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PubMed1995

Long-term course of obsessive-compulsive disorder treated in adolescence.

OBJECTIVE: To investigate the long-term course of obsessive-compulsive disorder treated in adolescence. METHOD: Fifteen young adults treated for the disorder in adolescence, mainly through not only by behavior therapy and family therapy, were followed up between 9 and 14 years later. RESULTS: Data were collected on 14 of the cases (93%, N = 15) from various sources including interview in person in 6 cases. Of the 14 cases, 6 were found to satisfy DSM-III-R criteria for obsessive-compulsive disorder at long-term follow-up, while 8 were not. These recovered participants were not currently taking medication, and long-lasting recovery was associated with good social adjustment. Chronic course was not attributable to lack of subsequent treatment. CONCLUSIONS: The recovery rate of 57% (N = 14) is similar to those found in other recent studies of outcome following vigorous treatment in adolescence. The findings are over the longest follow-up period so far reported for obsessive-compulsive disorder treated in adolescence. Positive response to treatment in adolescence can be followed by relapse after longer periods than have usually been studied.

Adjustment Disorders↗
PubMed1993

[Eradication therapy of Helicobacter pylori in gastroduodenal ulcer and its long-term course].

We investigated the efficacy of antimicrobial drugs, amoxicillin and clarithromycin that have the in vitro activity against H. pylori, and observed a long term course of ulcer after eradication. The eradication rate of combination therapy with PPI and amoxicillin showed best result (13/18: 72%). In eradicated cases, index of PAS positive substance and gastritis score in antral mucosa that is histological examination was improved, and ammonia concentration in gastric secretions decreased. The recurrent rate of ulcer in long term course after eradication was investigated, the recurrent rate of ulcer was significantly lower in H pylori eradicated cases than in H. pylori continuously positive cases. Results suggest that eradication of H. pylori may be controlled recurrence of H. pylori positive peptic ulcer.

Amoxicillin↗
PubMed2000

Reliability of the life chart schedule for assessment of the long-term course of schizophrenia.

We report on the inter-rater reliability of the Life Chart Schedule (LCS). The LCS is designed to assess the long-term course of schizophrenia in four key domains (symptoms, treatment, residence, and work) over two time periods (past two years, entire period of illness). The subjects were 27 consecutive admissions to a schizophrenia research unit. The LCS was filled out by pairs of raters, blinded to each others' ratings, using the same data (interview with subject and chart). Reliability was examined for 45 LCS ratings selected from all four domains and both time periods. Selected ratings pertained to the duration of specified experiences, the quality of these experiences, and the long-term time trend. The kappa statistic and the intra-class correlation coefficient (ICC) were used to determine inter-rater reliability for continuous and categorical ratings, respectively. LCS ratings proved reliable in all four key domains and both time periods. The reliability was fair to excellent for ratings of duration of experience (ICC ranged from 0.53 to 0.99), quality of experience (kappa ranged from 0.46 to 0. 92) and long-term time trends (kappa ranged from 0.66 to 0.94). The LCS can be used to obtain reliable ratings of the long-term course of schizophrenia in multiple domains.

Adolescent↗
PubMed2000

Psychosocial disability during the long-term course of unipolar major depressive disorder.

BACKGROUND: The goal of this study was to investigate psychosocial disability in relation to depressive symptom severity during the long-term course of unipolar major depressive disorder (MDD). METHODS: Monthly ratings of impairment in major life functions and social relationships were obtained during an average of 10 years' systematic follow-up of 371 patients with unipolar MDD in the National Institute of Mental Health Collaborative Depression Study. Random regression models were used to examine variations in psychosocial functioning associated with 3 levels of depressive symptom severity and the asymptomatic status. RESULTS: A progressive gradient of psychosocial impairment was associated with a parallel gradient in the level of depressive symptom severity, which ranges from asymptomatic to subthreshold depressive symptoms to symptoms at the minor depression/dysthymia level to symptoms at the MDD level. Significant increases in disability occurred with each stepwise increment in depressive symptom severity. CONCLUSIONS: During the long-term course, disability is pervasive and chronic but disappears when patients become asymptomatic. Depressive symptoms at levels of subthreshold depressive symptoms, minor depression/ dysthymia, and MDD represent a continuum of depressive symptom severity in unipolar MDD, each level of which is associated with a significant stepwise increment in psychosocial disability.

