Biomedical subjects
Publications and source records attributed to J Angst.
In an open multicenter trial 46 schizophrenic patients were treated with fluperlapine for 20 days. A mean daily dosage of 300-400 mg appeared to be an effective antipsychotic treatment in most cases. The marked antipsychotic effect was accompanied by a good improvement of depressive symptoms. Extrapyramidal side effects were extremely rare.
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269 patients with schizophrenia, schizo-affective or affective disorders admitted to a hospital in Zürich were examined by the AMP system and the syndrome checklist of Wing and co-workers. The data were analyzed using a special set-theoretical similarity measure for nonlinear graduations, multidimensional scaling to achieve a metric representation of the similarity matrices, and a cluster analysis, originally described by Meisel in 1972.
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Aspects of the course of manic depressive and schizo-affective psychoses with high recurrence (the patient must have suffered from at least three episodes) are measured by length of episodes, intervals, and cycles. Differences between two patient samples from Switzerland and Poland, and differences between the two diagnostic groups are analyzed taking into account some independent variables such as sex, marital state, age at onset, precipitation, and symptomatology. Bipolar and schizo-affective psychoses show similar patterns of course: early onset, high relapse rate, high number of episodes, and short intervals. Compared to schizo-affective psychoses bipolar psychoses tend to have a higher frequency of episodes per year, shorter intervals, and the length of episodes is longer. Multivariate analysis shows very few correlations of independent variables with aspects of the course. On the whole the differences between the diagnostic groups are much smaller than between the two centers. The Polish and Swiss patient samples differ in course considerably. The patients from Zurich show longer episodes, intervals, and cycles, therefore, the frequency of episodes per year is lower in Zurich. Only a smaller part of the variance can be explained by differences in psychopathology (the Polish patients are more manic and more paranoid). There remain unexplained qualitative differences between the two centers which show how difficult it is to compare scientific results from different sources.
The study deals with the course of three diagnostic groups, namely 50 bipolar manic-depressive, 50 bipolar and manic schizo-affective, and 50 recurrent paranoid psychoses. The patients course was observed over 14-17 years, at least 5 years prospectively. The study concentrates mainly on the prognosis based on the symptomatology observed during the first episode, the stability of the symptoms over several episodes, the residual symptomatology, and the degree of remission during the intervals. Bipolar and schizo-affective psychoses show a similar periodicity. The study further reveals that the periodicity of schizo-affective disorders is mainly linked with the affective symptoms of this disorder. Qualitatively the residual symptoms of bipolar and schizo-affective psychoses differ. Bipolar and phasic paranoid psychoses are quite different with regard to their periodicity and their symptomatology during the episodes and during the intervals.
A prospective epidemiological field study of psychosomatic syndromes among 600 young adults in Zurich, Switzerland, is presented. During a period of 3 years, the respondents completed two questionnaires and were once personally interviewed about their psychosomatic and psychological syndromes in the 12 months prior to the inquiring dates. This communication concentrates on the results of the first questionnaire and the personal interview. The anamnestic data as well as the information about the frequency and duration of a number of psychosomatic syndromes serve to formulate a prognosis about the future course of these syndromes. This prognosis will then be compared with the results of the second follow-up consisting of the second questionnaire.
In a general population sample of young adults the sociocultural aspects of the depressive syndrome are investigated. In the context of a theory of social integration the association of depression with the material resources, with social belonging and with self realisation are analysed. There are marked correlations with the perceived fulfillment of basic social needs. The correlations with the structural prerequisites for social integration, however, are much weaker.
