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Biomedical subjects

M Fichter

Publications and source records attributed to M Fichter.

At least 19 recordsLinked to original sources
PubMed2006

[New ways to combat eating disorders-evaluation of an internet-based self-help program in bulimia nervosa].

CONTENT: Results of the German part of a European multicenter study on the effectiveness and practicability of an internet-based self-help program (SHG self-help guide) in bulimia nervosa (BN). METHOD: The internet-based program SHG builds on the principles of cognitive behavioral therapy (CBT) and comprises seven cumulative therapeutic steps. Twenty-two women with BN made use of the program over a period of six months. The patients were supported by three evaluation interviews and a once-weekly email contact with a female psychologist. During the interview, data on general psychopathology, specific eating disorder complaints and symptoms of depression were collected. RESULTS: The examination showed definite effects both in terms of a reduction in eating disorder-specific behavior and a statistically and clinically relevant improvement in the symptoms of depression. CONCLUSION: After working with the SHG, the patient sample studied here registered improvements in eating disorder and depressive symptoms. The design of the study, however, made it impossible to assess effectiveness. Practicability and usefulness were positively assessed by the patients. Thanks to its considerable flexibility in terms of time and place, the method could well be a valuable supplementary building block in the treatment of bulimia nervosa.

Adult↗
PubMed2006

Collagen degradation products modulate matrix metalloproteinase expression in cultured articular chondrocytes.

Destruction of collagen within osteoarthritic cartilage depends in part on collagen-degrading matrix metalloproteases (MMP). Degradative fragments of type II collagen (Col II) occur in normal and in osteoarthritic cartilage, and may contribute to regulation of matrix turnover by interfering with normal cell-matrix communication pathways. Therefore, the effects of different types of collagen fragments on mRNA and protein levels of MMP-2, MMP-3, MMP-9, and MMP-13 in cultured bovine articular knee chondrocytes and explants were examined. Primary chondrocytes and explants were incubated with fragments from whole cartilage collagen matrix (Colf) and from purified type II collagen (Col2f), or with a synthetic 29-mer peptide representing the amino-terminal domain of type II collagen (Ntelo). Gelatin zymography revealed increases of proMMP-2, a shift towards active MMP-2 and increases in proMMP-9, depending on the type of fragment. In situ hybridization of cartilage sections displayed MMP-3 mRNA in virtually all cells. Moderate to strong increases in MMP-2, MMP-3, MMP-9, and MMP-13 mRNA levels were detected by quantitative PCR. The results demonstrate stimulating effects of collagen fragments on both mRNA and/or protein from MMP -2, -3, -9, and -13, and suggest a novel mechanism of MMP induction and activation that includes a particular role for N-telo in controlling catabolic pathways of matrix turnover.

Amino Acid Sequence↗
PubMed2006

15-year prospective follow-up study of behavioral therapy in a large sample of inpatients with chronic tinnitus.

CONCLUSION: The results of this study are in accordance with the assumption that cognitive-oriented therapy enabling the patient to live with tinnitus is of primary importance to enhance quality of life. BACKGROUND AND OBJECTIVES: This study describes the success of an integrative behavioral-medicine inpatient treatment for complex chronic tinnitus and presents its long-term effects. In 1987 we developed and evaluated a new treatment concept of psychological treatment of complex chronic tinnitus based on international experience and results. To evaluate the influence, effects and individual results of the specific therapy we analyzed the data of 434 consecutively treated patients. To investigate the long-term effects of the treatment, we contacted the patients 15 years after discharge from the hospital. PATIENTS AND METHODS: We used the tinnitus questionnaire (TQ) and visual analog scales (VAS) for specific tinnitus variables (loudness, discomfort, control of tinnitus, stress, general mood). The German version of the Derogatis psychopathology checklist (SCL-90-R) was used to analyze the impact of additional symptoms (depression, anxiety, introversion, etc.). RESULTS: Compared with a control group (patients on a waiting list) significant and clinically relevant effects were found. At the outcome, there were significant improvements in almost all parameters measured. For evaluation of the long-term effect we succeeded in contacting 312 of 434 former patients. Data were assessed using the same questionnaires that had been employed at the first contact. In all, 271 patients (86%) returned the questionnaires. Data for 244 cases (mean age 63 years; 79 females, 165 males) were complete enough to be used for data analysis. The results of the follow-up were as unexpected as clear: 15 years after conclusion of the treatment, the improvements of the tinnitus parameters and additional symptoms were stable when compared with the end of therapy.

Adaptation, Psychological↗
PubMed2005

Postprandial ghrelin release in anorectic patients before and after weight gain.

