Biomedical subjects
Publications and source records attributed to H Katschnig.
Background, discussion and results of a study involving a survey conducted on the prevalence of hypertension, the consumption of psychotropic substances in cooperation with a polling-institute that employed fifty physicians trained in interviewing techniques.
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Six new developments in the classification and diagnosis of functional mental disorders are described. These are: the standardization of data collection, the formulation of operational diagnostic criteria, the multiaxial approach to psychiatric diagnosis, the development of compromise classification systems, the polydiagnostic approach, and, finally, the idea of validating diagnostic concepts instead of taking them for granted. The merits and pitfalls of each of these new developments are discussed. It is concluded that both the traditional categorical diagnostic approach and the introduction of diagnostic compromise systems are an obstacle to progress in psychiatric research. On the other hand, a blind belief in operational diagnostic criteria also has its drawback. Only efforts at standardized data collection, at using a multiaxial and polydiagnostic approach, and regarding psychiatric diagnoses as hypothesis, will contribute to progress in psychiatric research.
By comparing six different operational diagnostic systems (International Classification of Diseases, Diagnostic and Statistical Manual; 3rd ed., Research Diagnostic Criteria, St. Louis criteria, Taylor criteria and Vienna Research Criteria), the data presented in this paper illustrate how attribution to various categories of functional psychoses varies according to the applied algorithms. Bleuler's basic symptoms are obviously considered by all of the compared systems to be more significant for attribution to schizophrenia than first-rank symptoms.
The relationship between diagnostic assignment and specific symptomatology on admission and the duration of the first hospital stay was investigated in 200 patients with a functional psychosis. There were considerable differences in the mean duration of stay in hospital for patients fulfilling different diagnostic criteria for schizophrenia: the broader the concept of schizophrenia, the shorter the duration of stay. In looking at symptomatology, it could be demonstrated that patients with formal thought disorder had the highest mean duration of first inpatient episode.
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The results of recent research indicate that the traditional subdivision of depressive disorders into a "biological" ("endogenous") and a "psychosocial" ("neurotic") type cannot be upheld in this simple categorical form today. This is demonstrated by referring to such new developments as the construction of international compromise classification systems, the formulation of operational research diagnosis criteria, attempts at validating diagnostic formulations by external variables (such as biological markers) and the introduction of multiaxial diagnostic systems. The use of a "polydiagnostic" approach to psychiatric research is recommended, i.e. to use several diagnostic formulations for subtyping depression simultaneously in psychiatric research. It is anticipated that by applying the "polydiagnostic" approach the growing uncertainty and confusion in the subclassification of depression can be reduced.
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A review is presented of recently developed forms of therapeutic work with relatives of psychiatric patients. Using the dimensions of "dominance of the expert" and "dominance of the relative" a typology of work with relatives is presented, which besides different forms of group work encompasses also "family therapy" at the one end of the spectrum and "self-help" at the other end.
The social environment in a psychic crisis situation is of great importance for the mode of action chosen to cope with the crises. Using suicide and the different characteristics of persons, who successfully attempted or completed suicide, as an example, different strategies are presented. Three questions of special importance are mentioned: 1. the question, as to what triggered the crisis; 2. the question of the social network and the quality of relationship and 3. the question, when the affected person and his social network were confronted with the problems.
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For treatment of hypertensive emergencies 36 patients received an intravenous bolus of 100 mg labetalol. The mean blood pressure of the whole group was decreased from 220/128 mm Hg to 167/107 mm Hg. Mean heart rate dropped from 85 to 76 per minute. 7 patients did not respond to treatment. Thereafter 4 patients received a second dose of 100 mg or 500 mg labetalol respectively, whereupon 2 showed a distinct drop in blood pressure. Simple handling and intensive efficacy and the lack of troublesome side effects recommend labetalol for the treatment of hypertensive emergencies.
This publication presents data concerning the prevalence of virus hepatitis B in dialysis patients and the dialysis staff of the Medical University Clinic Graz and describes means of controlling this infectious disease.
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Cerebral blood flow (CBF ml/100g/min) was measured by 133Xenon in 24 patients before and after haemodialysis (HD) and in 27 normal persons. A wide scatter of the absolute CBF values were observed to correlate with the haematocrit, whereas blood pressure, pCO2 and weight loss during HD did not. Before HD, when compared with the control group, the patients showed a distinct elevation of CBF due to the severe anaemia of this group. Though there was only a slight increase in haematocrit post-dialysis a return to normal of the post-dialysis CBF was observed. In order to achieve comparative data the CBF values were corrected mathematically to a normal haemoglobin (160g/L) and the adjusted mean pre-dialysis CBF value was within the normal range and decreased to the lowest limit of normal after HD. A significant decline in CBF was observed with increasing age and length of time on HD. When compared with normal the age-dependent decline was about twice as high and showed a 10-fold decrease with the time on HD treatment. When we grouped the patients with regard to the CBF values the following results were obtained: in eight patients CBF was elevated before HD and showed a return to normal after HD. These were younger patients with greater predialysis over-hydration and lower blood pressure. A distinctly reduced CBF was observed in nine patients and remained unchanged after HD. This group included older patients with a higher blood pressure. The reaction of CBF suggests three types of patients with different vascular reactivity to fluid excess: young normotensive patients with high vascular fluid storage capacity, patients with hypertensive vascular reactivity and patients with vascular damage.
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