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Biomedical subjects

J Angst

Publications and source records attributed to J Angst.

At least 37 records · Page 2Linked to original sources
PubMed1996

Comorbidity and boundaries of affective disorders with anxiety disorders and substance misuse: results of an international task force.

Associations between affective disorders, anxiety disorders, and substance use disorders were examined in epidemiological studies conducted in Germany, Switzerland, Puerto Rico, and the mainland US. There was a remarkable degree of similarity across studies in the magnitude and type of specific disorders associated with the affective disorders. Comorbidity with affective disorders was greater for the anxiety disorders than for substance misuse. Panic disorder was the subtype of anxiety that was most highly comorbid with depression. Social phobia was the specific phobic type with the strongest association with the affective disorders. The magnitude of associations between substance misuse and affective disorders generally was quite low and less consistent across sites. No major differences were found in the patterns of comorbidity by gender or age group, affective subtype or prevalence period. The onset of anxiety disorders generally preceded that of depression, whereas alcohol misuse was equally likely to pre-or post-date the onset of affective disorders. Finally, comorbidity was associated with an elevation in treatment rates across all sites, confirming Berkson's paradox on an international level.

Adolescent↗
PubMed1995

Therapeutic efficacy of antidepressants in agitated anxious depression--a meta-analysis of moclobemide studies.

The results of the meta-analysis of studies comparing the efficacy of moclobemide, imipramine and so-called sedative antidepressants (amitriptyline, mianserin and maprotiline) in 2416 patients are described. The results demonstrated that in agitated-anxious depressive patients (defined by HAMD factor score or HAMD item 9) a nonsedative, reversible MAO-A inhibitor moclobemide has about equal efficacy as imipramine or sedative antidepressants. All antidepressants were clearly superior to placebo, irrespective of the outcome measures applied (> 50% HAMD decrease, CGI improvement). The efficacy of antidepressants in agitated patients was unrelated to the severity of agitation and did not appear to be inferior to the efficacy in nonagitated patients. Comedication with benzodiazepines had no impact on overall efficacy of either moclobemide or other antidepressants in this patient population. Previous treatment with antidepressants, however, always negatively influenced the outcome with trial drugs, e.g., reduced their efficacy. Placebo response in agitated depressives appeared generally to be low (20-30%) and was clearly reduced with increased severity of agitation, irrespectively of how the agitation was defined.

Adult↗
PubMed1995

Social phobia.

Explore the source record for details and available documents.

Humans↗
PubMed1995

Comorbidity and social phobia: evidence from clinical, epidemiologic, and genetic studies.

This paper reviews evidence from clinical, epidemiologic, and family studies regarding the association between social phobia and other syndromes. Social phobia is strongly associated with other anxiety disorders, substance abuse, and affective disorders in both clinical and community samples. An average of 80% of social phobics identified in community samples meet diagnostic criteria for another lifetime condition. Social phobia is most strongly associated with other subtypes of anxiety disorders, with an average of 50% of social phobics in the community reporting a concomitant anxiety disorder including another phobic disorder, generalized anxiety, or panic disorder. Approximately 20% of subjects in the community meet lifetime criteria for a major depressive disorder. The onset of social phobia generally precedes that of all other disorders, with the exception of simple phobia. Both clinical severity and treated prevalence are consistently greater among social phobics with comorbid disorders. The results of family and twin studies reveal that shared etiologic factors explain a substantial proportion of the comorbidity between social phobia and depression, whereas the association between social phobia and alcoholism derives from a nonfamilial causal relationship between the two conditions. Clinical and phenomenologic implications of these findings are discussed.

Adult↗
PubMed1995

Depression in old age. Is there a real decrease in prevalence? A review.

The discrepancy between the constancy or increase of the prevalence of depressive symptoms and dysphoria in old age on one hand, and the decrease in the prevalence of the DSM-III diagnoses of major depression and dysthymia on the other, is discussed in light of the most frequent explanatory hypotheses such as memory defects, interpretation of depressive as somatic symptoms, higher risk of institutionalization as well as higher mortality of depressives and a mitigated course of depression in old age. We conclude that higher mortality, mitigation and the rarity of true late-onset depression are arguments for a real decline in prevalence, which occurs in accordance with the decline in all psychiatric disorders that are connected with emotional upheavals and substance ingestion. On the other hand, the connection of depressive states with somatic illness is strengthened, and according to preliminary validation studies, clinically relevant depressive states not reaching the threshold of DSM-III diagnoses may be typical for the depressive psychopathology of old age.

Adolescent↗
PubMed1995

The epidemiology of depressive disorders.

