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Biomedical subjects

H J Freyberger

Publications and source records attributed to H J Freyberger.

At least 19 recordsLinked to original sources
PubMed2007

Impulsiveness in obsessive-compulsive disorder: results from a family study.

OBJECTIVE: Although obsessive-compulsive disorder (OCD) is usually conceptualized as an anxiety disorder some studies suggested it to be a deficit of impulse control. The purpose of this study was to assess impulsiveness in OCD families and compare it to control families. METHOD: Seventy cases and their 139 relatives were compared with 70 controls and their 134 relatives from a German family study on OCD (German Epidemiologic Network for OCD Studies). All subjects were interviewed and diagnosed according DSM-IV criteria and were administered the Barratt Impulsiveness Scale (BIS) and PADUA-Inventory to assess obsessive-compulsive symptoms. RESULTS: OCD subjects had significantly higher scores of cognitive impulsiveness. However, first-degree relatives of OCD cases and of controls had comparable BIS-11 scores. Significant associations of aggressive obsessions and checking with cognitive impulsiveness were found. CONCLUSION: OCD is a severe mental disorder that is characterized by a lack of cognitive inhibition. However, impulsiveness does not represent a familial trait in families of OCD subjects.

Adult↗
PubMed2006

[Recurrent depressive disorder in Caspar David Friedrich. A pathographical approach with operationalized diagnosis].

Caspar David Friedrich (1774 - 1840) is one of the most important German Romantic painters. In his paintings, he prototypically represents the melancholy, which has been mentioned by his contemporaries and later biographers. Art scientists have also referred to his melancholy for the interpretation of his work. From a medical point of view, there are only two pathographies which remain inconclusive. Having applied diagnostic criteria for psychiatric disorders to his letters and publications, to statements of his contemporaries and to his art, we propose that he had suffered from a recurrent major depression which occurred in 1799 for the first time. At least three depressive episodes followed before he was struck by a stroke in 1835. There are epidemiological, psychodynamic and personality-typological reasons supporting our diagnostic assumption. The course of his depression corresponds to phases of reduced creativity, to the chosen techniques and motives. Finally we discuss the implications of our approach for the pathographical method in general.

Art↗
PubMed2005

[Dissociative disorders].

There are problems with dissociative and conversion disorders with respect to classification, diagnosis, and therapeutic strategies which can only be understood in the historic context of hysteria. Even current diagnostic systems such as the DSM-IV and ICD-10 differ in the classification of such disorders. High prevalence rates ranging from 3% in the general population to 30% in clinical samples underscore their clinical relevance, and traumatic experiences play a major role in the pathogenesis. High rates of comorbid psychiatric disorders, the tendency to chronicity, and concepts of somatization (particularly in patients with conversion disorders) complicate psychotherapeutic approaches. Depending on the treatment goals, both psychodynamic and cognitive-behavioral methods can be applied, supplemented by specific techniques from trauma therapy, e.g. EMDR.

Cognitive Behavioral Therapy↗
PubMed2005

Mental and physical distress is modulated by a polymorphism in the 5-HT transporter gene interacting with social stressors and chronic disease burden.

Previous studies have yielded conflicting results as to the putative role of the functional polymorphism of the promoter region of the serotonin transporter gene (SLC6A4) in the etiology of anxiety-related traits and depressive disorders. Recently, a significant gene-environment interaction was found between life stressors, the short allele of the SLC6A4 polymorphism and depression. The aim of the present study was to investigate if such a gene-environment interaction could be replicated within a different population with a different risk structure. A total of 1005 subjects from a general population sample (Study of Health in Pomerania) were genotyped. Mental and physical distress were assessed on 38 items of the modified complaint scale (BL-38). The interaction between the SLC6A4 genotype, social stressors and chronic diseases with regard to the BL-38 score was evaluated by ANOVA. There was no independent association of genotype with mental and physical distress. However, significant interactions between genotype, unemployment and chronic diseases (F = 6.6; df = 3, 671; P < 0.001) were found in females but not in males. The genotype explained 2% of the total variance of the BL-38 score and 9.1% of the explained variance. The results partly confirm previous findings of a significant gene-environment interaction of the short allele, indicating a higher mental vulnerability to social stressors and chronic diseases. The relevance of this finding is sustained by the fact that the sample characteristics and the risk structure were highly different from previous studies.

Adaptation, Physiological↗
PubMed2005

Mental and physical complaints in thyroid disorders in the general population.

