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Biomedical subjects

M M Fichter

Publications and source records attributed to M M Fichter.

At least 37 records · Page 2Linked to original sources
PubMed1999

Mortality risk in the octo- and nonagenerians: longitudinal results of an epidemiological follow-up community study.

The object of the study was the assessment of the mortality risk for persons in a representative two-wave community sample assessed longitudinally. In the first cross-section a total of 358 (89.1%) subjects of Munich, Germany, aged 85 years and above were interviewed by research physicians. One year later 263 (73.5%) persons were reexamined. Death certificate diagnoses were obtained after an interval of 4 years 8 months. 58% of the total sample were deceased. Sociodemographic factors, mental disorders, subjective health status and need for care were analysed in relation to mortality by Cox regression. The probability of death was increased in those diagnosed as having a dementia or depressive disorder, in those of increasing age, living in institutions, being in need of care and of bad health status. In the multi-variate Cox regression model the influence of these different factors was examined and evaluated. Need for care was the most powerful predictor of mortality.

Age Factors↗
PubMed1998

[Anorectic and bulimic eating disorders--new developments. 1: Definitions, clinical manifestations and etiopathogenesis].

In western industrial countries, anorectic and bulimic eating disorders have appreciably increased in recent decades. For the most part, but not exclusively, the victims of such disorders are young women. The eating disorders may be understood as a failed attempt to resolve such problems as feelings of insecurity, anxiety and a lack of self-esteem. Anorexia nervosa continues to be a very serious illness with a high mortality rate. Numerous medical complications can be observed in anorexia nervosa and in bulimic eating disorders in normal-weight (bulimia nervosa) and overweight (binge eating disorder) patients. The etiology is multifactorial. Bulimic eating disorders (bulimia nervosa) in particular, whether in normal-weight or overweight patients, have recently been investigated scientifically.

Adolescent↗
PubMed1998

[Anorectic and bulimic eating disorders--new developments. 2: Spectrum of evaluated therapy measures].

Therapeutic approaches to eating disorders--in particular the restrictive form of anorexia nervosa--should, in the first instance, be directed towards improving the patient's physical state of health. In addition, psychotherapeutic management of the interoceptive and emotional perception disturbances that are also usually present makes good sense (e.g. by cognitive behavioral therapy, video confrontation of the patient with her own appearance). On the other hand, disturbances in emotional expression also need to be addressed, and inadequate social skills improved. On an individual basis, the question must be investigated as to how far chronic stress, and/or major events in the patient's life are involved, or whether conflicts within the family or a partnership may be of significance for the initiation and maintenance of an eating disorder.

Adolescent↗
PubMed1998

Structured Interview for Anorexic and Bulimic disorders for DSM-IV and ICD-10: updated (third) revision.

OBJECTIVES: Earlier versions of the Structured Interview for Anorexic and Bulimic Disorders (SIAB) were modified in order to include new research findings and to update the expert rating interview to the diagnostic criteria of DSM-IV and ICD-10. The semistandardized interview was developed for reliable and valid assessment of the specific as well as the general psychopathology of eating disorders. METHOD: Data from SIAB-EX interviews (current and past/lifetime symptom expression) were available from three samples: (a) 330 eating-disordered patients assessed at the start of treatment, (b) 148 former eating-disordered patients with anorexia nervosa (AN) or bulimia nervosa (BN) assessed at follow-up, and (c) 111 community controls. Sixty-one of the 87 items of the SIAB-EX with a 5-point scale were factor analyzed. RESULTS: Principal components analyses with varimax rotation produced the following six components of the SIAB-EX (lifetime): (I) Body Image and Slimness Ideal; (II) General Psychopathology; (III) Sexuality and Social Integration; (IV) Bulimic Symptoms; (V) Measures to Counteract Weight Gain, Fasting, and Substance Abuse; and (VI) Atypical Binges. The factor solution for the current symptom expression was very similar to that based on lifetime symptom expression. Average item and factor scores are given for six groups of eating-disordered patients and controls. High interrater reliability was established for both current and the past symptom expression. Cronbach's alpha coefficients indicated good internal consistency for five of the six components of the SIAB-EX. DSM-IV and ICD-10 diagnoses for eating disorders can be derived directly or by using a computer algorithm from the SIAB-EX. A detailed 90-page manual facilitates the training of interviewers. CONCLUSION: The 87-item SIAB-EX was originally developed for detailed assessment of eating disorders cross-sectionally and longitudinally. The updated version which allows for diagnosis according to DSM-IV and ICD-10 is described here.

