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At least 19 recordsLinked to original sources
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↗
PubMed1999

[Psychogenic impairment and current feelings in the elderly. Which options are offered by the biographical perspective?].

In the Eldermen study funded by the German Research Association (DFG), a consecutive sample of patients, aged > or = 60 (n = 120) and being treated for a variety of internal medical complaints in an acute geriatric hospital were examined with the help of comprehensive somatic diagnostics, standardised questionnaires, and a semi-structured biographical interview. The study investigates the relationship between burdensome and supportive biographical experiences and the extent of psychogenic impairment as well as aspects of feeling tone and self-concept in later life. For the degree of psychogenic impairment (Impairment Score. IS; Schepank 1995), subjectively experienced burdens and support were found to be more relevant than "objective" burdens. As expected, subjective burdens consistently experienced over several life phases, particularly in association with limited experienced support, were found to be associated with greater psychogenic impairment and a higher "case risk" in later life. However, the patients with the highest values for current life satisfaction as well as a more positive self-concept were not those patients who never experienced more burdens than support in their biographies, but rather those who experienced more burden than support in one life phase. The results are presented in relation to models of learning theory and object relation theory and discussed for their clinical relevance.

Aged↗
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↗
PubMed1989

[Psychogenic impaired consciousness].

Until not too long ago, psychogenic trance was considered to be a 'conversion hysteria'. But clinical syndromes and personality disorders are now seen as separate entities; therefore, psychogenic trance is part of the so-called 'dissociative disorders'. Here, the integrative functions of the psyche are reduced and control of memory, identity, sensoric and motoric functions are impaired. As a consequence, certain disorders are observed, which have common characteristics, such as onset (psychogenic trauma), course (initial panic or belle indifference) and psychodynamics (repression of an unbearable reality). The following disorders can be distinguished: --psychogenic amnesia: partial or complete loss of memory --psychogenic trance: temporary loss of habitual identity with more or less full awareness of surroundings --psychogenic fugue: apparently purposeful journey away from home with psychogenic amnesia --psychogenic stupor: profound diminuation or absence of voluntary movement and no responsiveness to external stimuli.

Accidents, Aviation↗
PubMed1993

[Epidemiologic findings of the etiology of psychogenic diseases].

In an epidemiological longitudinal field study, a sample of high risk probands suffering from medium psychogenic impairment was investigated with regard to the etiological relevancy of factors influencing psychogenic disorders (psychoneuroses, character neuroses, psychosomatic and/or psychosomatic functional diseases). The study focused the question of the etiological impact of personality, life events, and social support. With theoretical reference to the psychodynamic concept of personality trained physicians and psychologists investigated 240 probands in a half standardized psychodynamic interview which included psychometric and social empiric instruments. Expert ratings and self ratings were used to assess the current psychogenic impairment. The impact of the constructs personality, critical life events, and social support on psychogenic impairment was specified in two path models. In both models psychodynamic personality variables had the highest impact on the criterium. Psychodynamically consistent, the ability to establish mature object relations and the maturity of ego functions was inversely related to the degree of psychogenic impairment, whereas an immature organisation of defense mechanisms exerted an aggravating influence on the severity of impairment. The present path analyses altogether point to a possible central etiological impact of personality and/or psychodynamic variables on the severity of psychogenic impairment.

Adaptation, Psychological↗
PubMed1994

[Inadequate utilization of somato-medical services by psychogenically ill patients].

Within the Mannheim Cohort Project on the epidemiology of psychogenic disorders 240 probands of a high risk sample (suffering from medium psychogenic impairment) were randomly selected from the general population and investigated with regard to their realized utilization of the medical and/or psychotherapeutic services of the health care system. On the basis of clinical criteria the probands were classified as case (n = 78) of psychogenic disorder or non-case (n = 162). Increased psychogenic impairment caused by psychoneurotic, character neurotic, or psychosomatic-functional disorders was primarily combined with an intensified utilization of the somatically oriented medical services. Only 2.5% of the cases indicated that the reason for their most recent visit to a physician was psychotherapeutic treatment. In view of the high percentage of psychogenic impaired patients in private practices and general hospitals this seems to be a particularly discrepant finding. In spite of the psychogenic nature of their complaints the cases were confronted with somatically oriented therapy offers like the non-cases. An increased psychogenic impairment did not lead to a qualitative alteration of the utilization of medical and/or psychotherapeutic services. Facing the fact that the utilization of somatically oriented medical services by psychogenic ill patients is still widespread but inadequate this finding is interpreted as indication for an essential demand of further studies on the determinants of psychotherapy acceptance.

