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PubMed2001

Epidemiology of prescriptions for neuroleptic drugs: tranquilizers rather than antipsychotics.

BACKGROUND: The pharmacology of neuroleptics as well as epidemiological and clinical observations of prescriptions of these drugs give the impression that they are and can be used for indications other than schizophrenia to a considerable degree. METHOD: We analyzed pharmacoepidemiological data on neuroleptic prescriptions in Germany. We used the following criteria: numbers of defined daily doses (DDDs) per annum, diagnoses for which they were prescribed, patient age, specialist medical training of the prescribing physician, and indicators that neuroleptics were used instead of other psychotropic drugs such as minor tranquilizers. RESULTS: Only 14% of the prescriptions for neuroleptic drugs were for schizophrenic psychoses, 18% for other paranoid psychoses and 5% for affective disorders. 63% were prescribed for neurotic disorders, sleep disorders, or dementia. Almost half of the neuroleptic prescriptions were given for patients aged 65 years or over. Only 40% were prescribed by psychiatrists or neurologists. Throughout the period from 1986 to 1995, neuroleptic prescriptions increased steadily, which was paralleled by a decrease in the prescription rates for benzodiazepines. CONCLUSIONS: Evaluation is urgently needed for those uses of neuroleptic drugs that, from a pharmacoepidemiological perspective, must be seen as their primary indication.

Adult↗
PubMed1988

Personality and quantified neuromuscular activity of the masticatory system in patients with temporomandibular joint dysfunction.

Patients suffering from temporomandibular joint dysfunction syndrome (TMJS) and healthy volunteers were examined by means of MMPI questionnaire and electromyography (masseter, anterior temporal and anterior digastric muscles) at rest and during natural chewing. In response to mental load (arithmetic chain task) TMJS patients showed an increase in postural activity and partly rhythmical short augmentations above the mean level of this activity. Chewing potentials were considerably diminished in patients compared with controls. There was evidence for neurotic disorders in the patients MMPI (neurotic triad: higher scores on hypochondria, depression, hysteria). Significant differences (multivariate variance and discriminant analysis: P less than 0.001) between patients and controls were found both in the group with psychic signs (MMPI scales) and in the group of quantitative electromyographic parameters. However, a sufficient discrimination was only obtained by a combination of both parameter groups. The results show that probably psychic dynamics, as well as the structure of neuromuscular activity within the masticatory system, are important in the aetiopathogenesis of TMJS.

Adolescent↗
PubMed1983

Antiepileptic drugs and psychiatric disorders: mechanism involved in manifestation of psychic symptoms of high blood level of antiepileptics.

The adverse psychic effects of antiepileptics embrace all categories of psychiatric symptomatology, including disturbances of consciousness (delirium, confusion), psychotic state (schizophrenia-like psychosis, affective disorder), neurotic state, behavior and character disorder. Antiepileptic intoxication can take the form of a psychotic episode. The lowered level of consciousness due to a high blood level of antiepileptics is expressed as inhibitory symptoms such as a lack of initiative, psychomotor slowing, lowering mood, stuporous state and the like. Another group of manifestation of a high blood level of antiepileptics, by contrast, consists of salient positive symptoms such as irritability, hyperkinetic syndrome, hysterical symptoms, aggravation of character change, delirium and confusion. An elevated blood level of antiepileptics by itself is not sufficient to give rise to a psychiatric symptom, which is rather prone to occur in the presence of some trouble or problems (defect in intelligence or personality, fragility of brain function, organic brain damage, psychogenic factors) in the patient.

Adult↗
PubMed1990

[Reliability of child and adolescent psychiatry diagnoses in ICD-10].

In the following, the findings from a field study on the reliability of ICD-10 for classifying psychiatric disorders in children and adolescents are presented. In the main study there were 33 raters from 9 different facilities; each rater assessed 29 case studies independently. The evaluations of the 29 case studies independently. The evaluations of the 29 case histories yielded 957 ratings. When 4-digit ICD-10 codes were used, the most common main diagnosis was coded by an average of 50.3% (ICD-9: 47.3%). When 3-digit ICD-10 codes were used, the figure was 60.6% (ICD-9: 66.5%), that is, as expected, agreement was clearly better. When alternative diagnoses were considered, agreement was substantially better; the same was true for intensive schooling of the raters (additional study). Some diagnoses were rather difficult to differentiate from each other. Among these were the mixed disorders of conduct and emotions (F92). The main problem was differentiating between this disorder and the categories conduct disorder (F91), emotional disorder (F93), affective disorders (F30-F39), and neurotic disorders (F40-F49). There were also problems classifying age-related depressive disorders which in ICD-9 could be coded under 313.1, probably in part because this category does no longer exist in ICD-10. These disorders have now to be coded as depressive disorders (F31.1, F33.1 or F34.1). The diagnostic descriptions of these categories are based mainly on the symptoms typical in adults. No facility-related tendencies to code in a particular way are evident.

