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Biomedical subjects

S Priebe

Publications and source records attributed to S Priebe.

At least 19 recordsLinked to original sources
PubMed2001

Specific body image pathology in acute schizophrenia.

Despite a wide phenomenological interest in body image pathology in schizophrenia, there has been little systematic empirical research. This study aimed at establishing the specificity of body image pathology in patients with schizophrenia, its changes during acute treatment, and its association with other symptom factors. Cognitive (thoughts/beliefs regarding the body--body concept), affective (body satisfaction--body cathexis) and perceptual (body size estimation--body schema) facets of body image and psychopathology were assessed in in-patients with paranoid schizophrenia (N = 60), schizoaffective disorder (N = 19), depressive disorder (N = 40) and anxiety disorder (N = 28) at admission, and after 2 and 4 weeks of treatment. Body size perception was also assessed in a sample of healthy subjects (N = 44). Patients with paranoid schizophrenia/schizoaffective disorder showed under-estimation of lower extremities at each time point. They expressed a higher degree of body concept disturbances at admission, but not at later stages. In a factor analysis, body perception and body concept loaded on distinct factors, which were separate from positive symptoms, negative symptoms, and anxiety. Patients with acute paranoid schizophrenia and schizoaffective disorder seem to have a specific and consistent disturbance of body size perception, which might indicate a dysfunction of sensory information processing.

Acute Disease↗
PubMed2001

Subjective response to and tolerability of long-term supraphysiological doses of levothyroxine in refractory mood disorders.

BACKGROUND: Although supplementation with supraphysiological doses of levothyroxine (T4) has been an effective treatment for refractory affective disorders in open studies, questions remain as to the tolerability of this treatment. This is the first study to investigate subjective patient response and tolerability to long-term treatment with adjunctive T4. METHODS: Of 24 patients with refractory affective disorders or schizoaffective disorder who were consecutively included into an open trial with supraphysiological T4, 16 were eligible for this study. Four measures were used to rate tolerability to T4 treatment. Subjective response was graded on a scale ranging from -33 (maximal negative response) to +33 (maximal positive response). Positive and negative effects were assessed on a structured questionnaire. Clinical tolerance was assessed with the clinician-rated Thyroid Symptom List and the self-rated Von Zerssen Complaint Lists. Outcome was assessed with the CGI for prophylactic ratings (CGI-BP). RESULTS: At the time of assessment, patients had been treated with supraphysiological T4 (mean dose 368 microg/d) for a mean of 54 months. The total subjective response score was +25.2. Positive subjective response and observer-rated treatment success were moderately correlated. Ratings on the Thyroid Symptom List indicated an overall favorable side effect profile. General physical and mental symptoms were only slightly higher than in the general population. LIMITATIONS: This was an open, cross-sectional study that only included responders and partial responders to T4 treatment. CONCLUSIONS: Subjective response and side-effect tolerability of long-term supraphysiological doses of T4 is favorable in patients with refractory mood and schizoaffective disorders who respond to the intervention.

Adult↗
PubMed2001

Patients' and relatives' assessment of clozapine treatment.

BACKGROUND: Subjective evaluations by schizophrenic patients and their relatives of clozapine treatment were assessed as part of an exploratory study. METHODS: A problem-centred interview was carried out with 80 patients at discharge from in-patient or day-hospital treatment. Views of 46 relatives on the treatment were also assessed. RESULTS: In addition to expected effects (improvement of or stabilisation of one's state of mental health, antipsychotic effects), patients surprisingly often highlighted the calming and relaxing effect of clozapine as well as improved sleep as particularly positive. While more than half of the respondents expected a worsening of their condition if they stopped taking medication, only every fifth patient feared a relapse. Among the negative effects, fatigue and sedation were cited by far the most often. The absence of extrapyramidal side effects was clearly noted as an advantage of clozapine. Only 10% of those questioned were aware of the risks for the haemotopoetic system associated with the drug. Differences were found between patients' and relatives' assessments particularly with regard to the negative effects. CONCLUSIONS: Patients and relatives frequently hold specific and distinct views on clozapine treatment. These views should be considered when patients and relatives are informed and when compliance is addressed.

Adult↗
PubMed2001

[Etiology of schizophrenia from the viewpoint of family].

OBJECTIVE: In a former quantitative study on relatives' beliefs about the causes of functional psychoses a preference for psychosocial explanations was found. There were also indications of an inclination towards a multicausal concept. The aim of this study is to try to replicate these findings using semi-qualitative methods. In addition, we are interested in knowing to what extent the causal beliefs of relatives are similar to those of the patients. METHOD: Problem-centered interviews were conducted with 31 relatives of schizophrenic patients. A computer-assisted qualitative content analysis was carried out with the transcripts of the interviews. RESULTS: As in the previous study, relatives showed a strong propendency to endorse psychosocial explanations. However, among only one third a multicausal concept could be observed. The causal beliefs of relatives and patients were quite similar. DISCUSSION: The findings are discussed with reference to the concept of subjective illness theory and the concept of social representations.