Cohort Studies↗
PubMed1995

[Indicators and factors of influence on the long-term follow-up of psychogenic diseases--a comparison of extreme groups].

The present investigation aimed at the identification of possible indicators of course, predictors, and etiologically relevant factors of psychogenic diseases. According to their complaints a sample of probands suffering from psychogenic impairment of medium degree (n = 240) was chosen out of a representative sample of an urban adult population (n = 528). This procedure should ensure a relatively high intraindividual variance of course of the criterion, since a sufficient variability of course seems improbable with chronic and severe psychogenic impaired or stabile healthy probands. Within 10 years the sample was investigated three times by psychodynamically trained physicians and psychologists. By means of cluster analysis the sample was subdivided in different types of course of psychogenic impairment. Both extreme types of course-the probands who showed the most positive and the most negative spontaneous longterm course-were investigated univariately and by means of a multivariate discriminant analysis with regard to potentially course determining variables. It became obvious that personality variables and conditions of early childhood considerably influenced the spontaneous longterm course of psychogenic impairment.

Activities of Daily Living↗
PubMed1994

[Epidemiologic findings on the spontaneous long-term course of psychogenic disease over 10 years].

207 individuals were selected from a random sample of the adult urban population of Mannheim according to the criterion of medium psychogenic impairment (high-risk population) and investigated three times between 1979 and 1991 with regard to prevalence and severity of psychogenic disorders. In contrast to clinical investigations, the present data render statements on the spontaneous course of psychogenic disorders in the general population. The existing psychogenic impairment was determined by means of various operationalizations (symptomatology, ICD-diagnoses, severity of impairment). The available data indicate a high stability of psychogenic impairment in the spontaneous course. Group statistically the severity of impairment even increases in the long term course. However, different subtypes of course in the investigated high-risk population can be identified by a cluster analysis.

Adult↗
PubMedDate not supplied

[Psychotherapy motivation and psychotherapy acceptance. Initial results of the Mannheim intervention study].

In our controlled longitudinal study of a representative high-risk sample of psychogenically impaired individuals, within a multidimensional model of mental health, the variables "life event", "social support" and "personality" are examined concerning their analysis of variance and their interdependence. We assume that a therapeutic influence on the variable "personality" causes a modified risk of becoming psychogenically impaired, and intend to prove this in terms of the altered maturity of defenses, the improved ego-functions, but also in terms of the improvement of the social network and the rarer constellation of critical life events. The modified effect on the variable "personality" is a differential offer of psychoanalytic therapy. By means of our instruments of investigation we tried to clarify if the acceptance of psychotherapy offered to resp. the motivational situation of our probands in regard to a psychotherapy covariates with certain sociodemographically or depth psychologically measurable personality patterns. There was a trend towards accepting the offer of therapy in case of high psychical and socio-communicative psychogenic impairment and in case of relatively high frankness on the FPI scale. The acceptance of an offer of therapy correlated highly significantly with the frankness scale of the Bond questionnaire extended for several defense items. The implications of this finding are discussed.

Cohort Studies↗
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↗
PubMed1993

[Psychometric assessment of defense mechanisms: correlation between questionnaire and expert rating. Initial study of validity].

Within the limits of an epidemiological longitudinal field survey on prevalence and course of psychogenic disorders a high-risk-population suffering from medical psychogenic impairment was investigated. The study was conducted in order to verify an etiological multi-level-model of psychogenic disorders in relation to the socialempiric variables "critical life events" and "social support" as well as the depth psychological oriented construct "personality". Besides other instruments a self rating scale based on Vallant's hierarchical model of defense, i.e. the german adaptation of the DSQ (Defense Style Questionnaire) of Bond and coworkers, was used for the accurate measurement of relevant personality parameters. Although defense processes predominantly work unconscious, manifestations of defense mechanisms could be measured indirectly by means of the rating scale. Its essential dimensions separated clinical patients from a group of healthy controls. Furthermore an immature organisation of defense was found to be related to psychogenic impairment. Concerning self- and expert-rating a significant correlation between "immature defense" and the defense mechanisms "schizoid phantasy", "projection" and "acting out" was proved.