Adolescent↗
PubMed1983

Relationship between neurosis and personality disorder.

316 psychiatric patients--predominantly out-patients--with a clinical diagnosis of neurosis (International Classification of Disease), were given an interview schedule for assessing personality disorders. Nearly two fifths were rated as having personality disorder, the anankastic type being the most common and sociopathic personality disorder the least. Patients with anxiety, phobic and obsessional neurosis were all significantly more likely to show personality disorder than those with depressive neurosis. Broadly, passive-dependent personalities were linked to anxiety neurosis, anankastic personality disorder to obsessional neurosis, and both anankastic and passive-dependent personalities to phobic neurosis. In a clinical trial of the efficacy of two dosage regimes of phenelzine in 60 patients the presence of personality disorder significantly impaired clinical outcome. The results suggest strongly that the assessment of personality in neurotic disorders is necessary to make an adequate diagnosis and predict the outcome of treatment.

Clinical Trials as Topic↗
PubMed1996

Clinical and psychosocial variables in different diagnostic groups: their interrelationships and value as predictors of course and outcome during a 14-year follow-up.

A 14-year follow-up study was conducted on 214 patients from the diagnostic groups schizophrenia, affective psychosis, and neurosis to determine the relationships between various clinical and psychosocial variables and to assess their value as predictors of long-term course and outcome. Particular emphasis was placed on ascertaining the interrelationships between the variables within the individual diagnostic groups. The results indicate that for schizophrenia, severity of disease at discharge from index hospitalization was the principal predictor of the number and duration of further hospitalizations. Furthermore, it predicted the severity of illness and social functioning at follow-up. For affective psychosis, the Global Assessment Scale score predicted the number and duration of further hospitalizations. Severity of illness, social functioning, and age at first hospitalization were predictors of occupational development. For neurotic disorders, severity of disease and social adjustment at discharge from index hospitalization were each predictors of themselves at final follow-up. In addition, age at first hospitalization was an important predictor of most course and psychosocial variables. Among the endogenous course variables within the schizophrenic group, the number and duration of further hospitalizations had a substantial bearing on severity of illness and social functioning at follow-up. For affective psychoses, indicators of occupational development and number of hospitalizations had an impact on severity of illness and social functioning at follow-up. Our findings reveal a good overall predictive value for the clinical and psychosocial variables within each of the diagnostic categories studied.

Adult↗
PubMed1993

Premature termination of psychiatric contact.

Failure to complete psychiatric treatment is an extensive and wasteful problem. This retrospective case note study of 252 patients, suffering from a neurotic disorder, investigated which clinical and sociodemographic factors were associated with premature termination of psychiatric treatment. It was found that a history of deliberate self harm was strongly linked with the patients discontinuing their treatment. Other clinical factors, viz, diagnosis, duration of illness, a history of alcohol abuse and a family history of psychiatric illness were not however associated with premature termination of treatment. Older patients and those who were married were least likely to end treatment in this fashion, but sex of the patient, employment status, and distance from the hospital had no such link. Belonging to socioeconomic group 5 was significantly associated with premature termination although no other associations with social groupings were found.

Adult↗
PubMed1968

[Early childhood brain damage and neuroses in adults].

Following some introductory remarks on the importance of multicausal factors in the genesis and development of neurotic disorders it is especially the part played by early-childhood cerebral lesions that is underscored by the author. The importance of this lesion to the development of neuroses in adults continues to be an open question. Within the framework of an attempt made with a view to finding an answer to this question the author presents the results of an analysis of 300 case histories of patients of the neurosis ward. After a description of an analysis of 22 patients diagnosed as having "neurosis", who had suffered from an early-childhood cerebral lesion, and of a comparison with a control group of anxiety-neurosis patients certain characteristics of these patients and of the clinical course of their disease are discussed. On the basis of this analysis there is then formulated a hypothetical model of the development of neurotic disturbances in the course of the lives of some persons with early-childhood cerebral lesions.

Adolescent↗
PubMed1982

[A combination of psychotherapy methods. Interim assessment and reconsideration].

Subject of our investigation was to analyse the results of our applied psychotherapy with in-patients at the Charité in the decade from 1968 to 1978. Contrary to our theoretical considerations regarding the combination of methods the practical results proved the success to combine under the specific conditions at the Charité symptom-centered and personality-centered procedures. Concentrating on the personality-centered aspect of the therapy this combination is not just under the economic point of view more efficient, but is also prevents far more intensive the relapse-rate of neurotic disorders with our patients.