Adaptation, Psychological↗
PubMed1998

Predicting extreme patterns of long-term course of psychogenic impairment: a ten-year follow-up.

This longitudinal study identifies predictors of course and etiologically relevant factors of psychogenic disorders. Since 1979, the Mannheim Cohort Project on the Epidemiology of Psychogenic Disorders has investigated neurotic spectrum disorders, personality disorders, stress reactions, and somatoform disorders in the normal population. Using these data, a cohort of probands suffering from moderate psychogenic impairment (N = 240; 121 men, 119 women) based on a representative sample of the urban adult population (N = 600; with cohorts 1935, 1945, 1955; gender distribution 1:1) of Mannheim, an industrial and university town in Germany, was followed up for almost 10 years. The cohort was investigated three times by psychodynamically trained physicians and psychologists. Tests were performed by means of cluster analysis. Different types of course of psychogenic impairment were identified. Both extreme types--the probands with the most positive and the most negative spontaneous long-term course--were investigated with regard to potential course-determining variables. Personality variables and conditions of early childhood development considerably influenced the spontaneous long-term course.

Adult↗
PubMed1986

[Long-term course over three years in a patient with unstable angina pectoris].

The long-term follow up in 48 patients with unstable angina pectoris was analyzed retrospectively. All patients were hospitalized in a coronary care unit during the acute phase and responded favourably to a medical regimen consisting of nitrates in 45 patients, betablockers in 23, calcium channel blocking agents in 22 and i.v. nitroglycerin in 12. 30 patients (group 1) responded promptly to oral medication with one or a combination of two drugs, whereas in 18 patients a combination of at least three drugs or intravenous nitroglycerin were necessary. After 42 +/- 6 months 21 patients remained asymptomatic, with 8 still on antianginal therapy. In 27 patients (56%) complications had occurred. These complications were severe limiting angina pectoris in 16, of whom 11 were treated surgically after 3.5 +/- 3 months, and myocardial infarction in 11 patients after 16 +/- 9 months, of whom 4 patients died. Complications occurred in 10 of the 30 patients in group 1 and in 16 of the 18 patients in group 2 (33% vs. 89%, p less than 0.01). This study confirms that the long-term course in patients with unstable angina is often complicated by severe angina pectoris or myocardial infarction. The late response to initial therapy and the need for the combination of more than two antianginal drugs or of i.v. medications identifies a subgroup of patients with a high complication rate.

Adrenergic beta-Antagonists↗
PubMed2006

Pediatric bipolar disease: current and future perspectives for study of its long-term course and treatment.

AIM AND METHODS: Findings from recent long-term, prospective longitudinal studies of the course, outcome and naturalistic treatment of adults with bipolar illness are highlighted as background for long-term developmental study of pediatric bipolar illness. RESULTS: Accumulating knowledge of bipolar illness in adults underscores a high risk for multiple recurrences through the lifespan, significant medical morbidity, high rates of self-harm, economic and social burden and frequent treatment resistance with residual symptoms between major episodes. At present, there is no empirical foundation to support any assumption about the long-term course or outcome of bipolar illness when it arises in childhood or adolescence, or the effects of conventional pharmacotherapies in altering its course and limiting potentially adverse outcomes. The proposed research articulates specific descriptive aims that draw on adult findings and outlines core methodological requirements for such an endeavor. CONCLUSIONS: Innovations in the description and quantitative analysis of prospective longitudinal clinical data must now be extended to large, systematically ascertained pediatric cohorts recruited through multicenter studies if there is to be a meaningful scientific advance in our knowledge of the enduring effects of bipolar illness and the potential value of contemporary approaches to its management.

Age of Onset↗
PubMed1998

Long-term course of anorexia nervosa: response, relapse, remission, and recovery.

There is no predictable or normative long-term course associated with anorexia nervosa. Some Individuals achieve complete recovery; others are ravaged by a chronic disorder; and some die from it. Predicting course and outcome of anorexia nervosa is complicated by the intrinsic complexity of the disorder; a lack of shared terminology in studying the disorder; and a paucity of controlled clinical treatment studies. This manuscript provides a review of the current state of knowledge based on the long-term studies and discusses ways in which methodological issues limit our ability to generalize more confidently regarding the course and outcome of anorexia nervosa. In order to advance the field, we need to bridge the gap between treatment outcome studies and naturalistic follow-up studies. Further we need to devine more carefully and consistently the milestones of initial treatment response, relapse, remission, and recovery. Building on previous works, criteria for each of these terms are proposed. Based on existing studies, a discussion of treatment outcome and prognostic factors is provided. Finally, clinical recommendations are provided for the clinician who is responsible for the long-term care of an individual with anorexia nervosa.