Adult↗
PubMed1999

Information from false statements concerning visual acuity and visual field in cases of psychogenic visual impairment.

BACKGROUND: If visual acuity (VA) and/or visual field (VF) is claimed to be worse than in reality, it can be difficult to estimate the actual VA/VF. This paper describes a method of proving malingering and of estimating the actual VA by statistical evaluation of the subjective responses to discrete visual stimuli. METHODS: VA is measured by using a Landolt or Snellen optotype with four possible directions. There are n (> or = 16) questions at each acuity level. Each direction of the optotype occurs with the same frequency. The sequence is not predictable. In testing the VF, the stimulus is presented in an unpredictable sequence but with the same frequency at each of four distinct locations outside the claimed field at the horizontal and the vertical meridian. The field is divided into four quadrants defined by the 45 degrees-225 degrees and 135 degrees-315 degrees meridians. The candidate is requested to search for the light. The target quadrant of the first eye movement is recorded. At each VA level, the distribution function of the binomial formula allows estimation of the probability Pc of < or = kc and > or = kc correct answers to n questions by mere accident. Regarding the VF, the direction of the first saccade at each stimulus presentation can be processed accordingly. RESULTS: If n = 32 and kc = 0,1,2, the chance P that this pattern is merely accidental is about 0.0001, 0.001, 0.007. Values of P < or = 0.01 strongly suggest that the answers were voluntarily wrong. Preference for the opposite direction can also point to psychogenic influence: If ko = 15,16,17,18, P is about 0.006, 0.002, 0.0006, 0.0002. CONCLUSION: Systematically false statements can yield valuable information about the actual visual functions.

Adult↗
PubMed2001

[The closed Landolt ring--a handy test for evaluating suspected simulation].

PURPOSE: We present a visual acuity test for proof of malingering and psychogenic impairment of visual acuity. METHOD: The book contains 36 plates. On 32 plates, a Landolt-C is shown with a gap of 10 minutes of arc, thus corresponding to a visual acuity of 0.1, when applied at a distance of 1 metre. Each of the 4 alternatives of the Landolt-C occurs eight times in random order. Starting at position 21, four plates are interspersed showing a closed circle of the same size. The test is used at a distance corresponding to an acuity level of maximum 50% of the presumed factual acuity. Following a four alternative forced choice paradigm, the tested person is requested to call the direction of the Landolt-C within about 2 seconds, when the plates of the book are turned over. The responses and their latency are recorded using a digital electronic system which allows later audiovisual analysis. The response on the first closed circle and its latency is compared to the previous responses. Two subjects were tested who tried to pretend a reduction of their visual acuity. RESULTS: Malingering was proved by the verbal response of the first subject and by the long latency of the response of the second subject (4.0 s vs. 1.2 s-2.7 s for the previous responses). The entire test, explanation included, took less than 5 minutes. CONCLUSION: This handy test can be a useful tool in cases suspect of malingering or psychogenic impairment of visual acuity.

Adult↗
PubMed1996

[Different lay etiologic attributions of psychogenically ill probrands from an epidemiologic field study].

The correlation between causal attributions of symptoms and sociodemographic, psychometric and clinical variables among psychogenic impaired persons is investigated in this paper. 114 individuals, who had presented psychogenic symptoms in the last year, were selected from the representative sample of the Mannheim Cohort Study. Two extreme groups have been identified through one Scale of Disease Conception: one with a somatogenic (n = 80) and the other with a psychogenic conception (n = 34). Female, younger and well educated individuals predominate in the group with psychogenic conception. In FPI the group with psychogenic conception is characterized by high depressivity, emotional lability, aggressivity, inhibition, irritability, anxiety and frankness. The diagnosis psychoneurose (ICD) is also more frequent in this group. The psychic impairment is more severe in the group with psychogenic conception (Impairment Score). Subjects of the group with psychogenic conception utilized psychotherapeutic services more frequently. In the logistical regression the variables agecohort, the FPIdimensions "Sociability" and "Inhibition", the number of psychic and physical symptoms in the last year and the BSS-subscale "psychic impairment" prove to be relevant in the estimate of relative risk for the type of causal explanation for symptoms.