OBJECTIVE: To test the hypothesis that untreated overt and subclinical thyroid disorders and autoimmune thyroiditis (AIT) are associated with mental and physical complaints in the general population. METHOD: A total of 3790 participants from the Study of Health in Pomerania (SHIP) with no known thyroid disorders were analyzed concerning their thyroid function (TSH, FT3, FT4), autoantibodies (TPO-Ab), their thyroid structure and size and their mental and physical complaints (Zerssen Complaint Scale). RESULTS: Overt hyperthyroidism (prevalence: 0.4%) was associated with a significantly lower total complaint-score than euthyroid subjects. Subjects with overt hypothyroidism (0.5%), subclinical hypothyroidism (0.7%), or subclinical hyperthyroidism (1.6%) were not different from controls in their total complaints. Females with AIT showed higher scores of tachycardia and anxiety independent from their thyroid function. CONCLUSION: In non-patient samples, hyperthyroidism is associated with positive effects on self-rated mental and physical health. AIT may be associated with negative effects on health also in euthyroid subjects.

Adult↗
PubMed2005

Relation between psychological strain and carotid atherosclerosis in a general population.

OBJECTIVE: To investigate the hypothesis that psychological strain is related to carotid atherosclerosis in a large general population sample. METHODS: Intima-media thickness and the prevalence of atherosclerotic plaques in the carotid arteries were quantitatively assessed by high resolution ultrasound among 2164 participants (1112 women and 1052 men, aged 45 to 75 years) of the SHIP (study of health in Pomerania), an epidemiological survey of a random sample of the population of north eastern Germany. Psychological strain was measured by 13 items reflecting typical psychological complaints. Each item was graded by the study participants on a four point scale (from 0, absent, to 3, severe) and a psychological strain score was generated by summing these 13 items. RESULTS: Mean psychological strain score was 10.8 (7.0) (median score 10) among women and 8.5 (6.2) (median score 8) among men. Psychological strain did not predict carotid intima-media thickness among either men or women. However, after adjustment for covariates, high psychological strain and carotid plaques were independently and linearly related, with plaque prevalence odds of 1.03 (95% confidence interval (CI) 1.01 to 1.05, p = 0.009) per increment of the psychological strain score among women and 1.04 (95% CI 1.01 to 1.07, p = 0.003) among men. CONCLUSIONS: This study identified a relation between general psychological strain and carotid atherosclerosis.

Aged↗
PubMed2004

[Effect of temperament, effect of alcohol expectancies and peer group on amount of drinking and alcohol-related problems in adolescence].

OBJECTIVE: The purpose of this longitudinal study was to investigate the relationship between temperament (novelty seeking, harm avoidance and reward dependence), alcohol expectancies, membership in a deviant/substance-using peergroup and drinking behaviour of adolescents drawn from a general population. METHODS: 147 adolescents about 15 years of age were interviewed and completed several self-rating questionnaires. We gathered additional information by interviewing their parents. One year after the initial assessment the adolescents only were interviewed and given questionnaires again. RESULTS: Adolescents with alcohol problems at the time of the second interview reported less harm avoidance, less reward dependence, and were more likely to be a member of a deviant/substance-using peergroup a year before, compared to offspring without alcohol problems. Furthermore, they held more positive alcohol expectancies than adolescents without alcohol problems. Taking into account the quantity of alcohol consumed per occasion, all results were confirmed, but temperament did not predict the extend of alcohol consumed after one year. CONCLUSIONS: Alcohol expectancies and peer group deviance/substance-use are strongly associated to alcohol problems and the amount of alcohol consumed. Therefore, they should be the focus of prevention and intervention in this age group.

Adolescent↗
PubMed2004

[The "AMDP scale for dissociation and conversion (AMDP-DK)": development of an observer-rated scale and first psychometric properties].

The AMDP scale for dissociation and conversion (AMDP-DK) represents an observer-rated scale for the assessment of dissociative and conversive phenomena, which closes the gap between available self-report questionnaires and time-consuming structured interviews with their respective disadvantages. The instrument comprises 30 operationalized items, which are rated according to the AMDP rules, and which are theoretically-driven divided into the subscales dissociation (15 items), conversion (9 items) and a "formal" dimension (6 items) to cover associated phenomena. In a sample of psychiatric inpatients (n = 73) the covered symptoms showed a great variety of frequency and intensity. The AMDP-DK and its subscales had good internal consistency (Cronbachs alpha between 0.76 and 0.85). A factor-analysis mostly replicated the theoretically constructed subscales. The convergent and divergent validity of the scale was good, as well as its ability to discriminate between high- and low-dissociating patients. The findings are discussed with regard to the psychometric properties and the relevance for the theories of dissociation and conversion.

