[Longitudinal study of changes in heart activity and peripheral circulation during the learning stage of autogenic training (author's transl)].
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Adolescent↗
Biomedical subjects
M Linden
Publications and source records attributed to M Linden.
[X-ray findings in the esophagus, stomach and intestines in hemoblastoses].
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Adult↗
Research diagnosis of current depressive disorder: a comparison of methods using current symptoms and lifetime history.
Data from the WHO international study of Psychological Problems in General Health Care were used to compare two alternative algorithms for diagnosing current major depression using the Composite International Diagnostic Interview: the traditional method based on lifetime diagnosis and an alternative method based on number of current symptoms. Using DSM-IV criteria for current major depression, 6.2% of 5394 primary care patients were diagnosed by both methods, 2.0% by the lifetime-based method only, and 1.9% by the current symptom method only. Measures of severity (current symptoms, lifetime symptoms, disability, and comorbid anxiety) indicated that those diagnosed by only one method were only slightly less ill than those diagnosed by both. While the symptom-based method identifies a slightly more ill group, use of either method alone may exclude many who differ little from those classified as cases.
Adult↗
Subthreshold disorders in psychiatry: clinical reality, methodological artifact, and the double-threshold problem.
The introduction of modern operationalized classification systems for mental disorders has led to the issue of subthreshold disorders. Definitions for illness do not at the same time define health, e.g., in the sense of the World Health Organization (WHO) definition from 1947. The threshold not only to define disorders but also to define health is open to discussion. So-called subthreshold disorders require the definition of 2 thresholds. Empirical research has suggested that these "between-threshold disorders" are associated with increased disability and many other negative consequences. Part of the problem with subthreshold disorders is methodological in nature. Psychopathology and the Gestalt characteristic of psychopathological signs are ignored, and categorical instead of dimensional concepts are used. Thus, the distinction between syndromes and disorders, as well as the hierarchical structure of disorders, is not taken into account, and statistical problems with the prognostic power, which is dependent on the epidemiological distribution, are not solved. Variations in threshold definitions have important consequences for the individual and for society, be it because of the negative effects of "diagnostic labeling" or because of the costs to the health care system. Treatment options are presently rather insufficient, although modern sequential treatment algorithms and newer treatments (e.g., selective serotonin reuptake inhibitors [SSRIs] and Saint-John's-wort) promise interesting perspectives. Also in this context, self-help should become an important area of medical treatment research.
Anxiety Disorders↗
Anxiety and anxiety disorders in the old and very old--results from the Berlin Aging Study (BASE).
Within the context of the Berlin Aging Study, we examined the distribution of anxiety symptoms and disorders in a representative community sample. The participants were beyond the age of 70 years, thereby extending results from other studies not covering this age range. Additionally, we analyzed the distribution of anxiety symptoms and syndromes not fulfilling specified diagnostic criteria. A sample of 258 old (70 to 84 years) and 258 very old (85 to 103 years) subjects were examined. Anxiety disorders as defined in DSM-III-R and according to clinical judgment (diagnoses termed NOS) were assessed. In addition, items from the Geriatric Mental State-A (GMS-A) covering a wide range of symptoms of anxiety were subjected to factor analysis. The raw score distributions of anxiety subscales obtained by this procedure are examined by age, gender, education, personal living situation, and psychiatric comorbidity. The weighted overall prevalence of anxiety in the elderly community is 4.5% (n = 17), including specified (n = 8) anxiety disorders according to the DSM-III-R and unspecified (n = 9) disorders. Prevalence rates in the younger old were 4.3% and in the older old 2.3%. Weighted prevalence rates for males were 2.9% and for females 4.7%. The most common comorbid disorders were affective disorders in both age groups as well as both genders. Independently of the nosological level, 52.3% reported one or more symptoms of anxiety. Factor analysis of anxiety-related symptoms yielded 5 independent subscales, reflecting hypochondriasis, panic, phobia, worries, and vegetative anxiety. There were more phobic symptoms in the younger age group (P < .001). Except for worries and hypochondriac symptoms, females showed significantly higher anxiety in all other anxiety dimensions. There was no relation between anxiety and cognitive status or socioeconomic status (SES). Only for subjects living alone was more phobic-type anxiety found. Anxiety disorders in old and very old persons are less frequent than other psychiatric disorders of old age, and do not increase with age. Gender differences can still be observed. The symptomatic structure of anxiety seems similar to that found in younger cohorts. Thus, anxiety disorders in old age do not seem substantially different from those in younger age. Their relative contribution to the spectrum of mental disorders seems to decrease, rather than increase, with age, while at the same time anxiety symptoms are an almost daily experience.
