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R Heun

Publications and source records attributed to R Heun.

At least 91 records · Page 5Linked to original sources
PubMed1998

Differential validity of informant-based diagnoses of dementia and depression in index subjects and in their first-degree relatives.

There is no study indicating that informant-derived information on dementia and depression (i.e. family history information) is equivalently valid for first-degree relatives and for index subjects (i.e. patients and control subjects). However, this unproven assumption is the basis for the frequent, possibly inappropriate, use of instruments validated for patients and control subjects in family studies which focus on frequencies of psychiatric disorders in first-degree relatives. Consequently, there is a need to compare the validity of family history information for both disorders in index subjects and their first-degree relatives. Validity was assessed by comparison of family history information for dementia and depression with interview-derived diagnoses in 75 index subjects and 195 age-matched first-degree relatives. The validity of informant-derived information varied for different disorders, i.e. dementia and depression, and different samples, i.e. index subjects and first-degree relatives. In agreement with the study hypothesis, the sensitivity of surrogate information on dementia was significantly reduced in first-degree relatives in comparison with index subjects. In contrast, the sensitivity to detect depression was equivalent in subjects and in relatives. The results indicate the necessity to assess the validity of the psychiatric diagnoses of interest in the sample of interest, e.g. dementia or depression in first-degree relatives of patients and of control subjects. Observations in selected samples, i.e. subjects treated, hospitalised and/or autopsied, cannot be generalised to first-degree relatives in family studies.

Aged↗
PubMed1998

Interinformant reliability of family history information on psychiatric disorders in relatives.

Knowledge on the reliability of family history information is essential for every family study. However, systematic analyses of interinformant reliability of family history information on individual relatives have not yet been published. Consequently, family history information on 1306 first-degree relatives and spouses of patients and of control subjects was collected from at least two other family members using questionnaires. Interinformant reliability was acceptable for dementia [Kappa = 0.58, 95% confidence interval (CI) = 0.48-0.68], but less so for alcoholism (Kappa = 0.41, CI = 0.23-0.59), depression (Kappa = 0.26, CI = 0.14-0.38) and anxiety disorders (Kappa = 0.19, CI = 0.05-0.43). Demographic variables of subjects and informants and their familial relationship did not influence diagnostic agreement on the diagnosis of dementia. Diagnostic agreement on depression was significantly reduced when information from siblings of index subjects was compared with information from spouses of index subjects. The interinformant agreement for the diagnosis of depression was higher in younger than in older subjects (relative risk for disagreement 1.08/additional year, CI = 1.02-1.15). Siblings of index subjects seem to provide different, but not necessarily less relevant, family history information in comparison with other relatives. Researchers should be aware of the problem that depression in the elderly can be easily missed by family history. It seems more important for the diagnosis of depression than for a diagnosis of dementia to get information from multiple informants.

Adult↗
PubMed1997

Subject and informant variables affecting family history diagnoses of depression and dementia.

The aim of the present study was to evaluate subject and informant factors affecting the validity of the family history for dementia and depression. Relatives of patients and control subjects (n = 531) were interviewed directly. At least one 'significant' other provided family history information on every interviewed relative. The detection of dementia or depression based on the family history increased with the severity of the respective disorder. The likelihood of detecting dementia based on the family history increased in proportion to the subject's age. A lifetime diagnosis of depression in the informant improved the detection of this disorder in a relative. The presence of another psychiatric disorder in either the interviewed relative or the informant significantly increased the risk for false-positive diagnoses of depression. The present results demonstrate that family history information on depression and dementia is influenced by different proband and informant variables. On the basis of these results, we cannot recommend reducing thresholds for family history diagnoses.

Adult↗
PubMed1997

Improvement of picture recall by repetition in patients with dementia of Alzheimer type.

The evidence for positive effects of repetition on recall performance in patients with dementia of Alzheimer type is equivocal. This may be due to the difference repetition conditions used. The aim of this study was therefore to evaluate the effects of different repetition modes on the improvement of recall performance in demented subjects. Twenty-four patients with Alzheimer type dementia and 24 control subjects with remitted depression were included in the study. Pictures were presented repeatedly using different presentation modes at a constant total presentation time. Free recall was tested repeatedly after different periods of delay (0-8 hours). Immediate and delayed list repetition significantly improved recall performance in both groups. Within-list repetition did not improve total recall in demented subjects. The repeated measurement design sensitively detected minor changes in recall performance. These were not observed using other measures of recall and recognition (hits, false alarms, indices of signal discrimination).

