Biomedical subjects

Alex Gamma

Publications and source records attributed to Alex Gamma.

At least 19 recordsLinked to original sources

PubMed2006

The spectra of neurasthenia and depression: course, stability and transitions.

BACKGROUND: Neurasthenia has had a chequered history, receiving changing labels such as chronic fatigue or Gulf war syndrome. Neurasthenia is recognized by ICD-10, but not by DSM-IV. Its course, longitudinal stability and relationship to depression is not well understood. METHODS: In a stratified community sample (n = 591), representative of 2600 persons of the canton of Zurich, Switzerland, neurasthenia and depression were assessed in six structured interviews between ages 20 and 41. Course, stability and comorbidity were examined. A severity spectrum of neurasthenia and depression from symptoms to diagnosis was taken into account. RESULTS: The annual prevalence of a neurasthenia diagnosis increased from 0.7% to 3.8% from age 22-41, while mere symptoms became less prevalent. Intraindividual courses improved in 40% and deteriorated in about 30% of symptomatic cases. The most frequent symptoms overall, besides criterial exhaustion, were increased need for sleep, over-sensitivity, nervousness and difficulty concentrating. Cross-sectional associations and overlap with depression were strong. Longitudinal stability of ICD-neurasthenia was low. CONCLUSIONS: Neurasthenia is intermittent, overlaps significantly with depression, and shows improvement and deterioration over time to roughly equal measures.

Adult↗

PubMed2006

The use of complementary and alternative medicine in the general population: results from a longitudinal community study.

BACKGROUND: Many patients with psychological or physical problems are interested in non-medical approaches. The reasons for the growing popularity of complementary and alternative medicine (CAM) are not well understood considering that evidence of the effectiveness of conventional therapies is greater than ever before. We have examined data from the Zurich Study to determine trends and predictors of CAM use in Switzerland. METHOD: The Zurich Study is a longitudinal community study that was started in 1979 with a sample of 591 participants born in 1958 and 1959. In 1999, the last of six interview waves with face-to-face interviews was conducted. CAM use was analyzed with data from interviews in 1993 and 1999. Polytomous logistic regression analysis focused on the personal, demographic and sociocultural background of CAM users. RESULTS: CAM use in the last 12 months was reported by 21.9% of the participants in 1993 and by 29.5% in 1999. CAM use among those exhibiting either physical or psychological problems was in the ratio of two to one. There was a trend from alternative variants of CAM (homeopathy) to complementary ones (massage, osteopathy, acupuncture). The vast majority of CAM use was in addition to conventional therapies. Predictors of CAM use were, among others, attribution of physical complaints to stress and other psychological variables, very low education level in parents, and lacking political interest. CONCLUSIONS: Besides the sociocultural background, characteristics such as the psychological attribution style play an important role in CAM use. CAM use in Switzerland is mainly of a complementary rather than an alternative nature.

Complementary Therapies↗

PubMed2006

How ubiquitous are physical and psychological complaints in young and middle adulthood? A longitudinal perspective.

OBJECTIVES: To investigate continuity and change of self-reported physical and psychological complaints in young adults over a period of 20 years. STUDY DESIGN AND SETTING: The Zurich Study--a long-term panel survey in psychiatric epidemiology--is based on a stratified sample of 591 subjects born in 1958 (women) and 1959 (men). The sample strata combine SCL-90-R high-scorers and low-scorers in a 2:1 ratio. Up to now, the Zurich Study has included six interviews between 1979 and 1999, i.e. 20 years of life in young adults. We analysed the longitudinal frequency data of a variety of physical and psychological complaints, as well as information about subjective suffering and use of professional help. The analyses utilised on the McNemar's test, the Q-test and Markov chain models. RESULTS: Sleep disorders, depression, menstruation, backache, headache, stomach and bowel complaints yielded cumulative prevalence rates of 80% or higher. Physical and psychological complaints systematically differ with respect to the change patterns between 1979 and 1999. Moreover, strong differences were found in view of subjective suffering and use of professional help. CONCLUSIONS: Even though many self-reported physical and psychological complaints are very common in young adulthood, the underlying dynamics and the implications largely differ. It seems to be crucial whether respondents use somatic glasses or psychological lenses.

