PubMed Health⌕ Search

Biomedical subjects

F Schultze-Lutter

Publications and source records attributed to F Schultze-Lutter.

9 recordsLinked to original sources
PubMed2003

Early detection and intervention in the initial prodromal phase of schizophrenia.

Attenuated and transient psychotic symptoms as well as a combination of different risk indicators and a recent significant deterioration in global functioning are currently used as a preliminary definition of the initial prodromal or at-risk mental state by the vast majority of investigators in research on early psychosis detection and intervention. Recently published results demonstrated a mean progression to frank psychosis within one year in 36.7 % of cases showing emerging symptoms, indicating that these criteria already seem to provide a satisfying assessment for risk of an imminent psychosis. However, as functional decline often sets in before this time, detection in earlier prodromal stages seems necessary. In a prospective study, certain basic cognitive and perceptive symptoms showed good to excellent predictive accuracy for schizophrenic psychosis, thus potentially offering a reasonable approach for earlier detection. Early intervention is aimed at improving prodromal symptoms, avoiding functional deterioration, and suppressing or delaying transition to psychosis. Initial study results targeting an earlier or later prodromal phase are promising, but longer follow-ups and larger samples are needed.

Disease Progression↗
PubMed2001

Diagnosing schizophrenia in the initial prodromal phase.

BACKGROUND: In schizophrenia research, early detection in the initial prodrome before first psychotic episodes is a major topic. Therefore, the prognostic accuracy of initial prodromal symptoms was examined prospectively. METHODS: The study sample was composed of patients referred to outpatient departments of German psychiatric university departments, because of diagnostic problems, between 1987 and 1991. They were examined with the Bonn Scale for the Assessment of Basic Symptoms and the Ninth Version of the Present State Examination to detect an incipient schizophrenic disorder. Of 385 patients showing no schizophrenia-characteristic symptoms, between 1995 and 1998, 110 with and 50 without initial prodromal symptoms were followed up and reexamined with the same instruments for a transition to schizophrenia. RESULTS: During a mean follow-up period of 9.6 years, 79 (49.4%) of the 160 patients had transited to schizophrenia. The absence of prodromal symptoms excluded a subsequent schizophrenia with a probability of 96% (sensitivity: 0.98; false-negative predictions: 1.3%), whereas their presence predicted schizophrenia with a probability of 70% (specificity: 0.59; false-positive predictions: 20%). Certain disturbances, such as thought interference, disturbances of receptive language, or visual distortions, predicted schizophrenia, even with a probability up to 91% (specificity: 0.85-0.91; false-positive predictions: 1.9%-7.5%). CONCLUSIONS: The Bonn Scale for the Assessment of Basic Symptoms operationalization of prodromal symptoms performed well in the early detection of schizophrenia. It therefore might be useful for the prediction of the disorder, especially if it is further refined to select those items with particularly high prognostic accuracy.

Adult↗
PubMed2001

[Is there a primary prevention of schizophrenic psychiasis?].

At first, this article comprises the innovative programme of the international "Early Detection and Intervention" research and then shows results of the "Cologne/Bonn Early Recognition - CER" project on schizophrenia, the first longterm prospective study on patients in potentially initial prodromal stages prior to the first psychotic manifestation. At re-examination at an average of 9.6 years later, 79 of 160 patients had subsequently developed a schizophrenic psychosis according to DSM-IV criteria. Prediction values for the complete range of prodromal symptoms, for 5 subsyndromes and for individual symptoms were assessed. Best prediction values with a high positive predictive power (71 - 91 %) and a low rate of false-positive predictions (7.5 - 1.9 %) were achieved for 10 symptoms and symptom complexes mainly out of the group of thought, speech and perception disturbances. As only unsatisfactory prediction values for other prodromal symptom definitions were reported, e.g. the commonly used DSM-III-R definition, empirical evidence for the possibility of diagnosing schizophrenia as early as in the initial prodromal stage, has been found for the first time. In the following, this article considers essential initiatives for the development, performance and evaluation of a promising early intervention programme based on the results found. In Germany, within the project unit "Early Recognition and Intervention" of the competence network "Schizophrenia", such a programme has been initiated. Late prodromal stages are defined by attenuated or transient psychotic symptoms and early prodromal stages by the presence of at least one of the highly predictive prodromal symptoms from the CER-study or decline in psychic functions in combination with other risk factors. Intervention strategies are a multimodal psychological programme for the intervention in early prodromal stages and a combination of psychotherapy with atypical neuroleptic drugs in the late prodromal stages. If such strategies were able to suppress the progress to first psychotic episodes, this prevention could be classified as a primary prevention, not with regard to the prodromal symptoms but to frank/manifest schizophrenia.

Clinical Trials as Topic↗
PubMed2000

[Early intervention in increased risk for schizophrenic illnesses. Multimodal psychotherapy--antipsychotic drugs only in treatment failure].

Interventional strategies for the prodromal phase of schizophrenia are based largely on treatment concepts that have already been shown to be effective for the prevention of relapses. Such a multimodal concept for early psychotherapeutic intervention has been developed at the psychiatric department of the University of Cologne. This model emphasizes individual symptom-oriented cognitive/behavioral treatment and psychoeducation directed both to the patient and his/her contact person(s). In addition, stress and symptom management, training of social skills and computer-aided cognitive training tailored to individual needs are also offered. In contrast, pharmacological treatment is considered only when, despite the above-mentioned strategy, the clinical picture worsens appreciably and attenuated psychotic symptoms have appeared.