Aged↗
PubMed1997

Proton magnetic resonance spectroscopy in dementia of Alzheimer type.

Reduced N-acetyl aspartate (NAA) and increased myo-inositol (MI) levels have been reported in patients with dementia of Alzheimer type (DAT) in comparison with controls. We wished to assess the validity of these findings and to evaluate possible correlations of metabolite proportions with cognitive dysfunction in DAT. Twelve patients with DAT and 10 healthy age-matched controls were included. The severity of dementia was assessed using different scales including the Mini-Mental State Examination. MRS was performed with a conventional 1.5 Tesla scanner in a single voxel in the centrum semi-ovale (TE = 30 ms or TE = 136 ms; TR = 1500 ms). The evaluation of MRS results was limited by low interrater, intermeasurement (different echo times) and test-retest reliabilities, by a high interindividual variance and by the failure to measure absolute metabolite concentrations. These problems in mind, it was remarkable that previously reported reductions of NAA levels in patients with DAT could be reproduced in the present sample. The proportion of NAA was diminished in demented subjects in comparison with controls (37% vs 44.90%, short TE). A non-significant trend towards minor reductions of creatine, choline and MI proportions in these subjects might indicate that proportions of other metabolites necessarily increase when NAA is reduced. Cognitive dysfunction of demented subjects was significantly correlated with reductions of NAA, but not with increases of MI. Due to the present technical and methodological problems and to the non-specificity of findings, proton MRS cannot be applied to support the diagnosis of DAT in a clinical setting.

Aged↗
PubMed1997

Selection bias during recruitment of elderly subjects from the general population for psychiatric interviews.

The aim of the present study was to determine and assess a possible selection bias in an epidemiologic investigation in the elderly. A stratified sample of 1305 probands aged 60-99 years was initially contacted by mail and then by telephone to obtain their consent to participate in a psychiatric interview. A liberal recruitment procedure led to interview participation of only 291 subjects. The proportion of younger, male, and married subjects participating in the study was greater than that of elderly, female, and single or widowed subjects. Subjects without a psychiatric lifetime diagnosis were more cooperative than those with a psychiatric disorder. The latter finding demonstrates the need to determine and assess the selection bias in psychiatric epidemiologic studies in elderly subjects.

Aged↗
PubMed1997

Obstetric complications and age at onset in schizophrenia: an international collaborative meta-analysis of individual patient data.

OBJECTIVE: An excess of obstetric complications in the histories of schizophrenic patients is a well-replicated finding, but less consistent results have been found concerning the relationships between obstetric complications and family history of schizophrenia, age at onset of schizophrenia, and gender. Small sample size limited the power of previous studies that attempted to assess such relationships. The aim of this study was to use data on individual patients from all available studies to examine the links between a history of obstetric complications and family history of schizophrenia, age at onset, and gender. METHOD: Raw data from 854 schizophrenic patients concerning history of obstetric complications rated according to the Lewis and Murray scale were obtained from 11 different research groups. Weighted average estimates were calculated with the use of regression techniques. RESULTS: A significant association was found between age at onset of schizophrenia and obstetric complications: the earlier the age at onset, the more likely the history of obstetric complications. Subjects with onset of schizophrenia before age 22 were 2.7 times more likely than those with onset at a later age to have had a history of abnormal presentation at birth and 10 times more likely to have had a history of complicated Cesarean birth. No association was found between obstetric complications and family history of schizophrenia or gender. CONCLUSIONS: The association between obstetric complications and early age at onset of schizophrenia indicates that the pathophysiology of early-onset schizophrenia involves neurodevelopmental impairment.

Adolescent↗
PubMed1996

Validity of the family history method in relatives of gerontopsychiatric patients.

It was the aim of the present study to evaluate the validity of the family history method in relatives of a sample of elderly subjects. A total of 201 relatives of patients and 89 relatives of control subjects were interviewed directly using the Composite International Diagnostic Interview and the Structured Interview for the Diagnosis of Dementia of the Alzheimer Type, Multi-infarct Dementia and Dementias of other Etiology. At least one relevant other could provide family history information on a respective subject. Family history information for psychiatric disorders including dementia (DSM-III-R) was neither accurate, nor sensitive (10 to 40%), but highly specific (> 95%). The sensitivity of the family history for dementia and depression increased in relation to the severity of the disorder. Relatives of patients were better informants than relatives of controls (at least for the presence of any psychiatric disorder). The use of several informants only slightly improved the sensitivity of the family history, without reducing the specificity to a significant extent. The combination of different sources of information may serve to reduce information biases. The evaluation of possible biases in future family studies is required to draw adequate conclusions from differences in familial loads.

