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Biomedical subjects

H Helmchen

Publications and source records attributed to H Helmchen.

At least 19 recordsLinked to original sources
PubMed2001

[Therapeutic effectiveness. Effects, effectiveness and value of therapeutic interventions].

Terms such as efficacy and efficiency of treatment are presently taking on growing importance for medical practice. Two examples are the increasing limitation of cost reimbursement to evidence-based, scientifically proven therapeutic measures and assessment of efficiency in terms of budgeting. We briefly discuss the definition and application of important terms and concepts in this context and ethical and methodological problems involved.

Clinical Trials as Topic↗
PubMed2001

[Subthreshold psychological disorders].

Subthreshold psychic disorders are mild, masked, atypical, or intense but brief psychopathological syndromes below the threshold of standardized diagnoses. They indicate beginning, intermittent, or residual states of well-known psychic disorders or ("comorbid") syndromes associated to other psychic or somatic disorders or possibly partially morbid states by themselves. At least the subthreshold depressions and anxiety disorders are more than twice as frequent as specified diagnosable psychic disorders and have serious consequences with regard to both individual suffering and cost. Primarily they are a problem for primary medical care. It is mainly up to the general practitioner to recognise beginning or residual psychic disorders underlying disturbed well-being or uneasiness in order to treat them preventively or curatively or to co-treat such comorbid states in somatic diseases. Open questions of research and possible consequences for health policy are discussed.

Comorbidity↗
PubMed2001

Psychiatrists' diagnoses of subthreshold depression in old age: frequency and correlates.

BACKGROUND: Depressive syndromes not fulfilling the criteria for specified disorders (subthreshold depression, SD) may be clinically important. We aimed to study SD in old and very old age, in comparison with subjects with no depressive symptoms (NDS) and subjects with major depression (MD). METHODS: A community-based random sample of 516 subjects, age 70 to 100 years and over, stratified by age and sex, was examined. All participants were investigated by psychiatrists and by geriatricians independently. RESULTS: In 16.5% (N = 85) of the study subjects SD was identified. Study subjects with SD had, similarly to the subjects with MD, significantly more somatic diagnoses and used more somatic as well as psychotropic medications than the subjects with NDS. Self-ratings and observer ratings of depression indicated that SD was a milder depressive state than MD. CONCLUSIONS: Compared with MD, SD is probably a milder form of depression. The increased use of psychotropic medications indicates that at least a portion of these individuals have a disorder requiring treatment. One of the characteristics of SD is co-morbidity with somatic illnesses and physical disability.

Aged↗
PubMed2001

[Clinical research methods].

The methodology of clinical research will be commented upon according to the components of the research design: a precise question, hypotheses derived from that which can be examined empirically, the biometrical estimation of the sample size and its practicability, the selection of control groups, measures for assessing psychopathological phenomena, analysing the data and preparing the findings for publication, further the time structure of the research project, and some aspects of the framework of clinical research: patient access, financing of the needed resources and ethical implications.

Humans↗
PubMed2000

[Ethical aspects of clinical neuroscience].

This paper deals with ethical implications of neuroscientific research on patients as well as with the application of its results in diagnosis and treatment for brain diseases, in which a considerable demand for research exists due to their high frequency, long duration, disabling consequences, and unsatisfactory or nonexistent treatment possibilities. Such indispensable research on patients calls forth the basic ethical tension between respect of autonomy and dignity of the sick individual (as well as the avoidance of somatic and psychic risks and burdens) and the ethically justified demand for flawless research in recognizing, preventing, reducing, or eliminating disability and suffering caused by disease. The demand for research today also results from the increasing orientation of insurance companies towards scientifically proven evidence of the efficacy and safety of medical interventions: "evidence-based medicine." This is illustrated by 3 examples: (1) use of fetal brain tissue/cells from planned abortions in patients in therapy-resistant final stages of Parkinson's disease and the effects of neurotransplantation on the recipients, (2) research with demented patients incompetent to give informed consent, and (3) predictive (presymptomatic, prenatal) testing in the genetic counseling of individuals from families with Huntington's chorea. We conclude that adherence to high ethical standards is of inestimable significance, not only for those participating in research but also for public acceptance of that research. This is particularly valid in Germany, where nonobservance and the undermining of ethical principles was grossly practiced in the first half of this century on the slippery descent into the abyss. Therefore, continued scrutiny with the increasing variety of ethical problems in medical research is demanded. However, this will be achieved not by taboos and prohibitive regulations but only through open discussion between scientists, particularly probands in research, patients' relatives, and the public. This leads to four demands: listening honestly and openly, both in single cases and in the public sector, training in recognition and consideration of ethical problems, and reducing unfavorable conditions such as complex bureaucratic regulations, negative public views, overzealous efficiency, and insufficient time. Sufficient numbers of qualified personnel are needed who are trained in listening and who will have the time to do so.

