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At least 19 recordsLinked to original sources
PubMed2000

[Not Available].

Using the data basis of the Mannheim Cohort Study the present paper investigates the correlation between socio-economic Status and psychogenic impairment due to predominantly psychosocially influenced ("psychogenic") disorders (neurotic spectrum disorders, personality disorders, stress reactions and somatoform disorders) in a representative adult Community sample. The period of observation amounted up to 11,1 years. Subjects investigated within our follow-up study for this interval (n=301) were drawn from an representative adult Community population sample (N=600). Within the three step class model members of the lower class were at all investigation time points significantly stronger impaired compared to the members of the middleand upper class. Investigating the clinical impairment related to the intragenerative class mobility those subjects, which could achieve a social rise between two points of investigation were even prior, to the first investigation time point, less affected compared to the ones remaining in their social class. Vice versa subjects in the process of an social decline presented a stronger psychogenic impairment prior to their decline compared to those, which remained stable in their social class. These dynamic correlations offer evidence for the effect of the socalled "drift-hypothesis", which postulates, that persons due to their disease decline in their social Status respectively after improving rise to a higher social class.

Epidemiology↗
PubMed1999

A decade of spontaneous long-term course of psychogenic impairment in a community population sample.

BACKGROUND: Our epidemiological study demonstrates the spontaneous long-term course of predominantly psychosocially influenced ("psychogenic") disorders (neurotic spectrum disorders, personality disorders, stress reactions and somatoform disorders) in a representative community sample of the normal adult population of Mannheim, an industrial and university town in Germany. The natural spontaneous course of these disorders in a population sample over a long period remains largely unknown. METHOD: Beginning in 1979 (nt1 = 600) a random population sample was investigated three times over a mean period of approximately 11 years. The last follow-up study ended in 1994 (nt3 = 301). The follow-up sample was representative of the t1 sample. Psychodynamically trained and clinically experienced interviewers used a semi-structured interview and standardized clinical and psychometric instruments. Psychogenic impairment was assessed using a standardized expert rating (Impairment Score, IS). RESULTS: The mean sum-score of psychogenic impairment after 11 years exceeded the value at t1. The case rate (point prevalence, ICD diagnosis + clinical cut-off/IS) increased from 21.6% at t1 to 26.2% at t3 in the investigated follow-up sample. Intra-individual correlation of psychogenic impairment between t1 and t3 was high (r = 0.55). We found strong evidence for an unfavorable long-term course of psychogenic impairment and only a weak tendency (23.1%) for spontaneous remission of clinically relevant psychogenic impairment. Within a regression model clinical variables, childhood development conditions and personality traits at t1 predicted psychogenic impairment at t3. CONCLUSION: All clinical variables conclusively indicate an unfavorable spontaneous long-term course of psychogenic impairment. Together with the well-known high prevalence of psychogenic disorders in the normal population, this underlines the need for early therapeutic and preventive intervention.

Adult↗
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↗
PubMedDate not supplied

[The neurotic conversion disorder spectrum in neuropediatrics].

The incidence and symptomatology of conversion disorders in a neuropaediatric department was described. One year was retrospectively evaluated. From totally 12 patients with conversion disorders 7 were suffering for an impaired walk and each 1 patient for visual defect, choreoathetosis and confusion, convulsive seizures, tic, paralysis. "Conversion disorder" is an important and often ignored diagnosis in neuropaediatrician.

Adolescent↗
PubMed1999

[Not Available].

Facing the increasing number of single-parent-families we investigated the impact of fathers absence within the first six years of childhood on psychic/psychosomatic impairment in later life. We used data from the Mannheim Cohort Study on the Epidemiology of Psychogenic (neurotic spectrum) Disorders for a comparison of extreme groups with a favourable or bad course of clinical impairment. In adition we performed regression analysis of the long term course of clinical impairment for the total follow-up sample (mean follow-up intervall 11 years, N=301) with psychometric, clinical and childhood variables. The absence of the probands father (> six months within the first six years of life) was a significant independend predictor of clinical impairment in later life, accompanied by clinical and psychometric variables. A significant and increasing impairment existed even in 73 of 125 older probands (birth cohort 1935), who missed their father in early childhood. The sociopolitical implications of these findings are discussed.