Anorexia Nervosa↗
PubMed2005

Long-term course and predictive factors of elevated serum thyroglobulin and negative diagnostic radioiodine whole body scan in differentiated thyroid cancer.

UNLABELLED: Following the initial management, some patients with differentiated thyroid cancer (DTC) develop a state of high thyroglobulin (Tg) and negative diagnostic radioactive iodine (RAI) whole body scan (DxWBS). The predisposing factors and outcome of this condition are unclear. In this study, our objectives were to determine the predictive factors for the development of high Tg and negative DxWBS (Tg+/scan-) and to study the long-term course of the disease in patients with this condition. METHODS: We, retrospectively, reviewed the medical records of a cohort of 105 non-selected DTC patients (26 males and 79 females; median age 37.7 yr, range 7-72). None of these patients had positive Tg antibodies or distant metastases. All Tg levels were obtained off thyroid hormone therapy. At the first follow-up visit after RAI ablation (13 +/- 7.6 months), patients were classified into those with low Tg (<2 ng/ml off L-T4) and negative DxWBS (control group) and those with high Tg ( > or = 22 ng/ ml off L-T4) and negative DxWBS (Tg+/scan- group). Using univariate and multivariate logistic regression analyses, we evaluated a number of parameters (see results) for their association with the development of Tg+/scan-. In addition, the long-term course of the disease in Tg+/scan- group was analyzed. RESULTS: In univariate analysis, the following factors were found to be significantly associated with Tg+/scan-: perithyroidal tumor extension (p=0.025), soft tissue invasion (p=0.001), cervical lymph node metastases (p=0.014) and Tg level before RAI ablation (p=0.015). In multivariate analysis, only soft tissue invasion remained significantly associated with Tg+/scan- [p 0.001, odds ratio, 15.6 (95% Cl, 2.96-82.06)]. Age, sex, duration of goiter before surgery, pressure symptoms, tumor size, tumor multifocality, lymph nodedissection at initial surgery, tumor-node-metastasis (TNM) stage, and RAI ablative dose were not associated with Tg+/ scan-. In 53 patients with Tg+/scan-, 42 cases were followed without any therapeutic intervention; over a median follow-up of 71.6 months (range, 13-144.7), 31 cases had a spontaneous remission and 11 cases continued to have a persistent disease (Tg > or = 2 ng/ml, negative DxWBS, and no palpable disease or distant metastases); Tg declined from 9.32 +/- 9.91 ng/ml at first visit after RAI ablation to 1.59 +/- 5.39 ng/ml at last visit (p<0.0001). In the other 11 cases of Tg+/scan- group, one or more therapeutic interventions (RAI, surgery, or external radiotherapy) were undertaken. Over a median follow-up of 98.4 months (range, 6-147), Tg decreased from 110.2 +/- 147.5 to 23.5 +/- 41.2 ng/ml (p 0.026); 4 cases achieved remission, 5 cases continued to have persistent disease, and 2 cases had progression of their disease, which led to their death. CONCLUSION: Soft tissue invasion on original surgery strongly predicts the development of Tg+/scan- in DTC patients. The long-term course of the disease is mostly favorable especially when the Tg level is only modestly elevated.

Adolescent↗
PubMed1995

[A long-term course of experimentally produced choroidal neovascularization in the rat].

We studied morphologically a long-term course of experimental choroidal neovascularization (ChNV) induced by krypton laser photocoagulation in the rat retina. Fifty-two weeks after photocoagulation, ChNV was enveloped completely by the retinal pigment epithelium. Vascular endothelial cells of ChNV were thin, with many fenestrations and wide lumen. The ChNV maintained the morphological characteristics of mature leaky capillaries similar to choriocapillaris. The lumen of the neovascularizations tended to be compressed by massive collagen fibers produced by the retinal pigmented epithelium. We found that experimental ChNV in the rat retina retains the characteristics of leaky capillaries for a long time unlike that in the monkey ChNV.

Animals↗
PubMed1999

Long-term course and outcome in AIDS patients with cerebral toxoplasmosis.