The appetite-modulating hormone ghrelin transmits changes in food intake to the central nervous system. In patients with anorexia nervosa, weight gain reduces elevated fasting ghrelin levels to normal, however, less is known about the effects on postprandial ghrelin levels. In 20 female anorectic in-patients (25.6 +/- 1.0 years; body mass index (BMI) 15.1 +/- 0.3 kg/m2) a standardized test with 250 ml fluid meal (250 kcal: 9.4 g protein, 34.4 g carbohydrates, and 8.3 g fat) was performed at three different times (at admission, after partial weight gain of at least 2 kg, and at discharge) and compared to healthy controls (n = 6; BMI 21.1 +/- 0.7 kg/m2). Plasma ghrelin levels were measured preprandially as well as 20 and 60 min postprandially by a commercially available radioimmunoassay (Phoenix Pharmaceuticals, USA). At admission plasma ghrelin levels significantly decreased postprandially (from 871.9 +/- 124 to 620.3 +/- 80 pg/ml 60 min after meal; P < 0.005). After partial weight gain (2.8 +/- 0.1 kg; BMI 16.1 +/- 0.3 kg/m2) postprandial ghrelin concentrations decreased from 597.0 +/- 79 to 414.7 +/- 39 pg/ml (P < 0.0001), at discharge (weight gain: 7.6 +/- 0.5 kg; BMI 17.9 +/- 0.4 kg/m2) from 570.4 +/- 78 to 395.4 +/- 44 pg/ml (P < 0.0001). Mean postprandial ghrelin decrease was not significantly different between the three tests (29, 25, and 26%, respectively) or to controls (20%). In anorectic patients mean postprandial ghrelin decrease did not change during weight gain. These findings indicate that in anorexia nervosa the suppression of ghrelin release by acute changes of energy balance (feeding) is not disturbed and that it is independent from chronic changes in energy balance (weight gain).

Adult↗
PubMed2003

Candidate genes for anorexia nervosa in the 1p33-36 linkage region: serotonin 1D and delta opioid receptor loci exhibit significant association to anorexia nervosa.

Serotonergic and opioidergic neurotransmitter system alterations have been observed in people with eating disorders; the genes for the serotonin 1D receptor (HTR1D) and the opioid delta receptor (OPRD1) are found on chr1p36.3-34.3, a region identified by our group in a linkage analysis of anorexia nervosa (AN). These candidate genes were evaluated for sequence variation and for linkage and association of this sequence variation to AN in family and case : control data sets. Resequencing of the HTR1D locus and a portion of the OPRD1 locus identified novel SNPs and confirmed existing SNPs. Genotype assay development and genotyping of nine SNPs (four at HTR1D and five at OPRD1) was performed on 191 unrelated individuals fulfilling DSM-IV criteria (w/o amenorrhea criterion) for AN, 442 relatives of AN probands and 98 psychiatrically screened controls. Linkage analysis of these candidate gene SNPs with 33 microsatellite markers in families including relative pairs concordantly affected with restricting AN (N=37) substantially increased the evidence for linkage of this region to restricting AN to an NPL score of 3.91. Statistically significant genotypic, allelic, and haplotypic association to AN in the case : control design was observed at HTR1D and OPRD1 with effect sizes for individual SNPs of 2.63 (95% CI=1.21-5.75) for HTR1D and 1.61 (95% CI=1.11-2.44) for OPRD1. Using genotype data on parents and AN probands, three SNPs at HTR1D were found to exhibit significant transmission disequilibrium (P&<0.05). The combined statistical genetic evidence suggests that HTR1D and OPRD1 or linked genes may be involved in the etiology of AN.

Anorexia Nervosa↗
PubMed2002

Genetic predisposition to obesity in bulimia nervosa: a mutation screen of the melanocortin-4 receptor gene.

Obesity has been identified as a risk factor for the development of bulimia nervosa (BN). Accordingly, we hypothesize that genotypes predisposing to obesity can be detected in patients with this eating disorder. In order to investigate this hypothesis we screened the melanocortin-4 receptor gene (MC4R) for mutations using single strand conformation analysis in 81 female inpatients treated for BN. A single patient with both extreme obesity and BN had a haplo-insufficiency mutation in the MC4R. Comparison of current and maximal body mass index (BMI) of all patients with cross-sectionally obtained BMI in the general population revealed an age appropriate distribution for current BMI and a substantially increased frequency for overweight at time of maximal BMI. Our findings suggest that overweight is a risk factor for BN in clinically ascertained patients. For the first time a genotype predisposing to obesity has been detected in an extremely obese patient with BN.

