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H Häfner

Publications and source records attributed to H Häfner.

At least 91 records · Page 5Linked to original sources
PubMed1991

An animal model for the effects of estradiol on dopamine-mediated behavior: implications for sex differences in schizophrenia.

Schizophrenic women have been consistently found to have a later age of onset and a less severe clinical course of illness as compared with schizophrenic men. Because these differences are not explained by diagnostic artifacts or sociocultural factors, we tested the hypothesis that they are determined by the influence of the gonadal hormones testosterone and estradiol on dopaminergic (DA) neurotransmission. We used animal models in which the effects of the hormones on behavioral changes induced by the DA antagonist haloperidol (catalepsy) and by the DA agonist apomorphine (oral stereotypies, grooming and sitting behavior) were investigated in neonatal and in adult treated rats. No consistent effects of testosterone were observed. Estradiol significantly reduced the behavioral changes induced by both haloperidol and apomorphine, and this effect was more pronounced in neonatally treated animals. These results suggest a downward regulation of DA neurotransmission by estradiol, which is supported by the results of 3H-sulpiride binding determinations in brain homogenates from the same animals: estradiol caused a 2.8-fold reduction of DA receptor affinity to sulpiride. Our findings suggest that estradiol might act as a protective modulator in schizophrenia by enhancing the vulnerability threshold for psychosis through the downward regulation of DA neurotransmission. Such mechanism could explain, at least in part, the later onset and the more favorable course of schizophrenia in female patients.

Age Factors↗
PubMed1991

[Sex differences in schizophrenic diseases].

Sex differences in schizophrenic diseases have been known for a long time but have also been subject to long-term neglect by psychiatric epidemiological research, although a study of these sex differences could, in our opinion, yield valuable pointers to pathogenic factors involved in this group of diseases the aetiology of which still awaits clarification. For this reason we initiated large-scale investigations focussed on this topic. The paper presented here discusses a few initial results, basing on data of Mannheim and National Danish Case Records and on our own study on schizophrenia, the latter being a representative record of 392 patients hospitalised for the first time in the Rhine-Neckar region and the eastern part of the Palatinate. First of all, sex differences at the age at which the disease appeared for the first time, were studied while paying close attention to artifacts and other, usually neglected methodical error sources. The difference in the average age of the sexes at first hospitalisation was confirmed, and also--using an instrument specially developed for that purpose--at the onset of the disease. At the time the first signs of the disease are noticed and the first schizophrenic symptoms become apparent, men are about 3 to 4 years younger than women. On the other hand, the cumulative lifetime risk--calculated up to 60 years of age--seems to be the same for both sexes. It appears that there are no sex differences in the pattern of symptoms of the disease at the time of initial hospital admittance, in respect of both the most common and the characteristic signs and symptoms. There were significant although quantitatively not very great differences in respect of patient behaviour which displays socially positive aspects somewhat more often in women and socially negative ones distinctly more often in men. In respect of the course of the disease we could not find any marked sex differences over a period of 10 years after onset of the disease; however, this is presently based only on the Danish case record data and on criteria of the course of the disease, such as number and duration of inpatient treatments.

Adolescent↗
PubMed1991

Evaluating effectiveness and cost of community care for schizophrenic patients.

The two main types of mental health services research are (1) the evaluation of the mental health sector within comprehensive systems of health care and (2) the evaluation of individual mental health facilities or types of care. Depending on the information systems available, the difficulties of evaluating complex systems of care can be partially obviated by using descriptive approaches. Structural quality can be assessed by structural indices, the functioning of a system by monitoring utilization, and the overall effectiveness of a national mental health care system roughly by health indicators. Causal analyses of effectiveness are practical when they are based on individual facilities or types of care, which can be studied as isolated systems on the basis of intervention and outcome variables. Reliable and reproducible results can be achieved only if a standardized intervention is used or if the intervention and its objectives are described clearly, the output indicators are defined in terms of identifiable and repeatable operations. The assets and liabilities of quasi-experimental designs and three types of naturalistic approaches will be discussed. When the cost of a new type of care is compared with the cost of traditional mental health care, the section of the population actually served out of the total of patients with comparable needs for care should be considered. Results from the authors' studies will show how the neglect of this epidemiological aspect can lead to false statements.

Activities of Daily Living↗
PubMed1991

[A computer algorithm for diagnostic assessment with DSM-III in the early course of schizophrenic diseases].