The Zürich cohort study of a community sample identified, up to age 35, a lifetime prevalence rate for DSM mania/hypomania of 5.5%, half of these cases also met the criteria for major depressive episodes. The lifetime prevalence rates obtained for major depressive disorder were 17.85% and the rate for all depressive subgroups including dysthymia, minor depression, recurrent brief depression and major depression was 35.4%. Data on the validity of the diagnostic subgroups suggest that these high prevalence rates are based on clinically relevant case definitions.

Adult↗
PubMed1995

Moclobemide and tricyclic antidepressants in severe depression: meta-analysis and prospective studies.

There is no generally accepted definition of severe depression, but hospitalization, high scores on rating scales, and the presence of psychotic symptoms are widely considered to be indicators of severe cases. For the purpose of this analysis of the antidepressant efficacy of the reversible inhibitor of monoamine oxidase A moclobemide, all hospitalized cases were selected from the current database of comparative studies and compared with the standard tricyclics imipramine and clomipramine. The cases from comparisons of moclobemide and imipramine were analyzed together, because in accordance with the recommended range of doses, the dose ratio over all studies was approximately 3:1 (moclobemide: N = 238, mean dose, 453 mg/day; imipramine: N = 248, mean dose, 159 mg/day). The cases from comparisons of moclobemide and clomipramine could only be analyzed over all studies if dose was taken into account, because the dose ratio of approximately 3:1 was only given in one study (moclobemide: N = 62, mean dose, 466 mg/day; clomipramine: N = 66, mean dose, 154 mg/day), whereas the dose ratio over the other, earlier studies was approximately 2:1 (moclobemide: N = 58, mean dose, 258 mg/day; clomipramine, N = 59, mean dose, 124 mg/day). The efficacy as judged on the Hamilton Rating Scale for Depression (HAM-D) and Global Assessment of Efficacy was analyzed for subgroups of inpatients, according to different severity bands (17-item HAM-D baseline total score, cut-off, 28 points) and according to the presence or absence of mood-congruent psychotic features. The results of our analysis failed to reveal any difference in efficacy between moclobemide and imipramine in any subgroup of hospitalized depressives, including patients in the highest HAM-D severity band and psychotic patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Antidepressive Agents↗
PubMed1995

Outcome of a clinical cohort of unipolar, bipolar and schizoaffective patients. Results of a prospective study from 1959 to 1985.

In a prospective study, 186 unipolar depressives and 220 cases of bipolar disorder meeting DSM-III criteria for major depression or mania were followed up. Subjects were classified according to polarity and the presence or absence of schizophrenic symptoms, into four diagnostic subgroups: unipolar depression, bipolar disorder, unipolar schizoaffective disorder and bipolar schizoaffective disorder. At the last follow-up in 1985, 53% of the patients had deceased. Eleven percent of the sample (17% of all deaths) had committed suicide. The risk of suicide was associated with clinical severity and onset prior to the age of 60. However, there was no difference in suicide rates according to sex or diagnostic subgroup. Late onset of affective illness was associated with chronicity, which occurred in 10 to 19% of cases. Recovery was more frequent among unipolar than among bipolar patients. The 5-year remission rates (i.e. 26% in unipolars, 16% in bipolars) were independent of the number of episodes.

Adult↗
PubMed1995

Course of a clinical cohort of unipolar, bipolar and schizoaffective patients. Results of a prospective study from 1959 to 1985.

This paper reports the results of a 27 year prospective study of 186 unipolar depressives and 220 bipolar disorders meeting DSM-III criteria for major depression or mania. Subjects were classified into four diagnostic subgroups, according to polarity and presence or absence of schizophrenic symptoms: unipolar depression, bipolar disorder, unipolar schizoaffective disorder and bipolar schizoaffective disorder. Course parameters were assessed for all samples. As the sequence of subtypes of affective and schizoaffective disorders progresses from unipolar depression, schizodepression, pure affective bipolar disorder to schizobipolar disorder, a systematic decrease in age of onset and length of episode can be observed. When compared to unipolar disorders (unipolar depression and schizodepressive disorder), bipolar (bipolar and schizobipolar) disorders showed more periodicity, characterized by greater number of total episodes, more episodes per year, but with shorter episodes and cycles. Despite the lower age of onset among schizoaffective subjects compared to pure affective disorders, the only difference in course between the two groups was a greater frequency in episodes requiring hospitalization among schizoaffectives.

Adult↗
PubMed1995

[Epidemiology of the bipolar spectrum].

