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Biomedical subjects

C Haasen

Publications and source records attributed to C Haasen.

At least 19 recordsLinked to original sources
PubMed2001

[Psychotic experiences in a transcultural context - case report analysis on the importance of the second language for the therapeutic process].

The use of the second language among migrants can lead to a separation of affect and content of speech, which can be used in therapy when touching upon emotionally strenuous events. On the basis of 3 case reports of migrants of Turkish origin with a psychotic disorder, the importance of the second language when used by a native speaking therapists is analyzed. This can lead to the establishment of a therapeutic alliance, even though emotionally central themes are avoided in the process.

Adult↗
PubMed2001

Cocaine use and the utilisation of drug help services by consumers of the open drug scene in Hamburg.

In order to describe the patterns of use in the open drug scene in Hamburg, a study was carried out among 616 drug users in the drug scene and in or in the vicinity of low-threshold institutions close to the drug scene in summer 2000. The special focus was on the prevalence of cocaine and crack use as well as on the utilisation of help services for drug users. 80% of the interviewed persons were male, the average age was 32.6 years. They had been using drugs such as heroin or cocaine for an average of 11 years. 84% had used heroin and 74% cocaine within the last 24 h. Use was intravenous for 66%. 57% used cocaine intravenously, the percentage of crack smokers was 22%. Compared to previous studies, an increase in cocaine use can be noted among the scene users in Hamburg, mainly related to intravenous cocaine use. Crack smoking has only increased slightly over the past few years. Based on cluster analysis, four consumption pattern groups can be established. The largest group (38%) mainly uses cocaine and heroin. The second group (26%) consists of polyvalent drug consumers using methadone in addition to heroin and cocaine, as well as, partially, benzodiazepines, cannabis or alcohol. Group 3 (19%) mainly uses heroin only, some of them also using methadone and/or cannabis. The fourth group (17%) is mainly related to alcohol, the greater part of them additionally using heroin. On the whole, it appears that those users who currently do not use cocaine (or crack) are in a better health and social situation. The group using only heroin (cluster 3) also compares favourably with the other three consumption pattern groups with regard to the intensity of use, consumption in public and risk behaviour. Almost all the interviewed persons are in contact with general practitioners. However, the increasing cocaine use has not been met by sufficient intervention and treatment programmes so far.

Adult↗
PubMed2001

Negative outcome factors for addicted migrants.

Several risk factors as well as protective factors are discussed in the development of mental disorders among migrants. With respect to addiction there are reports of an increased prevalence despite a higher threshold for utilisation of the treatment system. A case report is presented that exemplifies psychosocial and legal factors affecting the development and treatment possibilities of addicted migrants. It calls for a closer co-ordination between institutions and authorities in favour of the addicted individual.

Adult↗
PubMed2000

Differential sustained attention/vigilance changes over time in schizophrenics and controls during a degraded stimulus Continuous Performance Test.

The Continuous Performance Test (CPT) is a widely used procedure for sustained attention/vigilance measurement. However, though the key index of vigilance impairment is the decrement of sensitivity over time during the test period, only few studies have examined whether schizophrenics show a larger drop in CPT performance than do healthy controls. 48 schizophrenic inpatients and 48 controls were investigated with the Munich CPT (480 visual stimuli, 25% target stimuli, one stimulus per second). Stimuli were degraded by randomly inverting 40%, 41%, 42%, or 43% of the pixels. Results were calculated separately for three consecutive trial sections. Additionally, PANSS ratings, medication, and other clinical data were documented. Schizophrenics show a vigilance decrement over time, controls show a vigilance increase. Differential vigilance changes were not related to the level of stimulus degradation. Schizophrenics performed worse than controls only at the lowest degradation level. While overall sensitivity correlated negatively with the dose of atypical neuroleptics and benzodiazepines, vigilance shifts over time correlated negatively with the dose of typical neuroleptics. Furthermore, sensitivity was related to the cognitive PANSS syndrome, number of admissions/duration of illness. Differential sensitivity decrements of schizophrenics and controls can be shown if suited CPT procedures are used. The need for basic research on experimental conditions of the CPT as well as examination of the relationship between sustained attention/vigilance decrements and clinical features of schizophrenia is suggested.