The purpose of the computer algorithm described here is the evaluation of diagnostic criteria according to DSM-III for schizophrenia and schizophreniform disorders. It also dates the first time point of the assessment of these diagnoses. The necessary information comes from a semistructured interview, called IRAOS (Interview for the Retrospective Assessment of the Onset of Schizophrenia). With this interview early indicators of a beginning schizophrenia can be evaluated in their chronological order and their type of course. The algorithm was first used in a sample of patients admitted for the first time with a diagnosis of either schizophrenia or paranoid psychosis. One third of these patients fulfills the DSM-III-criterion of a duration of at least six months. The other patients fulfill criterion B of a schizophreniform disorder. To strengthen the validity of a diagnosis including the criteria A up to E successively, the sample is reduced to 70%. The average time point of the first assessment of the diagnosis by the computer algorithm is about 1.5 years before the index-admission. Together with the IRAOS the computer algorithm allows an operationalized assessment of the real onset of schizophrenia.

Adult↗
PubMed1991

[Trends in the number of patients with senile dementia and need for nursing care in the upcoming 50 years--a demographic projection based on epidemiologic data for former West Germany].

According to population projections there will shortly be an increase in the number of aged people. Since these population groups show a high risk to develop old age dementia and because this sickness goes along with the need of care, it is necessary for planning future needs of buildings and funds to know about the extent of expected dementia and the number of people needing care. Based on population projections up to the year 2040 for the (West) German Länder of the Federal Republic of Germany and based on four epidemiological studies, we developed a model to project empirically the number of dementia cases for the next 50 years. This model is based on an exponential growth of prevalence with increasing age. According to our estimates the number of patients with severe and moderate dementia will rise by about 50% from 1990 until 2040. The expected number of people needing care is estimated to facilitate prospective planning as well as timely provision of adequate financial and personnel resources.

Aged↗
PubMed1991

[Sex differences in age of onset, symptomatology and evolution of schizophrenia].

Gender differences in age at onset, symptomatology and course of schizophrenia are examined by analyzing case register data and by direct investigation of a representative sample of first-admitted patients. The main finding that males fall ill at an earlier age than females can be confirmed even after ruling out other interpretations due to sample bias, different time span between real onset and first hospital admission, gender differences in symptom development or other confounding factors. When looking for causes of these gender differences it seems that disturbances in early social development must be understood as a consequence of beginning schizophrenia rather than a prerequisite. The need for explanatory models is stressed that allow for the empirical testing of hypotheses concerning gender specific development of schizophrenia.

Age Factors↗
PubMed1991

[Schizophrenia and age].

The association of age with time of onset, symptomatology and early course of schizophrenia was studied on a large, representative sample of first-admitted patients with a diagnosis of schizophrenia (nuclear and related diagnoses) from a total population of about 1.5 million by using a semi-structured interview (IRAOS) developed specifically for this purpose. As a result an age distribution differing between men and women was obtained when the appearance of the first sign of a mental disturbance was studied. 61.6% of the men and 47.4% of the women fell ill prior to the age of 25. Negative symptoms and the early course of the disease turned out to be relatively independent of age at onset. The few age differences observed with positive and unspecific symptoms seem to be accounted for by factors not specific for schizophrenia, such as slightly increased anxiety at young age, slightly increased depressiveness in early adulthood and slightly increased paranoid delusions later in adulthood. At young age delusional symptoms, probably as an expression of immature personality, are less stable, less differentiated and less systematized, whereas fully developed delusions of persecution become more frequent at higher age. An unexpected finding was a comparatively high proportion of lengthy phases characterized by negative symptoms prior to first admission in late-onset schizophrenia in females. Hence, beginning schizophrenia seems to be a fairly uniform pattern of response at all ages, female sex appearing to be the only factor independent of the disease that influences it to any significant extent by delaying onset.

Adolescent↗
PubMed1990

Ernst Kretschmer 1888-1964.

Until his retirement in 1959 Ernst Kretschmer was Professor of Psychiatry at the University of Tübingen. He published eight monographs, five of which were of eminent importance and at least two exerted considerable influence on European psychiatry for several decades, namely Der sensitive Beziehungswahn (1918) and Körperbau und Charakter (1921). His theory on constitutional body types and character became an integral part of German schoolbooks.

Germany↗
PubMed1989

Evaluation of care for the disabled mentally ill: theoretical issues.

