Biomedical subjects

A Schmidtke

Publications and source records attributed to A Schmidtke.

At least 37 records · Page 2Linked to original sources

PubMed1998

[Violent and non-violent methods of parasuicide: what determines the choice?].

UNLABELLED: Patients with violent methods of parasuicide share a number of common characteristics with those who complete suicide. They can be differentiated from patients with non-violent methods. Whereas surgery is usually the first-line care in cases of violent parasuicide, detoxification and/or psychiatric hospitalisation are first employed with non-violent parasuicide. Therefore it is important to know the specific needs and characteristics of both patient groups, as it may be hypothesised that patients with violent methods are at specifically high risk of committing suicide. As part of the WHO/EURO Multicentre Study on Parasuicide, we examined 120 cases of parasuicide in hospitals of the Bonn area with the instrument EPSIS 1. Violent and non-violent methods were differentiated following the WHO X-classification. RESULTS: The following independent variables differentiate between violent and non-violent methods and predict the choice of violent methods: Diagnosis (schizophrenia vs. other diagnoses, p = 0.00027), gender (male, p = 0.04), high score of anger as a trait in State-Trait-Anger Scale (p = 0.017), poor mental health within the last 3 months (p = 0.058), time of parasuicide after 6 p.m. (p = 0.024). A higher number of previous parasuicides (p = 0.008) and unemployment (p = 0.047) were predictive of the choice of non-violent methods. A logistic regression analysis generated a model including the independent variables diagnosis, gender and "anger". Suicidal intent, sociodemographic variables, motives of parasuicides and "life events" did not discriminate between violent and non-violent methods.

Adult↗

PubMed1998

Relation between attempted suicide and suicide rates among young people in Europe.

STUDY OBJECTIVE: To determine if there are associations between rates of suicide and attempted suicide in 15-24 year olds in different countries in Europe. DESIGN: Attempted suicide rates were based on data collected in centres in Europe between 1989 and 1992 as part of the WHO/EURO Multicentre Study of Parasuicide. Comparison was made with both national suicide rates and local suicide rates for the areas in which the attempted suicide monitoring centres are based. SETTING: 15 centres in 13 European countries. PATIENTS: Young people aged 15-24 years who had taken overdoses or deliberately injured themselves and been identified in health care facilities. MAIN RESULTS: There were positive correlations (Spearman rank order) between rates of attempted suicide and suicide rates in both sexes. The correlations only reached statistical significance for male subjects: regional suicide rates, r = 0.65, p < 0.02; national suicide rates, r = 0.55, p < 0.02. CONCLUSIONS: Rates of attempted suicide and suicide in the young covary. The recent increase in attempted suicide rates in young male subjects in several European countries could herald a further increase in suicide rates.

Adolescent↗

PubMed1998

["Multiple personality disorder" in childhood and adolescence].

UNLABELLED: Multiple Personality Disorder (MPD) (ICD 10, DSM-III-R) or Dissociative Identity Disorder (DSM IV) is seen as a dissociative disorder. The diagnosis is mainly made only in adults. Descriptions of MPD in children or adolescents are rare in scientific literature. Both sexual and physical abuse are seen as the most important etiological factors. The diagnostic criteria include the presence of two or more identities within one person, the alternating control of the person's actions by the different personalities and amnesia with regard to episodes in one's life history which cannot be accounted for by forgetfulness. OBJECTIVES: Is MPD diagnosed in children and adolescents? Which criteria are relevant in this disorder? METHODS: All scientific publications found in an online search were individually analyzed. RESULTS: The literature survey yielded 120 published cases of MPD in children and adolescents. The main clinical presentations are affective and anxiety symptoms, auditory hallucinations, amnesia and behavioral disturbances. The sex ratio for children and adolescents is 5:4 f:m, resp. 9:1 for adults. Description of the social and familial backgrounds of children and adolescents with MPD is inadequate. The number of MPD cases among children, adolescents and adults has risen in recent years. CONCLUSION: MPD is diagnosed in children and adolescents. The diagnostic criteria are inconclusive.

Adolescent↗

PubMed1997

A repetition-prediction study of European parasuicide populations: a summary of the first report from part II of the WHO/EURO Multicentre Study on Parasuicide in co-operation with the EC concerted action on attempted suicide.

