PubMed Health⌕ Search

Biomedical subjects

H Häfner

Publications and source records attributed to H Häfner.

At least 109 records · Page 6Linked to original sources
PubMed1989

The concept of mental illness.

In recent years it has often been suggested that there is no such thing as mental illness. In naive Cartesianism this assertion starts out from the assumption that illness may develop solely from physical causes. Before clarifying what mental illness is, we should ask what is understood by the general notion of 'illness'. A constituent of the general disease concept is an unvoluntary and sufficiently serious disturbance of vital functions that needs to be defined in detail-and not just any region of disease causes or symptoms. The general disease concept can be defined in the context of everyday life and in the social and legal context and be filled with detailed normative and threshold values in the medical context. A society with a humanitarian orientation responds to the incapacity of its members owing to illness with attempts at institutionalization, which find their expression in norms, privileges and duties. Special disease concepts were developed for defining specific diseases and distinguishing them from others. Since solely the general disease concept, on which the distinction between illness and deviations from moral or legal norms is founded, is aetiologically neutral, it can be filled with any explanation model at the physical or at the mental level in the frame of specific disease concepts: e.g. with the one cause--one disease model, with multifactorial models or behavioural dysfunction models.

Humans↗
PubMed1988

What is schizophrenia? Changing perspectives in epidemiology.

The psychotic syndrome at the core of schizophrenia appears to be invariable across cultures. The risk of morbidity also seems to vary very little from country to country and over medium periods of time. Moreover, apart from gender differences in first onset, the cumulative lifetime risk is the same in females and males. A similar epidemiological pattern is only found in pathological conditions that are characterized by a precisely defined section of a psychopathological dimension with a continuous distribution in the population, e.g. severe mental retardation being the extreme section of normally distributed IQ values. The interpretation of schizophrenic psychosis as the extreme section of a psychopathological dimension or disposition that is almost evenly distributed in all populations is supported by the fact that milder psychiatric disorders occur more frequently before the onset of the psychosis and in close relatives of schizophrenic patients. The psychopathological heterogeneity of these disorders argues against the assumption of a manifest psychopathological dimension with a continuous transition from the schizophrenic psychosis to the "normal" schizothymic personality. More probable is a continuously distributed latent vulnerability to schizophrenia--with or without a threshold effect--which in severe degrees disposes to the uniform reaction pattern of the schizophrenia syndrome. Smaller degrees of vulnerability are associated with an increased risk for milder patterns of disturbances, which are also more strongly determined by environment and personality and therefore are rather heterogeneous. These assumptions lead to other epidemiological and genetic models than Kraepelin's early concept of a disease entity does.

Female↗
PubMed1988

The social supports of suicide attempters: the different roles of family and friends.

The social support patterns of a sample of 101 suicide attempters were compared with the patterns of a control sample on the basis of structured interview data. Network characteristics and the extent of support in different functional categories were examined as to their absolute and relative power to discriminate between the suicide attempters and the controls. A clear separation of the functions of kin and of friends/acquaintances emerged. The crucial difference between the attempters and the controls lay in the number of friends with whom the subjects had agreeable everyday interactions and in the number of kin that provided crisis support, both psychological and instrumental. Other support differences between the two groups were of secondary importance. While there was no overall difference in the frequency of social interactions between the two groups, the size of the social network differed greatly. Consequences for the conceptualization and measurement of social support as well as for the prevention of suicidal behavior are discussed.

Adult↗
PubMed1988

The Werther effect after television films: new evidence for an old hypothesis.

In this study it was possible to prove the Werther effect in suicides after watching fictional models for the first time. A twice-broadcast (1981, 1982) six-episode weekly serial showing the railway suicide of a 19-year-old male student provided a quasi-experimental ABABA design to investigate differential effects of suicide imitation. Imitation effects were most clearly observable in the groups whose age and sex were closet to those of the model. Over extended periods (up to 70 days after the first episode), the number of railway suicides increased most sharply among 15- to 19-year-old males (up to 175%); the effect steadily decreased in the older age groups, so that no effect was observable for males over 40 years and females over 30 years. Also, the imitation effects remained detectable for longer periods in the groups closest in age to the model. The increases observed after the first and second broadcast for males aged less than 30 years closely corresponded with the respective audience figures for the two showings.