A precondition for the discharge from an institution of the chronically disabled mentally ill is the availability of adequate alternative facilities and services, optimally meeting their social and mental health needs and allowing as much quality of life as possible at the lowest possible cost. Only a few studies have found alternative care to lead to better outcomes than treatment in good-quality hospitals with respect to illness course and social disablement. Therefore, it is an important question whether extramural care and of what type is better and possibly less expensive than traditional inpatient treatment and for which patients. Health data collected at the national and regional levels provide a basis for continuous monitoring of utilization of services. Such data, however, usually have the limitation of being aggregate in nature and not including contacts with social services. These deficits can be avoided by using cumulative case registers, recording if possible all contacts of the socially disabled mentally ill with intramural and extramural mental health and social services and covering a define catchment area. Because the disabled mentally ill, depending on their own resources and those of their family and the community at large, have basic needs differing in each individual case, as well as various specific needs determined by the illness which they cannot meet on their own, it is necessary to provide a variety of facilities and services and to coordinate their work. Evaluation and cost-effectiveness investigations of complex packages of care yield generalizable results only if the forms of care under study are defined precisely enough.(ABSTRACT TRUNCATED AT 250 WORDS)

Aftercare↗
PubMed1989

Schizophrenia--a disease of young single males? Preliminary results from an investigation on a representative cohort admitted to hospital for the first time.

The later age at onset of schizophrenia in females, reported in the literature, led to a study of transnational case register data and of a cohort of all patients admitted to hospital for the first time with a non-affective functional psychosis from a defined catchment area. The preliminary analysis of the first representative sample of 86 patients showed that at the time of first admission with a diagnosis of schizophrenia (according to different diagnostic definitions) as well as at the time of onset of the disease (operationalized on different levels) females were on average 5 years older than males. Singles, and even more so young single males, were clearly overrepresented among those first hospitalized in comparison to the population of the same age. To remain single seems to be in most cases a consequence of the disease or of premorbid characteristics in those predisposed to schizophrenia.

Adolescent↗
PubMed1989

The stability of the ecological distribution of the incidence of treated mental disorders in the city of Mannheim.

In 1965, Häfner et al. (1969) conducted an ecological study of the incidence of treated mental disorders in the industrial city of Mannheim. They found large variations in incidence rates in 20 urban areas: excess morbidity in the socially disorganized areas located mainly in the city center, and low rates in areas on the outskirts. This study incorporates additional data from the Cumulative Psychiatric Case Register established in Mannheim in 1973. It focuses on the short- and long-term stability of the spatial distribution of mental disorders comparing the year 1965 with the period 1974-80, and analysing the individual years from 1974-80. Despite marked changes between 1965 and the seventies (the increase in the number of guest workers; the development of extensive building and urban renewal programs; the establishment of the Central Institute of Mental Health and several community psychiatric services after 1975), the ecological correlation remained relatively high (r = 0.79). Prior to the establishment of the Central Institute of Mental Health, the spatial distribution of mental disorders in the year 1974 was also very similar to that in 1965 (r = 0.73). In general, the study revealed a highly stable ecological distribution of treated mental disorders not only on a long-term basis, but also for the individual years from 1974 to 1980.

Cross-Sectional Studies↗
PubMed1989

How does gender influence age at first hospitalization for schizophrenia? A transnational case register study.

Numerous studies have reported a lower mean age at first hospitalization for schizophrenia in males than in females. For this finding not only a gender difference in age at first onset of schizophrenia, but also other factors can be responsible. With the aim of providing a comprehensive analysis of gender differences in onset, symptomatology and course of schizophrenia, we started by testing the hypothesis postulating a gender difference in mean age at first hospitalization. By using the Danish and the Mannheim psychiatric case registers we analysed all hospital admissions for schizophrenia and related diagnoses and all previous admissions for other diagnoses of the Danish population in 1976 and those of the inhabitants of the German city of Mannheim in the period of 1978-80. Artefacts were controlled for systematically. The impact of intervening variables such as selection factors as well as the influence of gender on the ascription of a diagnosis of schizophrenia for the first time were assessed. We found a mean difference of 5 to 6 years in age at first hospitalization between males and females in both countries when a broad definition of the diagnosis was used and of 4 to 5 years when a restrictive definition was applied. The higher mean age at first hospitalization among females is not attributable to artefacts, diagnostic procedures or to any essential extent to gender differences in help-seeking behaviour or occupational status. When a distinction was made between 'single' and 'married', the significant difference in age at first hospitalization between the sexes disappeared in singles. With case register data and without knowing the chronological order of marriage and onset of the disease, it remains an open question whether this finding can be explained by purely correlative associations between sex, marital status and age of onset or by causal effects.

