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Biomedical subjects

J Angst

Publications and source records attributed to J Angst.

At least 37 records · Page 2Linked to original sources
PubMed1991

The natural history of anxiety disorders.

The article reviews research and presents our results on the natural history of 2 forms of anxiety disorder, panic disorder and generalized anxiety disorder. Data from our epidemiological cohort study give evidence of premorbid anxiousness and overadaptation already in childhood. Distressing conditions in the family are more prevalent among subjects with anxiety disorders or major depression than among controls. Anxiety disorders frequently begin between age 20-30 and can be triggered by life events. The course is often characterized by a certain chronicity that manifests itself in residual symptoms and mild impairment in social roles even after many years and is frequently complicated with depression. The best predictors are severity and duration of symptoms, as well as comorbidity with depression. Future studies of the natural history should take into account these factors in multivariate approaches.

Anxiety Disorders↗
PubMed1991

Long-term prognosis of schizophrenia.

The question of determining prognostically relevant features for schizophrenia was approached with multivariate statistical methods applied to the data from the Bonn longitudinal study of 502 schizophrenic patients. In this study, personal interviews according to a clinical classification scheme allowed every patient to be ranked within each of three different outcome classes: psychopathological remission, occupational remission, and course type. Our multivariate analysis encompassed a total of 50 items pertinent to the time up to and including the first 6 months after the first psychotic manifestation. Despite the introduction of mathematical methods considerably more sophisticated than those employed in earlier studies, no satisfactory solution could be found to the problem of predicting end states of schizophrenia. Reliable predictions could be made only for 'extreme' end states (i.e. full remission versus (1) characteristic residues in the narrower sense; (2) total unemployment, or (3) surging or simple courses to mixed residues or to typical schizophrenic defect psychoses). Accordingly, sufficiently reliable assertions applied only to a minority of about 1/3 of patients, whereas for the majority of 2/3, no generalizable prognostication was possible (67-71% true-positive predictions on 36-63% of total population in extreme states). By contrast, our analyses have clearly uncovered a fundamental problem of investigations into the long-term prognosis of schizophrenia: the extreme dependence of results on the clinical definition of end states. The further the phenomenon 'end state' is qualitatively subdivided, the poorer and less reproducible is the mutual discrimination between intermediate states and the less reliable are allocations of patients to these intermediate states by means of multivariate classifiers. Furthermore, our analyses have also demonstrated the usefulness of multivariate, adaptive procedures for investigations into the structural properties of long-term courses, so that predictions might be considerably improved if more reliable definitions of schizophrenic end states are available.

Activities of Daily Living↗
PubMed1991

[Depressive disorders. Risk factors of recurrence].

The prediction of recurrence in affective disorders is very difficult and in individual cases not possible at all. Socio-demographic variables as body build, positive family history, marital status and social class, do not predict recurrence. This is probably true for sex and age, too. The impact of stressors and social support on the course is relatively weak. In this context the research on expressed emotion is of interest, as it gives some evidence that the presence of a sick spouse may increase the relapse rate. On the other hand an inadequate premorbid personality, especially a high neuroticism score, could predict recurrence. Classification of the illness is an other variable with prognostic value. Relapse rate is probably higher in endogenous than in neurotic depressions. Comorbidity and a history of other psychiatric disorders correlate with a high relapse rate. One of the best established clinical and epidemiological finding is the prognostic value of the past course. Recurrence is higher in bipolar disorders and in patients with a high number of previous episodes. An older age of onset probably increases the likelihood of recurrence. A prospective study on the course of affective disorders was initiated in Zurich in 1959. All patients suffering from affective and schizoaffective psychoses (n = 406) who were admitted to the Psychiatric University Clinic of Zurich between 1959 and 1963 were followed up every 5 years. The last assessment was carried out in 1985. On the basis of a multiple regression analysis, we tried to establish correlations of several independent variables with the length of cycles and the number of episodes per year. Correlations were only found in bipolar disorders.(ABSTRACT TRUNCATED AT 250 WORDS)

Causality↗
PubMed1990

Migraine and psychopathology. Results of the Zurich cohort study of young adults.

