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Biomedical subjects

W Gaebel

Publications and source records attributed to W Gaebel.

At least 109 records · Page 6Linked to original sources
PubMed1988

Auditory evoked potentials as possible predictors of outcome in schizophrenic outpatients.

As part of a follow-up study on long-term neuroleptic treatment, 36 schizophrenic out-patients under neuroleptic treatment were studied in an 'auditory oddball' event-related potential paradigm after a 3-month stabilization phase following clinical discharge. In the first cross-sectional analysis, we evaluated the influences of age and gender and tried to find auditory evoked potential (AEP) variables, which might be promising as potential predictors of the course of illness. Compared with healthy age-matched controls, the patients showed smaller N1/P3-amplitudes. Males and females showed only minor AEP-differences, the amplitude N1/P2 being slightly higher in females. Age correlated positively with the latency P3 and negatively with the latency P2R. The interpeak latency P3-P2R showed the highest correlation with age. Test/re-test reliability was measured and variables with r less than 0.60 were rejected. The amplitudes N1/P2 and N1/P3 showed the highest test/re-test correlations. The more severely disturbed patients (global assessment scale [GAS]-score less than 65) had shorter interpeak latencies P2F-N1F than the less disturbed patients (GAS greater than or equal to 65). Patients with a high rate of relapse tended to have shorter interpeak latencies P2F-N1F than patients with low rates of relapse. Our results indicate that the interpeak latency P2F-N1F has an acceptable test/re-test reliability (C3: r = 0.72; C4: r = 0.80) and is related to clinical variables characterizing the course and outcome of illness. This leads to the hypothesis that a short interpeak latency, P2F-N1F, might be a predictor of poor prognosis.

Adult↗
PubMed1988

Topographical distribution of absolute alpha-power in the EEG and psychopathology in schizophrenic outpatients.

In 36 schizophrenic outpatients (Research Diagnostic Criteria) under neuroleptic maintenance treatment the EEG was recorded under resting conditions. The absolute alpha-power (7.5-13 Hz) was estimated by Fast Fourier Transform as the mean of 300 2-second epochs for the leads F3/A1, F4/A2, 01/A2 and 02/A2. Two lateralization quotients (anterior, posterior) and two anteriorization quotients (left, right) were calculated from the absolute alpha-power. Clinical status was assessed cross-sectionally with BRPS, GAS and CGI. The main findings are: 1) A linear relationship between the left/right ratio of absolute alpha-power over posterior regions and anxiety/depression--the more the alpha-power is left-lateralized, the higher the anxiety/depression score; 2) a curvilinear, inverted U-shaped relationship between the left/right ratio of absolute alpha-power over posterior regions and the score of schizophrenia-specific symptomatology; 3) the amount of daily neuroleptic dose (mgCPZ) has no impact on EEG-parameters. Results are discussed with respect to hemisphere asymmetry models of psychopathology.

Adult↗
PubMed1987

Visuomotor performance of schizophrenic patients and normal controls in a picture viewing task.

The eye movements of 20 partially remitted schizophrenic outpatients (ICD-9) under neuroleptic maintenance medication and those of 20 normal controls were recorded using corneal reflection pupil-center measurement. The visuomotor performance during a 1-min picture viewing task was studied on the basis of several eye movement parameters. Clinical evaluation comprised self-ratings (Frankfort Complaint Questionnaire) and observer ratings (BPRS, CGI, GAS), as well as recording of current daily neuroleptic dosage (mg CPZ). The main results are that schizophrenics differ from normals in their correlational pattern of fixation- and movement-related parameters, reflecting two opposite viewing styles in schizophrenics: staring and extensive scanning. Both styles are differently related to clinical symptomatology. There was no strongly marked relationship with neuroleptic dosage.

Adult↗
PubMed1987

[Psychophysiology of schizophrenic disorders of attention--concepts, findings and working hypotheses].