Adolescent↗
PubMed1989

Spatial concentration of the incidence of treated psychiatric disorders in Mannheim.

The spatial concentration of the incidence of treated psychiatric disorders in Mannheim was determined in 2 ways. The first, the classical zone model according to Neller (1), distinguishes an inner, intermediate and outer zone. This concept was applied to data from an ecological study conducted by Häfner et al. (2) in 1965 and to those derived from the Cumulative Psychiatric Case Register for the years 1974-1980. For the second period of time we developed, in addition, a factor ecological concept. The 23 districts of Mannheim were divided into 5 areas that were as homogeneous as possible in terms of segregation and density. There was a marked increase in the concentration index for schizophrenia in the inner zone, as well as for neuroses and personality disorders between 1974-1980 as compared with 1965. There were strong concentrations in the inner zone during both periods of study for the diagnosis of alcoholism and drug addiction. Although in 1965 there was a visible concentration trend in the inner zone for affective psychoses, it had almost vanished between 1974-1980. Using the factor ecological classification we demonstrated that, with the exception of affective psychoses and neurotic depression, all diseases concentrate in the city areas that, besides being centrally located, are characterized by high population density, poor housing conditions, low social status of the residents and where foreign nationals were segregated in the 1970s.

Adolescent↗
PubMed1989

Effectiveness and cost of community care for schizophrenic patients.

Schizophrenic patients in Mannheim, West Germany, were studied to determine whether psychiatric treatment in the community reduces duration and frequency of rehospitalization, whether it has an impact on symptomatology and behavior, and whether it can be provided less expensively than hospital care. The findings showed a relationship between increased psychiatric outpatient treatment and lower levels of inpatient care as well as between psychiatric aftercare and reduced symptomatology and disease-related behavior. The cost of community care was found to be substantially lower than that of hospital care for less disabled patients, but it exceeded the cost of hospital care for the more severely disabled.

Adolescent↗
PubMed1989

The evaluation of mental health care systems.

While the demand for deinstitutionalization, strongly supported by the economic aspect of the issue, has resulted in a steep decline in the number of psychiatric beds in many Western countries, the evaluation of extramural psychiatric care has several difficulties, including that of proving effectiveness without experimental control of confounding influences. For a cohort of schizophrenic patients we investigated the impact of out-patient psychiatric treatment on length of stay in hospital and length of stay in the community. Out-patient care had a significant influence on readmission, but no effect on the length of in-patient treatment. While the average cost of community care was less than half that of traditional hospital care, in 6% of the patients this threshold value of continued in-patient care was exceeded. There also seems to be a non-monetary threshold, above which community care is no longer appropriate.

Cohort Studies↗
PubMed1989

[The epidemiology of suicide and attempted suicide].

Since more than one century suicides have been registered in national statistics of death causes. They thus furnish one of the few parameters of psychiatrically relevant behaviour by means of which trends, cohort, age-group and period effects can be studied over longer periods. Since the second half of last century, the suicide rates for Swiss males--similar to those found in England and Wales--show a decrease in consecutive birth cohorts up to males born in the decade 1930-1940, and a continued decline in the total trend until about World War II. From then on the suicide rates of males in consecutive birth cohorts have been slowly increasing in the majority of European and North American countries--but not so in Sweden. Opposite to this, the predominantly low rates for females display little change. Further to the considerable differences between nations and the predominance of suicides committed by females in some Asian countries and Cuba, the changes indicate the significance of cultural and economic environmental factors. Typical period effects are mainly the result of changes in conception and conditions of life. In attempted suicide they proceed in a more sensitive and more rapid way and are about ten times higher. Such a period effect showing increases by about 300% in younger age-groups followed by a decline, attaining its peak about 1976, was ascertained in large cities of the Federal Republic of Germany. By the example of the effects of a television serial, the study of causal processes turning collective environmental factors into individual suicidal behaviour, proved that regularities are effective in learning by a process of modelling. Besides, the epidemiological data give essential hints how to treat suicidal behaviour.

Adolescent↗