Adolescent↗
PubMed1988

[Does unemployment cause illness? A review of the status of knowledge of the correlation between unemployment, physical and psychological health risks].

Unemployment appears to be a complex condition that burdens the individuals affected in multiple ways both at job loss and in long-term unemployment. To a lesser extent unemployment may also relieve the stressors and risks associated with the place of work. The scope and nature of the burden experienced depends on individual factors, such as mental stability and coping resources, on economic, social and cultural factors, such as availability of alternative roles, system of social security and social context. In the industralized countries, especially in the Federal Republic of Germany, financial security and society's attitudes towards unemployment are less unfavourable than during the economic recession between the two world wars. Nevertheless, household income should not be overlooked as an important factor leading to stress beyond a certain threshold. In this respect it is noteworthy that the income of the unemployed households in the Federal Republic of Germany decreased by 8% between 1981 and 1983 (Brinkmann, 1986). Quantitative relationships between unemployment and physical health have frequently been reported. In studies whose designs allow such associations to be explained selection factors, i.e. an overrepresentation of frequently or chronically ill and disabled individuals among those losing their jobs and the long-term unemployed, contribute to the increased morbidity among the unemployed to a considerable extent. Causal relationships between unemployment and physical health risks have not yet been proven directly, which does not mean that there are none. The mediation of health risks by changes in behaviour during unemployment which as such might lead to or reduce morbidity and mortality risks has not yet been studied sufficiently. Unemployment appears to have both an increasing and a reducing effect, but also no effect at all on the use of alcohol and tobacco in different populations. But we do not yet know enough about the mechanisms bringing about these effects. There are more consistent findings indicating that sustained unemployment influences personal well-being. This influence is reflected primarily in unspecific physical complaints and mild or moderately severe depressive changes of mood. The most important finding of increased health risks in the unemployed versus the employed are elevated rates of suicide and attempted suicide. This finding, too, seems to be attributable to selection factors, i.e. predominantly to an overrepresentation of mental disorders and substance abuse associated with an increased suicide risk among job-losers.(ABSTRACT TRUNCATED AT 400 WORDS)

Disease Susceptibility↗
PubMed1988

Patterns of mental health care in two European areas: Mannheim, Federal Republic of Germany; and Groningen, The Netherlands.

All consecutive cases entering the mental health services cooperating with the cumulative psychiatric case register of Mannheim between 1-31 July 1976 were followed up until the end of June 1978 and compared with the consecutive cases entering the mental health services cooperating with the psychiatric case register of Groningen between 1 January and 1 May 1979. Patterns of in-, day- and outpatient care delivered to these 2 cohorts of patients, who were greater than or equal to 15 years of age, and who had not been in contact with one of the services for at least 6 months prior to entry, were compared by diagnostic category. The most common episode of care was the relatively brief outpatient one. Mixed types of care and chronic cases were more common among patients with a psychosis or an addiction than in other diagnostic categories. Between 6 and 24 months after first contact 76% of the patients in Mannheim and 43% of the patients in Groningen had no more contacts. Between 18 and 24 months after the first contact the percentages had increased to 90 and 72% (respectively). In Groningen a higher percentage of patients received outpatient care only. Although a larger percentage of patients in Mannheim received inpatient care, the accumulation of "new chronic" patients was larger in Groningen, as a result of a greater length of stay in Groningen.

Adult↗
PubMed1988

[The value of the social service unit in ambulatory gerontopsychiatric management].