Starting from early clinical descriptions according to which there exists a polarity of attentional behavior in schizophrenia, we compare a number of pertinent theoretical concepts put forward up to now. Special attention is given to the question of functional hemispherical asymmetries, and here especially to a working hypothesis according to which the neuropsychological deficits in schizophrenics result from a coordination deficit of two differently lateralized attention systems. Taking into consideration certain neurophysiological (especially electro-encephalographical) findings, we discuss a model which places in opposition sensory intake behaviors and sensory rejection behaviors. Then we give a condensed presentation of relevant findings of our own. In particular, it could be shown that clinical improvement goes along with a certain change of the topographical distribution of absolute alpha-power, and that the intensity of some psychopathological symptoms correlates with the lateralization of posterior absolute alpha-power. Relationships also occurred between psychopathology on the one hand and the performance level in a visuo-motor tracking task or the eye movement behavior recorded during a picture viewing task, on the other. A concluding synopsis, comprising both empirically proven and theoretically postulated relationships, serves to formulate working hypotheses for clinical-psychophysiological correlation studies to be done in the future. In contrast to the current practice of assigning patients to the usual diagnostic subgroups, we advocate from a research-oriented point of view the grouping of those patients who show certain combinations of clinical and psychophysiological signs at a certain moment. Such a procedure holds out a prospect of solving a central problem of schizophrenia research consisting of the considerable intra- and individual variability of findings. Instead of changeable sick persons, defined systems states would be classified. Knowledge of the dynamics of such systems states could contribute to a rational therapy in the individual patient.

Attention↗
PubMed1987

Prospective study of course of illness in schizophrenia: Part I. Outcome at 1 year.

In a prospective study involving 161 patients discharged from inpatient psychiatric treatment, outcome data were obtained for 93 percent of the patients 1 year after clinic discharge. Sixty-seven percent of the patients were directly interviewed for the followup examination. Outcome data for symptomatology, relapses, employment, and social contacts did not differ significantly for patients with schizophrenic psychoses as compared to those with affective psychoses, neuroses, and other psychiatric diagnoses (predominantly alcohol dependency). A discrepancy between self-ratings and observer-ratings was particularly striking in the group of neuroses at discharge from inpatient treatment. These patients also had comparatively more prominent depressive symptomatology at followup. These findings raise questions about the influence of possibly different levels of intensity in outpatient followup treatment, and about outcome predictors independent of diagnosis. These questions are pursued in Parts II and III.

Adolescent↗
PubMed1987

Prospective study of course of illness in schizophrenia: Part II. Prediction of outcome.

In a prospective study of the course of illness of 86 schizophrenic patients (ICD 9), outcome data were obtained for 86 percent 1 year after clinic discharge. The Strauss-Carpenter Outcome Scale (frequency of social contacts, employment duration, symptomatology, and duration of rehospitalization) and the Clinical Global Impressions were used to assess outcome. The prognostic scales developed by Vaillant, Stephens, Phillips (in the abbreviated version by Harris), and Strauss-Carpenter were used as potential outcome predictors at the time of index admission. The findings were as follows: The outcome criteria used correlated at best moderately with one another. Between 60 and 90 percent of the sample were judged to have an unfavorable prognosis on the Vaillant and Stephens scales. In contrast, the outcome was relatively favorable for 50 to 60 percent of the patients. In prognostic validity, the Strauss-Carpenter scale was superior to all of the other scales investigated. However, a prognostic relationship was only established for social outcome. Social outcome dimensions showed the highest prognostic validity (e.g., employment and social contacts). The amount of variance explained by the best predictors was between 12 percent (symptomatology) and 55 percent (employment duration).

Adolescent↗
PubMed1987

Prospective study of course of illness in schizophrenia: Part III. Treatment and outcome.