Childhood↗
PubMed2005

Early traumatic life events, parental attitudes, family history, and birth risk factors in patients with borderline personality disorder and healthy controls.

Patients with borderline personality disorder (BPD) were compared with a healthy control group with regard to traumatic life events during childhood. The patients (n=66) and controls (n=109) were investigated using a comprehensive retrospective interview with 203 questions about childhood traumatic life events, parental attitudes, family history of psychiatric disorders and birth risk factors. The frequency of reports of traumatic childhood experiences was significantly higher in patients than in controls, including sexual abuse, violence, separation from parents, childhood illness, and other factors. On a 0- to 10-point "severe trauma scale," patients had significantly more severe traumatic events (mean score=3.86, SD=1.77) than control subjects (0.61, SD=0.93). Only four (6.1%) of the BPD patients, but 67 (61.5%) of the controls did not report any severe traumatic events at all. Compared with controls, patients described the attitude of their parents as significantly more unfavorable in all aspects. Patients reported significantly higher rates of psychiatric disorders in their families in general, especially anxiety disorders, depression, and suicidality. Among birth risk factors, premature birth was reported more often in BPD subjects. In a logistic regression model of all possible etiological factors examined, the following factors showed a significant influence: familial neurotic spectrum disorders, childhood sexual abuse, separation from parents and unfavorable parental rearing styles. The present data support the hypothesis that the etiology of BPD is multifactorial and that familial psychiatric disorders and sexual abuse are contributing factors.

Adolescent↗
PubMed2006

Alcoholism in the elderly: a study of elderly alcoholics compared with healthy elderly and young alcoholics.

OBJECTIVES: To test the hypothesis that early-onset alcoholism can be differentiated from alcoholism in the elderly by more severe substance related problems, more frequent family history, higher mortality rate, and antisocial behaviour. METHODS: 73 elderly (E) alcoholics (mean age 70.2 yrs) were compared with 90 young (Y) alcoholics (mean age 43.9 yrs) and 70 elderly non alcoholics (mean age 76 yrs). We focused on, family history (FH), co morbidity, mortality, biological markers (AST, GGT, MCV), and demographics. Geriatric Scale of Depression, Standardized Mini-Mental State Examination and Munich Alkoholism Test were also used. All results analysed by the SPSS. RESULTS: FH was significantly (p<0.001) more often positive in Y (52%) than in E (15%) and C (10%). Significantly (p<0.001) more E (57.5%) are married than Y (37.8%) and C (21.4%), significantly (p<0.001) more E (72. 6%) has elementary education compared with Y (44.4%). E alcoholics abstain significantly (p<0.001) more (>27 months) than Y ones (approximately 11 months). Significantly (p<0.001) more Y (43%) had forensic history than E (8.2%). Significantly (p<0.01) more death rate was found in E (19.2%) than in Y (5.6%) and C (1.4%). Significantly (p<0.01) more E (61%) prefer spirits than Y (21%), but significantly more Y (>63%) combine spirits with beer and wine than E (>32%). Significantly (p<0.001) more alcoholics (E and Y) had elated levels of MCV (>70%), AST and GGT (>60%) than C. We have found significantly (p<0.001) higher rate of comorbidity of CNS diseases, GIT, injuries, haematological and infectious diseases in the groups of elderly and young alcoholics than in C subjects. On the other hand, prevalence of cardiovascular, ORL, ophtalmological, endocrine and orthopedic diseases were significantly (p<0.01) higher in C. To compare elderly patients with young ones, we found significantly (p<0.01) higher rate of respiratory, endocrine, cardiovascular and CNS diseases, and dementia in E alcoholics (p<0.001). Depression and abuse of prescribed medication was significantly (p<0.01) more often in the C, but suicide attempts, neurotic spectrum disorders and personality disorders were significantly (p<0.01) often in group of Y. CONCLUSION: Young alcoholics have significantly more often positive FH, drink significantly bigger amounts of alcohol, have more forensic history, and personality disorders in comparison to elderly ones. On the other hand elderly alcoholics tend to have more somatic complication due to alcohol abuse, but drink less alcohol, tend to abstain longer, and have less psychopathic traits. In contrast to literature, the majority of elderly alcoholics are married, have low education and do not belong to high social classes.