Dementia↗
PubMed2000

Ranges of psychiatric morbidity in the old and the very old--results from the Berlin Aging Study (BASE).

The purpose of this study was to determine prevalence rates of psychiatric morbidity in the elderly, distinguishing different levels of psychiatric caseness as compared to the diagnoses of the DSM-III-R. In a cross-sectional population-based study in Berlin (West), Germany, 516 people aged 70 to 95+ were randomly selected from the obligatory city registry (1990-1993) and stratified by age and gender (N = 43 men and N = 43 women in each of six 5-year age groups). Psychiatric and physical examinations were carried out in an extensive standardized assessment. Distinct psychopathological syndromes occurred in 72.7% of the elderly (54.6% of the men, 79.1% of the women). A clinically defined psychiatric disorder was found in 49.4% of the elderly (95% confidence interval 43.9%- 54.9%; 36.4% of the men, 54.0% of the women). Excluding insomnia, the overall psychiatric morbidity was 40.4% (30.9% m, 43.8% w). Excluding clinical diagnoses that were not otherwise specified in the DSM-III-R, the overall prevalence of specified DSM-III-R diagnoses was 23.5% (16.3% m, 26.0% w). Excluding dementia, which is known to be age-related, the prevalence was 11.3% (8.5% m, 12.2% w) and no significant effect between the age groups was seen. A considerable proportion of clinically relevant psychiatric morbidity in the elderly does not meet the criteria of specified DSM-III-R diagnoses, although these cases are in need of care. The data show that the threshold and severity of caseness accounts for important differences when overall psychiatric morbidity is assessed.

Aged↗
PubMed2000

From the Hawaii Declaration to the Declaration of Madrid.

The Declaration of Hawaii, adopted by the World Psychiatric Association (WPA) in 1977, was a significant event. But the needs and new ethical dilemmas of the 1990s led WPA to develop new recommendations on the duties of psychiatrists resulting in the Declaration of Madrid, adopted by WPA in 1996. It outlines the framework of ethical conduct of psychiatrists, formulates seven general guidelines with an increased emphasis on research and resource allocation, and gives five specific guidelines on euthanasia, torture, the death penalty, selection of sex, and organ transplantation.

Capital Punishment↗
PubMed1998

[Depression in the very elderly].

In the Berlin Aging Study (BASE) an age and gender stratified sample of 516 persons aged 70 to over 100 was assessed by means of the semi-structured GMS-A interview, the CES-D-self-rating scale and the Hamiltion-Depression-observer-rating scale. Prevalence rates were 4.8% for Major Depression, 9.1% for all DSM III-R specified depressive disorders and 26.9% of subthreshold depression was included. There was no increase in prevalence rates with age but an increase in scores on the self rating CES-D. The prevalence rates for DSM III-R specified depression in females was 10.3% and almost double that of men (5.6%). Depressed persons do not show significant cognitive impairment as measured with the MMSE in comparison to controls. As compared to the total sample higher prevalence rates of overall depression were seen in persons with multimorbidity (36.8%) and lower rates in married persons. 13.2% of the elderly talked about feeling tired with life, 7.9% had thoughts about death and 1.2% reported suicidal ideation, which was closely linked to depressive disorders. In 44% of depressed cases undertreatment was observed. Only 6% got Antidepressants but 40% benzodiazepines.

Aged↗
PubMed1998

[Normal and pathological cognitive aging].

