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J Angst

Publications and source records attributed to J Angst.

At least 91 records · Page 5Linked to original sources
PubMed1993

Time course of improvement under antidepressant treatment: a survival-analytical approach.

A meta-analysis of an earlier multicenter, double-blind efficacy study comparing placebo, oxaprotiline and amitriptyline was performed in order to test the survival-analytical approach in modelling the onset of improvement and response to treatment with antidepressants. The sample consisted of moderately depressed male (n = 154) and female (n = 275) patients (aged 17-73), diagnosed according to DSM-III criteria for major depression. Of these, 120 were treated with oxaprotiline, 120 with amitriptyline and 189 with placebo. Efficacy criteria were Hamilton Depression (HAMD) and Anxiety (HAMA) and Zung Self-Rating scales. Up to eight ratings over a period of 40 days were available for analysis. The results showed that the sensitivity in discriminating between groups was substantially enhanced through the inclusion of drop-outs and consideration of the effect of time to withdrawal from the study due to lack of improvement. Withdrawal from the trial due to inefficacy occurred earliest under placebo (50% within the first 8 days), whereas less than 40% dropped out within the first 12 days under active treatments. The most interesting and unexpected finding of the analysis was that the time course of improvement among responders was independent of the treatment modality, and thus identical in all three groups. Specifically, the efficacy of any of the given treatments was reflected only by the total number of responders or nonresponders. Once triggered, the time course of recovery from illness becomes identical to that of spontaneous remissions as observed, for example, under placebo.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

Current concepts of the classification of affective disorders.

The introduction of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), which uses a descriptive approach to operational definitions of psychiatric diagnostic groups, is an important step forward. Still the present classification systems of DSM or the International Classification of Diseases (ICD) are preliminary. A systematic descriptive approach based on data collection as a foundation for diagnostic definitions is strongly recommended. Data-based definitions have a good change of surviving later changes of diagnostic fashion. Treatment studies will be more valuable when the course of a disorder is included in its definition. The diagnosis of depression has to include operationalized subthreshold syndromes, such as minor depression and recurrent brief depression. In the face of the elementary importance of the distinction between uni- and bipolar disorders, a development of the definition of hypomania is proposed. Based on this definition, bipolar disorders are more prevalent in the normal population than is commonly assumed. Most diagnostic subgroups of depression are artificial. They are not diagnostic entities, but subtypes of the same spectrum disorder. During his/her lifetime, a patient may therefore receive two or more diagnoses, but still suffer from a single disorder. Dual diagnoses, such as double depression and combined depression, define more severely affected patients with major depression, characterized by higher suicide attempt rates. Thus the differentiation of subgroups is more than an academic exercise but has a practical use.

Bipolar Disorder↗
PubMed1993

Comorbidity of anxiety, phobia, compulsion and depression.

The longitudinal association of several syndromal diagnoses is very frequently a direct consequence of modern descriptive diagnosis. Comorbidity in this sense is clinically relevant. Comorbid cases are more severe, are more amenable to treatment and are more frequently suicidal. The level of association between psychiatric syndromes can lead to nosologic hypotheses that can be further examined by independent investigations, and especially by means of family studies. Generalized anxiety disorders are very closely associated with the affective disorders, particularly with depressions and suicide attempts, but also with hypomania. There is no close relationship with panic disorder. Social phobias are highly associated with agoraphobia, but also with simple phobia; also with panic, obsessive-compulsive syndromes and substance abuse. The prevalence of obsessive-compulsive syndromes depends to an exceptional degree on the definition. Syndromes below the diagnostic threshold of DSM-III are extremely frequent, and longitudinally a fluctuation about this threshold is apparent. OCS are especially found to be associated with social phobia and agoraphobia as well as with dysthymia and recurrent brief depression, but less with major depression.

Adult↗
PubMed1993

Coping and illness behavior among young adults with panic.

The present study investigated illness behavior and coping strategies among young adults with panic (N = 21), with other anxiety disorders (N = 27), and without anxiety disorders (controls; N = 296). The sample represented a cross-section of 29- to 30-year-old adults from the canton of Zurich in Switzerland. Coping was defined as the ways in which subjects react to life stress. Illness behavior was defined as use of medical care and substance consumption. Subjects with panic differed significantly from subjects with other anxiety disorders and controls in their coping strategies by seeking social support, using cognitive avoidance, and using rumination more frequently. Cognitive avoidance and rumination, however, are ineffective and maladaptive ways of dealing with stress. With respect to illness behavior, we found fewer differences. Subjects with panic had more psychiatric consultations and more days off from work than controls, but otherwise, they did not use medical care excessively. Also, their consumption of psychoactive substances was minimal, with the exception of tranquilizers. There was no indication of excessive use of nonpsychiatric medical care. The possible implications of these findings for psychotherapy and diagnostics are discussed.