Adult↗
PubMed2000

Longitudinal study of the influence of life events and personality status on diagnostic change in three neurotic disorders.

It has been known for many years that diagnosis within the neurotic spectrum of disorders is temporally unstable and also that life events can be major precipitants of change in symptoms. Reasons for this instability could include inherent inadequacy of current diagnostic practice, the influence of life events as an agent of diagnostic shift, and an innate course of disorder with features dependent on the stage at which disorder presents (e.g., development of panic to agoraphobia). These possibilities were examined in a prospective study that was initially a randomised controlled trial. Two hundred ten patients recruited from primary care psychiatric clinics with DSM-III diagnosed dysthymic, generalised anxiety, and panic disorders were randomly allocated to either drug treatment (mainly antidepressants), cognitive-behaviour therapy, or self-help therapy over a 2 year period, irrespective of original diagnosis. Life events were recorded by using a standard procedure over the period 6 months before starting treatment and at five occasions over 2 years; 181 (86%) of the patients had follow-up data and 76% maintained compliance with the original treatment allocated over the 2 years; and 155 of the 181 patients (86%) had at least one diagnostic change in this period. There was no difference in the number of diagnostic changes between the three original diagnostic groups, but dysthymic disorder changed more frequently to major depressive episode than did GAD or panic disorder (20; 11; 12) (%) and panic disorder changed more frequently to agoraphobia (with or without panic) than did dysthymia or GAD (18; 8; 6) (%). There was no relationship between loss events and depressive diagnoses or between addition events and anxiety diagnoses, but greater numbers of conflict events were associated with diagnostic change. More life events were associated with the flamboyant and dependent personality disorders, reinforcing other evidence that many life events are internally generated by personality characteristics and cannot be regarded as truly independent.

Cognitive Behavioral Therapy↗
PubMed2000

A pilot study: stability of psychiatric diagnoses over 6 months in burning mouth syndrome.

Ten people with burning mouth syndrome (BMS) were interviewed by a psychiatrist using the Schedules of Clinical Assessment in Neuropsychiatry (SCAN) at initial presentation and at 6-month follow-up. A range of psychiatric disorders from the neurotic spectrum was identified using the International Classification of Diseases (ICD-10) criteria, but the diagnoses were unstable. Six of the ten individuals received a psychiatric diagnosis, suggesting that the prevalence of psychiatric morbidity is high in this common dental syndrome. Psychiatric aspects of BMS require further investigation.

Anxiety Disorders↗
PubMed1997

Reliability of the ICD 10 version of the Psychiatric Assessment Schedule for Adults with Developmental Disability (PAS-ADD).

The Psychiatric Assessment Schedule for Adults with Developmental Disability (PAS-ADD) is a semi-structured clinical interview designed for use with respondents who have learning disability. The first version was based on the Present State Examination. The revised version was derived from the Schedules for Clinical Assessment in Neuropsychiatry (SCAN), and makes ICD 10 diagnoses using the SCAN diagnostic program. This current version has a 4-point scale of severity, compared with the 3-point scale of the first version. It also has a new module relating to psychotic disorders. The sample consisted of 40 individuals representing a spectrum of neurotic, depressive and psychotic disorders. Videotapes of 40 PAS-ADD interviews were re-rated by trained interviewers who had not been involved in the original study in which the videotapes were produced. The mean Kappa across all individual item codes was 0.65, ranging from 0.94 to 0.35. The mean Kappa agreement on item groups was 0.66. Correlation between total symptom scores was 0.74. Agreement on index of definition was Kappa 0.70. We concluded that, agreement was generally lower than for the ICD 9 version. This was probably due mainly to the increase in the severity categories from three to four. However, the new items (most of which related to psychosis) were of comparable reliability to other items.