Adult↗
PubMed2000

[Conversion from typical to atypical neuroleptics. Guidelines for ambulatory and inpatient treatment].

The introduction of atypical antipsychotics has presented new options for the pharmacological treatment of schizophrenic patients. It is assumed that in the near future, neuroleptic medication will shift from conventional to atypical antipsychotics for an increasing number of patients. The present article addresses guidelines for the conversion from conventional to atypical neuroleptics in inpatient and outpatient settings.

Ambulatory Care↗
PubMed2000

[The Eppendorf Schizophrenia Inventory (ESI). Development and evaluation of a questionnaire for assessment of characteristic self perception of cognitive dysfunctions by schizophrenic patients].

This study explored characteristic subjective experiences of schizophrenia. A questionnaire for self-assessment of disturbances in several cognitive and perceptual areas (the Eppendorf Schizophrenia Inventory, or ESI) was constructed and administered to first-episode schizophrenics (SCHe, n = 45), negative syndrome schizophrenics (SCHn, n = 45), remitted schizophrenics (SCHr, n = 24), depressives (DEP, n = 43), alcoholics (ALK, n = 48), obsessive-compulsive patients (ZWA, n = 46), and healthy controls (KON, n = 57). Comparisons between the SCHe, SCHn, DEP, ALK, and ZWA groups and a subsequent factor analysis revealed four schizophrenia-specific dimensions: attention and speech impairment (AS), ideas of reference (IR), auditory uncertainty (AU), and deviant perception (DP). Further analyses suggested that the AS syndrome may represent a mediating vulnerability factor while IR, AU, and DP probably are reversible episode indicators. The results may contribute to refinements in the measurement of specific prepsychotic signs, thus facilitating the development of early intervention approaches.

Adult↗
PubMed2000

[Differences between psychopathological evaluation in German and Turkish language of Turkish immigrants].

The elevated rate of schizophrenia among migrants has been explained, among others, with misdiagnosis due to symptoms' being misinterpreted as psychotic. Previous studies have shown both higher and lower rates of psychotic symptoms of these patients when interviewed in their mother tongues, compared to being interviewed in the second language. In this study, 91 patients of Turkish origin and 50 of German origin with a paranoid-hallucinatory syndrome at admission were examined by an one interviewer each of Turkish and German origins using a standardized psychopathological instrument. In spite of comparative samples, correlation of psychopathological evaluation as well as diagnostic agreement between the two interviewers was significantly higher in the German patient group. Within the Turkish patient group, correlation was higher for those with good German language knowledge than for those with poor knowledge, yet only on a few items and without an effect on diagnostic agreement. The greatest difficulties lie in the evaluation of delusions. In spite of higher disagreement on psychopathology, the potential misdiagnoses cannot sufficiently explain the higher rate of schizophrenia among migrants.

Acculturation↗
PubMed2000

Potential for misdiagnosis among Turkish migrants with psychotic disorders: a clinical controlled study in Germany.

OBJECTIVE: The elevated rate of schizophrenia among migrants has been explained in part by possible misdiagnosis. In this study an attempt is made to quantify the extent of potential misdiagnosis among migrants in comparison to non-migrants. METHOD: One hundred patients of Turkish origin (Tr-Pat) and a control group of 50 patients of German origin (G-Pat), all with a paranoid-hallucinatory syndrome upon admission, were examined by an interviewer of Turkish origin (Tr-Int), an interviewer of German origin (G-Int) and the clinician. The diagnostic evaluation was then compared. RESULTS: Nineteen per cent of Tr-Pat and 4% of G-Pat showed diagnostic disagreement between the three raters, while in 8% of Tr-Pat and 0% of G-Pat the two research diagnoses disagreed. In Tr-Pat with 'bad' German knowledge showed tendentially more (29%) diagnostic disagreement than Tr-Pat with 'good' German knowledge (17%). CONCLUSION: The rate of potential misdiagnosis is higher among migrants, yet not strongly correlated to poor second language proficiency.