Adolescent↗
PubMed2001

[Bulimia nervosa in homosexuality and HIV infection in the man. Case report].

A male with bulimia nervosa is reported whose homosexual behavior resulted in HIV infection. The goal of this case study is to shed light on the course characteristics of bulimia nervosa occurring together with HIV infection in connection with homosexuality. The patient had experienced a number of traumas including sexual abuse, which surely had an influence on his developing bulimia nervosa. His longing for slimness, shown by the excessive preoccupation and dissatisfaction with body shape and weight may be considered typical for bulimia nervosa in homosexual men. Furthermore, male subjects with eating disorders often seem to be overweight prior to the start of bulimia nervosa, which also was the case in this subject. The course of his HIV infection so far has had no effect on severity of the bulimic symptoms. However, his bulimia nervosa apparently did had negative effects on the course of the HIV infection.

Adult↗
PubMed2001

The structured interview for anorexic and bulimic disorders for DSM-IV and ICD-10 (SIAB-EX): reliability and validity.

OBJECTIVE: For reliable and valid assessment and diagnostic categorization of eating disorders, self-report measures have considerable limitations. A semi-structured interview - the SIAB-EX - was developed for a more reliable and valid assessment of eating disorders. METHODS: One study (videotapes of 31 inpatients, seven raters) was made to establish inter-rater reliability; in another study with 80 patients the SIAB-EX was compared to another semi-structured interview designed for comparable purposes (EDE). In a third study data was obtained on 377 eating disorder patients seeking treatment to explore discriminant and convergent (construct) validity using the following self-rating scales: EDI, TFEQ, SCL-90, BDI, and the PERI Demoralization Scale. RESULTS: Inter-rater reliability of dichotomous ratings was good with mean kappa values of.81 (current) and.85 (past). Comparison of the SIAB-EX with the EDE generally showed quite similar results and higher intercorrelation of the total scale (.77). There are, however, a number of differences between the two scales, which are discussed in detail. Construct validity of the SIAB-EX was established. CONCLUSION: Inter-rater reliability was good. Convergent and discriminant (construct) validity of the SIAB-EX was demonstrated. The constructs assessed by the SIAB and its subscales and items are discussed in the context of their correlations with other well-known scales.

Adaptation, Psychological↗
PubMed2001

Weight gain decreases elevated plasma ghrelin concentrations of patients with anorexia nervosa.

OBJECTIVE: Ghrelin is a new gastric hormone that has been identified as an endogenous ligand for the growth hormone (GH) secretagogue receptor subtype 1a (GHS-R1a). Ghrelin administration however not only stimulates GH secretion but also induces adiposity in rodents by increasing food intake and decreasing fat utilization. We hypothesized that impaired ghrelin secretion in anorexia nervosa may be involved in the pathogenesis of this eating disorder. To examine this hypothesis and to further investigate the role for ghrelin in regulating energy homeostasis, we analyzed circulating ghrelin levels in patients with anorexia nervosa and examined possible correlations with clinical parameters before and after weight gain. METHODS: Plasma ghrelin levels were measured in overnight fasting plasma samples from 36 female patients with anorexia nervosa (age: 25.0+/-1.2 years, BMI: 15.2+/-0.2 kg/m(2)) before and after weight gain following psychotherapeutic treatment intervention in a psychosomatic institution. Plasma ghrelin levels were also measured in fasting plasma samples from 24 age-matched female controls (31+/-1.4 years, BMI: 22.9+/-0.45 kg/m(2)). For quantification of ghrelin levels a commercially available radioimmunoassay (Phoenix Pharmaceuticals, USA) was used. RESULTS: Fasting plasma ghrelin levels in anorectic patients were significantly higher (1057+/-95 pg/ml) than in normal age-matched female controls (514+/-63 pg/ml n=24, P=0.02). Therapeutic intervention in a psychosomatic institution caused an BMI increase of 14% (P<0.001) leading to a significant decrease in circulating ghrelin levels of 25%, (P=0.001). A significant negative correlation between Deltaghrelin and DeltaBMI was observed (correlation coefficient: -0.47, P=0.005, n=36). CONCLUSION: We show for the first time that fasting plasma levels of the novel appetite-modulating hormone ghrelin are elevated in anorexia nervosa and return to normal levels after partial weight recovery. These observations suggest the possible existence of ghrelin resistance in cachectic states such as caused by eating disorders. Future studies are necessary to investigate putative mechanisms of ghrelin resistance such as a possible impairment of intracellular ghrelin receptor signaling in pathophysiological states presenting with cachexia.