Care of aged mentally diseased patients is one of the subjects whose reform had been underlined as particularly urgent in the 1975 report on the state of psychiatry in the Federal Republic of Germany. Whereas in psychiatric hospitals there is now evidence of a growing trend to reduced hospital stay and to readmission after a period of release, no change seems to be in sight in respect of caring for the aged on an outpatient basis. The financial losses suffered by public health care organisations for aged mental outpatients have resulted in housing an increasing number of mentally ill persons of old age in homes for the aged, instead of caring for them as psychiatric outpatients. Since more and more aged persons will be represented among the population in future, it is more than ever before imperative to arrive at suggestions for a feasible solution. The article reviews the present situations (including acceptance of existing institutions by the aged) and explains the importance of public social care units in outpatient care of elderly people. The assessment was made by means of an official questionnaire operation in the Land of Baden-Württemberg. Efforts are suggested in respect of revised basis rules of organisation and staff to improve public outpatient gerontopsychiatric care.

Combined Modality Therapy↗
PubMed1988

[Need for social psychiatric services--a management model in scientific evaluation].

Social-psychiatric services have for a long time been a focus in the controversial discussion about the further development of outpatient mental health care. Presented is the Baden-Württemberg Social Psychiatric Services model, which is oriented towards outpatient social welfare provision of persons with chronic mental illness, complementing the medical-psychiatric treatment provided by office-practice psychiatrists. Evaluation of the Social Psychiatric Service for its first year of full operation, 1984, has shown that this type of service delivery organization is capable, above all, of reaching persons with "recently" chronic mental illness, who are serviced in the framework of community mental health care systems mainly on an outpatient basis. Provision of care, i.e. of social welfare and counselling measures, may in this group constitute an efficient contribution towards their social rehabilitation. Effective functioning of this organizational model presupposes sufficiently well-established cooperation with other facilities and services involved in service provision, which, as the Baden-Württemberg trial has shown, can in actual fact be ensured.

Chronic Disease↗
PubMed1987

[Correlation of "latent hyperthyroidism" with psychological and somatic changes].

The study reported here was undertaken to establish the degree to which a person in a preclinical state of hyperthyroidism, with (by definition) euthyroid T3 and T4 levels but suppressed TRH on testing, already exhibits psychological changes and clinical symptoms. Two groups of 20 patients each, with clear clinical and preclinical hyperthyroidism (as defined by laboratory parameters), were studied, as well as a group of 20 controls. The subjects' psychological state of mind was investigated using self-rating scales, including the state-trait-anxiety inventory (STAI), "Befindlichkeits"-Skala (Bf-S'), depression scale (D-S'), and a list of adjectives (EWL-K) with 14 different aspects of affective moods. Cognitive achievements were evaluated using the d2 test. Subjects were examined for somatic symptoms in accordance with Crooks' index of hyperthyroidism. The results clearly showed that typical psychological and somatic changes are already present in preclinical hyperthyroidism, these changes being partly identical with those of definite hyperthyroidism. In both patient groups, a significant increase in anxiety, a sense of not feeling well, and emotional irritability were found, as well as a tendency towards depressiveness, and an increased lack of vitality and activity. Attentiveness and concentration in both patient groups were lower than in the control group. Both patient groups showed the same prevalence of symptoms, such as palpitations, preference of cold over heat, excessive sweating, nervousness, fine digital tremor, and increased heart rate. With regard to the results, the diagnosis "preclinical hyperthyroidism" thus gains importance. Further prospective studies are required to answer the question whether antithyroidal treatment will influence the described psychological and somatic state of patients with preclinical hyperthyroidism.

Adult↗
PubMed1987

Abnormal seasonality of schizophrenic births. A specific finding?