One of the aims of the European Study on Parasuicide, which was initiated by the Regional Office for the European Region of the World Health Organization in the mid-1980s, was to try to identify social and personal characteristics that are predictive of future suicidal behaviour. A follow-up interview study (the Repetition-Prediction Study) was designed, and to date 1145 first-wave interviews have been conducted at nine research centres, representing seven European countries. The present paper provides an abridged version of the first report from the study. The design and the instrument used (The European Parasuicide Study Interview Schedules, EPSIS I and II) are described. Some basic characteristics of the samples from the various centres, such as sex, age, method of suicide attempt, and history of previous attempts, are presented and compared. The male/female sex ratio ranged from 0.41 to 0.85; the mean age range for men was 33-45 years and that for women was 29-45 years. At all of the centres, self-poisoning was the most frequently employed method. On average, more than 50% of all respondents had attempted suicide at least once previously. The representativeness of the samples is discussed. There were differences between the centres in several respects, and also in some cases the representativeness of the different samples varied. Results obtained from analyses based on pooled data should therefore be treated with caution.

Adolescent↗

PubMed1997

Perspective: suicide in Europe.

In many European countries, suicidal behavior constitutes a major public and mental health problem. In most countries, the number of suicides is significantly higher than the number of deaths due to traffic accidents. According to official figures, the suicide rates among European countries differ widely; for example, Hungary has the highest rates. Suicide attempt rates, based on data from the WHO/Euro Multicentre project on Parasuicide, equally show variation; for example, the highest average rate of suicide attempts is for Helsinki, Finland. This paper outlines the epidemiological findings and then presents some hypotheses (e.g., age, ethnic difference) to explain the differences.

Culture↗

PubMed1996

A repetition-prediction study on European parasuicide populations. Part II of the WHO/Euro Multicentre Study on Parasuicide in cooperation with the EC Concerted Action on Attempted Suicide.

One of the aims of the inter-European study on parasuicide, which was initiated by WHO/Euro in the mid-1980s, was to try and identify social and personal characteristics predictive of future suicidal behavior. A follow-up interview study (the Repetition-Prediction Study) was designed, and so far 1145 interviews have been carried out at nine research centers, representing seven European countries. The study and the instrument used (the European Parasuicide Study Interview Schedules, EPSIS I and II) are described here. Some basic characteristics of the material from the various centers are presented and compared, and the representativeness of the samples are discussed. There were differences between the centers in several respects. Results from analyses based on pooled data have to be treated with some caution because of the possible lack of representativeness.

Adult↗

PubMed1996

The WHO-EURO Multicentre Study: risk of parasuicide and the comparability of the areas under study.

The 15 areas under study in the WHO/Euro Multicentre Study on Parasuicide vary considerably with regard to socio-economic factors, culture, life-styles, etc. In this paper, the authors discuss whether the traditional high risk factors for suicidal behavior (such as unemployment, abuse, divorce, etc.) take on different weights depending on local societal and cultural settings. Results from analyzing covariations between various background factors characteristic of the different areas under study and the frequency of attempted suicide showed weak or insignificant correlations, indicating that high-risk factors can only be identified from international pooled data with great care.

Adult↗

PubMed1996

Attempted suicide in Europe: rates, trends and sociodemographic characteristics of suicide attempters during the period 1989-1992. Results of the WHO/EURO Multicentre Study on Parasuicide.

The World Health Organization/EURO Multicentre Project on Parasuicide is part of the action to implement target 12 of the WHO programme, "Health for All by the Year 2000', for the European region. Sixteen centres in 13 European countries are participating in the monitoring aspect of the project, in which trends in the epidemiology of suicide attempts are assessed. The highest average male age-standardized rate of suicide attempts was found for Helsinki, Finland (314/100,000), and the lowest rate (45/100,000) was for Guipuzcoa, Spain, representing a sevenfold difference. The highest average female age-standardized rate was found for Cergy-Pontoise, France (462/100,000), and the lowest (69/100,000) again for Guipuzcoa, Spain. With only one exception (Helsinki), the person-based suicide attempt rates were higher among women than among men. In the majority of centres, the highest person-based rates were found in the younger age groups. The rates among people aged 55 years or over were generally the lowest. For the majority of the centres, the rates for individuals aged 15 years or over decreased between 1989 and 1992. The methods used were primarily "soft' (poisoning) or cutting. More than 50% of the suicide attempters made more than one attempt, and nearly 20% of the second attempts were made within 12 months after the first attempt. Compared with the general population, suicide attempters more often belong to the social categories associated with social destabilization and poverty.

Adolescent↗

PubMed1996

[Weight reduction in bulimia nervosa by abuse of thyroid hormones].

We report on a 24-year-old female patient with an 8-year history of bulimia nervosa. Following high-calorie food intake the patient counteracts weight gain by massive abuse of laxatives and L-thyroxine. In addition to the abuse of slimming agents in patients with bulimia nervosa, which was recently reviewed by Krüger and Bräunig [3], abuse of thyroid hormones also has to be considered in these patients.