Adult↗
PubMed1996

Gender and AD.

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Aged↗
PubMed1995

Personality disorders and personality variations in relatives of patients with bipolar affective disorders.

Family studies may elucidate etiological relationships between two psychopathological conditions. This study explored the prevalences of personality disorders (DSM-III-R) and the variation of personality traits measured by the Munich Personality Test (MPT) in first-degree relatives of patients with bipolar disorder in comparison to control families recruited in the general population. Although the overall prevalence of having any personality disorder did not distinguish both groups of relatives we found significantly more compulsive personality disorders among relatives of probands with bipolar disorder. Relatives of patients with bipolar disorder also revealed significantly higher mean scores of "rigidity' (MPT); other personality traits, including neuroticism and extraversion, did not distinguish both groups. The observed differences in personality features between both groups of relatives are not mediated by current or previous axis I disorders. Therefore, they may reflect overlap of etiological factors of familial origin.

Adult↗
PubMed1995

Relation of schizophrenia and panic disorder: evidence from a controlled family study.

The intention of this controlled family study was to evaluate reasons for comorbidity of schizophrenia and panic disorder. Observed rates of psychiatric disorders in first-degree relatives of patients and of controls were compared with rates predicted by possible hypotheses explaining comorbidity. The sample consisted of 59 patients with schizophrenia (including seven with schizophreniform disorder), 54 patients with panic disorder (with or without agoraphobia), 29 comorbid patients with lifetime diagnoses of panic disorder and schizophrenia (or schizophreniform disorder, 2 patients) and 109 controls, and their 1068 first-degree relatives. Information from clinical performance, clinical and structured interviews, and from family history was joined to establish DSM-III-R diagnoses in patients and relatives. As expected, schizophrenia and panic disorder were found to be familial. The hypothesis, that the familial load for primary panic disorders distinguished schizophrenics (4.3%) and controls (0.9%), could be verified (P < 0.01); the familial aggregation for primary panic disorders did not distinguish schizophrenics and subjects with panic disorder. However, the risk for schizophrenia was not enhanced in relatives of patients with panic disorder (0%) in comparison to controls (0.3%, P > 0.05). The observed familial aggregation pattern of psychiatric disorders in relatives of schizophrenics, panic patients, comorbid patients, and controls refers to an etiological relation of schizophrenia and panic disorder, or at least to a relationship of subgroups of these disorders.

Adult↗
PubMed1995

The relationship between bipolar disorder and alcoholism: a controlled family study.

Bipolar disorder and alcoholism are familial disorders. The familial-genetic relationship between both is controversial and has received insufficient study. This study explores whether bipolar disorder and alcoholism share familial risk factors, and whether the co-occurrence of lifetime diagnosis of bipolar disorder and alcoholism is familial. We report on first-degree relatives of 146 consecutively admitted patients with either bipolar disorder or/and alcoholism; relatives of the patients (in total 728 relatives directly interviewed) were compared with first-degree relatives of 109 general population probands (320 relatives directly interviewed). Overlap between the familial components underlying bipolar disorder and alcoholism was not observed if the analysis was restricted to 'pure' diagnostic groups. Excess comorbidity between bipolar disorder and alcoholism was observed in relatives. Multiple sources for this excess of comorbidity between major affective disorders and alcoholism in families of probands with bipolar disorder are likely; in particular, we found evidence for a distinct subgroup of comorbid cases with familial comorbidity; however, excess comorbidity was also found in absence of familial loading with alcoholism.

Adolescent↗
PubMed1994

Personality variations in healthy relatives of schizophrenics.

A familial relationship between schizophrenia and schizotypal personality disorder is widely acknowledged; the familial relationship between schizophrenia and the broad continuum of schizoid personality variation is less clear. In a comprehensive family study healthy relatives of schizophrenics were compared by self rated personality features with relatives of unipolar depressed patients and with relatives of controls. The dimension of schizoidia was not able to distinguish the groups of relatives. However, relatives of schizophrenics (in particular male relatives) scored higher on 'normalized' personality dimensions such as 'rigidity' and 'neuroticism'. Healthy relatives of probands with unipolar depression revealed a similar deviant pattern.