Aged↗
Prodromal states in schizophrenia.
The vulnerability-stress-coping (VSC) model is the most influential heuristic concept in understanding the course of schizophrenia, whose prodromal status still offers unsolved conceptual and methodological issues. Improved knowledge about the prodromal phase would provide a better understanding of the developing psychopathology and psychophysiology of schizophrenia and could also be of predictive value to attune therapeutic actions to the course of the illness more precisely. To shed more light on the characteristics of prodromal states, data from a German multicenter study on intermittent versus maintenance neuroleptic long-term treatment in schizophrenia (ANI study) were reanalyzed with respect to the prevalence and profile, nature, time course, and predictive value of prodromal symptoms in impending relapse. The results demonstrate that prodromes are a category of symptoms on their own, but they share variance with other symptom domains. Treatment side effects, psychotic symptoms, dysphoric mood, and social dysfunction are all associated with prodromal states--the direction of this association, however, is still to be clarified. Prodromal symptoms are also related to the neuroleptic treatment strategy and its relapse-preventive efficacy--findings that underscore neuroleptic maintenance medication in preventing both overt and subthreshold psychotic morbidity in schizophrenia.
Adult↗
Suicidal behavior--symptom or disorder?
This article examines the diagnostic status of suicidal ideation with and without additional signs of defined or subthreshold mental disorders. Data from the World Health Organization (WHO) study on Psychological Problems in General Health Care (PPGHC) show that 8.8% of all general practice patients report that they recently had a wish to be dead. Among patients with acute depressive episodes, the rate is 34.5%, as compared with 1.3% in persons without any sign of mental disorder. Rates of suicidal ideation in persons with subthreshold disorders (10.4%) are similar to the rate in persons with other, nondepressed forms of mental disorders (12.9%). Still, 30.1% of all persons with suicidal ideation do not have a defined mental disorder, and 21.5% do not even have subthreshold disorders. But in these persons also, suicidal ideation is associated with an increased rate of depressive complaints. Suicidal ideation therefore, in any case, can be seen as an indicator of mental problems. But it seems impossible to lower the thresholds of defined mental disorders so that all forms of suicidal ideation will be covered. Instead, suicidal thoughts must be regarded as a symptom with the status of a disorder itself which should be handled as a comorbid condition if other mental disorders co-occur.
Comorbidity↗
Classic conditioning and dysfunctional cognitions in patients with panic disorder and agoraphobia treated with an implantable cardioverter/defibrillator.
OBJECTIVE: A model for the development of anxiety disorders (panic disorder with or without agoraphobia) is needed. Patients with an implantable cardioverter/defibrillator (ICD) are exposed to repeated electric shocks. If the theory of anxiety development by aversive classic conditioning processes is valid, these repeated shocks should lead to an increased risk of anxiety disorders. To study this hypothesis, we retrospectively studied 72 patients after implantation of an automatic ICD. METHODS: Patients were assessed with the semistructured Diagnostic Interview of Psychiatric Disease 1 to 6 years after implantation of an automatic ICD. Panic disorder and/or agoraphobia was diagnosed in patients who fulfilled all DSM-III-R criteria for those conditions. RESULTS: Anxiety disorder developed in 15.9% of patients after ICD implantation. This was significantly related to the frequency of repeated defibrillation (shocks) to stop malignant ventricular arrhythmias. Dysfunctional cognitions are an additional vulnerability factor. CONCLUSIONS: The data support both the conditioning hypothesis and the cognitive model of anxiety development. These findings suggest that ICD patients are an appropriate risk population for a prospective study of the development of anxiety disorders.
Aged↗
Clinical skin temperature measurement to predict incipient pressure ulcers.