Adult↗

PubMed1996

Cerebellar arachnoid cyst in a firesetter: the weight of organic lesions in arson.

A 52-year-old female patient was accused of arson; the patient had had an arachnoid cyst of the cerebellar vermis. Even after surgery, she showed marked instability of mood and pseudologia fantastica, but did not suffer from cognitive impairment. Possible associations of the presence of this cerebellar arachnoid cyst and behavioral disturbances are discussed.

Arachnoid Cysts↗

PubMed1995

Evidence against unusual sex concordance and pseudoautosomal inheritance in the catatonic subtype of schizophrenia.

The study is based on sibships with multiply afflicted members derived from a family study of consecutively admitted probands with catatonic schizophrenia. As shown recently, the clinical subtype of periodic catatonia, as defined by Leonhard, is compatible with a major gene effect and genetic anticipation; that is, the age of illness onset of the probands is significantly earlier than that of their parents. In the present study, 83 probands with the clinical subtype of periodic catatonia had 26 afflicted siblings that were distributed among 23 families. We analyzed sex-concordance and pseudoautosomal inheritance patterns. Stratifying the 26 afflicted siblings by sibship size and by the proband's sex, we did not find unusual sex-concordance rates in sibships afflicted with periodic catatonia. Further, there was no association between sex concordance and maternal or paternal origin of the disease. Thus, our results provide strong evidence against pseudoautosomal inheritance or sex-linked transmission in affected sibships in the obviously familial schizophrenic subtype of periodic catatonia.

Adult↗

PubMed1995

Background and introduction to the WHO/EURO Multicentre Study on Parasuicide.

In most European countries, suicidal behavior is a major public health problem and a considerable drain on resources at both the primary and secondary health care levels. Unfortunately, due to cross-cultural differences both in medical treatment of nonfatal suicidal behavior and in research methodologies, it has proved almost impossible to make valid comparisons between countries. It is therefore imperative that international studies based on the same definitions and methodologies be facilitated if we want to extend our knowledge of suicidal behavior and be able to make suggestions for intervention and prevention. The WHO Regional Office for Europe decided to support a collaborative multicenter study, designed to provide a reliable epidemiological picture of parasuicide in Europe. This article provides an introduction to the study.

Adolescent↗

PubMed1995

[Hyperthyroidism, psychiatric syndromes and cranial CT].

Acute hyperthyroidism is known to be a cause of psychopathologic and especially anxiety syndromes. A review of the literature will be given. Nonreversible psychopathologic changes in an euthyroid state after hyperthyroidism are also described. Correlations between T4-concentration and neuropsychologic and electroencephalographic findings were reported. CT findings of the brain are not mentioned. A case report should help to discuss nonreversible changes after hyperthyroidism and cranial CT findings.

Adult↗

PubMed1994

Suicidal behaviour on railways in the FRG.

Between 1976-84 there were 6090 suicides and 391 attempted suicides on railways in the Federal Republic of Germany. This suicide method was compared to other methods with respect to seasonal and daily distributions and fluctuations by time of day for age and sex. The ratio of males to females was 2.54:1 and the relative incidence of this type of suicide as compared to the total number of suicides was high among the younger age groups. Investigation of seasonal variation revealed a peak for males in the autumn. There was a markedly higher incidence of railway suicides committed by males on Mondays and Tuesdays. This peak was less pronounced for females. Most incidents occurred in the evening hours (especially after sunset). An investigation of the relationship between the severity of injuries and the location of the suicide attempt revealed that those who attempted suicide on railway tracks in the countryside were more seriously injured than those whose attempt took place in or near main stations.

Aged↗

PubMed1994

[Hyperintensive intramedullary lesions in psychiatric patients. Spatial distribution and psychopathologic symptoms].

In a sample of 130 patients who had undergone MRI (transverse T2-weighted SE sequence) patchy white matter lesions (WML) were documented according to number and spatial distribution in the brain. Ventricle-to-Brain Ratio (VBR) was determined. Configural frequency analysis led to delineation of four patient groups on the basis of WML location: 1. no WML (n = 35), 2. right frontal-temporal WML (n = 23), 3. bifrontal WML (n = 12), 4. WML in all/all but one brain region (n = 16). Psychopathological symptoms reported in the course of a maximum of 3 years were documented by chart review. In the 'pervasive WML' group psychopathological items characteristic of organic brain syndromes prevailed, mean VBR exceeded values in all other groups (ANOVA, p < 0.001). WML spatial distribution accounted for 10.2% of total psychopathological variance. Patient age, but not VBR, had a significant impact on symptom profile (MANCO-VA). When the 'pervasive WML' group was excluded, the finding of a significant effect of WML location on psychopathological symptom profiles was robust. Bifrontal WML were associated with thought incoherence, right frontal-temporal WML with affective symptoms. Findings support an impact of spatial distribution of unspecific WML on psychopathological symptoms in psychiatric patients.