Adult↗
PubMed2001

[Etiology of schizophrenia from the viewpoint of the patient].

OBJECTIVE: According to a quantitative study on causal beliefs patients with functional psychoses favour psychosocial over biological explanations. They also tend to endorse a multicausal concept. The aim of this study is to try to replicate these findings using semiqualitative methods. METHODS: Problem-centered interviews were conducted with 78 schizophrenic patients consecutively discharged from inpatient or dayhospital treatment. RESULTS: As in the previous study, patients provided more frequently psychosocial explanations. Biological causes were relatively rarely mentioned--mostly in response to suggestions of the interviewer. In addition, they were rather brief and not very elaborated. By contrast to the previous study, hardly any indications for a multicausal concept could be observed. DISCUSSION: Patients' beliefs are contrasted with the results of psychiatric research on the causes of schizophrenia.

Adult↗
PubMed2001

[Long-term patients in supported housing after deinstitutionalisation--part V of the Berlin Deinstitutionalisation Study].

OBJECTIVE: In part IV of the Berlin Deinstitutionalisation Study, we reported a positive change in quality of life for 65 resettled patients one year after discharge. In this part, we investigated changes in a longer follow-up period. METHODS: A group of 66 patients discharged into supported housing was assessed one and five years after baseline. Quality of life, needs for care, patients' assessment of treatment, re-hospitalisation and characteristics of care were studied in a control-group design. RESULTS: After five years, 61 % of the patients continued to live in highly staffed settings (mean staff-patient-ratio: 1 : 3.5). Eleven percent had moved on to independent living and 16 % had returned into an institutional setting. Standard mortality ratios were 4.4 (all causes of death) and 62.5 (2 suicides only of schizophrenic patients). After one year patients (n = 20) showed a significant increase in satisfaction with their living situation and more social contacts. Over the longer period of time, there were also favourable changes, which failed to reach statistical significance (n = 24). Average length of inpatient stay per year of the illness was decreased significantly at both follow-ups. CONCLUSIONS: Interpretation of the findings is difficult because of the small sample size and selection effects. Most of the former long-stay patients appear able to live in the community with a significant decrease of time spent in hospital. Whilst patients were particularly satisfied with their accommodation at one year follow-up, this did not lead to a generalised improvement in subjective quality of life and other subjective criteria in the long term. In line with other recent studies on community mental health care one may conclude that small case loads alone do not have major beneficial effects. Further research should evaluate more systematic and targeted models of mental health care in the community in general and of supported housing in particular.

Adult↗
PubMed2001

[Effects of a brief couples therapy intervention in coronary rehabilitation. A controlled study].

The effects of a brief couple therapy intervention in cardiac rehabilitation was investigated in a randomised controlled trial. The treating physician and a psychologist conducted an intervention of two to four sessions with 19 patients with coronary diseases at the IIa stage according to WHO and their partners. The 21 patients in the control group received standard care with no additional intervention. Depressive symptoms, global self-rating of health status and disease related concerns were assessed at the beginning of training and nine months later. Patients in the experimental group more often stated to feel better immediately after the intervention. Over the observation period they showed significantly more favour-able changes in observer rated depressive symptoms, self-rated health status and concerns. Patients and partners in the experimental group assessed the outcome of rehabilitation significantly more positive after nine months. The findings suggest that a very short couple therapy intervention, which can be administered in routine care, can have positive effects in cardiac out-patient rehabilitation. Larger studies are required for testing whether the effects of such interventions are restricted to depressive symptoms and subjective appraisals, or whether other outcome criteria such as mortality can also be influenced.

Adult↗
PubMed2001

[Causal beliefs of schizophrenic patients].

RESEARCH QUESTION: Aim of the study is to investigate whether the preference of schizophrenic patients for psychosocial causal explanations found in a previous study carried out in Hamburg can be observed elsewhere. Further aim of the study was to find out how stable patients' causal attributions are over time. Finally, we were interested to know to what degree patients' beliefs reflect those held by the general public. METHOD: Using an inventory comprising 15 items, we inquired about 105 schizophrenic patient's aetiological ideas at the time of discharge from hospital from inpatient or daycare treatment at 4 psychiatric hospitals in Germany. Follow-ups were carried out 3 months and 6 months later. RESULTS: Psychosocial factors, especially psychosocial stress, were most frequently held responsible for the onset of the illness. The possibility that biological factors might play a role in the causation of schizophrenia was considered more rarely by the patients. There were practically no regional variations as concerns aetiological beliefs. The tendency to endorse psychosocial stress factors was more pronounced among patients as compared with the general public. In total the causal beliefs proved to be quite stable over a time period of 6 months. DISCUSSION: Patients' causal beliefs are compared with findings of psychiatric research, and possible ways to bridge the gap between the two are discussed.

Adult↗
PubMed2000

Political change and course of schizophrenia in East Germany, 1984-1994.