We present data regarding the association of psychiatric syndromes and migraine headache from a prospective epidemiologic cohort study of 27- and 28-year-olds in Zurich, Switzerland. The prevalence of migraine of 13.3% approximates estimates from previous epidemiologic studies in other regions of the world. Consistent with previous reports, there was a strong association between migraine and depression. However, this is the first study to demonstrate this association in an unselected epidemiologic sample with standardized assessment of psychiatric diagnoses by direct interview. The association between migraine and the anxiety disorders was even stronger than that for the affective disorders. The combination of anxiety disorder and major depression, but not pure anxiety disorders, nor pure depression, were significantly associated with migraine. Our data suggest that migraine with anxiety and depression may constitute a distinct syndrome comprising anxiety, often manifested in early childhood, followed by the occurrence of migraine headaches, and then by discrete episodes of depressive disorder in adulthood. Because of the prospective longitudinal design of this study, future assessments of this cohort will provide further information on the stability of these findings and the course of this cohort as subjects proceed through adulthood.

Adolescent↗
PubMed1990

The Zurich Study. IX. Panic disorder and sporadic panic: symptoms, diagnosis, prevalence, and overlap with depression.

The purpose of the present epidemiological study is to investigate and describe panic disorder and sporadic panic attacks among a cohort of young adults, aged 28 years, from the Canton of Zurich in Switzerland. Both DSM-III panic disorder and sporadic panic are characterized by frequent symptoms of somatic anxiety and tension, as well as by frequent symptoms of depressed mood and low vitality. Sporadic panic is more prevalent than panic disorder and shows a greater excess of females over males. The association with depressions (major depression and recurrent brief depression) is similarly high for both types of panic syndromes, while the association with other anxiety disorders is negligible. Several indicators suggest a marked similarity between sporadic panic and DSM-III panic disorder. More impressive differences were observed between subjects with panic disorder alone and subjects with comorbidity of panic and depression. For the latter group, the SCL-90R scores indicated higher severity. Comparison of the scores of life events, conflicts, self-esteem, and the number of chronic problems in childhood suggests a more specific nosological pattern for subjects with panic and depression as compared with those with panic alone.

Adult↗
PubMed1990

Recurrent brief depression: a new subtype of affective disorder.

This paper presents the diagnostic criteria for a new subtype of affective disorder, recurrent brief depression (RBD). Data from a prospective longitudinal cohort of young adults from the general population of Zurich, Switzerland, showed that a substantial proportion met all of the criteria for major depression in current diagnostic systems except duration. The validity of the subtype of RBD was examined according to clinical manifestations, severity, longitudinal course, and family history. RBD was found to be similar to major depressive disorder (MDD) on most of the indicators of validity including symptomatology, association with somatic and psychiatric disorders, age at onset, family history, longitudinal course and levels of impairment, except duration of depressive episodes. This suggests that RBD constitutes a valid subtype of affective disorder. The major implications of these findings are that both recurrence and duration should be considered in developing diagnostic thresholds for depression and in assessing the severity of affective disorders.

Cohort Studies↗
PubMed1990

Alcohol, tobacco and cannabis: 12-year longitudinal associations with antecedent social context and personality.

In a 12-year longitudinal study of a birth cohort 1577 men were questioned at the age of 19 and again at 31 years. Personality, social background and substance use were connected with subsequent consumption of alcohol, tobacco and cannabis, using correlation and discriminant analysis on the total and on two split samples, respectively. The preceding level of substance use was the best predictor for later use. Antisocial attitudes, depressiveness and psychosomatic complaints were associated as non-specific indicators. The following predictors were specific for: Alcohol: parental consumption, self-description as aggressive-extraverted; Tobacco: broken home, low level of vocational training, extraversion; Cannabis: alienation from society. The results are related to various theoretical frameworks and discussed with regard to possible efforts for prevention.

Adult↗
PubMed1990

Recurrent brief depression. A new concept of depression.

In an epidemiological cohort study from age 20 to 28, DSM-III criteria were used for the diagnosis of Major Depressive Disorder (MDD). Many subjects met the criteria A (dysphoric mood or loss of interest or pleasure) and B (presence of at least four out of eight criteria) but the episodes were shorter than the minimum of two weeks. Within this group of Brief Depressive Episodes, a recurrent form can be characterized with at least monthly reoccurrence over one year. These subjects are defined as cases of Recurrent Brief Depression (RBD) if they also suffer from reduced capacity at work. No exclusion criteria are applied. In the present cohort, the prevalence and treatment rates of RBD are comparable to MDD.

