode to another is dependent on the length of illness. Stability was not greater later during the course of illness than at the beginning.

Adult↗
PubMed1992

[Incidence and type of premenstrual symptoms in relation to experienced infertility: a comparative study].

Using the symptomatological criteria of "Late Luteal Dysphoric Disorder" according to DSM-III-R, the frequency and type of premenstrual symptoms were investigated in a group of 405 infertile women (participants in an in-vitro-fertilisation programme at the University of Bonn) and a control group of 101 female medical students. 84% of both groups of women reported premenstrual psychological and/or physical changes. 52% of the infertile patients and 42% of the students fulfilled the symptomatological criteria of late luteal dysphoric disorder. Comparing both groups, it was found, that infertile women reported significantly more often mood lability, anger/irritability, anxiety/tension and loss of interest.

Adult↗
PubMed1991

Stability of diagnoses in affective, schizoaffective and schizophrenic disorders. Cross-sectional versus longitudinal diagnosis.

The present study investigated the syndrome shift during the course of disease in 355 patients with functional psychoses. The mean observation time was 25.2 years. Every episode was diagnosed cross-sectionally as schizophrenic, melancholic, manic, manic-depressive mixed, schizodepressive, schizomanic or schizomanic-depressive mixed. With regard to the whole course, 148 patients fulfilled the diagnostic criteria of schizophrenic, 106 of affective and 101 of schizoaffective disorders. Patients with a schizophrenic initial episode showed the greatest stability: 90% had no other type of episode. The majority of patients who suffered a melancholic initial episode remained unipolar melancholics or developed manic symptomatology, and only a few suffered schizoaffective or schizophrenic episodes. Patients with a manic symptomatology at the beginning had a very unstable and changeable course. The stability of patients with initial schizodepressive episodes lay between that of patients with melancholic initial episodes and that of those with manic initial episodes. The findings demonstrate the relevance of longitudinal considerations in making the final diagnosis.

Bipolar Disorder↗
PubMed1991

[Phenomenologic constellations of persistent alterations in idiopathic psychoses. An empirical comparative study].

The long-term outcome of 355 patients with affective, schizoaffective and schizophrenic disorders was evaluated after long duration of the illness (mean more than 25 years). All patients were personally interviewed using operational instruments (PSE, WHO/DAS, WHO/PIRS, GAS, Huber's Psychopathological Criteria). By application of descriptive methods, integrating operationally estimated findings with clinically-impressively estimated "interactional atmosphere", we defined eight types of phenomenological constellations of persistent alterations ("residual-types") of functional disorders: "depletion syndrome", "apathetic-paranoid syndrome (resp. apathetic-hallucinatory syndrome)", "adynamic-deficient syndrome", "chronic psychosis", "structural deformation", "asthenic insufficiency syndrome", "chronic subdepressive syndrome", and "chronic hyperthymic syndrome". It was found a different distribution of persistent alterations in affective and schizophrenic disorders while schizoaffective disorders occupied a position in-between. The differences in the phenomenology of persistent alterations are interpreted as the result of differing biological and psychological processes. It was also found that the phenomenology of persistent alterations is related to the degree of disability.

Adult↗
PubMed1991

[Affective, schizoaffective and schizophrenic psychoses. A comparative long-term study].

A total of 402 patients were followed up for, on average, 25 years after the onset of their illness. The diagnoses, made longitudinally, were as follows: schizophrenic disorder (n = 148); schizoaffective disorder (n = 101); affective disorder (n = 106). The remaining 47 patients did not fulfil the criteria for any of these diagnoses. A distinction was made between "episode" (cross-sectional diagnosis) and "illness" or "disorder" (longitudinal diagnosis). The "episodes" (cross-sectional diagnosis) were classified according to slightly modified DSM-III criteria into schizophrenic, affective (melancholic, manic, manic-depressive mixed), schizoaffective (schizodepressive, schizomanic, schizomanic-depressive mixed) and non-characteristic episodes. The criteria for the episodes are: Schizophrenic episode: criteria of DSM-III, slightly modified. Melancholic episode: according to "Major Depression, Melancholic Type" of DSM-III-R. Manic episode: according to the criteria of DSM-III, slightly modified. Manic-depressive mixed episode: Presence of manic and depressive symptomatology during one episode. Schizodepressive episode: Presence of schizophrenic and depressive symptomatology during one episode. --Schizomanic episode: presence of schizophrenic and manic symptomatology during one episode. Schizomanic-depressive mixed episode: Presence of schizophrenic, manic and depressive symptomatology during one episode. The diagnosis of an "illness" or "disorder" (longitudinal diagnosis) took account of all the kinds of episodes that occurred during the whole course. The final diagnosis (longitudinal diagnoses) were defined as follows: Schizophrenic disorder: only schizophrenic episodes during the whole course Affective disorder: only affective episodes during the whole course (melancholic, manic, manic-depressive mixed episodes). Schizoaffective disorder: at least one schizoaffective episode during the course (schizodepressive, schizomanic, schizomanic-depressive mixed episode), independently of the type and number of other episodes, or sequential manifestation of schizophrenic and affective episodes. The principal instruments of investigation and evaluation were: Global Assessment Scale (GAS); Disability Assessment Schedule (WHO/DAS); Psychological Impairment Rating Schedule (WHO/PIRS); Present State Examination (PSE); Criteria for social class and social mobility according to Kleining and Moore (also transferred to the criteria of Hollingshead and Redlich) - A pool of items based on WHO instruments for social parameters; Items for pharmacological treatment and prophylaxis.

Activities of Daily Living↗
PubMed1990

The concept of distinct but voluminous groups of bipolar and unipolar diseases. I. Bipolar diseases.