Adult↗

PubMed2006

Is the association of alcohol use disorders with major depressive disorder a consequence of undiagnosed bipolar-II disorder?

BACKGROUND: There is emerging evidence that there is a spectrum of expression of bipolar disorder. This paper uses the well-established patterns of comorbidity of mood and alcohol use disorder to test the hypothesis that application of an expanded concept of bipolar-II (BP-II) disorder might largely explain the association of alcohol use disorders (AUD) with major depressive disorder (MDD). METHOD: Data from the Zurich study, a community cohort assessed over 6 waves from ages 20/21 to 40/41, were used to investigate the comorbidity between mood disorders and AUD. Systematic diagnostic criteria were used for alcohol abuse, alcohol dependence, MDD, and BP-II. In addition to DSM criteria, two increasingly broad definitions of BP-II were employed. RESULTS: There was substantially greater comorbidity for the BP-II compared to major depression and for alcohol dependence compared to alcohol abuse. The broadest concept of BP-II explained two thirds of all cases of comorbidity of AUD with major depressive episodes (MDE). In fact, the broader the definition of BP-II applied, the smaller was the association of AUD with MDD, up to non-significance. In the majority of cases, the onset of bipolar manifestations preceded that of drinking problems by at least 5 years. CONCLUSIONS: The findings that the comorbidity of mood disorders with AUD was primarily attributable to BP-II rather than MDD and that bipolar symptoms usually preceded alcohol problems may encourage new approaches to prevention and treatment of AUD.

Adult↗

PubMed2006

Varying temporal criteria for generalized anxiety disorder: prevalence and clinical characteristics in a young age cohort.

BACKGROUND: This study questions the 6-month duration criterion for generalized anxiety disorder (GAD) used in DSM-III-R and DSM-IV. METHOD: In adults from age 20/21 to 40/41 in the prospective Zurich Cohort Study, four groups of generalized anxiety syndromes defined by varying duration (2 weeks, 1 month, 3 months and 6 months) were compared. RESULTS: Applying DSM-III (1979-1999) and DSM-III-R (1986-1999) criteria, there were no significant differences between the four groups in terms of family history of anxiety, work impairment, distress, treatment rates or co-morbidity with major depressive episodes (MDEs), bipolar disorder or suicide attempts. Only social impairment related to the length of episodes. The 6-month criterion of DSM-III-R and DSM-IV GAD would preclude this diagnosis in about half of the subjects treated for generalized anxiety syndromes. CONCLUSIONS: In this epidemiological sample, the 6-month duration criterion for GAD could not be confirmed as clinically meaningful. GAD syndromes of varying duration form a continuum with comparable clinical relevance.

Adult↗

PubMed2006

The accuracy of the Italian version of the Hypomania Checklist (HCL-32) for the screening of bipolar disorders and comparison with the Mood Disorder Questionnaire (MDQ) in a clinical sample.

BACKGROUND: The study measured the accuracy of the Italian version of the Hypomania Checklist (HCL-32) for self-assessment as a screening instrument for bipolar disorder (BPD) in a psychiatric setting and compared results with a previous study, carried out in a comparable sample and in the same setting, using the Mood Disorder Questionnaire (MDQ). METHODS: 123 consecutive subjects attending a psychiatric division were screened for BPD using the Italian translation of the HCL-32, and diagnostically interviewed with the SCID by physicians. The sample of the previous study using the MDQ consisted of 154 subjects. RESULTS: On the basis of the SCID: 26 received a diagnosis of bipolar/schizoaffective disorder, 57 were diagnosed as having at least another psychiatric disorder in Axis-I, whilst 40 were unaffected by any type of psychiatric disorder. Comparing the bipolar with all other patients the HCL-32 showed a good accuracy: cut-off 8: sensitivity 0.92-specificity 0.48; cut-off 10: sensitivity 0.88-specificity 0.54; cut-off 12: sensitivity 0.85-specificity 0.61. The accuracy for BPD-II (10) remains good: cut-off 8: sensitivity 0.90-specificity 0.42; cut-off 10: sensitivity 0.80-specificity 0.47; cut-off 12: sensitivity 0.80-specificity 0.54. The comparison with the MDQ performance shows that both screening tools may show good results, but HCL-32 seems to be more sensitive in detecting BPD-II. CONCLUSION: Our results seem to indicate good accuracy of HCL-32 as a screening instrument for BPD in a psychiatric setting, with a low rate of false negatives, and a fairly good degree of identification of BPD-II.