Depressive Disorder↗
PubMed1989

[Perspectives of the 3d Basel Psychiatry Rounds].

This work discusses the papers of the third symposium on psychiatry held in Basle. Herzka interprets substance abuse from a historical and cultural point of view as an escape from external tensions into an internal fight with the drug. The increase of tolerance of the many controversies and discrepancies in our culture could help to prevent drug abuse. The doctor is also in a clash between different cultures and social systems, where most values have become relative. In this situation the doctor will be tempted to only take some of the aspects of the bio-psychosociological model of psychiatric illnesses into account and to become highly specialized as to evade the conflict himself. The development of new benzodiazepines is progressing and the isolation of partial effect components, such as pure antianxiety and antiaggressive effects, is an important goal which has been partly reached. Benzodiazepines today belong to the most important medication for insomnia, restlessness, tension, anxiety present in different functional disorders, which not only concern psychiatry but medicine in general. A lot of patients need longterm treatment with benzodiazepines. This fact is contrary to the common recommendation to avoid benzodiazepine dependence. The one year prevalence of dependence is estimated to be, according to Ladewig, 0.1% of the population, which is, with regard to frequency and toxicity, compared to other substances, socially and medically relatively low. The therapeutic benefit is worth the risk of dependence. The prophylaxis for the reduction of drug dependence in the population is effective.(ABSTRACT TRUNCATED AT 250 WORDS)

Anti-Anxiety Agents↗
PubMed1989

Effect of neuroleptics on positive and negative symptoms and the deficit state.

The concept of negative symptoms tries to operationalize a deficit syndrome observed in schizophrenia, but also in other disorders. The instruments for the measurement developed so far are unclear in their dimensional structure and validity. Further methodological development is needed. A new scale for measuring negative symptoms was derived from the AMDP-system and applied to results of drug trials with clozapine, fluperlapine, and haloperidol. The three drugs were equally effective on negative symptoms of acute and chronic schizophrenics.

Antipsychotic Agents↗
PubMed1989

The Zurich Study. VII. Insomnia: symptoms, classification and prevalence.

This study describes sleep behaviour and insomnia in a representative cohort of a Swiss population. Interviews were carried out prospectively from age 20-21 to 27-28 years, starting with 292 males and 299 females. Females usually go to bed earlier and sleep 30 min longer than males. Taking into account length and periodicity of insomnia we can distinguish occasional insomnia (OI), repeated brief insomnia (RBI), and continued insomnia (CI), defined by operational criteria. The prevalence of sleep problems is stable from age 21-28, at 36%-40%. CI (prevalence 8%-10%) and RBI (13%-19%) are both medical problems in terms of treatment by professionals (10%-17%) or self-medication (7%-12%). The majority of insomniacs cope with sleep problems in various other ways. Frequency and patterns of symptoms of insomnia are described.

Adult↗
PubMed1989

The Zurich study. VIII. Insomnia: association with depression, anxiety, somatic syndromes, and course of insomnia.

The association of three subtypes of insomnia with psychic and functional syndromes, and the course of insomnia over 7 years were examined in a Swiss cohort of young adults interviewed three times. Specific associations were found between repeated brief insomnia (RBI) and recurrent brief depression (RBD). Continued insomnia (CI) was associated with major depression. All three subtypes of insomnia were associated with anxiety disorders; 52% of insomniacs were free of concurrent anxiety and depression. Insomnia--especially RBI and CI--was also associated with a number of functional complaints, but not with the consumption of alcohol, medicine, or illegal drugs. Insomniacs with RBI and occasional insomnia (OI) experienced more life events and interpersonal conflicts than controls. These findings support the subdivision of insomnia into different subtypes. The longitudinal analysis showed that insomnia tends to reoccur. For subjects with insomnia either at age 21 or 23 years, there was a higher risk of further insomnia at follow-ups. The specific subtype of insomnia at the first occurrence was not predictive for the outcome: all subtypes of insomnia enhance the risk of relapses in a similar way. Insomnia at age 21 is no precursor of the first onset of a depressive or anxiety disorder within a 2-year follow-up. With respect to the course of insomnia over 7 years, the subtypes did not differentiate.

Adult↗
PubMed1989

Affective state and voice: results of a pilot study with six depressive patients.