Adaptation, Psychological↗
PubMed1993

Validation of diagnostic criteria for migraine in the Zürich longitudinal cohort study.

This paper reports the results of a systematic assessment of the validity of the specific diagnostic criteria for migraine without aura, as defined by the International Headache Society (IHS), in a longitudinal epidemiologic sample of young adults who were selected from the general population of Zürich, Switzerland. Systematic modification of each of the IHS criteria for migraine without aura yielded one-year weighted prevalence rates ranging from 24% for the unmodified IHS criteria to 9% for the most restrictive definition of migraine. The major implications of the findings for the IHS criteria are: (a) they provide adequate coverage to classify the majority of subjects with headache in the general population; (b) there is little overlap between migraine and tension-type headache, suggesting that the criteria define moderately independent subgroups; (c) the criteria for migraine without aura appear to be too unrestrictive for application in the community, particularly among young adults at the peak period of incidence of migraine; (d) the criteria for "aura" need more precise operationalization; and (e) models of validation of the diagnostic criteria suggest that Criterion D of the IHS criteria for migraine without aura should be modified to require both gastrointestinal symptoms and photophobia and phonophobia.

Adult↗
PubMed1993

Efficacy of moclobemide in different patient groups. Results of new subscales of the Hamilton Depression Rating Scale.

Data from 38 double-blind and two single-blind studies with moclobemide vs. placebo and/or standard antidepressants (10 drugs) were available for an intent-to-treat meta-analysis (n = 2,371). In all, 236 subjects received placebo and 1,107 moclobemide. As a measure of efficacy, a > or = 50% decrease from the baseline on the Hamilton Rating Scale for Depression (HAM-D) and its new subscales was taken. Furthermore, the Global Assessment of Efficacy (GAE) was analyzed. New subscales of the HAM-D consist of a retarded depression and an agitation/anxiety scale. The two factors were obtained from factor analyses of 12 x 8 random subsamples resulting in a stable solution. The subjects were subclassified by severity (low, medium, high) prior to treatment. The response to placebo was consistently lower in high scorers. In contrast to that, high scorers on active drugs (moclobemide, imipramine, and clomipramine) showed a tendency to higher response rates. Response rates were, in general, higher on the subscale retarded depression than on agitation/anxiety for both placebo and active drugs. Response rates to moclobemide were highest in unipolar endogenous depressives (66%) followed by bipolars (57%), neurotic depressives (52%), and reactive depressives (43%).

Antidepressive Agents↗
PubMed1992

The Zurich Study. XII. Sex differences in depression. Evidence from longitudinal epidemiological data.

A prospective study of depressive syndromes and diagnoses was performed among a young adult Swiss population with three interviews over 7 years. Different definitions of depressive states were used: on the one hand, depressive syndromes including mood disturbances of any severity, on the other, well-defined diagnoses of depression. Women were consistently overrepresented among subjects with depressive syndromes of some length and among those with DSM-III major depressive disorder. Both sexes appeared equally affected by brief recurrent depressions with work impairment. Between the ages of 20 and 30 years, men as a group in contradistinction to women showed depressive syndromes with decreasing frequency, whereas, for diagnoses, the sex rates remained quite constant. For identical syndromes, women at each interview reported a greater number of symptoms. DSM-III-R symptoms of melancholia were not reported more often by women than by men. When syndromes or diagnoses were controlled, women and men suffered to an equal rate from subjective impairment at work. Women's syndromes were more recurrent. Among women, a diagnosis of depression was more often associated with disturbances of appetite and with phobias than among men. The importance of differential recall for sex differences in prevalence is discussed. Sex differences may have different weight and different causes with regard to depressive syndromes and to a diagnosis of depression.

Adult↗
PubMed1992

The Zurich Study: XV. Suicide attempts in a cohort from age 20 to 30.

The life-time prevalence of suicide attempts in a Swiss population, interviewed four times between the ages of 20 and 30 years, was 3.8% (females 5.4%, males 2.1%). One fifth of the 30-year-olds reported persistent suicidal ideation. In comparison with controls, attempters reported a more disturbed childhood, and subjects with multiple attempts reported more sexual abuse. Over 10 years attempters persistently showed more negative affectivity, more feelings of helplessness and lower self-esteem. At age 30 they were higher on the scales neuroticism, masculinity and aggressivity in a personality test. Over ten years, a higher than expected comorbidity appeared of suicide attempts with depressive and anxiety disorders, with substance abuse, and with sociopathic features.