Hospitalization↗
PubMed1984

Growth hormone secretion in prepubertal children with major depression. III. Response to insulin-induced hypoglycemia after recovery from a depressive episode and in a drug-free state.

Insulin tolerance tests (ITTs) were performed after at least four months of sustained recovery from an episode of a major depressive disorder in 18 drug-free prepubertal children. Eleven had a definite endogenous subtype; seven did not. Sixteen children with nondepressed neurotic disorders made up a control group. The children with past endogenous depression continued to have significant hyposecretion of growth hormone (GH) in this test when compared with the other groups. Illness-recovery correlations were highly significant for the major depressive group as a whole. Paired comparisons of both depressive groups were not significantly different from illness to recovery. We conclude that prepubertal children with endogenous major depression continue to have hyposecretion of GH in response to ITTs in a recovered state and that this neuroendocrine marker is state independent. A GH hyporesponse to ITT may be a true marker of a past episode or of trait for endogenous major depressive disorder in prepuberty.

Affective Symptoms↗
PubMed1989

Modifiability of trait anxiety and neuroticism: a meta-analysis of the literature.

It is argued that personality scales of neuroticism and anxiety are tapping the same personality trait and that this is a risk factor for neurotic disorders. To see whether this trait is modifiable, a meta-analysis was carried out of therapy outcome studies which included a measure of trait anxiety or neuroticism as a dependent measure. This meta-analysis showed that all psychological therapies are to some extent effective. However, rational-emotive and related therapies produced particularly large reductions in trait anxiety/neuroticism (around 1.25 standard deviations). The possibility that rational-emotive education programmes could be used to lower trait anxiety/neuroticism as a preventive measure is discussed.

Adaptation, Psychological↗
PubMed1987

Familial aspects of obsessive-compulsive neurosis.

The first-degree relatives of 50 obsessive-compulsive patients and those of matched controls completed the General Health Questionnaire (GHQ) and the Leyton Obsessional Inventory (LOI). Relatives who were identified as possible 'cases' by their high GHQ scores, or by their own or informant relatives' reports, were interviewed using the Schedule for Affective Disorders and Schizophrenia. Index relatives had a significantly higher lifetime prevalence of mental illness (36%) than had those of controls (17%), due mainly to an excess of depressive and neurotic disorders. However, only one relative from each group was diagnosed as having definite obsessive-compulsive neurosis. In addition, the LOI scores were similar for the index and control relatives.

Adolescent↗
PubMed1987

Is there more dementia, depression and neurosis in New York? A comparative study of the elderly in New York and London using the computer diagnosis AGECAT.

A computerised diagnosis, AGECAT, is applied to data from random community samples of the elderly in New York and London in order to examine the prevalence of mental illness in the two cities, especially the result reported from the same study, using a different diagnostic procedure, that the proportion of dementia was higher in New York. The greater proportion of dementia in New York is confirmed for all AGECAT's levels of diagnostic confidence, for both sexes and at all half-decades over 65 years. Provided that this difference is upheld and genetic differences can be discounted, these findings would seem to support a contributory environmental cause for dementia. Proportions of depression as a whole are similar in both cities. Syndrome case and sub-case levels of neurotic disorder are generally higher in London.

Aged↗
PubMed2001

Common mental disorders in Santiago, Chile: prevalence and socio-demographic correlates.

BACKGROUND: There have been relatively few surveys in Latin America that have attempted to estimate the prevalence of psychiatric morbidity in private households. AIMS: To determine the prevalence of common mental disorders and socio-demographic correlates among adults from Santiago, Chile. METHOD: Cross-sectional survey of private households with a probabilistic sampling design was used. Common mental disorders were measured using the Clinical Interview Schedule-Revised (CIS-R). RESULTS: Three thousand eight hundred and seventy adults were interviewed. Twenty-five per cent were CIS-R cases and 13% met criteria for an ICD-10 diagnosis. Low education, female gender, unemployment, separation, low social status and lone parenthood were associated with a higher prevalence. CONCLUSIONS: Prevalence rates were higher than those found in urban areas of Great Britain, both for ICD-10 diagnoses and 'non-specific neurotic disorders'. Similar socio-demographic factors were associated with an increased prevalence of common mental disorders in Chile as in the UK. There is a need to unify methodologies to be able to compare results internationally.

Adolescent↗
PubMed1982

Clobazam: single or divided doses?