Adult↗
PubMed1997

Six-year course of bulimia nervosa.

OBJECTIVE: Because little is known about the longer-term course of bulimia nervosa, the 2- and 6-year course and outcome of 196 consecutively treated females with bulimia nervosa-purging type (BN-P) was assessed. METHOD: One hundred ninety-six females with BN-P were assessed longitudinally at four points of time: at the beginning of therapy, at the end of therapy, at 2-year follow-up, and at 6-year follow-up. Self-rating scales as well as expert ratings from interview data were used. Eating disorder specific and general psychopathology was assessed. RESULTS: The general pattern of results over time showed substantial improvement during therapy, a slight (in most cases nonsignificant) decline during the first 2 years after treatment, and further improvement and stabilization from 3 to 6 years posttreatment. At 6-year follow-up, 20.9% had BN-P, 0.5% BN-nonpurging type (BN-NP), 1.1% had shifted from BN to binge-eating disorder, 3.7% had anorexia nervosa, 1.6% were classified as eating disorder not otherwise specified (ED-NOS), and 2 patients had died; obesity with a body mass index (BMI) of > 30 was seen in 6.0%; the majority (71.1%) showed no major DSM-IV eating disorder. CONCLUSIONS: Based on a composite global outcome score at 6 years follow-up, 59.9% achieved a good outcome, 29.4% an intermediate outcome, 9.6% a poor outcome, and 2 (1.1%) persons were deceased. Course and outcome were generally more favorable than in anorexia nervosa.

Adult↗
PubMed1997

Risk factors and psychosocial consequences in depression of octo- and nonagenerians: results of an epidemiological study.

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. The probands showed a high prevalence of depression--nearly one quarter of the interviewees. In this extreme age group gender differences in depression were minimal. Depressive were distinctly impaired in daily life. Depressive probands were more often found in institutions than in private households. Depressives were high users of the medical care system, but very rarely treated by specialists. Need for care and certain specific especially threatening life events were identified as risk factors for depression.

Aged↗
PubMed1997

How disabled are patients with somatoform disorders?

The purpose of this study was to evaluate the level and quality of psychosocial disabilities in patients suffering from somatoform disorders (SFD). Of 221 patients referred for psychiatric and cognitive-behavioral inpatient treatment, 37 were diagnosed according to DSM-IV as having SFD, 56 as pain disorder, 70 met the criteria for the subsyndromal form of SFD called the "Somatic Symptom Index" (SSI). The control group consisted of 58 patients with other mental disorders. All patients completed the Dysfunctional Analysis Questionnaire (DAQ) which measures social, vocational, personal, familial, and cognitive disabilities on psychometric scales. The results showed substantial disabilities in all somatoform subgroups; however, the levels and patterns of dysfunction in these patients were not statistically different from those in the control group. Impairment was generally more severe when patients had a comorbidity of somatoform and affective disorders. It is concluded that SFDs are associated with marked psychosocial disabilities similar to those seen in other mental disorders. The strongest predictor for psychosocial dysfunction is the comorbidity of somatoform with affective disorders, but not with anxiety disorders.

Adult↗
PubMed1997

Effects of fluvoxamine on depression, anxiety, and other areas of general psychopathology in bulimia nervosa.