Adult↗
PubMed2000

Psychopathological syndromes of schizophrenia: evaluation of the dimensional structure of the positive and negative syndrome scale.

The Positive and Negative Syndrome Scale (PANSS) was originally designed as a rating system that provides balanced representation of positive and negative symptom features. Evidence from recent factor-analytic studies suggests that a five-dimensional solution appears to best fit the psychopathological data as assessed with the PANSS. To investigate the dimensional structure, we administered the PANSS to 253 inpatients with schizophrenia. In accordance with former studies, principal components analyses yielded five orthogonal dimensions: hostile excitement; negative, cognitive, and positive syndrome; and depression. When compared with questionnaires measuring subjective nonpsychotic experiences of schizophrenia, paranoid mood, and depression, the correlation pattern verifies the PANSS components. In addition, we investigated a subsample of 70 male patients with a Continuous Performance Test (CPT), a Span of Apprehension Task, and a Modality Shift Effect (MSE) paradigm; the CPT was significantly associated with the cognitive syndrome, and the MSE correlated with the negative syndrome.

Adult↗
PubMed2000

[Relationship between depression and psychosocial stress among Iranian emigrants].

Specific studies on the situation of mentally ill Iranian migrants do not exist in Germany. Studies from the USA analyze the difference between culturally dependent dysphoric affect and clinical depressivity among Iranians. Goal of this study was to discuss specific aspects of migration for depression among Iranians. 94 Iranian migrants were interviewed in different settings. Half of them met criteria for a depressive disorder, which correlated well with the depression scales BDI and HAMD. Depressives showed higher acculturation problems, immigration stress and social isolation than non-depressives. Therapy for depressive Iranian migrants should focus more strongly on barriers of acculturation than on cultural differences in psychopathology.

Acculturation↗
PubMed1998

Maintenance treatment of opiate addicts in Germany with medications containing codeine--results of a follow-up study.

AIMS: Outpatient maintenance treatment of opiate addicts with codeine/dihydrocodeine is a common approach in the treatment of drug addicts in Germany. This study was carried out to assess possible benefits of codeine maintenance in terms of patients' health stabilization, social rehabilitation and drug consumption. DESIGN: Three-year follow-up study. SETTING: Three practices of substituting physicians in large-city areas in Germany. PARTICIPANTS: Of a random sample of 297 people attending for opiate outpatient treatment in 1993, 199 were successfully followed up 3 years later. MEASUREMENTS: Measures of health, living conditions, employment, criminal activities and drug use were collected at baseline and follow-up. The data were based on standardized interviews and medical examinations by the attending doctors as well as on questionnaires from the patients. FINDINGS: Based on a 67%-follow-up rate, after 3 years of codeine maintenance there was improvement in general health and mental problems. The living and working situation remained more or less unchanged and stabilized at a satisfactory level. The same applies to the consumption of drugs. CONCLUSION: The patients' progress shown in this study was comparable to that achieved by methadone maintenance in similar geographical regions. Codeine has a weaker pharmacological effects and our results suggest that codeine maintenance treatment deserves more attention and controlled trials to assess the benefits compared with methadone (or other opioids).

Adult↗
PubMed1998

Impact of ethnicity on the prevalence of psychiatric disorders among migrants in Germany.

OBJECTIVES: Studies on psychiatric disorders among migrants have described higher rates, especially of schizophrenia. Some evidence points to the possibility of misdiagnosis for this higher rate; other studies point to the underrepresentation of migrants in psychiatric services, leading to artefactual epidemiological data. METHODS: All admission records of migrants to a psychiatric clinic from 1993 to 1995 were assessed for diagnosis, symptomatology and treatment. RESULTS: Admissions of 408 migrants, 8.1% of total admission, were assessed. Of these, 38.7% received a diagnosis of a schizophrenic disorder, significantly more than the other clinic patients. The mean age at admission was 34.0 years, at onset of illness 28.6 years and at time of migration 20.4 years. Only 8.3% were mentally ill at the time of migration. Language problems correlated with the diagnosis of a schizophrenic disorder. CONCLUSION: An underrepresentation of migrants shows differences in the use of psychiatric services. Some evidence from the mental status and reported language problems may explain the higher rate of schizophrenia due to misdiagnosis.