Journal Article↗

PubMed2006

Inconsistency in reporting potentially traumatic events.

BACKGROUND: Research on post-traumatic stress disorder (PTSD) relies mainly on self-reports of exposure to trauma and its consequences. AIMS: To analyse the consistency of the reporting of potentially traumatic events (PTEs) over time. METHOD: A community-based cohort, representative of the canton of Zurich, Switzerland, was interviewed at the ages of 34-35 years (in 1993) and 40-41 years (in 1999). A semi-structured diagnostic interview, including a section on PTSD, was administered. RESULTS: Of the 342 participants who attended both interviews, 169 reported some PTE (1993, n=110; 1999, n=120). In 1999, 56 participants (33.1%) reported for the first time PTEs that actually occurred before 1993, but which had not been reported in the 1993 interview. In total, 68 participants (40.2%) who had reported a PTE in 1993 did not report it in 1999. The overall frequency of inconsistent reporting was 63.9%. CONCLUSIONS: The high level of inconsistency in the reporting of PTEs has implications for therapy as well as for research.

Adult↗

PubMed2005

Prevalence of exposure to potentially traumatic events and PTSD. The Zurich Cohort Study.

OBJECTIVE: The aim of this study was to estimate the prevalence rate of exposure to potentially traumatic events (PTE) and posttraumatic stress disorder (PTSD) in a representative sample of the general population. METHOD: A representative community-based cohort from the canton of Zurich, Switzerland was interviewed in 1993 and 1999 at the age of 34/35 and 40/41 years, respectively, by means of a semi-structured diagnostic interview. RESULTS: The weighted lifetime prevalence of PTE in 1999 was 28%. Of the persons who reported exposure to PTE (criterion A), none met all the remaining criteria for PTSD according to the DSM-IV. Eleven persons (2 males and 9 females) met the criteria for subthreshold PTSD. This corresponds to a weighted 12-month prevalence for subthreshold PTSD of 1.30% (0.26 % for males; 2.21 % for females). In 1993, no participant met all criteria for PTSD according to the DSMIII- R. The weighted 12-month prevalence for subthreshold PTSD was 1.90 % (2.9 % for males; 0.9 % for females). CONCLUSION: The prevalence of exposure to PTE in Switzerland was relatively low. No single case of full PTSD was found in the sample, and even for subthreshold PTSD the prevalence was very low. The relatively stable socio-economic and political climate in Switzerland may contribute to a sense of safeness, which may protect Swiss citizens to some extent from developing PTSD in the aftermath of traumatic experiences.

Adaptation, Psychological↗

PubMed2005

Atypical depressive syndromes in varying definitions.

BACKGROUND: Atypical depression (AD) exhibits distinct patterns of gender,bipolar-II disorder, genetic, and neuro-biological measures. Using prospective data from a community sample, this paper identifies criteria (and correlates) for an AD syndrome that maximizes the association with female sex and bipolar-II. METHODS: The Zurich cohort study is composed of 591 subjects selected from a population-based cohort of young adults in the canton of Zurich in Switzerland, screened in 1978 and followed with six interviews through 1999. Seven definitions of atypical depression were tested, using varying combinations of vegetative symptoms and mood reactivity. RESULTS: The atypical definitions using 2 of 3 (fatigue, overeating, oversleeping) or 2 of 2 (overeating, oversleeping) vegetative symptoms showed the strongest association with gender, bipolarity, and family history of mania. The 2/3 definition was chosen for further analysis due to its high sensitivity for identifying these characteristics. This syndrome had cumulated weighted prevalence of 16.4% (males 9.7%, females 23%); when associated with major depressive episodes, 8.2% (males 3.2%, females 15.1%). AD patients were characterized by high treatment rates, severity, and work impairment, early age of onset and long illness. AD was comorbid with social phobia, binge eating, neurasthenia, migraine headache, and subjective cognitive impairment.