Adult↗
PubMed2002

[Evidence of validity of the German version of the TAS-20. Contribution to the 52nd conference of the German Board of Psychosomatic Medicine in Bad Honnef (2001)].

419 patients (psychosomatic-C/L-service unit; neurotic spectrum, somatoform and personality disorders) were investigated by collecting data of clinical and psychometrical variables (SCL-90-R, NEO-FFI, IIP-D). The aim was to evaluate whether the sum score and the three factors of the German 20-item-version of the Toronto-Alexithymia-Scale (TAS-20) postulated by Bagby correlate with other clinical variables in a convergent way. The TAS-20 sum score and the factors (F1) "Difficulties identifying feelings" and (F2) "Difficulties describing one's feelings" correlated convergently with the NEO-FFI-scales "neuroticism" and "openness for new experiences", with numerous scales of the SCL-90-R, as well as with the scales "cool/repelling" and "introverted/social avoiding" interaction style of the IIP-D. Factor (F3) "Externally oriented thinking" correlated with "Extraversion" but was not related to clinical impairment (SCL-90 R). The results could be interpreted in terms of convergent validity of the TAS-20. In addition, alexithymic patients seem to be impaired with respect to interpersonal communication and they are subjectively able to perceive appreciate this restriction.

Adolescent↗
PubMed2003

Categorical versus dimensional models of mental disorder: the taxometric evidence.

OBJECTIVE: To review studies of the categorical versus dimensional status of mental disorders that employ taxometric methodology. METHOD: A comprehensive qualitative review of all published taxometric studies of psychopathology. RESULTS: Categorical and dimensional models each receive well-replicated support for some groups of mental disorders. Studies favour categorical models for melancholia, eating disorders, pathological dissociation, and schizotypal and antisocial personality disorders. Dimensional models tend to be favoured for the broad neurotic spectrum--general depression, generalized anxiety, posttraumatic stress disorder--and for borderline personality disorder. CONCLUSIONS: Taxometric research clarifies the latent structure of psychopathology in ways that have implications for the classification, assessment, explanation and conceptualization of mental disorder.

Humans↗
PubMed2002

Is weakened circadian rhythmicity a characteristic of neuroticism?

The aim of this study was to undertake a preliminary investigation of the novel hypothesis that weakened circadian rhythmicity is an aspect of the psychobiology of neuroticism (N). Two groups of subjects [young healthy females categorised as High N (N=8) or Low N (N=6)] were compared in terms of a classical circadian variable (the unmasked rhythm in core body temperature), and a validated psychological variable (diurnal rhythm in Positive Affect), under two experimental protocols (constant routine and ambulatory). As predicted, model-fitting analyses found that the High N group was characterised by attenuated circadian amplitudes in unmasked body temperature under both protocols. Also as hypothesised Positive Affect exhibited a circadian rhythm that was only significant in the Low N group. A stronger synchronisation between the biological and psychological rhythms was also observed in the Low N group. Results are discussed in terms of the implications of a possible circadian diathesis for disorders and complaints across the neurotic spectrum.

Adolescent↗
PubMed1997

Low serum cholesterol in suicide attempters.

Previous studies have shown an association between low serum cholesterol concentration and suicide; however, conflicting results have also been reported. To examine this potential association, cholesterol levels in 99 patients admitted to an emergency ward following an attempted suicide were compared with those in 74 nonsuicidal psychiatric inpatients, and those in 39 psychiatrically normal individuals with accidental injuries. Cholesterol concentrations in suicide attempters were found to be significantly lower compared with both psychiatric and normal controls, when sex, age, psychiatric diagnosis, and physical conditions (serum total protein and red blood cell count) were adjusted for. This significant relationship was observed in mood disorders and personality or neurotic disorders, but not in schizophrenia spectrum disorders. These results support the previous claim that lower cholesterol level is associated with an increased risk of suicidal behavior.