The efficacy of fluvoxamine in maintaining improvement of general psychopathology (depression, obsessive-compulsive symptoms, anxieties, interpersonal trust, and body perception) was tested in a double-blind placebo-controlled study of 72 patients with bulimia nervosa who were being treated successfully with inpatient behavioral psychotherapy. Over a period of about 15 weeks (2-3 weeks inpatient titration phase, 12 weeks outpatient relapse-prevention phase), fluvoxamine or placebo were given. The relapse-prevention design was used to avoid potential confounding effects of other concomitant treatments. Assessments concerning general psychopathology were made on the basis of expert ratings (CGI, HDRS) and self ratings (HSCL, Eating Disorders Inventory (EDI)-subscales "ineffectiveness," "perfectionism," "maturity fears," "interpersonal distrust," and "interoceptive awareness"). Fluvoxamine had significant effects in preventing relapse as measured on the basis of the Clinical Global Impression (CGI) scale "severity of illness", and a positive trend for relapse preventing effects was observed for the HSCL "general symptomatic index". Further, a relapse preventing effect was observed for the HSCL subscale "obsessive-compulsive symptoms", but not for the EDI subscale "perfectionism". Various dependent variables measuring depression showed no significant relapse-preventing effects of fluvoxamine, but only positive trends. Fluvoxamine had no relapse preventing effects according to our results for dependent variables assessing anxieties, interpersonal trust, and body perception. During a final short (4-week) off-medication phase, no statistically significant effects of discontinuation of medication, but some trends in the expected directions, were observed.

Adult↗
PubMed1997

Family climate and expressed emotion in the course of alcoholism.

Family-based predictors of relapse were examined in 100 alcoholics who participated in a 12-week treatment program with 6-month and 18-month followups. "Expressed Emotion" (EE), or attitudes of relatives toward the alcoholic as measured by the Camberwell Family Interview, scales measuring rejection of the alcoholic by relatives, and self-reports of partner interaction were evaluated as possible predictors of abstinence. During therapy, partnership interactions showed a transient deterioration with increased temporary friction. Based on conservative criteria, the abstinence rate was 40% at 6-month followup and 30% at 18-month followup. An association with the relapse at followup could be obtained for the Patient Rejection Scale (PRS) and, using empirically derived classification rules, for the main three variables of the Camberwell Family Interview (CFI) conducted on admission: "Critical Comments," "Emotional Overinvolvement," and "Warmth." A low number of Critical Comments and a high score in Warmth were associated with a lower risk of relapse; however, contrary to expectations, Emotional Overinvolvement of the significant other was associated with more abstinence. In addition, the number of Critical Comments made by relatives about the alcoholic, a major component of high EE as measured by the CFI, had a statistically significant impact on the "survival function" of abstinence, and thus contributed to the prediction of the course of alcoholism in the expected direction.

Adult↗
PubMed1996

What does the Toronto Alexithymia Scale TAS-R measure?

One hundred seventy four inpatients of a psychosomatic hospital were examined with the revised version of the Toronto Alexithymia Scale TAS-R, as well as further measures of emotionality, somatization, psychopathology and personality. A significant association was found between TAS alexithymia and the number of somatoform symptoms. This association, however, disappeared when it was corrected for the possible impact of depression. The factor 1 of the TAS (ability to describe feelings to others) correlated significantly with the use of negative emotional words. Thus TAS alexithymics do not use less, but more emotional words, especially words describing negative feelings. The validity of factor 2 (externally oriented thinking) seems to be low. TAS alexithymia may measure specific aspects of depression or general distress.

Adult↗
PubMed1996

Mental illness in a representative sample of homeless men in Munich, Germany.

The aim of the study was to reliably assess the 6-month and lifetime prevalence of mental illness according to DSM-III criteria in a representative sample of homeless individuals in the city of Munich, Germany. Because the characteristics of the homeless population were unknown, we first conducted a pre-sampling survey to determine a proportionate allocation of the main interviews in three nested sampling strata. For the pre-sampling we approached 300 males, who appeared to be homeless, for a brief interview; of these, 271 were homeless according to our definition and were allocated to one of three sectors ("shelter", "meal services", "outdoor"). Thereafter, we randomly sampled homeless males in these three strata until the indicated allocations were met. The Diagnostic Interview Schedule (DIS) was used for diagnostic classification according to DSM-III in the main interview. Results from this representative urban sample show that the mean age of the homeless males was 43 years; most were unmarried or divorced, had a relatively low level of school education and a long duration of homelessness. Based on the main interviews with 146 homeless males the following lifetime prevalence rates were obtained: 91.8% for substance use disorder (82.9% alcohol dependence), 41.8% for affective disorders, 22.6% for anxiety disorders and 12.4% for schizophrenia. Of the homeless males in Munich, 94.5% had at least one DIS/DSM-III axis I diagnosis. Six-month prevalence data is also presented. Results are compared with those of a very similar study on homeless individuals in Los Angeles, which also used DIS/DSM-III diagnoses. In comparison with representative community samples in the United States and in Germany, mental illness was much more frequent among homeless individuals in Munich as well as in Los Angeles. Implications for health care planning are discussed.