Adult↗

PubMed1992

IRAOS: an instrument for the assessment of onset and early course of schizophrenia.

Since Kraepelin's first description of dementia praecox in 1889 many data and theories have been published on the onset and course of schizophrenia. Until now studies on these topics had to rely on first admission data and on the subsequent course of the disease. However, first hospitalisation is preceded by a wide variety of patterns and duration of the early course. Items taken from the pre-admission phase of the disease are often incorrectly used as premorbid characteristics, understandably preceding the subsequent course and outcome of schizophrenia with high predictive power. In relation to our interest to study the beginning of schizophrenia, systematically, paying special attention to the age and gender distribution of true onset and the symptomatology and pattern of the early and later course, we developed an 'Interview for the Retrospective Assessment of the Onset of Schizophrenia (IRAOS)'. It allows an objective, reliable, and valid assessment of the symptoms, psychological impairments, demographic and social characteristics as well as the referring points in time of the early course of psychosis. The instrument is administered as a semi-structured interview with both the patient and a key informant. The obtained information is extended by a systematic examination of the clinician's case notes. Some results derived from an ongoing study on age and gender differences in onset and patterns of early course are added to demonstrate the use of the instrument.

Combined Modality Therapy↗

PubMed1992

Parasuicide in Europe: the WHO/EURO multicentre study on parasuicide. I. Introduction and preliminary analysis for 1989.

The WHO/EURO multicentre study on parasuicide is a new, coordinated, multinational, European study that covers two broad areas of research: monitoring trends in the epidemiology of parasuicide (epidemiological monitoring study); and follow-up investigations of parasuicide populations, with a view to identifying the social and personal characteristics predictive of future suicidal behaviour (repetition prediction project). This article provides background information on the development and organization of the multicentre study, and presents selected findings from the epidemiological monitoring project, based on a preliminary examination of data collected in 15 centres on parasuicides aged 15 years and over treated in health facilities in defined catchment areas during the year 1989. The overall parasuicide incidence varied considerably across the centres, from a high (event) rate of 414 per 100,000 males in Helsinki to a low of 61 among males in Leiden. The highest female event rate was 595 in Pontoise, and the lowest 95 in Guipuzcoa. The mean event rate across all centres was 167 among males and 222 among females. Parasuicide incidence tended to be elevated among 15- to 34-year-olds, with lowest rates among those aged 55 years and over. With one exception (Helsinki), the female parasuicide rate was higher than the male rate, the F:M ratio ranging from 0.71:1 to 2.15:1, with a median of 1.5:1 (events). Short-term repetition rates (as measured by the event:person ratio) differed between centres, from 1.03 to 1.30 (median = 1.12) among males, and from 1.07 to 1.26 (median = 1.13) among females. Although we warn against generalizing from our findings to make statements about differences in parasuicide between countries, we argue that the differences between centres are valid and should be addressed in further research.

Adolescent↗

PubMed1991

Biogenic amines and metabolites in spinal cord of patients with Parkinson's disease and amyotrophic lateral sclerosis.

In four human controls, four cases of Parkinson's disease and three cases of amyotrophic lateral sclerosis analysis of dopamine, noradrenaline, serotonin and the metabolites 3,4-dihydroxyphenylacetic acid, homovanillic acid and 5-hydroxyindoleacetic acid was performed in various segments of postmortem spinal cord. In controls the concentrations of dopamine are about 1/3 to 1/4 that of noradrenaline; the significantly highest content of noradrenaline was found in the lumbar, and dopamine in thoracic, lumbar and sacral segments of the spinal cord. Intersegmental distribution of monoamines was only present in spinal cord of controls, while in the spinal cord of parkinsonian patients such a difference was not found. Otherwise, biogenic amine and metabolite concentrations in spinal cord segments of parkinsonian patients did not differ significantly from those in the control subjects. However, it cannot be excluded that these segments are sensitive to drugs including neuroleptics and combined L-DOPA treatment. In subjects with amyotrophic lateral sclerosis significantly lower concentrations of noradrenaline in the cervical and thoracic, and of dopamine and homovanillic acid in the thoracic and lumbar segments were found in comparison with controls. The concentrations of serotonin and 5-hydroxyindoleacetic acid in the thoracic segments of amyotrophic lateral sclerosis were significantly lower than that of controls. Differences in the inter-segmental distribution of noradrenaline in lumbar, lumbar-sacral, and serotonin in lumbar segments of spinal cord were found in this group.

3,4-Dihydroxyphenylacetic Acid↗