Adolescent↗
PubMed2000

Interrelationships between the size of the pancreas and the weight of patients with eating disorders.

OBJECTIVE: Starvation severely affects normal pancreatic function in children suffering from Kwashiorkor and in animals undergoing food deprivation. This study examines whether pancreatic size, as determined by ultrasound, is dependent on starvation or on eating patterns in patients with eating disorders. METHOD: In 109 inpatients with eating disorders, 86 with anorexia nervosa and 23 with bulimia nervosa, we determined the pancreatic size by means of abdominal ultrasonography before increase in weight. Twenty-four inpatients with other psychiatric disorders served as controls. Pancreatic size was defined by the maximal diameter and the length of the head, the diameter of the head at the confluence of the splenic and mesenteric veins, and the diameters of the body and tail. In 41 eating disorder patients, pancreatic size was also measured during the course of therapy and increase in weight. RESULTS: Pancreatic size correlates highly with body mass index (BMI). Counteracting actions such as purging do not seem to influence this pathophysiologic finding. Dystrophy of the pancreas is reversible in a short period of time. The increase in pancreatic size after maintenance of a normal eating pattern, however, exceeded the size expected by regression equation with an increase in the BMI. Pancreatic size seems to correlate with the actual amount of digested food. The increase in BMI is only an indicator of food intake. DISCUSSION: Pancreatic size might therefore be useful for the assessment of normalization of the eating pattern. Future research is necessary to investigate the impairment of pancreatic function resulting from dystrophy, the impact of possible pancreatic malfunction on the course of eating disorders, and the regulatory mechanisms responsible for the change of pancreatic size.

Adolescent↗
PubMed2000

[Utilization of medical and psychosocial services by mentally ill homeless persons. Results of an epidemiological study].

The aim of this study was to ascertain to what extent homeless, mentally ill subjects in Munich take advantage of available psychosocial services. To obtain a representative picture of the situation, the first step was to ascertain how many people in Munich are actually homeless. The next step was to ascertain what proportion of them are in need of psychotherapy. Using the standardized Diagnostic Interview Schedule (DIS), 146 men and 32 women were interviewed. The results according to the DSM-III demonstrated high lifelong and 6-month prevalence of psychic disturbances. Medical and social services were often enjoyed, but mostly over a short period of time in particularly critical situations. Continued treatment rarely followed. Women were treated more often than men. Elements such as age and level of education hardly influenced patients' seeking help. Despite a high prevalence of addictive disease, alcohol and drug clinics were rarely consulted. The increase in the number of diagnoses was paralleled by an increase in the number of patients seeking help. Most treatments involved schizophrenia and anxiety. By means of logistic regression models, predictors of the extent to which these services were used were analysed. We conclude that new clinical models are needed and that the aversion to the present care system is too great. Continued treatment occurs only rarely.

Adult↗
PubMed2000

[Institutional care for the very old. Results of the Munich study of the very old].

In a two-wave community study in Munich, Germany, a representative sample of 402 people older than 85 years was restudied 1 year later. In the first cross-section a total of 358 (89.1%) subjects were interviewed. One year later 263 (73.5%) subjects were reexamined. Several diagnostic systems were used. We analysed the living situation in different risk groups. Women, singles and the older ones more often lived in institutions. Women suffering from dementia and men suffering from depression were more often in homes. Need for care and subjective health status influenced the living situation.

Aged↗
PubMed2000

Perfectionism in anorexia nervosa: variation by clinical subtype, obsessionality, and pathological eating behavior.

OBJECTIVE: The purpose of this study was to examine the role of perfectionism as a phenotypic trait in anorexia nervosa and its relevance across clinical subtypes of this illness. METHOD: The Multidimensional Perfectionism Scale and the perfectionism subscale of the Eating Disorder Inventory were administered to 322 women with a history of anorexia nervosa who were participating in an international, multicenter genetic study of anorexia nervosa. All participants were additionally interviewed with the Yale-Brown Obsessive Compulsive Scale and the Yale-Brown-Cornell Eating Disorder Scale. Mean differences on dependent measures among women with anorexia nervosa and comparison subjects were examined by using generalized estimating equations. RESULTS: Persons who had had anorexia nervosa had significantly higher total scores on the Multidimensional Perfectionism Scale than did the healthy comparison subjects. In addition, scores of the anorexia subjects on the Eating Disorder Inventory-2 perfectionism subscale exceeded Eating Disorder Inventory-2 normative data. For the anorexia nervosa participants, the total score on the Multidimensional Perfectionism Scale and the Eating Disorder Inventory-2 perfectionism subscale score were highly correlated. Total score on the Multidimensional Perfectionism Scale was also significantly related to the total score and the motivation-for-change subscale score of the Yale-Brown-Cornell Eating Disorder Scale. CONCLUSIONS: These data show that perfectionism is a robust, discriminating characteristic of anorexia nervosa. Perfectionism is likely to be one of a cluster of phenotypic trait variables associated with a genetic diathesis for anorexia nervosa.