Adult↗

PubMed2005

Nosology and treatment of primary headache in a Swiss headache clinic.

We assessed demographics, diagnoses, course, severity, impact and treatment of primary headache outpatients from records in the Headache and Pain Clinic, Neurological Department, Zürich University Hospital. All outpatients seen from 1996 to 1998 for migraine, tension-type headache, and both, were included. Diagnoses, drug, physical and alternative treatments before and after referral were listed. Descriptive statistics were used for differences between the general population and this sample, the diagnoses, and treatments. The coexistence of migraine and tension-type headache, and the high frequencies of headache days would have excluded most migraine patients from typical drug trials: at best, only one third were eligible. The socioeconomic impact of combined and difficult syndromes calls for comprehensive management beyond simple treatment with instant relief drugs. The diagnostic and therapeutic practices of referring physicians exposed a deficit of information on headache, and a need for relevant education.

Adolescent↗

PubMed2005

Asthma and panic in young adults: a 20-year prospective community study.

RATIONALE: Psychologic factors are increasingly recognized to influence the onset and course of asthma. Previous cross-sectional community-based studies have provided evidence for a relatively specific association between asthma and panic. OBJECTIVES: To examine concurrent and longitudinal associations between asthma and panic in young adults. MEASUREMENTS AND MAIN RESULTS: Prospective community-based cohort study of young adults (n = 591) followed between ages 19 and 40. Information was derived from six subsequent semistructured diagnostic interviews conducted by professionals. Cross-sectionally (over the whole study period), asthma was more strongly associated with panic disorder (odds ratio [OR] = 4.0; 95% confidence interval [CI], 1.7, 9.3) than with any panic, which included panic disorder and panic attacks (OR = 2.1; 95% CI, 1.1, 4.5). Longitudinally, after adjusting for potentially confounding variables, active asthma predicted subsequent panic disorder (OR = 4.5; 95% CI, 1.1, 20.1), and the presence of panic disorder predicted subsequent asthma activity (OR = 6.3; 95% CI, 2.8, 14.0). Asthma predicted any panic (OR = 2.7; 95% CI, 1.1, 7.1), whereas any panic did not predict subsequent asthma activity. Associations were stronger in smokers than in nonsmokers, and stronger in women than in men. Smoking, early-childhood anxiety, and a family history of allergy were important confounders of the asthma-panic association. CONCLUSIONS: This is the first long-term follow-up study on asthma and panic. It showed dose-response-type relationships between panic and asthma, and bidirectional longitudinal associations between the two conditions. It provided evidence for familial factors and smoking as possible shared etiologic explanations.

Adult↗

PubMed2005

Is ecstasy perceived to be safe? A critical survey.

Recent publications claim that the recreational drug ecstasy is considered to be safe by many or most ecstasy users, or by young people or the general public. Unfortunately, there are no references that provide any support for this claim. Previous studies of various populations, including drug users and adolescents in several nations, also failed to support claims of the perceived safety of ecstasy. Epidemiological surveys from the USA and UK consistently report high proportions of young people who perceive great risk in using ecstasy. Studies in ecstasy users show that they are aware of a number of short- and long-term risks of ecstasy use, although, in the absence of actual problems, they evaluate the personal significance of these risks as low. This study further investigated the perceived harmfulness of ecstasy, drawing on an online survey of over 900 drug users. Little support for the claim was found. Seventy-three percent of the participants in the online survey viewed ecstasy as carrying at least 'some risk'. The claim of ecstasy's perceived safety is plausibly based on researchers' assumptions that the continued widespread use of the drug indicates that users are unaware of the associated risks, and that informing them about these risks would lead to a reduction in drug use. We argue that these assumptions are inadequate and that drug information and harm reduction strategies should focus on more affective and personally significant aspects of risk perception.

Adolescent↗

PubMed2005

Obsessive-compulsive syndromes and disorders: significance of comorbidity with bipolar and anxiety syndromes.