BACKGROUND: We tested the hypothesis that the political change occurring in East Germany after the fall of the Berlin Wall in November 1989 affected patients with long-term schizophrenia, resulting in more and longer hospitalisations. METHODS: In two samples in East Germany (120 patients in East Berlin, 70 patients in Chemnitz) and in a control group from West Berlin (40 patients), hospitalisations for each month between November 1984 and October 1994 were assessed. Each sample included all schizophrenia patients who were in continuous treatment in the given community mental health centre throughout the full observation period. RESULTS: Hospitalisation indices were not higher after November 1989 than before in any of the groups. CONCLUSIONS: There is no evidence that political change in East Germany negatively affected the course of longterm schizophrenia as assessed by hospitalisations. If consistent medical care is provided, characteristics of the political system may have less impact on the course of schizophrenia than is sometimes assumed.

Adult↗
PubMed2000

Quality of life in first-admitted schizophrenia patients: a follow-up study.

BACKGROUND: While most studies of quality of life (QoL) in schizophrenia have investigated long-term patients, relatively little is known about QoL early in the illness and how it changes over time. This study was conducted to investigate objective and subjective quality of life in first-admitted schizophrenia patients as compared to patients with long-term schizophrenia, changes between first admission and 9-month follow-up and predictors of changes. METHOD: Eighty-six patients were examined after first admission and 51 were re-interviewed at follow-up. Results were compared with samples of in-patients and out-patients with long-term schizophrenia. QoL was assessed using a German version of the Lancashire Quality of Life Profile. RESULTS: Although some objective QoL data were more favourable in first-admitted patients, subjective QoL was lower than in each of the other two groups, even when psychopathology and age were controlled for. On a group level, patients showed a slight improvement in subjective QoL, which was not statistically significant. Individual changes over time were not predicted by initial data, but were correlated with changes in anxiety/depression. CONCLUSION: Subjective QoL appears to be lower in first-admitted schizophrenics than in groups with long-term illness and, on a group level, it changes little within 9 months. On an individual level, changes in depressive symptoms need to be considered when interpreting changes in satisfaction with life.

Adult↗
PubMed2000

[Political change in East Germany 1989-90 in the lives of chronic schizophrenic patients].

Theoretical models suggest a higher vulnerability of chronic schizophrenic patients for critical life events and rapid change of objective living circumstances. On the basis of these models one may hypothesise that the political change in East Germany in 1989/90 was objectively or subjectively distressing to such patients and had a negative impact on their illness. In a retrospective longitudinal study, we investigated patients' assessment of political change, life events that were potentially related to the political changes, impact of the changes on subjective quality of life, and hospitalization rates during five year periods prior to and following the change. 120 patients with chronic schizophrenia in East Berlin and 70 in Chemnitz were examined using quantitative and qualitative methods. Patients reported more individual freedom and better care after 1989. They complained about stress due to loss of employment, financial disadvantages and rising crime rates. Despite the occurrence of potentially change-related life events after 1989, patients stated very little impact of the changes on their illness. Retrospectively, patients in East Berlin reported a significantly better subjective quality of life in 1994 than in 1984. Hospitalization rates did not increase after 1989. The findings are not consistent with the hypothesis and do not suggest that political changes in East Germany in 1989/90 had--subjectively or objectively--a substantial negative effect on the illness of patients with chronic schizophrenia.

Adult↗
PubMed2000

[Open care--the Rodewisch theses--psychiatry enquete: 3 reform approaches compared].

AIM: The three most important German approaches for reforming psychiatric care in the 20th century--i.e. "open care" in the Weimer Republic in the 20ies, the "Rodewisch Theses" published in the GDR 1963, and the "Psychiatry-Enquete" in the Federal Republic in 1975--were compared using seven criteria. METHODS: Psychiatric and general medical journals were systematically searched for articles on aims and objectives of mental health care. RESULTS: All three approaches promoted stronger community based care. None of them suggested an "empowerment" as it is understood today. Differences between them concerned equal care for mentally and physically ill patients, international relations, and economic arguments. Comparisons on other criteria, e.g. the relationship with university psychiatry, yield a less clear picture. CONCLUSIONS: All three ideas for reforms have been successful--to a limited and different extent. They resemble each other in essential principles, but there are also substantial differences.

Community Mental Health Services↗
PubMed1999

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Humans↗
PubMed1999

[Short assessment of subjective quality of life. Application and results of a short form of the Berliner Lebensqualitätprofil (BELP-KF)].

The concurrent validity between the Berliner Lebensqualitätsprofil (BELP) and a new developed short form (BELP-KF) was tested in a sample of schizophrenia outpatients (N = 36) and turned out to be very high. The restriction to subjective quality of life questions did not lead to a greater halo-effect in the sense of an increasing similarity of single item values. Correlations with psychopathological symptoms were almost identical for both interview-versions. The same is true concerning the factorial structure of the satisfaction items which was nearly congruent. Two optional items on satisfaction with sexual life and with psychopharmacological treatment, which had been included into the short interview version, were attributable to an underlying general satisfaction dimension. Among 14 variables satisfaction with psychopharmacological treatment had the second highest factor-loading on the resulting general satisfaction factor.

Antipsychotic Agents↗