OBJECTIVES: We compared clinical long-term course and outcome in all AIDS patients admitted to our outpatient department from January, 1989 to June, 1998 with toxoplasma encephalitis (TE) as first AIDS-defining infection (n= 106) and in 106 patients with Pneumocystis carinii pneumonia (PCP) as first AIDS-defining disease. MATERIAL AND METHODS: The 2 groups were matched with respect to age, sex, risk group, degree of immunodeficiency as measured by CD4 cell counts and duration of HIV-1-positivity. TE was diagnosed radiologically and by response to treatment. RESULTS: Forty-three TE patients surviving the first TE symptoms > 14 months developed dementive symptoms, leucoencephalopathy in imaging procedures and died from dementia. In contrast only 5 patients surviving PCP for an equally long period showed dementive symptoms. CONCLUSION: Cerebral infections like toxoplasma encephalitis (TE) may negatively influence HIV-1-activity so far latent in the brain.

AIDS Dementia Complex↗
PubMed2006

Ophthalmologic findings and long-term course in patients with neurofibromatosis type 2.

PURPOSE: To evaluate ophthalmologic findings and long-term course in patients with neurofibromatosis type 2 (NF2). DESIGN: Retrospective observational case series. METHODS SETTING: Single-center institutional practice. STUDY POPULATION: Thirty referred patients with NF2 were enrolled from 1991 to 2003 and underwent at least one thorough neuroophthalmologic examination. Follow-up of 23 patients ranged from 4.3 to 12.5 years. MAIN OUTCOME MEASURES: Visual function, structural ocular abnormalities, onset and type of presenting NF2-related symptoms, and number of central nervous system tumors. RESULTS: Initial symptoms for patients with early-onset NF2 mostly comprised ophthalmologic symptoms (n = 7) and lower motor neuron extremity weakness (n = 6), as opposed to eighth nerve impairment (n = 11) in late disease onset. NF2-specific ocular findings were noted in 83% of all patients (94% childhood onset; 67% adult onset): 67% had cataracts, 40% epiretinal membranes, 3% hamartoma, 13% disk gliomas, and 27% optic nerve sheath meningiomas. Only 14% in the childhood-onset group-as opposed to 78% in the adult-onset group-sustained visual acuity of 1.0 in both eyes at final examination. Significantly more patients with early onset of symptoms developed multiple central nervous system tumors (P = .004) and showed a higher amount of NF2-specific findings (P = .015). CONCLUSIONS: Initial manifestations of NF2 differ between children and adults. NF2-specific ophthalmologic findings can help establish the diagnosis. Symptom onset at a young age is clearly a risk factor for marked disease progression. These patients should be carefully followed because survival rates have increased, and vision becomes increasingly important as the disease progresses.

Adolescent↗
PubMed1989

[The long-term course of depression and dementia in the aged].

Results of measurements of geropsychiatric syndromes are different. The statements are based on application of various methods and investigations of non-comparable populations. Nevertheless it is possible to draw the following conclusions out of the scientific papers and experiences of our own: A chronicity of depressive long-term courses is expected on old and higher age. Somatic diseases and organic brain syndrome render more difficult the amelioration and pharmacotherapy. The symptoms of affective disorders in old age most differ from depression in early and adult biographic phase. The course of dementias take off age and attendant somatic illness. In old age increase dementias. Their prognosis is worse. Added somatic process affects the further course negatively and renders more difficult the therapy. Long-term courses of dementias in old and higher age complicate the precise differential-diagnostic attach on pathogenetics. Social influences take effect on the course of depression and dementia advantageously or disadvantageously.

Aged↗
PubMed1993

Long-term course of adult patients with delayed sleep phase syndrome.

A response to treatment and long-term course of 14 adults with delayed sleep phase syndrome were investigated with the use of their hospital records and mailed questionnaires. Six patients treated with chronotherapy showed full recovery just after the treatment. In three of them the delay of sleep phase relapsed one year afterwards. Four of five patients treated with pharmacotherapy alone showed partial recovery. Six of nine patients followed for periods of longer than three years after treatment showed good prognoses, though all of them still had a mild phase delay and had to shorten their sleep time in order to work full-time. The three others had poor prognoses and one of them was under psychiatric treatment for affective instability. These findings suggest that a long-term follow-up is needed to judge the effect of the treatment.