Adult↗
PubMed1996

Incidence of dementia in a Munich community sample of the oldest old.

In a two-wave community study a representative sample of 402 very old people (older than 85 years) was restudied 1 year later. Four instruments in the clinical examination were used for case identification: (a) the Geriatric Mental State Interview (GMS-A); (b) the Structured Interview for the Diagnosis of Dementia (SIDAM); (c) the Global Deterioration Scale (GDS); and (d) the Mini Mental State Examination (MMSE). The clinical examination was performed by the interviewing physician who made a diagnosis according to DMS-III-R. The focus of the present study is on the (true) incidence of dementia in a representative community sample. The establishment of incidence rates is particularly important for dementia because the prevalence of dementia is affected by the length of survival, which is reduced in dementia and with increasing age. The annual incidence rates per 1000 person years on the basis of the SIDAM DSM-III-R were 116.6 for all cases at risk, 113.6 for those aged 85-89 years, 112.5 for those aged 90-94 years and 235.7 for those aged 95 years and older at first assessment (t1). Incidence rates based on the other methods of assessment are reported. In order to obtain the most meaningful estimate of incidence rates a compound dementia diagnosis was defined. According to this the annual incidence rate per 1000 person years was 144.1 for all persons at risk. The incidence rate tended to be higher in the older-age cohorts: It was 126.2 for those aged 85-89 years, 193.1 for those aged 90-94 years and 295.5 for those aged 95 years and older. In comparison with the literature the incidence rates were high. The results are plausible when the very old age of the sample is taken into account.

Cohort Studies↗
PubMed1996

Incidence of depression in octo- and nonagenerians: results of an epidemiological follow-up community study.

The incidence rate of depression in very old people was examined. In a two-wave community study of 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%) subjects were interviewed. One year later 263 (73.6%) subjects could be reexamined. Only persons with two examinations were included for analysis of incidence. Several diagnostic systems were used. According to the project diagnosis of 203 persons at risk, 25 subjects suffered 1 year later from depression. The incidence rate amounted to 133.49 per 1000 person years at risk. According to the project diagnosis of 203 persons at risk, 25 subjects suffered 1 year later from depression. The incidence rate amounted to 133.49 per 1000 person years at risk. According to the GMS-A computer AGECAT diagnosis the incidence rate amounted to 140.97 per 1000 person years at risk. The younger age cohort, persons with changing living situations and subjects suffering from dementia in the first cross section had a higher risk for depression. The results were not significant.

Aged↗
PubMed1996

Fluvoxamine in prevention of relapse in bulimia nervosa: effects on eating-specific psychopathology.

In a double-blind, placebo-controlled study of 72 patients with bulimia nervosa treated successfully with inpatient psychotherapy, the efficacy of fluvoxamine in maintaining improvement was tested. Fluvoxamine and placebo, respectively, were given over a period of about 15 weeks (2-3 weeks inpatient titration phase, 12 weeks outpatient relapse-prevention [maintenance] phase). The variables assessed concerned bulimic behavior and other aspects of eating disorders, global status, depression, anxieties, obsessive-compulsive behavior, and other aspects of psychopathology. Because the dropout rate was relatively high (N = 27 [33%]) and because it was considerably higher in the fluvoxamine group (19 out of 37 subjects), analyses were performed on the intent-to-treat sample (ideally including all 72 subjects). Results of the completer sample analyses (including only those subjects who finished the study) are briefly presented for comparison. In both the intent-to-treat and the completer analyses, the following scales showed fluvoxamine to have a significant effect in reducing the return of bulimic behavior: (1) self-ratings: Eating Disorder Inventory (EDI)-bulimia, urges to binge in previous week and the number of actual binges in the previous week; (2) expert ratings: Psychiatric Status Rating Scales for Bulimia nervosa, Structured Interview for Anorexia and Bulimia nervosa (SIAB)-"total score," SIAB-subscale "fasting," and SIAB-subscale "vomiting." Two further variables (EDI-total score and SIAB-subscale "bulimia") showed the superior relapse prevention effects of fluvoxamine compared with placebo for the completer sample, while they did not reach significance for group-by-time interactions in the intent-to-treat sample. During a final, short (4-week) off-medication phase, no effect of the discontinuation of medication was observed.