Adult↗
PubMed1999

Sub-grouping non-melancholic major depression using both clinical and aetiological features.

OBJECTIVE: In previous papers we have considered the extent to which two contrasting analytic approaches, examining reported clinical symptom variables alone and aetiological variables alone, assist definition of subgroups of non-melancholic major depression. Here, we address the same objective but combine both sets of variables, and contrast the combined solution with each of the contributing ones. METHOD: We study a sample of 185 subjects with a putative non-melancholic major depressive disorder, with analyses involving 13 aetiological and 38 symptom variables. RESULTS: A four-class subgrouping was derived by use of a cluster analytic technique, with 'neurotic depression', non-anxious 'depressed', 'situational' and 'residual' groups. The largest group comprised 'neurotic depression' subjects, with characteristics compatible with a spectrum disorder encompassing both clinical features as well as an underlying temperament and personality style marked by anxiety. CONCLUSIONS: Comparative advantages and properties of the three differing analytic approaches to defining 'meaningful' non-melancholic major depressive subgroupings are considered. As a 'neurotic depressive' class has been consistently identified across those three approaches, but with quite varying numbers of subjects circumscribed, it is clearly a 'fuzzy' entity which may benefit from a dimensional approach to its measurement. As many of the non-melancholic groupings appear secondary to a substantive predisposing factor such as anxiety or disordered personality functioning, the clinical importance and treatment utility in identifying and circumscribing such classes are clearly supported.

Adult↗
PubMed2005

Diagnostic stability in depressive disorder as according to ICD-10 in clinical practice.

BACKGROUND: The diagnostic stability of the ICD-10 diagnosis of depressive disorder has not been investigated in clinical practice. SAMPLING AND METHODS: All patients who were diagnosed with depressive disorder at least once in a period from 1994 to 2002 in psychiatric out- or inpatient settings in Denmark were identified in a nationwide register. RESULTS: A total of 39,741 patients were diagnosed with depressive disorder at least once; among these, 81% were diagnosed at the first contact. In approximately 56% of patients, the initial diagnosis of depressive disorder eventually changed during follow-up mainly to the schizophrenic spectrum (16%), but also to personality disorders (9%), neurotic, stress-related and somatoform disorders (8%) and to bipolar disorder (8%). Among the 18% of patients who were later diagnosed with depressive disorder, 23% initially had a diagnosis of adjustment disorder. CONCLUSIONS: When the ICD-10 diagnoses are used in clinical practice, the diagnosis of depressive disorder has a low stability over time. These findings emphasize the need for a longitudinally based diagnostic process in the diagnostic systems.

Adult↗
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↗
PubMed1997

[Mental disorders in the offspring of alcoholic fathers (children from an early age to 28)].

The examined groups included 175 children whose fathers were alcoholics and 73 individuals from nonalcoholic parents. The study group was divided by age into children from infantile age to 15 years and 16-28-year-olds. The wide range of psychopathologic disorders were revealed in children up to 15 years of age: syndrome of hyperactivity, neurotic disturbances, mental retardation, epileptic-like syndrome. Alcoholism was found in sons only (3.77%). Mental disorders were revealed significantly more frequently in sons of alcoholic fathers than in their daughters. Their incidence increased with the age of the sons. The disturbances occurred significantly more frequently in the test group as compared with the control one (19 and 6.38%, respective by). In the older group (16-28-year-olds) the spectrum of mental disorders consisted of alcoholism, mental retardation, psychopathic-like and neurotic disorders. Alcoholism occurred most frequent and its rate depended on the age and sex. Frequency of alcoholism was 66.7% in sons aged 21-28 years and 15.38% in daughters of the same age. The conclusion was made about multiple risk for children of alcoholic fathers. More vulnerable contingent was the sons for which the risk of alcoholism was very high.

Adolescent↗