The unusual finding of an abnormal seasonal distribution of schizophrenic births, showing an excess of 10% in the winter or spring months and an equal deficit in the summer or autumn months, cannot be explained by artefacts. It has not yet been established whether the finding is specific to schizophrenia. We observed an excess of schizophrenic births of some 10% in March to May, significant at the 5% level, and a deficit of approximately the same size in June to August on the birth data of first-admission patients with the clinical diagnosis of schizophrenia. The data, obtained from the Mannheim Psychiatric Case Register, were compared with those of the Mannheim population and a control group matched by birth year and sex. The total population of mentally retarded children aged 7 to 16 years from the Mannheim population showed an excess of some 20% in April to June and an equal deficit in the last two quarters of the year, compared with the Mannheim population of the same birth years. The finding was not significant, but allowance must be made for the low case number of 415. We also compared 3409 first-admission patients with depressive syndromes (ICD 296 and 300.4) and 5615 first-admission patients with the diagnosis of "neurosis and personality disorders" (ICD 300-302, except 300.4, and 305-309) from the Mannheim Case Register with a control population and a parallel control group. Depressed males showed an excess of births in March to May, which was significant at the 1% level; the birth peak for females was smaller and not significant. The same findings were obtained for the category of neurosis and personality disorders, i.e. an excess of about 10% in March to May for males, significant at the 1% level, and a non-significant excess for females. Our findings are awaiting replication. Causal explanations will be discussed with great reservation. The procreational hypothesis, assuming those factors that lead to an equidirectional seasonal pattern of births with a slight deviation from the average of a year in the general population, to be reinforced in the disease categories mentioned, is regarded as the most simple and plausible explanation. It is based on the assumption that some of the parents of individuals suffering from schizophrenia, mental retardation or probably also some other mental disorders running from generation to generation, have a higher threshold in partner-seeking behaviour, which is overcome more easily in the summer months with the consequence of increased pregnancies.

Adolescent↗
PubMed1987

Do we still need beds for psychiatric patients? An analysis of changing patterns of mental health care.

While the utilization of outpatient psychiatric care increased steeply in the last few decades, the number of beds in psychiatric hospitals declined continuously in most countries. The future need for psychiatric hospital beds is influenced by changes in psychiatric morbidity, the range of services offered by mental hospitals and the availability of alternative forms of care for the chronically ill. A prospective cohort study conducted in Mannheim showed that currently, at a favourable standard of complementary service provision, one quarter of the schizophrenic patients requiring institutional care for more than one year - schizophrenics are the largest group of mental patients in need of long-term residential care - still need to be treated in mental hospitals. Beyond this threshold value the costs of alternative care exceed those of a continuous inpatient treatment, and, concurrently with them, the burden upon the people involved grows. Estimates of the future need can be made on the basis of field surveys, utilization data of a population and an analysis of long-term trends by using case register data. Provided a well-functioning system of alternative and outpatient mental health services is available, psychiatric bed ratios covering the actual needs in developed countries seem to range from 0.5 to 0.8 per 1000 population over 15 for the short-stay group and from 0.3 to 0.6 per 1000 for long-stay patients. The uncertainty inherent in the estimates requires a sufficient degree of flexibility in service planning and a continuous monitoring to make adjustments to changed conditions possible.

Adult↗
PubMed1987

[Research in psychiatric care: a contribution to the evaluation of the extramural care of schizophrenic patients].

The conceptual approach and the structures of psychiatric service have changed, and hence the question of efficacy of measures and institutions for mental patients is of special significance. In the U.S.A. this realization has led to a regulation that compulsorily prescribes the evaluation of Government-sponsored programs (Dowell and Ciarlo, 1983). Whereas the investigation into the efficacy of individual therapeutic measures is part of standard psychiatric research (Garfield and Bergin, 1978, Clark and del Guidice, 1970), the evaluation of institutions or part systems of service has only just begun, to a major part due to the methodical difficulties arising from investigating such a claim. It is often impossible, for both ethical and practical reasons, to initiate an experimental study approach that definitely provides for random allocation of patients to various service care and monitoring parameters. Hence, we must look for alternative research strategies enabling analysis of cause and effect relationships on the basis of observation studies. In this study we attempted to improve the significance of statistical analyses by means of adequate data analysis technique, the object of analysis being a community psychiatric service; such a procedure would restrict the number of possible alternative possibilities of interpretation. We could prove for a group of schizophrenic patients that continual aftercare by aftercare clinics had a really significant effect on the rehospitalization of patients, which was considerably reduced without entailing any adverse effect on the patients in consideration of the pattern of signs and symptoms involved.