OBJECTIVE: To determine the prevalence and clinical characteristics of comorbid obsessive compulsive disorders and syndromes (OCD/OCS), compared with pure OCD/OCS among adults in the community. METHOD: Data were drawn from the Zurich Study, a longitudinal cohort study of 591 adults in the canton of Zurich. Comorbid OCD/OCS was compared with pure OCD/OCS groups in terms of distress, impairment, family history, suicide behavior and treatment using multivariable logistic regression analyses. RESULTS: OCD was significantly comorbid with bipolar I/II and minor bipolar disorders, anxiety states (GAD, repeated panic attacks) and social phobia, whereas there was no clear association between OCD and major depressive disorder or phobias other than social phobia. Results suggest that comorbid OCD/OCS is common among adults in the community, with the majority of those with OCD/OCS having at least one comorbid mood or anxiety disorder with a prevalence of 7.4% compared to 4.8% of remaining OCD/OCS. Comorbidity of OCD/OCS and anxiety states was more common among women (85.6 %) and comorbidity with bipolar spectrum was more common among men (69.6%). Comorbid OCD/OCS was associated with significantly higher levels of treatment seeking, impairment,distress and suicidality compared with pure OCD/OCS. Comorbidity with bipolar disorders significantly increased the risk for alcohol abuse/dependence. CONCLUSION: Comorbidity of OCD/OCS with bipolar disorder and bipolar spectrum disorders is common and very probably explains the association between OCD and depression found in other studies. The early recognition of bipolar/cyclothymic OCD/OCS may help to prevent the abuse of/dependence on alcohol.

Adult↗

PubMed2005

The HCL-32: towards a self-assessment tool for hypomanic symptoms in outpatients.

BACKGROUND: Bipolar disorders (BP) are frequently diagnosed and treated as pure depression initially; accurate diagnosis often being delayed by 8 to 10 years. In prospective studies, the presence of hypomanic symptoms in adolescence is strongly predictive of later bipolar disorders. As such, an instrument for self-assessment of hypomanic symptoms might increase the detection of suspected and of manifest, but under-treated, cases of bipolar disorders. METHODS: The multi-lingual hypomania checklist (HCL-32) has been developed and is being tested internationally. This preliminary paper reports the performance of the scale in distinguishing individuals with BP (N=266) from those with major depressive disorder (MDD; N=160). The samples were adult psychiatry patients recruited in Italy (N=186) and Sweden (N=240). RESULTS: The samples reported similar clinical profiles and the structure for the HCL-32 demonstrated two main factors identified as "active/elated" hypomania and "risk-taking/irritable" hypomania. The HCL-32 distinguished between BP and MDD with a sensitivity of 80% and a specificity of 51%. LIMITATIONS: Although the HCL-32 is a sensitive instrument for hypomanic symptoms, it does not distinguish between BP-I and BP-II disorders. CONCLUSIONS: Future studies should test if different combinations of items, possibly recording the consequences of hypomania, can distinguish between these BP subtypes.

Ambulatory Care↗

PubMed2005

Diagnostic conversion from depression to bipolar disorders: results of a long-term prospective study of hospital admissions.

OBJECTIVES: To analyse the time course and some risk factors for a diagnostic change from major depression to bipolar disorders (BP) over an average of 20 years from the onset of the disorders. METHODS: Patients (406) with major mood disorders hospitalised at some time between 1959 and 1963 were followed-up until 1985. The analysis also included the course prior to hospitalisation. Survival analyses and Cox regression models were applied. RESULTS: A diagnostic change from depression to bipolar I occurred in about 1% of the patients per year and to bipolar II disorders in about 0.5% per year. Risk factors for a change from depression to BP-I disorder were male sex and an early onset of the disorder; risk factors for a change from depression to BP-II disorder were female sex, a later onset of the disorder and a positive family history of mania. CONCLUSIONS: Across the entire lifetime, every new episode of depression brings a new risk for mania; more than half of our severe mood disorder cases became bipolars. The risk of depression developing into bipolar disorder remains constant lifelong. LIMITATIONS: The diagnostic classification of ICD-9 met RDC criteria for bipolar disorder in only 90% of cases. Part of the data collected in retrospect may be less reliable; the prospective data were only collected every 5 years from 1965 to 1985 using multiple sources; mild manifestations between the follow-ups may have been partially missed. The sample of subsequent hospital admissions for major depression and mania represents a severe group of patients and generalisations to ambulatory cases may not be possible. Not all risk factors for diagnostic conversion described in the literature could be assessed in this study.