In 1973, 532 persons desiring to quit smoking and seeking the Hermano therapy of chirothesia were questioned prior to the ritual treatment session. Typical smoking behavior, social background, and personality tests were documented. At intervals of 4 months, 1 year, and 5 years after treatment the group was examined with a follow-up questionnaire. In two earlier studies Gmür evaluated the results of this treatment after 1 year and analyzed in detail the various factors which influence these results. The present paper investigates the determinations for success with a follow-up study 5 years after treatment. The analysis show that the treatment was seldom successful for persons with an accentuated addiction-like smoking behavior. There were no findings proving a correlation between personality pattern and/or sociodemographic data and treatment success. No criteria was found to suggest indications for the successful application of the Hermano therapy.
In epidemiological surveys about neurotic and psychosomatic disturbances there is the question of how relevant the reported syndromes are. An important criterion to evaluate the relevance of a syndrome is its individual and social consequences. In a general population sample of 600 young adults in the Canton of Zurich (Switzerland), subjects answered a structured interview (SPIKE) about 25 different neurotic and psychosomatic syndromes and their consequences: personal suffering, imparied role performance, tendency to become chronic, and medical treatment. A number of neurotic syndromes (especially depression, anxiety, and exhaustion) ranked highest with regard to individual suffering and impaired role performance, but they rarely led to medical treatment. Psychosomatic syndromes, on the other hand, while treated more often, only caused minor personal suffering and did not impair role performance very much.
Depression is an aetiologically unspecific reaction pattern of the human organism to psychological or physical changes. It can occur in all forms of psychiatric disorders. The depressive symptomatology in itself does not allow a valid classification. Nosology must take into account aetiology, pathogenesis, and the course. The former two are mostly unknown. Considering the restricted value of all classifications of depressive syndromes the concepts must be validated by external criteria (e.g. genetic, biochemical, neurophysiological criteria, and response to treatment). In this paper a classification based on the course and genetic criteria of depression is proposed. In a preliminary study the clinical diagnoses of 100 depressive patients are compared with the classification based on diagnostic criteria of Feighner et al., Taylor and Abrams, as well as on DSM-III.
The validity of various criteria for a prophylactic lithium indication was examined by means of the natural course of 356 unipolar depressive, bipolar manic-depressive, and schizoaffective patients. The prerequisite for a lithium prophylaxis was the occurrence of two or more episodes (excluding the index episode) within a 5-year's follow-up. The so far applied criteria for a lithium indication mentioned in the literature have proven to be too restrictive as far as this study is concerned, as the majority of the patients in need of lithium have been excluded from such a treatment. In this study new criteria have been deduced from the hypothetical examination of observed courses.
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The course of illness was investigated retrospectively and prospectively in a sample of 150 hospitalized schizoaffective patients and 95 hospitalized bipolar manic-depressive patients. The two disorders showed more similarities than differences in their course; this was true for the age of onset (31.8 versus 34.7 years) and the length of illness until the end of the observation period (22.5 versus 23.8 years). Schizoaffective disorders took a more benign course than bipolar disorders, as measured by the frequency of the episodes (median 7 versus 9 episodes). Accordingly, periods of remission between episodes were longer in schizoaffective patients. The length of the episodes themselves was about the same in both disorders (median 3 months). Although subjects had reached an average age of 60 years, 63% of schizoaffective and 82% of bipolar patients had experienced new episodes during the last 5 years of the observation period. Patients with schizoaffective psychoses were less likely to achieve a full remission than patients with bipolar disorders. A residual state was observed in 57% of schizoaffective and 24% of bipolar patients during the intervals between episodes. Because both schizoaffective and bipolar disorders showed a highly recurrent course, many patients received long-term treatment with neuroleptic drugs, antidepressants, or lithium.
In 48 patients with schizophrenia and 32 patients with affective disorders, different immune parameters were tested. Compared to blood-donors, IgG and IgM serum concentrations were increased in both the schizophrenic and affective disorders. However, these abnormalities did not differ from hospital control populations. The patients failed to show an association of antibodies considered to be characteristic of autoimmune diseases. In addition, no increased incidence of circulating immune compexes was detected. The only substantial serologic abnormality froun was an elevation of C4 levels in patients with biopolar psychosis.