OBJECTIVE: To evaluate temperature differences between areas of erythema and surrounding healthy tissue to determine whether clinical temperature measurement of sites at risk for pressure ulcer development could be used to indicate tissue damage. To validate the temperature portion of the National Pressure Ulcer Advisory Panel's new Stage I pressure ulcer definition. DESIGN: Repeated measures design. SETTING: Acute rehabilitation hospital. SUBJECTS: 65 outpatients and inpatients presenting with pressure-induced erythema at areas at risk for pressure ulcer development. The subjects were primarily non-ambulatory and exhibited a range of skin pigmentation and disabilities, including spinal injury, multiple sclerosis, and lower-limb amputations. MAIN RESULTS: The temperature and appearance of 80 pairs of erythematic and control sites were documented. Sites were considered to have equal temperatures if the difference was within plus or minus 1.0 degree F. Fifteen percent (n = 12) of the erythematic sites were the same temperature as the surrounding tissue, 23% (n = 18) of the erythematic sites were cooler than the control sites, and 63% (n = 50) were warmer. CONCLUSION: Both increased and decreased temperature differences can be used to indicate reactive hyperemia or a Stage I pressure ulcer, but a tissue integrity problem may still exist despite the absence of a temperature difference.
Persons with Disabilities↗
Testing the validity of erythema detection algorithms.
Dermatology has quantified skin color for monitoring progress of treatments. The most common and effective means of erythema detection is visual inspection of the skin. However, for people with darkly pigmented skin, erythema can be masked by melanin. Tissue Reflectance Spectroscopy (TRS) is a noninvasive method of quantifying skin color. Most commonly, TRS quantifies erythema caused by cosmetics, topical ointments, UV light, or other irritants. Recently, TRS has been used to characterize the presence of erythema due to reactive hyperemia or Stage I pressure ulcers. The objective of this study was to compare the reliability and validity of erythema detection algorithms by determining their sensitivity and specificity. Two algorithms, Diffey and Helen Hayes Hospital (HHH), had sensitivity exceeding 85% and specificity exceeding 75%, but most algorithms demonstrated adequate validity across all subjects. The validity of the HHH algorithm did not change with the skin pigmentation of the subject. The results of this comparison will be useful to researchers interested in using TRS to detect erythema in people with different skin pigment levels.
Algorithms↗
Cytologic differential diagnosis of bronchiolo-alveolar carcinoma and bronchogenic adenocarcinoma.
In order to estimate the possibility of a cytologic differential diagnosis of bronchiolo-alveolar carcinoma and bronchogenic adenocarcinoma, 121 histologically proven cases of these two types of lung cancer were studied. Certain features of the tumor cells were used as differential diagnostic parameters. By means of these features it was possible to correctly type 90% of the bronchiolo-alveolar carcinomas and 72% of the bronchogenic adenocarcinomas. The most striking characteristics of bronchiolo-alveolar carcinoma was the uniformity of cells, the occurrence of such cells in tightly packed clusters, the absence of prominent nucleoli and also the scarcity of single tumor cells. Thus, it seems possible to make a correct cytologic differential diagnosis between these two types of lung tumors with high accuracy.
Adenocarcinoma, Bronchiolo-Alveolar↗
[Gelatin for volume replacement in hemodilution: hemodynamic study].
OBJECTIVE: To evaluate whether volume replacement with gelatine infusion with 3.5% urea bridges during normovolemic intentional hemodilution manages to stabilize hemodynamic parameters. EXPERIMENTAL DESIGN: Randomized prospective study. SETTING: Operating theatre for general surgery. PATIENTS: ASA 1 and 2 patients undergoing major abdominal surgery. Criteria of admission: a) age < 70 years old; b) starting hematocrit > 30%; c) absence of coronary diseases or coagulative pathologies. INTERVENTIONS: Blood lost during surgery was replaced with gelatine and crystalloid in a ratio of 1:1. Hemodynamic monitoring was performed by inserting an Opticath catheter in the pulmonary artery and the resulting data were processed using an Oximetrix computer. FINDINGS: Oxygen transport (DO2), oxygen consumption (VO2) and heart rate (HR) were measured before the start of the operation and at the peak of hemodilution. RESULTS: At times T0 = Hct 35 and T1 = Hct 28, studied parameters (DO2, VO2, HR) did not show statistically significant variations. CONCLUSIONS: On the basis of the hemodynamic parameters studied gelatine was found to be an efficacious volume replacement solution during the course of moderate, intentional hemodilution.
Excipients↗