One hundred and six affective (76 unipolar and 30 bipolar) and 101 schizoaffective patients (45 unipolar and 56 bipolar) were investigated after a long-term course of illness, evaluating sociodemographic and general data, the long-term course of illness, disability and psychosocial alterations according to WHO/DAS, WHO/PIRS and GAS, as well as several social consequences of the illness (living situation at the end of the observation time, downward occupational drift, downward social drift, premature retirement, achievement of the expected social development). Comparing the 30 bipolar affective and 56 bipolar schizoaffective disorders, no differences were found regarding (a) sociodemographic and general data (i.e. sex distribution, age at onset, education and occupation at onset, stable heterosexual relationship, premorbid personality and social interactions, mental illness in the family, broken home, life events, season of birth and social classes) and (b) relevant patterns of the long-term course. Regarding long-term outcome, the only difference found concerned the more favourable outcome of the bipolar affective disorders according to WHO/DAS, while using GAS the difference was not statistically significant. No difference was found either between the two bipolar groups in the social consequences of the illness. The combining of both bipolar groups as "bipolar diseases" is discussed, as well as the use of the terms "bipolar disease, affective subtype" and "bipolar disease, schizoaffective subtype".

Adult↗
PubMed1990

The concept of distinct but voluminous groups of bipolar and unipolar diseases. II. Unipolar diseases.

Seventy-six unipolar affective and 45 unipolar schizoaffective patients were compared using the same instruments as mentioned in part I of this study (this issue). In contrast to bipolar diseases significant differences regarding age at onset were found between the unipolar groups: schizoaffective unipolar patients became ill at a significantly lower age than affective unipolar patients (about 8 years). No other sociodemographic differences were found between the two groups. Patterns of course were found to be similar in both unipolar groups. Unipolar affective patients had a more favourable long-term outcome (GAS and WHO/DAS) than unipolar schizoaffective ones. Altogether, unipolar affective and unipolar schizoaffective disorders seems to have more similarities than differences.

Activities of Daily Living↗
PubMed1990

The concept of distinct but voluminous groups of bipolar and unipolar diseases. III. Bipolar and unipolar comparison.

Comparing unipolar diseases (n = 121) as one group with bipolar diseases (n = 86) as another group (both groups including affective and schizoaffective disorders) relevant differences were found in sex distribution, age at onset, premorbid personality, long-term course and some aspects of long-term outcome. Although building two voluminous groups of "unipolar diseases" and "bipolar diseases" runs some risk of inhomogeneity, this danger could perhaps be limited by referring to the "affective subtype" and the "schizoaffective subtype".

Activities of Daily Living↗
PubMed1990

[Disability and residual symptoms in schizoaffective psychoses--data, methodologic problems and references for future research].

Schizoaffective disorders take a position between schizophrenia and affective disorders regarding outcome in the sense of psychological residuum and social consequences. What prognosis a schizoaffective illness has depends mainly on intrasymptomatological factors: Melancholic episodes during course seem to predict a good long-term outcome, schizophrenia-typical symptoms in the opposite predestinate to the development of residuum and disability. Non-symptomatological factors do not have any direct influence on the development of a residuum and disability. The comparison of course studies is limited by severe difficulties based on methodological and definitional shortcomings. Such shortcomings are (a) broad definition of schizoaffective but also of schizophrenic psychoses, (b) globalization of the term "outcome", (c) partialization of the term "prognosis", (d) equalization of the terms "course" and "outcome", (e) ignoring of inhomogeneity and polymorphism of schizoaffective disorders, (f) global evaluation of "outcome", (g) short follow-up periods. Some suggestions how to limitate the mentioned methodological shortcomings are discussed.

Disability Evaluation↗
PubMed1990

Psychopathological and social status of patients with affective, schizophrenic and schizoaffective disorders after long-term course.

A total of 106 affective, 101 schizoaffective and 148 schizophrenic disorders were investigated after a long-term course of illness (mean follow-up period 25.1 years), employing narrow definitions and using reliable international instruments of evaluation. In addition, the social consequences of the illness were evaluated (upward and downward social and occupational drift, premature retirement and achievement of the expected social development). Considering all aspects of outcome, schizophrenic patients (narrow defined, slightly modified DSM-III criteria) had persistent alterations in several aspects of social life, communication and cognitive functions, in some cases to a very high degree. Although the outcome of affective disorders is not always favourable, it is significantly more favourable than that of schizophrenia. Schizoaffective disorders occupy a position between affective and schizophrenic disorders regarding outcome, but with more similarities to that of affective than to that of schizophrenic disorders.

Adolescent↗
PubMed1989

Long-term outcome of schizoaffective and schizophrenic disorders: a comparative study. I. Definitions, methods, psychopathological and social outcome.

The long-term outcome of 72 schizoaffective and 97 schizophrenic patients with a mean duration of illness of 25.6 years and 19.6 years respectively was investigated. The outcome was assessed using the WHO Disability Assessment Schedule (WHO/DAS), the Psychological Impairment Rating Schedule (PIRS) (also developed by the WHO), the Global Assessment Scale (GAS), and the Bonn Psychopathological Criteria of Outcome. The outcome of schizoaffective disorders was found to differ from that of schizophrenia in several ways: (a) schizoaffectives achieve a full remission significantly more frequently than schizophrenics (50% vs 10%); (b) the development of so-called characteristic schizophrenic residua is the exception in schizoaffective disorders, but is frequent in schizophrenia; (c) disability, psychological impairment and disturbances of the level of functioning are not only significantly less frequent in schizoaffective disorders but are also less intense than in the schizophrenic group. The factors influencing the outcome of the two disorders are different (see part II), as are the social consequences (part III).

Adult↗