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M Hambrecht

Publications and source records attributed to M Hambrecht.

At least 37 records · Page 2Linked to original sources
PubMed1994

Beginning schizophrenia observed by significant others.

As a part of the ABC Schizophrenia Study, a large-scale investigation of the influences of age and gender on the onset and course of schizophrenia, this study compared retrospective reports about emerging symptomatology during the early course of schizophrenia given by patients and their significant others in a representative first admission sample. The Interview for the Retrospective Assessment of the Onset of Schizophrenia (IRAOS), a comprehensive interview assessing early signs and symptoms, revealed that, in most cases, patients as well as informants perceived negative, depressive, and unspecific symptoms as early signs of the disorder. Pairwise agreement about the presence of certain symptoms was good for a limited number of signs, e.g., substance abuse, suicidal behavior, parental and marital role deficits, and paranoid delusions. These items mainly concern abnormal behaviors that can be observed easily. In contrast, there was little agreement between reports about perceptual and formal thought disorder, i.e., subjective internal phenomena. The results supported a continuity model for the observability of symptoms in schizophrenia.

Adolescent↗
PubMed1993

Causal attributions in psychiatric patients.

An instrument for a systematic assessment of attributions that psychiatric patients have about their disorder is presented together with some preliminary results, for example on differences between sex and diagnostic groups. The comparison with a sample of (mostly untreated) students demonstrates that causal attributions in psychiatric patients should be assessed with specifically designed instruments. The presented scale may help to investigate longitudinally the course of causal attributions during treatment.

Adult↗
PubMed1993

Evidence for a gender bias in epidemiological studies of schizophrenia.

A higher lifetime morbidity risk for schizophrenia in males has been observed by several investigators. Studies controlled for errors in patient selection and other sources of artefacts, however, find an equal risk in both sexes. In order to detect the causes for the underrepresentation of women in many studies, sample composition of multicentre WHO studies was analysed. Severity of symptoms was not found to be responsible for imbalances in the male/female ratios, but cultural influences and design characteristics were: due to the scarcity of psychiatric facilities, women are less likely to receive adequate treatment in most of the developing countries investigated, since they are kept longer at home and seen by traditional healers in some cultures. Also, studies with an upper age limit of 44 years (according to DSM-III) exclude a greater proportion of female than male schizophrenic patients, and there is some evidence that schizophrenia is more often underdiagnosed in women than in men at least in some countries. Implications for future research on gender differences in schizophrenia are discussed.

Adult↗
PubMed1993

["Trema, apophany, apocalypse"--is Conrad's phase model empirically founded?].

Among several phase models of beginning schizophrenia, the study by Conrad ("Die beginnende Schizophrenie. Versuch einer Gestaltanalyse des Wahns") was particularly impressive in German psychiatry. The ABC-Schizophrenia-study with its representative sample of 267 first-admissions and a careful retrospective assessment of emerging symptomatology made it possible to test the empirical basis of Conrad's model. In this operationalization "trema" was confirmed as the frequent first stage of the disease process, whereas Conrad's hypothesized order of the two following phrases (first "apophany", then "apocalypse") could not be validated. Therefore, Conrad's model cannot completely be generalized. Because the methods employed so far have some limitations, analyses of additional data (especially reports by significant others) may control and probably enhance the presented results.

Adolescent↗
PubMed1993

[A chapter in systematic schizophrenia research--the search for causal explanations for sex differences in age of onset].