Adult↗
PubMed1994

Personality disorders among the relatives of schizophrenia patients.

In light of current linkage studies in schizophrenia, research on the "schizophrenia spectrum" deserves increased attention for an exact determination of the affected phenotype: Those disorders that have a much higher prevalence among biological relatives of schizophrenia patients are supposed to share common etiological factors with "core" schizophrenia. However, there is controversy over which of the DSM-III-R personality disorders should be included in the spectrum. In a controlled family study of inpatients with a DSM-III-R diagnosis of schizophrenia (n = 101), schizophreniform and schizoaffective disorders (n = 69), and unipolar major depression (n = 160), familial rates of personality disorders were assessed through personal interviews and compared with prevalence rates in 109 control families from the community. As predicted, schizotypal personality disorder occurred more frequently in the nonpsychotic relatives of schizophrenia probands (2.1%) than in the families of unscreened controls (0.3%). Paranoid personality disorder was more frequent in relatives of probands with unipolar depression (2.9%) than in relatives of schizophrenia patients (1.7%), and controls revealed the lowest rate (0.9%). Schizoid personality disorder, however, was extremely rare in all sample groups (between 0.3% and 0.7%), providing no sufficient statistical power for detection of group differences. Further analysis of the DSM-III-R criterion symptoms of schizotypal personality disorder demonstrated that items describing "negative" symptomatology are the main source of familial aggregation, but "psychotic-like" personality features are also contributing factors.

Adult↗
PubMed1993

Continuity and discontinuity of affective disorders and schizophrenia. Results of a controlled family study.

BACKGROUND: It is widely acknowledged that the genetic diatheses for schizophrenia and affective disorders are independent. However, there are increasing doubts about this classic view, and empirical evidence for a dichotomy of these two prototypes of functional psychoses is limited. A controlled family study of consecutive admissions was conducted to determine whether familial risks for schizophrenic (SCZ) and affective disorders were independent or overlapping. METHODS: Index probands met Research Diagnostic Criteria for SCZ (n = 146), schizoaffective (SA [n = 115]), bipolar (BP [n = 80]), or unipolar major depressive (UP [n = 184]) disorder. Comparison probands met Research Diagnostic Criteria for alcoholism (n = 64) or were sampled from the general population (n = 109). A total of 2845 first-degree relatives were blindly diagnosed from interview, informant, and/or record data, with direct interviews completed in 2070 (82% of living first-degree relatives). RESULTS: By Cox's proportional hazards analysis, SCZ, SA, BP, and UP disorders were familial, in that each group of relatives had an increased lifetime morbid risk (vs those with alcoholism and those from the general population) for the proband's diagnosis. The SCZ and BP disorders were transmitted independently: only probands with manic disorders (BP or SA-BP subtype) showed increased familial risks of BP disorder, and only probands with prominent SCZ features (SCZ or SA) showed increased familial risks of SCZ disorder. However, SCZ probands had an increased familial risk for UP disorder (as did SA, BP, and UP probands) and for the SA-UP subtype. Aggregation of depression in families of SCZ probands could not be explained by the subtype of depression, broad or narrow definition of SCZ disorder, presence or absence of history of depression in SCZ probands, whether onset of depression in a relative occurred before or after onset of a proband's SCZ disorder, or assortative mating. CONCLUSIONS: These data suggest that there could be a familial relationship between the predispositions to schizophrenia and to major depression. We discuss a number of alternative hypotheses about the nature of this possible relationship.

Adult↗
PubMed1993

The impact of gender and age at onset on the familial aggregation of schizophrenia.

Some recent family studies have shown that the familial risk for schizophrenia is higher in female than in male schizophrenics. It is debated whether the risks for the other disorders, such as schizotypal personality disorder or affective disorders in families of schizophrenics are similarly influenced by the proband's gender. Also, the reason for the effect of proband's gender on the recurrence risk for schizophrenia has not been clarified. This family study (159 probands, 589 first degree relatives) confirms that schizophrenia, but also schizophrenia spectrum disorders were more frequent in families of female compared with male schizophrenics. Neither age at onset in probands nor the interaction between gender and age at onset in probands had a relevant impact on the risk figures in relatives. Affective disorders occurred in families independently of the probands' gender. Aetiological heterogeneity or ascertainment bias may account for the modifying effect of proband's gender in schizophrenia.

Adult↗