Adult↗
PubMed1992

The Zurich Study. XVI. Early antecedents of depression. A longitudinal prospective study on incidence in young adults.

The purpose of this study was to investigate antecedents of first incidence of major depressive disorder and recurrent brief depression with the help of a cohort of 20 year-old Swiss, who was interviewed four times up to age 30. Cases diagnosed as depressed at the third or fourth interview (age 28 or 30) were compared with never diagnosed controls for antecedents at the first and second interview (age 21 and 23). Besides retrospectively assessed childhood precursors, later depressives showed slight differences in their relationship to parents and friends and early symptoms of subclinical depression, persistent helplessness and a surplus of life events. These antecedents were mainly found in females. The most persistent antecedent of later depression for both sexes was a higher score than controls' on the SCL-90R ("negative affectivity"). Whether this finding signifies that proneness to the milder depressions in young adults is rooted in personality is subject to discussion.

Adolescent↗
PubMed1992

The Zurich Study. XIII. Recurrent brief anxiety.

In the epidemiological Zurich cohort study a syndrome of 'Recurrent Brief Anxiety' (RBA) was identified and operationalized. It had a 1-year prevalence rate of 2.7, males seemed to prevail slightly. RBA was highly associated with 'Recurrent Brief Depression' (RBD) and panic, and to a minor extent with agoraphobia and dysthymia. The family history was positive for depression and anxiety (panic, generalized anxiety disorder). In studies of panic, one should look for the frequently associated syndromes of RBA and RBD.

Adult↗
PubMed1992

The Zurich Study. XIV. Epidemiology of seasonal depression.

In a longitudinal cohort study of young adults from the Canton of Zurich in Switzerland (Zurich Study), seasonal patterns of several psychiatric and psychosomatic syndromes were investigated in two interviews over a period of three years. At an age of 27-28 years, 23% of the depressives, 15% of the neurasthenic subjects, and 14% of the subjects with backache reported an increased susceptibility in autumn and/or winter. With respect to the course we found that 10.4% of the subjects of the longitudinal sample (n = 417) suffered from seasonal depression (including individuals with subsyndromal seasonal difficulties) over two consecutive years. Specific symptoms, such as hypersomnia, increase of appetite or weight gain, were not found to be consistently associated with seasonal depression. A comparison of actual and retrospective reports on seasonal depression resulted in a very low reliability. In view of these results the seasonal subtype of depression should be diagnosed with caution, except when the diagnosis is based on longitudinal observations and/or external sources of information (e.g. family members, partner).

Adult↗
PubMed1992

Epidemiology of depression.

Review of the published literature produces 1-year prevalence rates for major depressive disorder DSM-III between 2.6 and 6.2%, for dysthymia between 2.3 and 3.7%, bipolar disorder 1.0-1.7%. Data from the prospective Zurich Study with four interviews over 10 years give relatively high 10-year prevalence rates for subjects from age 20 to 30 (14.4% major depression, 10.5% recurrent brief depression, 0.9% dysthymia, 3.3% bipolar disorder, 1.3% hypomania). On average, 49% of all these cases received treatment for affective disorder, resulting in a weighted treatment prevalence rate of the population of 11.6% (18% for females and 5% for males). It has to be assumed that lifetime prevalence rates based on recall may greatly underestimate true morbidity.

Adult↗
PubMed1992

Efficacy of moclobemide in different patient groups: a meta-analysis of studies.

Whilst tricyclic antidepressants are efficacious in all depressive syndromes, classical MAO-inhibitors differ substantially from them in their action. They are considered less effective in general and not very effective in endogenous depression, but recommended for the treatment of 'atypical' depression. A new class of RIMA (Reversible Inhibitors of MAO-A) represented by moclobemide requires a change in clinical thinking on antidepressants. Moclobemide shows the same efficacy in depression as tricyclics: its effects are similar in unipolar and bipolar affective disorders, and in patients with major depressive episode superimposed on dysthymia (double depression). As with classical antidepressants, the response rate tends to be lower, but is still present in psychotic depression. Agitated depressives do not respond less well than non-agitated patients to moclobemide. Patients meeting DSM-III-R criteria for major depression with melancholia tend to respond better than non-melancholics, but this may be associated with the significantly higher baseline severity observed in melancholics. A slightly higher response rate in patients without concomitant benzodiazepine treatment, compared to those with benzodiazepine comedication, may also be related to baseline differences in the severity of depression. Elderly depressives respond less well than younger patients to classical antidepressants, but with moclobemide, elderly patients do as well as younger ones.

Adult↗