With the aim of detecting causal processes contributing to the onset of schizophrenic symptoms a systematic search strategy was worked out. One of the few epidemiological findings on schizophrenia consistently diverging from expected values, the sex difference in age at first admission, was taken as a basis and replicated on data from the Danish and the Mannheim case registers by controlling for selection and diagnostic artefacts. Danish psychiatrists turned out to have underdiagnosed schizophrenia to a considerable extent at least in 1976, the year from which the analysed case-register data dated. After the exclusion of alternative explanations, the time when symptoms appeared for the first time and the first acute episode occurred was determined for a representative sample of 267 first-admitted cases with a diagnosis of non-affective functional disorder by using the IRAOS interview designed for this purpose. At any of the definitions of first onset applied the mean age of females was significantly higher than that of males, the difference ranging from 3.2 to 4.1 years. The distribution of onsets across the female life cycle showed a clearly delayed increase at young age and a second, lower peak of onsets at the age of 45-54, whereas the cumulative incidence up to the age of 60 years was equal for males and females. On assessing the plausibility of psychosocial versus biological explanations it was hypothesized that due to the effect of estrogens the vulnerability threshold for schizophrenia is raised in females until the menopause. Animal experiments and postmortem analysis showed that chronic estrogen applications significantly shortened dopamine-induced behaviour and reduced D2 receptor sensitivity in the brain. The applicability of this pathophysiological mechanism on human schizophrenia was tested on acutely schizophrenic females with normal menstrual cycles. A significant negative correlation was found between measures of symptomatology and plasma estrogen levels. Apparently, the manifestation of schizophrenic symptoms is influenced by a sufficiently sensitive D2 receptor system in the brain, blocked by neuroleptics and modulated by estrogens.

Adolescent↗
PubMed1993

[Pseudo-hallucinations after long-term lithium treatment].

A 58-year old women with a history of recurrent depressive episodes had been on successful prophylaxis with lithium carbonate in controlled therapeutic dosage for 11 years. At this time she experienced with increasing frequency mostly visual, sometimes auditory pseudohallucinations which disappeared after stopping the lithium medication. Because a subsequent depressive episode did not respond to tricyclic antidepressants or to a MAO-inhibitor the patient was again prescribed lithium. At therapeutic lithium blood levels the previous perceptual disorders then returned.

Depressive Disorder↗
PubMed1992

Gender differences in schizophrenia in three cultures. Results of the WHO collaborative study on psychiatric disability.

As part of a systematic research project on the influence of gender factors on age at onset, symptomatology, and course of schizophrenia, data on gender differences in age at onset and symptomatology of schizophrenia from the WHO Collaborative Study "On Assessment and Reduction of Psychiatric Disability" were compared between seven research centres of three different cultural regions. Results on age at onset of five European centres confirmed the well known fact of an earlier onset in men. The earlier onset in women seen in Khartoum and Ankara could be attributed to patient selection because male/female differences in age at onset and male/female ratios in the various samples covary. In the Islamic centres no relevant gender differences in real age at onset and in symptomatology could be detected as probable causes of earlier hospitalisation of women. Major gender differences in symptomatology were found in the Balkan centres of Sofia and Zagreb with a high prevalence of delusional symptoms in women and depression in men. In Western Europe centres, nuclear schizophrenic symptoms were equally prevalent in either sex, while nonspecific symptoms like irritability and tiredness (more frequent in women) and maladaptive illness behaviours like alcohol abuse and social withdrawal (more frequent in men) differed between the sexes. Explanatory hypotheses and the implications of these results are discussed.

Adult↗
PubMed1992

Transnational stability of gender differences in schizophrenia? An analysis based on the WHO study on determinants of outcome of severe mental disorders.

Gender-specific analyses of the multinational WHO-Determinants of Outcome-Study (including 1,292 cases from 10 countries) demonstrate the transnational stability of major findings on gender differences in schizophrenia: Male patients have an earlier mean age at onset in all countries. In female patients, the distribution of the age at onset shows a second peak after age 40 years. No gender differences on nuclear symptoms of schizophrenia can be detected, but on uncharacteristic symptoms, particularly some aspects of the illness behaviour, differences appear. This investigation supports the transcultural validity of gender differences found in the German ABC-Schizophrenia-Study and in the Danish-German Psychiatric Case Register studies.

Adult↗
PubMed1992

IRAOS: an instrument for the assessment of onset and early course of schizophrenia.