Adolescent↗
PubMed2003

[Diagnosis related groups in psychiatry and psychotherapy--alternatives to DRGs].

Diagnosis related groups (DRGs) will be introduced in Germany in 2003 as a basis for hospital funding in all areas except for psychiatry and psychotherapeutic medicine. The following article provides an overview of the use of alternative casemix-systems in the treatment of patients with mental disorders. Overall, DRGs and alternative systems have proven to be poor predictors of resource consumption due to the high variation in the length of stay and the variable treatment opportunities. Therefore, a DRG-system must include the possibility of coded therapeutic treatments, analogous to the procedures used in surgical DRGs, in order to integrate psychiatry and psychotherapeutic medicine into a DRG-based payment system.

Diagnosis-Related Groups↗
PubMed2003

Gender differences in unipolar depression: a general population survey of adults between age 18 to 64 of German nationality.

BACKGROUND: Several studies from different epidemiological backgrounds have shown that unipolar depression is more prevalent in females than in males. This study examines gender differences in depression in a sample of 4075 probands recruited representatively from the general population in the northern German epidemiological catchment area of Lübeck. METHODS: Probands were interviewed with M-CIDI by lay interviewers. RESULTS: Being married only seems to increase the female depression risk when having children, while higher education reduced female excess; both male and female risk for depression raised sharply in separated, divorced and widowed probands. Not being employed was associated with an increased risk in male depression whereas in females risk was nearly unchanged. The gender ratio increased with the minimum number of depressive symptoms. Female excess was not reduced by a higher degree of subjective impairment or melancholic features. Females also predominated in longer episode durations. Female excess in the total group emerged beginning from adolescence with a tendency for a male excess in the prepubescent ages. No birth cohort effect was observed. LIMITATIONS: The cross-sectional design of this study precluded causal analysis of reported associations and some retrospective assessments are error-prone because of recall bias. CONCLUSIONS: We support previous findings of variations in gender differences in depression, however observed social parameter influences underline the need for a more detailed analysis of subgroups and underlying psychological mechanisms.

Adolescent↗
PubMed2002

[Alcohol problems in adolescence with reference to high risk children of alcoholic parents. Results of a family study in Mecklenburg Vorpommern].

In earlier studies, children of alcoholics (COAs) reported more alcohol and drug problems and higher levels of maladaptive behaviour and psychiatric distress than non-COAs. However, increased exposure to drugs and alcohol among COAs does not fully explain this phenomenon. In our family-based study design, we were able to investigate specific risk factors for alcohol problems in adolescence. In a first step, we compared a variety of psychosocial risk factors in 90 adolescents (12-18 years of age) from families with at least one alcohol-abusing parent with those of 90 adolescents of parents without alcohol disorders. In a second step, we investigated the meaning of all included risk factors for alcohol problems of the adolescents. Our results give some support to the existence of a lower extent of emotional warmth and support by parents of children in the COA sample. Moreover, males of the COA group reported more parental rejection and higher values on measures of attention problems and anxiety/depression than controls, whereas there were no such differences between females of the COA group and their control counterparts. Additionally, logistic regression analysis revealed that only the membership in a substance-using peer group and higher age are important risk factors for alcohol problems during adolescence. Considering our results, it is of great importance (a) to identify families at risk at the earliest possible stage and (b) to develop intervention and prevention programs further for parents and children to increase social competence and protect children at risk from later alcohol abuse.

Adolescent↗
PubMed2002

[The "AMDP-rating scale for obsessive-compulsive symptoms": The 2nd version].

The "Association of Methodology and Documentation in Psychiatry" (AMDP) has developed the 2nd version of a new observer-rated scale for a quick and precise assessment of obsessive-compulsive symptoms. The first version of the scale comprised 20 items on the dimensions "description", "distress and impairment" and "emotion and cognition". The item pool of the 2. version was enlarged to 44 items to accomplish a differentiated assessment of obsessions and compulsions and to assess the associated passive avoidance behaviour. The results of an empirical study (n = 141) demonstrated excellent internal consistency (Cronbach's alpha = 0,93), a split-half reliability of 0,83 (Spearman-Brown), a test-retest reliability of r = 0,84, a high interrater-reliability, a high differential validity and good convergent validity with the Hamburger Zwangsinventar (HZI) and the SCL-90-R. The results are presented and their implications on the final steps of the development of the scale will be discussed.

