Course of mood disorders: a challenge to psychopharmacology.
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Humans↗
Biomedical subjects
J Angst
Publications and source records attributed to J Angst.
Binge eating and weight concerns among young adults. Results from the Zurich cohort study.
In the longitudinal cohort study of young adults from the Canton of Zurich in Switzerland, two groups of eating problems were defined: binge eating and weight concerns. Subjects with these conditions were interviewed at the ages of 27-28 and 29-30 years. The binge eaters, mostly women, differed both from subjects with weight concerns and from controls. They had more severe eating problems and more anxiety and depression. Follow-up as well as retrospective data suggest that eating problems are persistent for the binge eaters, and, to a lesser extent, also for subjects with weight concerns. Even so, professional treatment is rarely sought by subjects with eating problems. These findings encourage long-term studies on eating problems in community samples.
Adult↗
[Functional stomach and intestinal complaints in young adults: incidence, follow-up, personality and psychosocial factors].
The prevalence rates and the course of functional gastrointestinal disorders in addition to psychopathology and psychosocial factors which are assumed to be associated with functional disorders were longitudinally investigated in an epidemiological cohort study of young adults aged 21-30 from the Canton of Zurich (Switzerland), by means of four interviews. Case definition was based on operational criteria concerning frequency and duration of symptoms reported by the subjects. One-year prevalence rates of (functional) stomach complaints and intestinal complaints were found to vary between 8.7 and 12.7 percent, and 9.1 and 11.1 percent, respectively, depending an the year of the interview. Subjects with stomach complaints scored higher on depression, anxiety and hostility (Hopkins Symptom Check List, Freiburger Persönlichkeitsinventar) then the controls. These associations were less strong among subjects with intestinal complaints. In addition, both complaints were found to be associated with scores on a life events measure, with distress from the social network, and with lack of social support.
Adaptation, Psychological↗
[Hypomania. Apropos of a cohort of young patients].
The Zurich prospective epidemiological study included 591 twenty-year old subjects. At age twenty-eight, 457 of these people (228 males, 234 females) were re-examined and 415 of them at age thirty (197 males, 218 females). The DSM III-R definition of hypomania was modified. We found the following prevalences: 1.7% with hypomania, 3% with bipolar syndromes, 18.6% with major depression (including mood disorders) and 12.3% with short recurrent depression. Compared to male subjects, the risk of major depression was twice as high in female subjects but was roughly the same for the other groups. The study compares three groups of subjects: subjects with hypomania (UM), bipolar subjects (BP) and unipolar depression. Considerable differences were found depending on the levels of treatment, positive family histories for depression or hypomania and attempted suicides. The results show that the distinction between a subject with hypomania and a bipolar subjects is not clear. The ratings of the Hopkins Symptom Checklist scales (SCL 90-R), and of the FPI personality test (Fahrenberg et al., 1973) are presented and discussed. 12.7% of major depression cases were bipolar and 8.3% of short depressions were recurrent. In this sample of normal Swiss population, the ratio of bipolar to unipolar syndromes was approximately 1:5.
Adult↗
The Zurich Study. X. Hypomania in a 28- to 30-year-old cohort.
Hypomania in a 28- to 30-year-old cohort is described. Data were taken from a prospective longitudinal cohort study from the general population of Zurich, Switzerland. An estimated 1-year prevalence rate of hypomania of 4% was found. Over a period of time hypomania was associated with major depression and dysthymia. We found equal proportions of suicide attempts and equal rates of treated family members among hypomanics and depressives. Furthermore, the previous history of treatment of mild bipolars (hypomania with depression) and unipolar depressives was comparable. The sum of life events, several SCL-90R scores and the scores of distress in relationships were already elevated in hypomanics 7 years before diagnosis of hypomania, indicating an increased activity level, a generalized increase in neuroticism, and a relatively unvarying behaviour pattern in social relationships.
Adult↗
The Zurich Study. XI. Is dysthymia a separate form of depression? Results of the Zurich Cohort Study.
Dysthymia was assessed in the prospective Zurich Cohort Study of young adults. The 1-year prevalence rate was around 3% if no exclusion criteria were applied. Pure dysthymics without major or recurrent brief depression accounted for about 1%. Most cases of dysthymia met the symptom criteria for major depressive disorder (MDD) and were characterized by a more continuous course. However, evidence presented in this paper suggests that a diagnosis separate from MDD is not warranted. The family history of dysthymic subjects did not differ from major depressives. The smaller group of primary dysthymics, on the other hand, did not differ from controls as regards family history for treated depression. The low prevalence rates, taken together with methodological problems involved in assessing dysthymia and the lack of a distinct course, suggest that dysthymia does not constitute a valid subtype of depression in an age group of 20-30 years of the community. Dysthymia belongs to the wide spectrum of major depressive syndromes and represents only a subgroup characterized by specific course characteristics.
Adult↗
Report on the third consensus conference on the methodology of clinical trials with antipsychotic drugs.
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Antipsychotic Agents↗
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↗
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↗
[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↗
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↗
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↗
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↗
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↗
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↗
Consensus Conference on the Methodology of Clinical Trials of "Nootropics", Munich, June 1989. Report of the Consensus Committee.
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Animals↗
[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↗
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↗