Consensus Conference on the Methodology of Clinical Trials of "Nootropics", Munich, June 1989. Report of the Consensus Committee.
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Animals↗
Biomedical subjects
J Angst
Publications and source records attributed to J Angst.
[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↗
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↗
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↗
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↗
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↗
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↗
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↗
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↗
Switch from depression to mania, or from mania to depression: role of psychotropic drugs.
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Bipolar Disorder↗
The course of affective disorders.
Onset, course, and outcome of affective disorders were studied prospectively--at 5-year intervals, until 1980--in 406 patients admitted to the Psychiatric University Hospital, Zurich, between 1959 and 1963. A few results are summarized. Bipolar I and bipolar II disorders take a very similar course. The distinction between unipolar depression and bipolar affective disorder, and the separation by presence or absence of psychotic features (delusions and hallucinations), and then again by mood congruence, are of high prognostic value.
Adult↗
[Increase of alcohol, tobacco and drug consumption by 19-year-old men. A cross-sectional comparison 1971-1978-1982].
The consumption of alcohol, tobacco, hypnotics and pain killers has been compared in three populations of 19-year-old men drawn from the Canton of Zurich in 1971 (6315), 1978 (3802) and 1982 (7341). The percentage of non-consumers in all substances had risen in 1982 above earlier values. The (mean) consumption of tobacco fell from 9.4 g in 1971 to 6.4 g tobacco/day in 1982, though the average cigarette consumption (of the cigarette smokers) only fell from 15.7 to 15.2 cigarettes/day. Alcohol consumption (beer, wine, spirits) decreased slightly from 5.3 glasses/week (mean 1978) to 5.0 glasses/week (mean 1982). These results are compared with investigations in other Swiss populations.
Adult↗
The Zurich Study. V. Anxiety and phobia in young adults.
From data collected within the frame of a longitudinal epidemiologic study of a representative sample population of young adults (the Zurich Study), anxiety disorders--anxiety and phobic states--were analyzed. The current prevalence rate was found to be 2.9% for anxiety states and 4.3% for phobic states, totaling 7.2%. Because of their anxiety disorders, one-fifth of the cases had undergone treatment during the preceding 12 months. Substantial difficulties arose, from the point of view of classification. The currently used categories, such as anxiety states, panic attacks, agoraphobia, simple phobia, social phobia, have more in common than differing symptoms. On a syndromal level, numerous overlapping configurations resulted which can only be artificially forced into the aforementioned diagnostic classes of anxiety disorders. On the symptom level, merely a few operationalized items defined these categories. In this way, most of a broad identical 'nonspecific' symptomatology was not taken into account. This was exemplified by a comparison of anxiety states and agoraphobia. In fact, these two groups did not differ significantly in many symptoms or in SCL-90 profiles, but did show a highly significant difference from control samples. Both groups suffered to the same great degree from depressive, cardiovascular, and gastrointestinal symptoms. We doubt whether any forced categorical diagnostic differentiation of anxiety and phobic states is at all reasonable.
Adult↗
The Zurich Study. VI. A continuum from depression to anxiety disorders?
A representative sample of 456 persons from the normal population aged 22 and 23 years was used to study the overlap of depression with anxiety disorders. The 1-year prevalence rate for major depression (DSM-III), minor depression, and anxiety disorder together was 16.4%. The observed cases of major depression occurred in 36% with anxiety disorder, the cases with minor depression in 60%. On the level of symptoms assessed by a semistructured clinical interview and on the level of self-assessed items of the symptom check list SCL-90, the overlap was even greater. The main finding was that subjects with both diagnoses, depression and anxiety disorder, were more severely affected in general. Discriminant analyses of the SCL-90 scales together with the qualitative distribution of SCL items characterizing depression, anxiety, or phobia, did not disprove the hypothesis of a continuum.
Adult↗
A family study of psychotic symptomatology in schizophrenia, schizoaffective disorder, unipolar depression, and bipolar disorder.
An evaluation was made of schizophrenics (140), schizoaffectives (40), unipolar depressives (59), and bipolars (30), and their relatives who had a chart diagnosis of psychosis or depressive neurosis. The purpose was to determine whether the psychosis (delusions and hallucinations) was transmitted independently of the illness itself. If this were true, there would be an excess of pairs of probands and relatives both positive for psychosis and pairs of relatives and probands both negative for psychosis when compared to relatives and probands who were not concordant for the variable. This was found to be true in schizophrenia and schizoaffective disorder and is probably the result of the simple transmission of an illness which includes the presence of psychotic symptoms in the definition. Thus, this would be a manifestation of the genetic propensity in schizophrenia. For the affective disorders there was no evidence that psychotic probands were more likely than the nonpsychotic to have psychotic relatives. So far the reason why some patients have psychosis and others not in the affective disorders remains unexplained.
Bipolar Disorder↗
The diagnostic value in assessing mood congruence in delusions and hallucinations and their relationship to the affective state.
An examination was carried out on 140 schizophrenics, 34 schizoaffective manics, 6 schizoaffective depressives, 59 unipolars, and 30 bipolars to determine the variables of affective states and mood-congruent and mood-incongruent psychotic symptoms. These patients had been admitted to a hospital in Zürich and were systematically diagnosed, using both clinical and computer-derived systems. Forty-eight patients (18%) had both mood-congruent and incongruent psychotic symptoms. However, the affective disorders usually showed mood-congruent symptoms and the schizophrenics the mood-incongruent types. The schizoaffectives were likely to show both types. There was a marked dissociation between affective states and mood congruence in the schizophrenics. Though the majority of these patients showed depressive syndromes, they were quite unlikely to have mood-congruent symptoms. Likewise, 25% of the schizophrenics had manic-like syndromes, which contrasted with the fact that they rarely had mood-congruent psychotic delusions and hallucinations.
Adult↗
Stability of psychotic symptomatology (delusions, hallucinations), affective syndromes, and schizophrenic symptoms (thought disorder, incongruent affect) over episodes in remitting psychoses.
A study was made on 140 schizophrenics, 40 schizoaffectives, 59 unipolar depressives, and 30 bipolar affective disorder patients in order to determine the quality of psychopathology over multiple episodes. The schizoaffectives were the most likely to have multiple episodes. Among the schizophrenics, there were few episodes that lacked psychotic symptoms, but almost half of the episodes for the schizoaffectives were associated with an absence of psychotic symptoms. Three-quarters of the patients with unipolar depression and bipolar illness showed no psychotic symptoms either congruent or noncongruent. There was a striking finding that all diagnoses were associated with a decrease in psychotic symptoms over time. These psychotic symptoms (delusions and hallucinations) became particularly more scarce among the schizoaffectives, unipolars, and bipolars. There was a 50% to 67% decrease of episodes with psychotic symptoms as more episodes occurred. For schizophrenia and schizoaffective disorder the first ten episodes were very similar to each other for affective syndromes, formal thought disorder and/or incongruent affect, and delusions and hallucinations. It was not until much time had passed that the symptom pictures changed.
Adult↗