Adult↗
PubMed1998

[Differential diagnosis of psychotic disorders in immigrants].

Several studies [5,6] on the prevalence of psychiatric disorders among migrants describe a higher rate of schizophrenic disorders. Other studies [2,3] as well as DSM-IV [1] point out that affective disorders with psychotic symptoms can be misdiagnosed as schizophrenic or schizoaffective disorders. We report on a patient admitted with the diagnosis of paranoid schizophrenia (ICD-10: F20.0), discussing differential diagnostic criteria and the problems of diagnosing along ICD-10 criteria.

Adult↗
PubMed1997

[Opiate dependent patients in inpatient detoxification. Prevalence of somatic diseases in hospital admissions].

AIM: To investigate whether the impression that prevalence rates of diseases in drug addicts undergoing detoxification could be verified empirically. In addition, to make an attempt to identify possible relationships responsible for this development. METHOD: Between 1989 and 1993, within the framework of a detoxification program, 1041 opiate addicts were investigated for the presence of somatic diseases. For this purpose, the overall sample was divided up into 3 groups corresponding to the following time periods: 1989/1990, 1991/1992, 1993. The baseline data comprised the standardised history at the time of admission, the results of the initial clinical examination, and the serological and clinico-chemical findings during the further course. RESULTS AND INTERPRETATION: A deterioration in the general state of health associated with more risky drug consumption patterns and social isolation was established. Apparently, low-threshold treatment programs and prophylactic strategies made available to almost two-thirds of the addicts in Hamburg have proved unable to prevent the deterioration of the situation of a subpopulation of addicts.

Adolescent↗
PubMed1997

[Subjective criteria of schizophrenic patients in selecting a physician in ambulatory care].

PURPOSE: Several studies Conducted during the last 30 years have shown the high prevalence of mental disorder among patients of general practitioners (GPs). The integration of out patients care of schizophrenics into primary care remains controversial. Yet there is a lack of studies determining the subjective view of clients on their choice of their physician. METHODS: In this study we interviewed in patient schizophrenics on their choice of physician for out patient care. RESULTS: 27.3% were being treated only by a GP, 29.9% only by a psychiatrist and 36.4% by a GP and a psychiatrist. Those treated only by a GP knew him a lot longer. The appraisal was more positive for those treated only by a GP, while those treated by both psychiatrist and GP rated the competence of the psychiatrist more positive by. CONCLUSIONS: Those treated by both GP and psychiatrist had the longest length of illness, yet the lowest rate of rehospitalisation. Although these results cannot only be seen as a result of the choice of physician, they still confirm the importance of interdisciplinary cooperation and should encourage GPs and psychiatrists to recommend their schizophrenics to be treated cooperatively.

Adolescent↗
PubMed1997

[Consumption patterns and motivation for use of addictive drugs in schizophrenic patients].

In particular studies conducted in the U.S. display a tendency for schizophrenics to combine hallucinogens and amphetamines, whereas other studies report on a combination of psychotropic substances with a similar range of action. Influencing negative symptoms is reported to be the motivation for consumption. A total of 222 patients with a schizophrenic disorder (F2) and addiction (F1) were examined. The main substance was alcohol (F10.1 or F10.2; 52.2%), followed by cannabis (F12; 25%), opiates (F11; 4.1%), sedatives or hypnotics (F13; 2.7%) and cocaine (F16; 0.5%). A multiple drug use (F19) is reported by 14% of them. The most frequent combination was alcohol and cannabis, whereas hallucinogens and amphetamines were only rarely combined. Actual multiple consumption was reported by 55% of the patients, while lifetime multiple consumption applied to 72%. The motivation seems to be an unspecified sedation of unpleasant affective symptoms of schizophrenia. The most frequently seen combinations do not correlate with the reports published in the literature. The great variations in motivation seem to mainly reflect the importance of the availability of the substance.

Adult↗