Ambulatory Care↗
PubMed1986

[Mental health in the aged].

The life expectancy of the world population has increased considerably and the absolute number of 65-year olds will approximately triple in the next 40 years. Since the prevalence of chronic illness and disability increases steeply with advancing age, it is to be expected that the utilization of health services and services provided for the elderly will also increase. In the developed countries about one quarter of those aged 65 and over suffer from mental disorders. An important risk factor for mental disorders of old age seems to be the subjective awareness of loneliness, combined with a quantitative deficit in social relationships. Losses in personal relationships, above all conjugal bereavement, are, in general, associated with a higher mortality, a higher risk of suicide, various physical diseases and mental disorders, in particular depression. Dementia, one of the severest disorders in late life, increases steeply with advancing age, reaching rates of 20 to 30% among those aged 85 and over. Depressive disorders are among the most frequent psychogeriatric disorders. Due to the heterogeneity of their symptomatology and differences in case identification the prevalence rates vary substantially between countries. Prospective follow-up studies have revealed the mortality risk to be markedly higher in organic than in functional mental disorders. Care of the mentally ill elderly patient is characterized by a relatively low utilization of outpatient mental health services, whereas contact with GPs becomes increasingly important in late life.

Aged↗
PubMed1986

The contribution of European case registers to research on schizophrenia.

Psychiatric case registers have become important instruments for epidemiological research and for the evaluation of care provided for persons suffering from schizophrenia. Under the condition of a sufficient provision of care, case registers permit relatively reliable estimates of "treated" incidence and prevalence, and enable the investigation of associations between morbidity risks, disease courses, and variables such as ecological, social, and occupational factors. The linkage with twin, adoption, and birth registers provides new opportunities for the investigation of the impact of genetic versus environmental factors on the probability of becoming ill with schizophrenia. On the basis of long-term utilization figures, case registers enable a valid measure for controlling utilization, effectiveness, quality, and costs of care. Because case registers take demographic and regional factors into account, they enable better planning of mental health services--a task that grows more important with the shift from hospital-based to community-based treatment, especially for the chronic patients.

Adolescent↗
PubMed1986

[Medical and social aspects of the psychological health of the elderly].

As a consequence of falling birth-rates and increasing life expectancy, the absolute and relative number of the elderly has been considerably growing in all industrial countries during the last hundred years. According to the findings of a field study carried out among inhabitants of the City of Mannheim, well in concordance with the results of comparable investigations undertaken in rural and urban areas of other countries, about a quarter of the individuals aged over 65 are mentally ill. Under the assumption of unchanged age-related morbidity rates, the absolute number of elderly persons suffering from mental illness more than doubled in the Federal Republic of Germany between 1950 and 1980, due to demographical changes only. The quantitatively most important risk factor for psychiatric morbidity in old age, especially for psycho-organic syndromes, seem to be physical illness and handicaps. Environmental factors determining the microsocial milieu of the elderly seem to influence the frequency of depressive syndromes, as was shown by a study carried out in homes for the elderly in New York, Mannheim and London. Also in old age, belonging to the lower socioeconomic stratum - as a macrosocial factor - correlates with increased rates for psychiatric morbidity as a whole, as it does with poor physical health and increased mortality. However, this correlation is significant only for the group of psycho-organic syndromes. In functional syndromes it is hardly marked. It can be assumed that to a large part, unfavourable socioeconomic conditions mainly have an indirect impact on psychiatric morbidity by way of higher rates of those somatic diseases leading to psychiatric sequelae, e.g. cardiovascular diseases. Events of losses and social isolation in a sense of experienced loneliness accompanied by a lack of contact enlarge the risk of developing psychiatric disturbances, in particular depressive syndromes, and also the risk of somatic diseases and suicides. Since coping resources of the individual also often decrease in old age, this phase of life shows specific mental health risks which should be counteracted as long as possible by medical and social care on the levels discussed before.

Aged↗