Antipsychotic Agents↗
PubMed2000

[Is the diagnosis of schizophrenic illness possible in the initial prodromal phase to the first psychotic manifestation?].

In the international research on schizophrenia, the early detection and intervention already in the initial prodromal phase prior to the first psychotic manifestation has become one of the main aims in recent years. Therefore, in the present study, the diagnostic efficiency of initial prodromal symptoms was examined prospectively for the first time ever. At index-examination, patients were examined with the 'Bonn Scale for the Assessment of Basic Symptoms--BSABS' and the ninth version of the 'Present State Examination--PSE 9'. At that time, none of the 160 patients had shown psychotic symptoms, but in 110 of the cases prodromal symptoms were found. At the reexamination that took place in average 9.6 years later, patients were explored with regard to a meantime transition to a first psychotic episode applying the same instruments as at index-examination. 79 of the 160 patients (49.38%) had developed a schizophrenic disorder according to DSM-IV-criteria in the catamnestic interval. In general, the 66 assessed prodromal symptoms exhibited a high sensitivity (.98), a high negative predictive power (.96) and a low percentage of false-negative predictions (1.3%), but lower values of specificity (.59) and positive predictive power (.70) as well as a higher percentage of false-positive predictions (20.6%). However, for a subset of mainly cognitive prodromal symptoms with a sensitivity sufficient for diagnostic criteria, high specificities (.85-.91) and positive predictive powers (.71-.91) as well as satisfactory percentages of false-positive predictions (7.5%-1.9%), and good classification rates (81.25%) were found. The results show that the applied conceptualization of prodromal symptoms that originates in the German psychopathological tradition is indeed useful for an early detection of psychoses. By assessing those prodromal symptoms, which were proven to be highly predictive, a diagnosis of schizophrenic disorders already seems possible in the initial prodrome. Thus in future, an early intervention related to them might enable a prevention of first psychotic episodes.

Adolescent↗
PubMed1998

[Self-experienced vulnerability, prodromic symptoms and coping strategies before schizophrenic and affective episodes].

For the first time, the present study explores self-experienced vulnerability, prodromal symptoms and coping strategies preceding schizophrenic and affective episodes. 33 schizophrenic and 29 depressive patients were assessed retrospectively for preepisodic alterations by means of the "Bonn Scale for the Assessment of Basic Symptoms- BSABS" after complete recovery from the acute episode. 97% of the schizophrenic and 93% of the depressive patients showed preepisodic alterations. In the schizophrenic group the first alteration occurred with a median of 10 weeks and in the depressive group with a median of 18 weeks before the onset of the acute episode. With regard to self-experienced vulnerability depressive cases were significantly less tolerant to stress, i.e work under time pressure or unusual, unexpected requirements. With regard to prodromal symptoms schizophrenics showed significantly more often interpersonal irritation and certain perception and thought disturbances, whereas depressive patients reported more often adynamia and certain disturbances of proprioception. 73% of the schizophrenic patients and 90% of the depressive patients reacted to early symptoms with coping strategies. The preepisodic alterations in schizophrenic patients could be described in terms of mild psychotic productivity, early symptoms of depressive patients could be described as a mild depressive syndrome. Prospective studies are necessary to show if assessment of mild psychotic productivity could be used for early diagnosis and early intervention in schizophrenia.

Adaptation, Psychological↗
PubMed1997

Early self-experienced neuropsychological deficits and subsequent schizophrenic diseases: an 8-year average follow-up prospective study.

The aim of the present study was to investigate the potential predictive value of early self-experienced neuropsychological deficits for the subsequent development of schizophrenia. A total of 96 patients with DSM-III-R diagnoses of personality disorders (formerly called 'neurotic disorders') who had been examined for the presence of such subjective experiences of deficits with standardized instruments were re-examined for the possible development of schizophrenic symptoms. After an average follow-up period of about 8 years, more than 50% of the patients had developed schizophrenia according to DSM-III-R criteria. In 77% of cases the outcome 'schizophrenia vs. no schizophrenia' was correctly predicted by the earlier presence or absence of self-experienced disturbances of thought, speech, memory, perception and action. These findings suggest that certain self-experienced neuropsychological deficits are able to indicate susceptibility to psychosis.

Adolescent↗
PubMed1996

Diagnostic validity of basic symptoms.

Although the Bonn Scale for the Assessment of Basic Symptoms (BSABS) [13] has come into use in several European countries, its diagnostic validity has not yet been sufficiently examined. That is why we have assessed BSABS items on a sample of 243 consecutive admissions to the Department of Psychiatry at the RWTH University, Aachen, and 79 psychologically healthy persons. Then, a cluster analysis was calculated to identify the empirical item-grouping. Five well-interpretable BSABS subsyndromes were found. In addition, uni- and multivariate analyses were computed to evaluate the diagnostic validity of these subsyndromes. We were able to show that every BSABS subsyndrome separates at least schizophrenic, organic mental and affective disorders from personality, neurotic and substance-induced disorders, as well as from psychological health. Furthermore, the subsyndrome "information processing disturbances" differentiates between schizophrenic and organic mental disorders, on the one hand, and affective disorders, on the other, and additionally, the subsyndrome "interpersonal irritation" between schizophrenics and all other persons examined.

Adult↗