Adult↗
PubMedDate not supplied

[The molecular basis of dopamine synapse activity in the mechanisms of learning and amnesia].

Neurochemical events underlying the activity of the dopamine synapse during the retrieval of memory and its impairment ("psychogenic" amnesia) are considered in the paper. Physico-chemical parameters of operation of D2 receptor and catechole content were investigated in various brain areas (striatum, neostriatum, hypothalamus, amygdala, frontal cortex, hippocampus, nuclei accumbens, A9, and A10) in intact, learned, and amnestic rats. The impairment in the memory trace retrieval was found to be associated with a significant decrease in activation of synaptic dopamine receptors and a modification of the dopamine transformation pathway.

Amnesia↗
PubMedDate not supplied

Cognitive performance in multiple trauma patients 3 years after injury.

OBJECTIVES: Patients with sequelae from multiple trauma commonly display cognitive disturbances, specifically in the areas of attention and memory. This study was designed to assess cognitive functioning 3 years after severe multiple trauma and to investigate how cognitive performance is related to head injury severity and psychological distress respectively. METHODS: Sixty-eight multiple trauma patients were tested with a screening battery consisting of six neuropsychological tasks 3 years after injury. A measure of psychological distress (20-item General Health Questionnaire, or GHQ-20) was also administered. RESULTS: Patients who neither showed signs of reduced consciousness on admission to the hospital nor reported significant psychological distress at follow-up tended to have normal test performance. In five of the six tasks, cognitive impairment was related to the severity of the traumatic brain injury as measured by the Glasgow Coma Scale (GCS). In both attention span tasks, patients designated as cases by the GHQ had significantly lower scores than noncase patients. These bivariate relationships were upheld in multiple regression analyses, in which age, sex, and GCS and GHQ scores were entered as independent variables. When patients with severe head injuries were excluded from the analyses, GCS scores still contributed to the variance in tests of verbal attention span and delayed recall, but performance on attentional tasks was more strongly related to psychological distress than to GCS scores. CONCLUSIONS: Cognitive deficits in multiple trauma patients were related both to the severity of the traumatic brain injury and to the degree of psychological distress. The strength of the association between brain injury as indicated by GCS scores and cognitive performance differed between different tasks. Neuropsychological testing may assist in differentiating primary organic from secondary psychogenic impairments.

Adolescent↗
PubMed1983

[Analysis of the structure of the depressive triad as a diagnostic and prognostic indicator].

In order to ascertain the diagnostic and prognostic importance of the structure of the depressive triad, the authors conducted a clinical psychopathologic study of 173 patients (88 males and 85 females) with depressions (manic-depressive psychosis, schizophrenia, residual-organic and vascular cerebral impairments, psychogenic depression). An analysis of the structure of the depressive triad was made based on the concept of heterogeneity of the depressive affect, with such acknowledged major components as melancholy, anxiety, and apathy. Depending on the nature of the leading elementary affect, three types of the depressive triad were identified, namely, melancholy, anxiety and apathy depressive triads. According to the criterion of qualitative and quantitative correlation between the triad components (ideational and motor) and the leading affect, harmonic, disharmonic and dissociated variants were identified within every type. The regular features of the time-course of the triad were established: from the initial stages to the over picture and then to the reduction of depression. These regularities were characterized by definite nosological preference, and may be helpful in the differential diagnosis and also be used as predictors of a protracted course of depression.

Adolescent↗
PubMed1993

[Incidence and follow-up characteristics of neurologically relevant psychogenic symptoms].

The author reports on the prevalence and stability of the course of neurologically relevant psychogenic symptoms as well as their dependence on age and sex. Altogether 240 probands from the Mannheim Cohort Study on the epidemiology of psychogenic disorders were examined for psychogenic impairment over a 10-year period during three investigation periods. On the whole, seven neurologically relevant groups of symptoms (headache, lumbar and cervical vertebral complaints, non-systematic vertigo, functional hyperkinesia, functional paresis, sleep disturbances, concentration disturbances) differ clearly in frequency, characteristics of the course and clinical relevance.

Adult↗