In a prospective study of 86 schizophrenic patients (ICD 9), outcome data were obtained for 86 percent 1 year after clinic discharge. The Strauss-Carpenter outcome scale (frequency of social contacts, employment duration, symptomatology, and duration of rehospitalization) served as the outcome criterion. The Strauss-Carpenter prognostic scale items served as the potential predictors of the course. The followup treatment, which took place during the catamnestic period, was compared with that of other psychiatric diagnostic groups with respect to its continuity and efficiency. The following findings emerged: When compared to patients with neuroses and alcohol dependency, the followup treatment of schizophrenic patients in a large city seems to be better ensured. This is attributed to a clearer concept of treatment for schizophrenic patients. The comparatively favorable outcome of this group of patients seems to be related to this. For the other groups, especially for neurotic disorders, effective treatment concepts have still to be developed and evaluated. Schizophrenic patients receiving continuous neuroleptic medication are rehospitalized significantly less often (28 percent) than those not in continuous treatment (55 percent). This treatment difference is most obvious for patients with multiple admissions. Differences dependent on treatment are not found in other outcome dimensions. However, patients with good heterosexual adjustment profit the most from continuous treatment with neuroleptics in reference to freedom from symptoms. For a more chronic subgroup with a poorer initial level of work adjustment, the functional level deteriorates over the course of illness. Relapse and inpatient readmission are related to retarded recompensation, particularly for chronic patients. This underlines the need for consistent neuroleptic treatment.

Adolescent↗
PubMed1987

Visuomotor tracking performance in schizophrenia: relationship with psychopathological subtyping.

30 schizophrenic outpatients (RDC) under neuroleptic maintenance treatment completed a visuomotor tracking task with four degrees of difficulty. The mean efficiency of performance was measured in bit per second from the difference between the target signal and the tracking signal. Clinical assessment was accomplished with the BPRS, CGI, and GAS. Besides generally poorer tracking performance in schizophrenics compared with healthy volunteers the main finding was a relationship between tracking performance and psychopathological subtyping. Negative symptoms were related to a generally lowered task performance, irrespective of task difficulty. However, this effect disappeared by controlling for illness duration. On the other hand, there was a syndrome-specific interaction effect with task difficulty: Schizophrenics with positive symptoms performed poorly, especially in the most difficult task condition. Generally, there was no significant relationship between daily neuroleptic dose and tracking performance. Results are discussed with respect to a differential deficit in attention in schizophrenic subgroups.

Adult↗
PubMed1987

Strategies of clinical research on neurobiological determinants of psychosis.

Despite great efforts in clinical psychiatric research in the last decades, many simple questions still remain open. Present day clinical practice still lacks theoretically founded and generally accepted therapeutic rules, especially in the individual case. Similarly, in basic research we are far from understanding the etiopathogenetics of psychiatric illness. From summarizing some aspects of previous research strategies and results in neurobiological determinants in psychosis, future research strategies are outlined, which already have proven successful and thus should be pursued more rigorously. Not least because of general limited research capacities with respect to time and costs, future research has to proceed economically, i.e. guided by clear strategies.

Antipsychotic Agents↗
PubMed1986

Eye movement research with schizophrenic patients and normal controls using corneal reflection-pupil center measurement.

The eye movements of 20 partially remitted outpatient schizophrenics (ICD 9), for the most part receiving neuroleptic maintenance medication, and 20 normal controls were recorded using corneal reflection-pupil center measurement. Performance was investigated on the basis of widely varied measurement parameters during a fixation task and a visual search task (list of letters). Psychopathological data were additionally recorded for the group of patients by means of self and observer ratings, current social adjustment, and neuroleptic dosage. The schizophrenic patients showed the tendency to perform more poorly than the normal controls in the eye movement parameters recorded, and there was marked variation in performance within the group of schizophrenic patients. In particular, various abnormalities in fixation performance were connected differentially with individual psychopathological syndromes and neuroleptic dosage. Connections between fixation performance and search performance were found only within the group of patients. They are interpreted as an indicator of disturbed interhemispheric coordination in schizophrenics. Based upon specific pupillary findings one concludes that the processing load imposed on the attentional system by the search task is different for various schizophrenic subgroups.

Adult↗
PubMed1985

Multidimensional study of the outcome of schizophrenic patients 1 year after clinic discharge. Predictors and influence of neuroleptic treatment.