Adult↗

PubMed2005

Major depression predicts an increase in long-term body weight variability in young adults.

OBJECTIVE: To test the hypothesis that major depression predicts an increase in long-term body weight variability (BWV). RESEARCH METHODS AND PROCEDURES: This was a prospective community-based single-age cohort study of young adults (N = 591) followed between the ages of 19 and 40. Following initial screening, information was derived from six subsequent semistructured diagnostic interviews conducted by mental health professionals. Major depression was diagnosed on the basis of DSM criteria. BWV was defined as the root mean square error of a regression line fitted to each individual's BMI values over time. Multiple regression analysis was used to test the association between major depression and BWV while controlling for potentially confounding variables including antidepressant treatment, eating disorder symptoms, and physical activity. We used random effects models to determine the temporal relationship between repeated measures of major depression and body weight change. RESULTS: A highly significant positive association between major depression and BWV was found, whereas major depression was not associated with BMI level or BMI trend. Depression severity showed a dose-response-type relationship with the magnitude of BWV. After controlling for potentially confounding variables including antidepressant use, eating disorder symptoms, smoking, and physical activity, major depression remained a significant predictor of BWV (beta= 0.13, p < 0.001). Longitudinal analysis revealed a unidirectional association between major depression and a later increase in body weight change rate irrespective of antidepressant medication. DISCUSSION: Results from this study implicate depression as an important risk factor for increased BWV. Given increasing evidence for a link between major depression and both diabetes and cardiovascular disease, current results encourage further research on depression, BWV, and negative health outcomes.

Adult↗

PubMed2005

Suicide in 406 mood-disorder patients with and without long-term medication: a 40 to 44 years' follow-up.

There is no data on the variation in the suicide risk over lifetime and on the suicide-preventive effect of the long-term treatment of mood-disorder patients with antidepressants and neuroleptics. Our research focused on 186 unipolar (D), 60 bipolar II (Dm), 130 nuclear bipolar I (MD), and 30 preponderantly manic patients (M/Md); that were followed-up from 1963 to 2003. By 2003, 45 (11.1%) of the 406 patients had committed suicide. Suicide rates were highest among D patients (Standardized Mortality Ratio, SMR = 26.4), MD (SMR = 13.6), Dm (SMR = 10.6) and lowest among M/Md patients (SMR = 4.7). Prospectively, the suicide rate decreased over the 44 years' follow-up; Lithium, neuroleptics and antidepressants reduced suicides significantly. Long-term treatment also reduced overall mortality, and combined treatments proved more effective than mono-therapy.

Aged↗

PubMed2005

The P3 in 'ecstasy' polydrug users during response inhibition and execution.

Substance abuse and associated externalizing disorders are characterized by behavioural disinhibition and low impulse control, with reduced neural inhibition postulated to be the common underlying brain mechanism. The P3 component of event-related potentials (ERPs) is a widely used neurophysiological measure thought to reflect inhibitory brain processes, but as yet has not been assessed in ecstasy users. We recorded ERPs evoked by a Continuous Performance Test (CPT) in 16 current ecstasy polydrug users and 17 controls. The CPT included conditions where a prepared motor response had to be executed (Go) or inhibited (NoGo). Both controls and ecstasy users showed normal, robust patterns of P3 anteriorization and delay in the NoGo compared to the Go condition. Ecstasy users had lower P3 amplitudes at midline electrodes and a less anterior location of NoGo P3 peaks. These effects became weaker after statistically controlling for age, educational level and lifetime cannabis use. While lower P3 amplitudes are consistent with higher levels of neural disinhibition in ecstasy polydrug users, the normal switch pattern between response execution and inhibition, and the less anterior location of the NoGo P3, do not indicate disturbed inhibitory brain mechanisms.

Adult↗