Since Kraepelin's first description of dementia praecox in 1889 many data and theories have been published on the onset and course of schizophrenia. Until now studies on these topics had to rely on first admission data and on the subsequent course of the disease. However, first hospitalisation is preceded by a wide variety of patterns and duration of the early course. Items taken from the pre-admission phase of the disease are often incorrectly used as premorbid characteristics, understandably preceding the subsequent course and outcome of schizophrenia with high predictive power. In relation to our interest to study the beginning of schizophrenia, systematically, paying special attention to the age and gender distribution of true onset and the symptomatology and pattern of the early and later course, we developed an 'Interview for the Retrospective Assessment of the Onset of Schizophrenia (IRAOS)'. It allows an objective, reliable, and valid assessment of the symptoms, psychological impairments, demographic and social characteristics as well as the referring points in time of the early course of psychosis. The instrument is administered as a semi-structured interview with both the patient and a key informant. The obtained information is extended by a systematic examination of the clinician's case notes. Some results derived from an ongoing study on age and gender differences in onset and patterns of early course are added to demonstrate the use of the instrument.

Combined Modality Therapy↗
PubMed1992

[Are sex differences in schizophrenia stable on a transnational basis?].

The ABC-Schizophrenia-Study (Häfner et al. 1991), investigating a large, representative sample of 267 first admissions, did not find any gender differences in the lifetime morbidity risk for this disorder or in the frequency of nuclear symptoms in male and female schizophrenic patients. Marked gender differences, however, could be detected regarding the age at onset and its distribution and regarding illness behavior and certain secondary symptoms. The transnational stability of these findings was tested with data from the WHO studies "On Assessment and Reduction of Psychiatric Disability" (including 510 patients from 7 centres) and on "Determinants of Outcome of Severe Mental Disorders" (with 1,292 patients from 11 centres). Studying pooled data sets from the studies minimized centre-specific selection effects on sampling. Major results of the ABC-Schizophrenia-Study were validated: the lack of a gender difference in the morbidity risk (cumulative lifetime incidence rates) for schizophrenia; lower mean age at first admission in males; an early, marked peak in the distribution of the age at onset in males; a later and broader peak in this distribution in females with a second peak after age 40-45; equal frequency of nuclear symptoms in both sexes; gender differences in some specific contents of delusions, secondary affective symptoms, social adjustment and illness behavior.

Adult↗
PubMed1991

Treating ourselves vs. treating our clients: a replication with alcohol abuse.

In an attempt to replicate previous findings, this study compared the change processes that psychologists report using when treating clients (n = 132) and when treating themselves (n = 140) for alcohol abuse. The results essentially replicated earlier research in that employment of particular change processes varied as a function of theoretical orientation for psychologists' client change but not for psychologists' self-change. Several processes, such as stimulus control and self-liberation, were employed more often with self-change, but medication more often with clients. Five possible explanations for this pattern and a general "facilitation effect" are discussed.

Adaptation, Psychological↗
PubMed1991

[A computer algorithm for diagnostic assessment with DSM-III in the early course of schizophrenic diseases].

The purpose of the computer algorithm described here is the evaluation of diagnostic criteria according to DSM-III for schizophrenia and schizophreniform disorders. It also dates the first time point of the assessment of these diagnoses. The necessary information comes from a semistructured interview, called IRAOS (Interview for the Retrospective Assessment of the Onset of Schizophrenia). With this interview early indicators of a beginning schizophrenia can be evaluated in their chronological order and their type of course. The algorithm was first used in a sample of patients admitted for the first time with a diagnosis of either schizophrenia or paranoid psychosis. One third of these patients fulfills the DSM-III-criterion of a duration of at least six months. The other patients fulfill criterion B of a schizophreniform disorder. To strengthen the validity of a diagnosis including the criteria A up to E successively, the sample is reduced to 70%. The average time point of the first assessment of the diagnosis by the computer algorithm is about 1.5 years before the index-admission. Together with the IRAOS the computer algorithm allows an operationalized assessment of the real onset of schizophrenia.

Adult↗