Several dimensions of the outcome of 86 schizophrenic patients were recorded 1 year after discharge from inpatient index-treatment to complete a prospective study concerning the course of illness (rehospitalization, symptoms, employment and social contacts). When compared with 75 psychiatric patients of other diagnostic groups, no differences were found other than a significantly longer average rehospitalization stay for the schizophrenic patients. Taking prognostic categories and the regularity of neuroleptic therapy conducted during follow-up into account, it was established that the social outcome status of schizophrenic patients is substantially determined by the original level at the time of index-treatment. In contrast, the rate of relapse and readmission depend significantly upon the continuity of neuroleptic treatment. More complex analyses show that particularly for patients already hospitalized several times, successful relapse prophylactic treatment also has a favorable influence upon the patients' symptoms in the sense of a more stable remission. This could be related to the finding that the more chronic patients apparently exhibit a delayed remission when they undergo a relapse. The findings are interpreted to the effect that continuous neuroleptic maintenance therapy is advantageous to the majority of the patients, and should be applied, in view of the fact that alternative therapy procedures such as neuroleptic interval strategies have not yet been sufficiently evaluated.

Adolescent↗
PubMed1985

One-year outcome of schizophrenic patients--the interaction of chronicity and neuroleptic treatment.

In an ongoing prospective investigation of the course and outcome of schizophrenia, the global functioning (employment, social contacts, symptoms) and rehospitalization rate of 72 patients were assessed one year after clinical discharge. With regard to chronicity of illness, the global outcome was better for first admissions than for multiple admissions. On controlling the patients' functioning one year before index admission, this difference did not hold true. Hence, there must be difference in the functioning of the two groups which dates back a rather long time. However, multiple admissions showed an actual downward trend in their work functioning (p less than 0.05). Rehospitalization rates of the two groups did not differ significantly (33% for first admissions versus 40% for multiple admissions). Evaluation of differences in drug-taking behavior revealed that patients with better global functioning tended to take their neuroleptics not as regularly as prescribed. Whereas for good functioning first admissions, taking into account, their better spontaneous course (rehospitalization rate 27%), an intermittent neuroleptic strategy may be in order, for multiple admissions the reversal seems to be true (rehospitalization rate for compliant patients 27%, for non-compliant patients 73%, p less than 0.01). However, a small group of good functioning multiple admissions did not have to be rehospitalized in spite of non-compliance, whereas the patients with the poorest function relapsed despite their compliance. We conclude that, whereas for first admissions long-term neuroleptic medication may not be generally indicated on account of their prognostic heterogeneity most of the multiple admissions will profit by this therapeutic strategy in respect of rehospitalization.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

[Influence of treatment course on the success of psychopharmacotherapy].

Psychiatric illness course is not characterized by total regularity. More often there is marked individual variability. This is an obstacle to making a valid prognosis and applying broadly based indication rules. Still today predictors of illness course as well as indication criteria for treatment are little elaborate and often faile in the individual case. The most reliable instrument for planning and assessing psychiatric treatment is the treatment course itself. The therapist as a participating observer can more easily check tendencies of illness course and adapt therapeutic strategies. Characteristics of treatment course in guiding further treatment are examplified by means of neuroleptic treatment in the acute and maintenance phase of schizophrenic psychoses.

Antipsychotic Agents↗
PubMed1984

Prognosis of the course of schizophrenic psychoses compared to other psychiatric illnesses. Catamnestic treatment and outcome 1 year after discharge.

In a prospectively designed study of the course of illness of 161 hospitalized psychiatric patients, data regarding outcome could be obtained for 93% 1 year after clinic discharge. It was possible to reexamine 67% of the patients by means of direct interviews. No significant differences appeared in the comparison of the course of illness outcomes (symptoms, rehospitalization, occupation and social contacts) of patients with schizophrenic psychoses, affective psychoses, neuroses or a group of mixed other diagnoses (predominantly alcohol dependency). For the group of neuroses there was a particularly striking discrepancy between the self- and the observer-ratings at the time of discharge from inpatient index-treatment. From this finding and from the comparatively more intense prominence of depressive symptoms at the time of follow-up, one can presume that there has been insufficient after-care treatment of this patient group considering the recorded treatment data. This seems to hold true for the group of alcohol dependents as well. In contrast, the after-care treatment of patients with affective and schizophrenic psychoses seems more likely to be ensured today. Despite this, however, for the latter the close link between the rate of relapse and the rate of rehospitalization can apparently scarcely be influenced.

Adolescent↗