Activities of Daily Living↗
PubMed1999

The long-term course of shoulder complaints: a prospective study in general practice.

OBJECTIVE: Assessment of the long-term course of shoulder complaints in patients in general practice with special focus on changes in diagnostic category and fluctuations in the severity of the complaints. DESIGN: Prospective descriptive study. SETTING: Four general practices in The Netherlands. METHOD: All patients (101) with shoulder complaints seen in a 5 month period were included. Assessment took place 26 weeks and 12-18 months after inclusion in the study with a pain questionnaire and a physical examination. RESULTS: A total of 51% of the patients experienced (mostly recurrent) complaints after 26 weeks and 41% after 12-18 months. Diagnostic changes were found over the course of time, mostly from synovial disorders towards functional disorders of the structures of the shoulder girdle, but also the other way round. Although 52 of the 101 patients experienced complaints in week 26, 62% of those patients considered themselves 'cured'. After 12-18 months, 51% of the 39 patients experiencing complaints felt 'cured'. CONCLUSION: Many patients seen with shoulder complaints in general practice have recurrent complaints. The nature of these complaints varies considerably over the course of time, leading to changes in diagnostic category. Because of the fluctuating severity of the complaints over time, feeling 'cured' or not 'cured' is also subject to change over time.

Adult↗
PubMed1975

[Long-term course of nonoperated tricuspid insufficiency following surgical correction of mitral and mitro-aortic valve diseases].

This study concerns 120 patients with tricuspid incompetence (TI) combined with mitral or mitral-aortic valve disease. This first part is devoted to the 48 patients TI of whom was not corrected, and the long-term course (average 40 months) after mitral-aortic lesions correction was analysed. Assessment of the degree of TI at operation differed markedly from its pre-operative clinical assessment; surgical findings agreed with the clinical estimations in 10 of 12 cases of TI considered to be negligible, but only in 4 of 24 cases with a TI considered as intense clinically. The long-term unfavourable courses (TI with persistent right ventricular failure) were more common in the group of TI considered intense clinically (59%) than in the TI considered clinically as negligible (23%). Assessment by the surgeon during operation of the degree of TI seemed a less accurate element of valuation of the long-term prognosis. The mean pulmonary artery pressure measured at operation did not have, in the patients studied, a significant influence on the long-terme course after mitral-aortic valve correction. On the contrary, the results were less favourable in the group of patients whose TI was old-standing and in the group of patients with a cardio-thoracic ration higher than 0.65. It seems therefore legitimate to recommend correction of both the cases of TI considered to be intense by the surgeon, and those considered to be intense clinically, even if the surgeon finds them to be negligible. This attitude is the more justified the older the TI and the larger the heart enlargement.

Aortic Valve↗
PubMed2005

Significance of comorbidity for the long-term course of opiate dependence.

OBJECTIVE: Studies on drug dependence show a high prevalence of comorbidity with additional mental disorders. Comorbidity patients also show more poly-substance use and other psychosocial problems. This study analyzed the importance of comorbidity for the long-term course of opiate dependence. METHOD: 350 opiate-dependent patients were examined at yearly follow-ups over 4 years using the EuropASI for the assessment of drug-related problems and the CIDI for diagnostic of psychiatric disorders. 196 patients were reached at final follow up (56%). RESULTS: Of the patients reached at final follow-up, 30% had severe, 29% mild and 41% no clinically relevant disorders at baseline. However, the linear relationship at baseline--the more severe the disorder, the greater the impairment through drug-related problems--was not present at final follow-up. The results show that lifetime diagnosis of mental disorder had no prognostic relevance for the long-term course of drug dependency. CONCLUSION: The assumption that opiate users with an additional mental disorder are more vulnerable in their course of addiction could not be confirmed.

Adult↗
PubMed1995

Long-term course of bronchiectasis and bronchiolitis obliterans as late complication of smoke inhalation.

We describe the long-term course of a patient with bronchiectasis and bronchiolitis obliterans, both of which developed as late complications of a smoke inhalation injury. Sequential chest X-rays obtained during the observation period showed gradual progression of bronchiectasis from the saccular to the cystic type. Symptoms, spirometry and blood gas analysis, however, remained stable for 15 years. We believe that symptoms and physiological derangement were due mainly to bronchiolitis obliterans, and that once the pathophysiological condition had been established following the initial injury, it could be maintained by conservative medical management.

Adult↗