The majority of epidemiologic studies indicate a prevalence rate of bipolar disorder of between 0 to 1.6% in the population. Some studies using other instruments have suggested lifetime prevalence rates of between 3 and 6.5%. Higher rates are often obtained when a wider range of cases belonging to the bipolar spectrum are included in data, for instance, cyclothymia or atypical bipolar illness. The Zurich cohort community study reported a prevalence rate of 5.5% for bipolar disorder and, moreover, found evidence for the existence of "brief hypomania", a condition characterized by short episodes of 1-3 days duration and a high recurrence. The prevalence rate found for this group was 2.2%, and is as such comparable in validity to DSM IV hypomania or mania measured by family history of depression, history of suicide attempts and treatment of depression. The quality of life for brief hypomanics is starkly reduced.

Bipolar Disorder↗
PubMed1994

The Zurich Study: XXIII. Epidemiology of headache syndromes in the Zurich cohort study of young adults.

This study examines the 1 year prevalence rates of headache syndromes in an epidemiologic cohort study of young adults ages 29-30 in Zurich, Switzerland. The 1 year prevalence rates of headache subtypes were 3.3% for migraine with aura and 21.3% of migraine without aura as defined by the International Headache Society (IHS) criteria. The demographic distribution, clinical features, sequelae, and treatment patterns of subjects with specific headache subtypes are described. The rates of migraine are compared to those of other community samples that have employed the IHS criteria for headache subtypes. Subjects with migraine reported pervasive impairment in nearly every life role including occupation, leisure, and social relationships. Despite the substantial degree of impairment in occupational and social functioning that was associated with migraine, an extremely low proportion of subjects had received professional treatment for headache. These results suggest that a concerted effort should be directed towards education regarding the classification of headache and the availability of efficacious treatment for migraine.

Absenteeism↗
PubMed1994

Premorbid personality traits of men who develop unipolar or bipolar disorders.

In 1972, all Swiss males in the Canton of Zurich who reported for a compulsory medical examination for selection for military service were given the Freiburg Personality Inventory. This was repeated in half the sample on three subsequent occasions. From 1983 to 1988, an effort was made to identify all male psychiatric cases. There were 99 unipolars and 26 bipolars. The unipolars who had their age of onset after the personality testing displayed elevated scores on a constellation of symptoms labelled autonomic lability which consisted of items that correlated highly with neuroticism. The trait endured even when it was retested at age 36 years. The bipolars did not differ from the controls in any respect on any occasion.

Adult↗
PubMed1994

Neurasthenia in a longitudinal cohort study of young adults.

This study examines the concept of neurasthenia in a longitudinal cohort of young adults selected from a community sample of the canton of Zurich, Switzerland. The major focus is on the validity of the case definition of neurasthenia. Close approximations of the proposed descriptive and research definitions of the ICD-10 are employed as well as the concept of 'irritable weakness' as described in 1831 by Kraus (1926-1932). The prevalence of neurasthenia defined according to the ICD-10 criteria was: 1% across 10 years and 0.9% in 1988 for a duration criterion of > or = 3 months; and 8.1% across 10 years and 12% in 1988 for a duration criterion of > or = 1 month. The duration criterion of > or = 3 months appeared to be excessively restrictive to represent individuals with neurasthenia in the community. Subjects with 1 month episodes of neurasthenia exhibited sufficient differences from controls and similarities to subjects with anxiety or depressive disorders to justify a 1 month duration criterion for neurasthenia in community samples. The clinical significance of neurasthenia was indicated by the magnitude of subjective distress, and occupational and social impairment reported by the majority of the cases. Prospective assessment of the longitudinal course of neurasthenia revealed that approximately 50% of the cases continued to exhibit this disorder at follow-up. Our findings suggest that neurasthenia is equally likely to represent an early manifestation of affective illness as it is a consequence in those neurasthenic subjects who exhibited comorbid affective disorders. The magnitude, chronicity, impairment, longitudinal stability and distinction from anxiety and depression associated with this condition in the general population, suggest that neurasthenia is an important diagnostic entity for which additional validation studies should be undertaken.

Adult↗
PubMed1994

Psychopathology and headache syndromes in the community.

The present study investigated the association between psychopathology and headache in a prospective longitudinal epidemiologic study of a cohort of 19- and 20-year-olds in Zurich, Switzerland. Prevalence rates of psychopathology by headache subtype were examined both cross-sectionally and longitudinally. Psychiatric disorders were evaluated using a direct interview administered by experienced clinicians. Personality was assessed using the Freiburg Personality Inventory and the Symptom Checklist 90. In general, subjects with migraine had more affective and anxiety disorders and exhibited elevated rates of neuroticism and somatization compared to nonmigraine subjects. When examined by headache subtype, migraineurs with aura exhibited greater rates of psychopathology and more personality abnormalities than any of the other headache subtypes or controls. In contrast to clinical wisdom, subjects with tension-type headache did not differ from controls in rates of psychopathology or on any of the personality or symptom factors.

Adolescent↗