As part of an investigation into the nonverbal information in human speech, a pilot study with depressive patients was designed in order to model the global affective state as a function of time and in terms of speech parameters. Over a two-week period, six patients were examined six times at two-day intervals under comparable experimental conditions. The psychopathologic status of these patients was assessed during a psychiatric exploration half an hour before the actual examination was carried out. Besides the solution of the baisc methodological problems, a principal goal of this study was to test the ability and cooperation of depressive patients when asked to speak in the laboratory. It turned out that even scalar parameters such as energy and dynamics give insight into the intraindividual variation of global affective state, and that the examination procedure is practicable even it patients are considerably handicapped by their illness.

Adult↗
PubMed1989

Outcome of panic and depression in a seven-year follow-up: results of the Zurich study.

In this study, the association and outcome of panic and depression were investigated in an epidemiological cohort of young adults interviewed at age 21, 23, and 28. The prevalence rates of sporadic panic, panic disorder, major depression, and recurrent brief depression were very stable. There was a clear preponderance of females in all diagnoses. Panic and depression overlapped to a large extent cross-sectionally at all 3 interviews, and this overlap increased in a longitudinal perspective. For the analysis of outcome, the subjects were divided into 4 groups according to their diagnosis at the first interview: pure panic, pure depression, mixed panic and depression, and controls. Irrespective of the first diagnosis, the 7-year outcome showed a strong tendency to develop into pure depression or mixed panic and depression at follow-up interviews. In a longitudinal perspective, cases that suffered from both panic and depression appeared more severely ill, as expressed in very high treatment rates and a high rate of lifetime suicide attempts.

Adult↗
PubMed1988

Familial syndrome patterns in schizophrenia, schizoaffective disorder, mania, and depression.

A major problem with studies in the field of quantitative genetics is that of phenotypical heterogeneity. In particular, such heterogeneities show up in psychiatric investigations: index cases often tend to display more severe forms of disorders than the respective affected relatives. The principal goal of the present investigation was to test the phenotypical equivalence of the two populations of index cases and their affected relatives. Our analyses were based on 269 hospitalized patients with functional psychoses and 350 affected first degree relatives. As opposed to the majority of earlier investigations in which phenotypes were uniquely defined by diagnoses, phenotypes were represented in this study by a list of 22 psychiatric syndromes. Accordingly, multivariate statistical procedures were applied to analyze the intrinsic properties of the empirical lists. The results showed that typical syndrome patterns clearly appeared in both populations and that the phenotypical equivalence of the corresponding population sample sets lay between satisfactory and good. Furthermore, it was possible to select phenotypically homogeneous and reproducible subsets on the basis of the 22 syndromes. These subgroups can be used as basic material to study the genetic modes via current models from quantitative genetics. Nevertheless, our analyses revealed no clear breeding true of either affective disorders or schizophrenia.

Bipolar Disorder↗
PubMed1988

European long-term followup studies of schizophrenia.

This article focuses on the variability of diagnostic concepts and their impact on the results of European followup studies. Continental European and Scandinavian definitions of schizophrenia are considered along with other factors such as age of onset, change of symptoms with time, development of defects, the effects of aging, treatment, and study methodology. The concepts of schizophrenia are regarded as too diverse to allow meaningful comparisons of course and outcome among studies. Multiaxial or multidimensional description of patients offers a solution to this conundrum.

Cross-Cultural Comparison↗
PubMed1987

Morbid risks of subgroups of affective disorders: some methodological and empirical results.

Based on two independently ascertained family studies, the problem of analysing disorders with variable age of onset has been investigated by means of survival analysis. This method of approach results in empirical risk functions which can be used directly as weights for age correction in the analysis of pedigrees. The main interest of the present investigation has been focused on the reproducibility of such risk functions and on their specificity with respect to clinical diagnosis. For this purpose, one family study was referred to as a calibration sample for estimating empirical risk functions, whereas, the second family study served as a test sample in order to test the hypotheses under discussion. As it turned out, the empirically derived functions from both the calibration and test samples are indeed comparable, thus suggesting that, for sufficiently representative calibration samples, the differences between the two populations of (1) affected and (2) susceptible individuals may be less important than expected. As to the specificity of these risk functions, the underlying diagnostic structure of the calibration samples (as represented by four diagnostic subgroups) could be characterized by distinct types of risk functions, each of which, in addition, reflects the severity of the respective affective disorder.

Bipolar Disorder↗