Adolescent↗
PubMed1996

Prevalence of mental illness in Germany and the United States. Comparison of the Upper Bavarian Study and the Epidemiologic Catchment Area Program.

The objective of the present study was to compare data on the prevalence of mental illness in Germany and the United States. For this purpose, data from the Upper Bavarian Study (UBS) and the Epidemiologic Catchment Area (ECA) are presented and compared. In both studies, personal interviews were administered to a sample of community residents. The UBS sample consisted of 1,847 persons aged > or = 18 years, and the ECA study consisted of 24,371 household members aged > or = 18 years in five sites; 1,876 persons from the ECA sample lived in rural sites, and they were used for comparison with the (rural) UBS sample. The diagnostic classification (according to DSM-III) obtained by clinical interviewers in the UBS and by lay interviewers in the ECA was used. The total 6-month prevalence for any axis I Diagnostic Interview Schedule mental disorder (corrected for sample stratifications and adjusted for age) was 18.5% in the (rural) UBS, 18.0% in the total ECA sample (five sites), and 13.4% in the rural sites of the ECA. High morbidity rates for substance use disorders (UBS, 5.8%; ECA rural sites, 3.4%) and affective disorders (UBS, 6.8%; ECA rural sites, 4.1%) were observed in both studies. The 6-month prevalence rates for alcohol use disorders (3.1% considered marked or severe) were 5.1% in the UBS and 2.9% in the ECA rural sites. Concerning anxiety disorders (UBS, 1.6%; ECA rural sites, 6.7%) there was a substantial difference between the studies, which mainly resulted from a higher prevalence of phobia in the ECA program. There were higher rates of dysthymia (3.8% considered marked or severe) in the UBS (5.4%) than in the ECA rural sites (2.6%), whereas the rate of major depression was somewhat lower in UBS (1.4%) as compared with the ECA rural sites (2.4%). Alcohol use disorder was the most frequent category of mental disorder for men in both studies; for women, affective disorder and phobia (in the ECA) were the most frequent categories. Despite differences in methodology concerning sampling, instruments, and case identification the similarities between the results of the two studies were considerable.

Adolescent↗
PubMed1996

The classification of multiple somatoform symptoms.

This study evaluated the concordance among different approaches to diagnose patients with multiple somatoform symptoms. Inpatients (N = 108) of a center for behavioral medicine were diagnosed using a structured clinical interview. Somatization disorder according to DSM-IV and ICD-10 was as rare as somatization disorder according to DSM-III-R. The overlap between the criteria of DSM and ICD for somatization disorder was lower than that between DSM-III-R and DSM-IV. Somatoform autonomic dysfunction, a diagnostic category proposed by ICD-10, included fewer patients diagnosed with somatization disorder than the criteria of Escobar and colleagues for abridged somatization disorder (SSI-4/6: this Journal 177:140-146, 1989). Therefore, the Escobar criteria may be a common link between ICD-10 and DSM-IV. Although the original Escobar criteria were built upon the symptom list of DSM-III-R somatization disorder, SSI-3/5 is an empirically derived equivalent according to DSM-IV in our study (a minimum of 3 symptoms for men or 5 symptoms for women out of the list of 33 somatization symptoms according to DSM-IV).

Adult↗
PubMed1995

Physical activity, total energy expenditure, and food intake in grossly obese and normal weight women.

The doubly labeled water method was used to measure average daily total energy expenditure (TEE) in 10 healthy normal weight women classified as unrestrained eaters and in 10 grossly obese women. The body mass index was 20.0 +/- 1.3 kg/m2 in the control group and 37.4 +/- 8.1 kg/m2 for the obese group. TEE was measured over a 2-week period. TEE was 2,357 +/- 504 kcal/day for the controls and 3,708 +/- 367 kcal/day for the obese group during a cognitive-behavioral treatment.

Adult↗