The relation of age associated changes of cognitive functions to those of dementia diseases is not well investigated for very old age. Because aging as well as dementia diseases are associated with cognitive deficits, this leads to differential diagnostic problems in very old age. Relevant with respect to this differentiation are on the one hand the concepts of cognitive ageing, the dementia syndrome and dementia diseases, and on the other hand empirical findings with respect to 1. the neuropsychological crossectional pattern, 2. the premorbid intelligence or adult intelligence level, 3. the speed of decline. ad 1. The speed of cognitive processes shows a considerable reduction in normal aging. However, the reduction of learning and orientation as well as pronounced word-finding problems seem to be characteristic of the development of a dementia syndrome. ad 2. The importance of the level of adult intelligence is demonstrated by the possibility that a very old person with low adult intelligence level is diagnosed as demented without suffering from one of the dementia diseases. In the opposite case of a slowly progressive dementia disease in a person with a superior level of adult intelligence a diagnosis of dementia according the standard criteria can be given only in an advanced stage of the disease. ad 3. The importance of the speed of decline of cognitive performance for the diagnosis of dementia is discussed (e.g. < 1 point of the MMSE vs > 3 MMSE points per year). An optimization of the time course criterion (change-sensitive tests and an empirically determined cut-off) could improve the early dementia diagnosis, which relies up to now mostly on crossectional features. The more precise assessment of the deterioration speed would be an opportunity to investigate the factors or processes which determine the deterioration speed, knowledge of which in turn would be a starting point for development of therapy.

Adult↗
PubMed1997

[Dementia in the very elderly. Results of the Berlin Aging Study].

The frequency of dementia in very old subjects, the risk factors and the consequences of the disease were investigated in the Berlin Aging Study in an age- and gender-stratified design (ages 70-103 years, n = 516). Psychiatrists diagnosed a dementia syndrome according to DSM-III-R, applying the GMS-A and HAS interviews. The dementia frequency steeply increases until the 90-94 year group, but there is no further exponential increase for the 95+ group--instead for men the data show a plateau of dementia prevalence. Low education level turned out to be a risk factor, which explains the gender effect in a logistic regression analysis. The apolipoprotein E4 genotype was confirmed as a risk factor--however, only for the older subjects (85+). Dementia was a major reason for institutionalization. The 2-year mortality was no higher in dementia than for age-matched non-demented controls. The results gave a detailed picture of dementia in the very old. This is a prerequisite for planning facilities for psychiatric diagnostics and therapy as well as nursing care.

Aged↗
PubMed1997

[Informed consent in psychiatry--European standards and differences, problems and recommendations].

Development and state of regulations and ethical debates of "informed consent" in 9 European countries are exposed. Commonalities and differences in significance, evaluation, and use of information, capacity to consent, and voluntariness as prerequisites of a valid consent are discussed with regard to care/dure and research. Consequently recommendations for regulations, research, teaching, and practice of "informed consent" and for research with incapacitated patients are given. The legal doctrine of "informed consent" tries to realize or even to operationalize the ethical demand for respect towards dignity and autonomy of the patient. This is particularly relevant in psychiatry because many states of mental disorders may impair the capacity to consent and the internal as well as external freedom of the patient. Validity, reliability, practicability, and acceptance of criteria and procedures of assessment of capacity to consent and of voluntariness of the patient, substitutes in the case of loss of these prerequisites of "informed consent", and its limitations, e.g. by the other ethical principle of the "best interest" of the patient or by his sociocultural context, are in need to be evaluated empirically in practice.

Cross-Cultural Comparison↗
PubMed1996

[Psychiatric morbidity in the oldest old. Results of the Berlin Aging Study].

An increasing life expectancy leads to a higher number of persons aged 70-84 years and persons aged 85 years and older. Information concerning changes in the spectrum of psychiatric morbidity is rare. The Berlin Aging Study was based on a representative age- and gender-stratified sample (n = 516) of Berlin citizens aged 70-100 years and older. In this inter-disciplinary study, an intensive investigation was carried out by psychologists, sociologists, internists and psychiatrists. This report focuses on subjectively reported complaints (Beschwerdeliste, BL), observed psychopathological symptomatology (Brief Psychiatric Rating Scale, BPRS) and psychiatric diagnoses following the criteria of DSM-III-R (based on the Geriatric Mental State Examination, GMSA). On the self-rating scale (BL) 10% of all persons reported severe subjective complaints, 32% moderate complaints. On the BPRS, 17% showed severe psychopathological symptomatology, 75% at least mild symptoms. Following the criteria of DSM-III-R, 23.5% of all persons had a psychiatric disease, 4.2% a disease of severe intensity. When the DSM-III-R diagnoses "Not Otherwise Specified" (NOS) were included 40.4% of all subjects were diagnosed by the clinical judgement of the psychiatrists to have a psychiatric disease. The most frequent psychiatric diseases were insomnia (18.8%), depression NOS (17.8%) and dementia (13.8%). Dementia showed the well-known age-related increase, whereas no other incidences of psychiatric morbidity were age-related. Persons aged 70-84 years did not differ in the investigated psychiatric variables from persons aged 85 years and older, the only exception being the prevalence of dementia.

Aged↗