Adolescent↗
PubMed1999

Alcoholism in homeless men in the mid-nineties: results from the Bavarian Public Health Study on homelessness.

Parallel to structural economic changes homelessness has become publicly more visible and has received increased media attention in Western industrialized countries. Most studies on mental illness and homelessness in recent years were carried out in North America but only few studies in Europe have dealt with these issues. The goals of the present study were (1) to assess alcohol abuse and dependence as well as other mental disorders in a representative sample of homeless men in Munich using reliable methods of case identification (Structured Clinical Interview for DSM-IV (SCID)), (2) to compare homeless alcoholics with homeless non-alcoholics in our sample on relevant variables, and (3) to compare our data from the Munich sample with data obtained by others. According to our results, the life-time prevalence of any SCID-DSM-IV Axis I diagnoses was 93.2% and the lifetime prevalence of substance use disorder was 79.6%. The single most prevalent diagnosis among homeless males in Munich was alcohol dependence (life-time 72.7%); alcohol abuse (life-time 5.5%) and drug abuse/dependence were considerably lower in prevalence (life-time 19.1%) (weighted data). A higher rate of psychotic disorders was found for non-alcoholic homeless men. Data show that alcoholism and its consequences were more severe in the Munich as compared to North American samples. Homeless alcohol dependent men showed a high comorbidity with other mental disorders (life-time) such as mood disorders (36.4%), anxiety disorders (16.4%), drug abuse/dependence (18.9%) and psychotic disorders (4.5%). Of those with alcohol dependence at some time during their life 59.1% had experienced at least one other life-time mental disorder. Alcohol-related behavioral patterns and symptoms as well as general social functioning are described. Considering the very high prevalence of alcohol dependence (frequently in combination with other mental disorders), the participation in alcohol rehabilitation and other services as well as self-help groups was rather low among Munich homeless alcoholics. Currently homeless men in Germany are adequately supplied with food, clothes, and shelter but psychiatrically (and medically) neglected. Existing concepts and programs for dealing with these problems need to be implemented.

Adolescent↗
PubMed1999

Cross-cultural comparison of depressive symptoms in Europe does not support stereotypes of ageing.

BACKGROUND: Stereotypes of older people suggest that they are depressed. AIMS: To examine depression symptoms among people aged > or = 65 in the general population and to ask the following questions. Are there high proportions of depressive symptoms among otherwise well people? Do these levels reflect the prevalence of depression? Do key symptoms vary with age and do they confirm stereotypes? METHOD: Nine centres contributed data from community-based random samples, using standardised methods (GMS-AGECAT package). RESULTS: Proportions of depressive symptoms varied between centres. Some often associated with ageing were rare. Many were more common in women. Low-prevalence centres tended to have fewer symptoms among 'well' people, but there were inconsistencies. Low levels of symptoms among the well population of a centre did not necessarily predict lower levels in the depressed. CONCLUSIONS: Variations in the prevalence of depressive symptoms occurred between centres, not always related to levels of illness. There was no consistent relationship between proportions of symptoms in well persons and cases for all centres. Few symptoms were present in > 60% of the older population--stereotypes of old age were not upheld.

Age Factors↗
PubMed1999

Development of the EURO-D scale--a European, Union initiative to compare symptoms of depression in 14 European centres.

BACKGROUND: In an 11-country European collaboration, 14 population-based surveys included 21,724 subjects aged > or = 65 years. Most participating centres used the Geriatric Mental State (GMS), but other measures were also used. AIMS: To derive from these instruments a common depression symptoms scale, the EURO-D, to allow comparison of risk factor profiles between centres. METHOD: Common items were identified from the instruments. Algorithms for fitting items to GMS were derived by observation of item correspondence or expert opinion. The resulting 12-item scale was checked for internal consistency, criterion validity and uniformity of factor-analytic profile. RESULTS: The EURO-D is internally consistent, capturing the essence of its parent instrument. A two-factor solution seemed appropriate: depression, tearfulness and wishing to die loaded on the first factor (affective suffering), and loss of interest, poor concentration and lack of enjoyment on the second (motivation). CONCLUSIONS: The EURO-D scale should permit valid comparison of risk-factor associations between centres, even if between-centre variation remains difficult to attribute.

Age Distribution↗