Adult↗
PubMed2002

The use of a symptom checklist (SCL-90-R) as an easy method to estimate the relapse risk after alcoholism detoxification.

We tested the use of some subscales of the psychiatric symptom checklist SCL-90-R in predicting relapse within a 1-year follow-up period after a combined detoxification- and abstinence-focused day patient psychotherapy program in 20 men and 13 women with alcohol dependence. Scores of the SCL-90-R subscales interpersonal sensitivity (p = 0.008), anxiety (p = 0.022), phobic anxiety (p = 0.019) and Global Severity Index (GSI; p = 0.040) on admission were higher in the subgroup with relapse within the first year after therapy. A decrease in depression (p = 0.004), anxiety (p = 0.006) and GSI (p = 0.006) scores during therapy was associated with a longer abstinence duration (shorter vs. longer than 24 weeks). Therefore we propose to further investigate the capacity of the SCL-90-R to identify subgroups at higher risk for relapse after detoxification and abstinence therapy in patients with alcohol dependence.

Alcoholism↗
PubMed2001

Lifetime-comorbidity of obsessive-compulsive disorder and subclinical obsessive-compulsive disorder in Northern Germany.

OBJECTIVE: Inspite of the worldwide relevance of obsessive-compulsive disorder (OCD), there is a substantial lack of data on comorbidity in OCD and subclinical OCD in the general population. METHODS: German versions of the DSM-IV adapted Composite International Diagnostic Interview were administered to a representative sample of 4075 persons aged 18-64 years, living in a northern German region. RESULTS: In both genders, high rates of comorbid depressive disorders were found in OCD and subclinical OCD, whereas somatoform pain disorder was only associated with OCD. In female subjects, OCD was additionally associated with social and specific phobias, alcohol, nicotine and sedative dependence, PTSD and atypical eating disorder. CONCLUSION: Due to low comorbidity rates, subclinical OCD seems to represent an independent syndrome not restricted to the presence of other axis-I diagnoses. Comorbidity patterns show a disposition to anxiety and to depressive disorders in OCD and subclinical OCD. A broad association with obsessive-compulsive spectrum disorders could not be confirmed in our general population sample.

Adult↗
PubMed2001

[On the impact of disorder-specific versus general psychotherapy from the psychiatric viewpoint].

Concerning the discussion of disorder-specific versus general psychotherapy it has to be taken into consideration that institutional aspects in psychiatry as well as the definition of adequate outcome criteria are specific for different subgroups of patients. During the last 20 years most elaborated interventional approaches were developed for schizophrenic patients illustrating different topics of change.

Humans↗
PubMed2001

Influence of the dopamine D2 receptor (DRD2) exon 8 genotype on efficacy of tiapride and clinical outcome of alcohol withdrawal.

We tested the hypothesis that allelic variants of the human dopamine D2 receptor E8 genotype are associated with (i) dopamine D2 antagonist tiapride dose in treatment of alcohol withdrawal (n = 50) and (ii) with anxiety and depression in patients during alcoholism detoxification therapy (admission n = 87; discharge n = 50). DRD2 E8 A/A genotype was associated with increased dose of tiapride during a 9-day detoxification therapy and with increased anxiety and depression scores on admission and 2 weeks later. The findings suggest a pharmacogenetic influence of DRD2 E8 genotype on tiapride efficacy in alcohol withdrawal. In an earlier report, DRD2 E8 A/A genotype was associated with reduced responsiveness to the dopamine D2 agonist apomorphine; however, it is not clear whether both findings share the same biological basis. Earlier findings concerning association of DRD2 E8 A/A with increased anxiety and depression are replicated for the first time.

Adult↗
PubMed2001

Neurotrophic factor S100 beta in major depression.

Disturbances in the serotonergic system are considered to be implicated in the pathophysiology of depressive disorders. The possible role of the neurotrophic factor S100 beta, which is suspected to regulate regeneration of serotonergic synapses, has not been investigated in depressive disorders. The S100 beta concentration in the cerebrospinal fluid was measured in 11 patients with the current diagnosis of mild or moderate depressive episodes (DSM-IV) and in 11 matched control patients. Using the t test for paired samples, the presence of a depressive episode was significantly associated with an elevation of the cerebrospinal fluid concentration of S100 beta (t = 2.6, d.f. = 10, p = 0.024). Replications of this finding in severely depressed patients are necessary to confirm the association between neurotrophic factor S100 beta and depressive disorders.

Adult↗