The results of treatment of neurotic disorders with single or divided daily doses of the anxiolytic drug clobazam have been compared. The trial was performed in two groups, each of 57 patients, paired according to age, sex, diagnosis, severity of initial disorder, and total daily dose. The 114 subjects formed a random subgroup from a total of 1369 patients taking part in a postmarketing surveillance trial of clobazam. In view of the changes in the overall severity of the symptoms, in "persistent anxiety" and "anxiety crises", in "sleep disorders", the global clinical impression and the tolerance, it is concluded that clobazam is a useful drug in the treatment of anxiety, and that single or divided daily dosage schedules produce similar results.

Adult↗
PubMed1989

Erythrocyte sodium pump activity in bipolar affective disorder and other psychiatric disorders.

Erythrocyte ouabain-inhibitable sodium pump activity, a measure of NaK-ATPase activity, was studied in 6 diagnostic groups of psychiatric subjects: bipolar affective disorder, unipolar depressive disorder, neurotic depression, chronic alcohol abuse, schizoaffective disorder, and schizophrenia, and in sex- and age-matched normal controls. In the bipolar manic-depressive group, which was restricted to lithium-free subjects, values for sodium pump activity were significantly lower than in the controls (-11.4%, n = 53, p less than 0.001); subgrouping of the bipolar group by sex or age showed a significantly lower sodium pump activity in each of the groups. In the unipolar depressive group, values for sodium pump activity were significantly higher than in the controls (+13.7%, n = 12, p less than 0.01). The difference in direction of changed sodium pump activity between the bipolar and the unipolar groups was also observed in the values for subgroups of subjects in the two categories who were in a depressed state at the time the blood sample was taken. In the chronic alcohol abuse group, values for sodium pump activity were significantly higher than those for the control group (+13.5%, n = 20, p less than 0.05). In the neurotic depression (n = 24), schizoaffective (n = 12), and schizophrenia (n = 35) groups, there were no significant differences in sodium pump activity between the group of psychiatric subjects and their matched controls. These observations indicate that there is a trait-dependent deficiency of NaK-ATPase activity in bipolar affective disorder.

Adolescent↗
PubMed1999

[The Dusseldorf short-term dynamic psychotherapy project (DKZP)].

Time-limited psychodynamic therapies in the outpatient setting are offered for a broad spectrum of psychogenic disorders. Meta-analyses prove their effectiveness mainly for neurotic disorders. We are interested in the suitability of the here applied CMP/SASB model (Tress et al. 1996) of psychodynamic short-term therapy for patients with psychosomatic and severe personality disorders. We extensively present the concept of Cyclic Mal-adaptive Pattern (CMP) in its clinically relevant parts as the core of psychogenic pathological developments. Particularly the introject, as the patient's attitude towards him- or herself, is of great importance for therapeutic change and its follow-up development. Within the DKZP (Duesseldorf Short-Term Psychotherapy Project), 36 male and female therapists, mostly interns at the local university clinic, treated 82 patients (m: 23/f: 59) with personality disorders (n = 26) and psychosomatic disorders (n = 31) as research groups and, in comparison, neurotic patients (n = 25) in a naturalistic design. 68 treatments have been completed so far, 11 patients have dropped out, the remaining 3 are still in therapy. Relevant research instruments are the Beeinträchtigungsschwere Score (BSS, an impairment score), Global Assessment of Functioning Scale (GAF), Cyclic Maladaptive Pattern (CMP), Symptom Check List (SCL-90-R), and Structural Analysis of Social Behavior (SASB) including process and content ratings, as well as the Intrex questionnaire. The treatments last 25 sessions. We carried out follow-up examinations after 6 months, 1 year, 2, and 5 years. Effect sizes for the whole sample by BSS and GAF are remarkably high, with further increase at follow-up interviews. Psychosomatic patients came off best, but personality disorders in comparison to neurotic patients profited surprisingly well. Effect sizes in self-rating (SCL and Intrex) were less high. However, in self-rating the changes of social functions are not sufficiently addressed. As a result, our form of focal therapy is well suited not only for neuroses, but also for psychosomatic disorders and personality disorders. An enlargement of the indication spectrum for this form of psychodynamic therapy to include these disorders is well founded and promising.

Adult↗
PubMed1985

Psychosocial functioning in prepubertal major depressive disorders. I. Interpersonal relationships during the depressive episode.

Psychosocial environment and relationships with parents, peers, and siblings of 115 prepubertal children were measured by interview with their parent(s) for the three-month period preceding the assessment. The children had a current diagnosis of major depression (52 children) or nondepressed neurotic disorder (23) or were assessed to be normal (40). Most aspects of psychosocial relationships were found to be significantly impaired in the psychiatric groups. This impairment was generally worse in the depressives and significantly worse for aspects of verbal and affective communication with parents and siblings. Prepubertal children with major depressive disorder regularly present social relation deficits in which two components can be distinguished: one general to childhood psychiatric disorder and another specific to major depression.

Age Factors↗