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Biomedical subjects

M M Fichter

Publications and source records attributed to M M Fichter.

At least 55 records · Page 3Linked to original sources
PubMed1995

Cognitive impairment and depression in the oldest old in a German and in U.S. communities.

Data on cognitive impairment in the oldest old is reported comparing two different samples, one in Munich, Germany, and the other in the United States (Epidemiologic Catchment Area [ECA] study). In both studies the Mini Mental State Examination (MMSE) was used for assessing cognitive impairment. The Munich sample consisted of 402 and the ECA sample of 827 very old people aged 85 years and above. The results indicate that approximately 40% of each sample scored below 24 points in the MMSE indicating at least mild cognitive impairment. Severe cognitive impairment was found in 13.4% of the Munich and in 14.6% of the American sample. The prevalence of major depression was 1.4% in Munich and 2.0% in the ECA study, and dysthymia was found in 5.1% in the Munich and in 2.0% in the ECA sample aged 85 years and above. Persons living in institutions in both studies more frequently showed signs of cognitive impairment than those living in private households. The ECA sample, but not the Munich sample, showed a significantly higher prevalence of cognitive impairment for females and for the oldest age cohort above 90 years of age. Major depression was more frequent in Munich in persons living in institutions and in the ECA study among the oldest age cohort above 90 years of age. Dysthymia in both studies did not show any association with sociodemographic factors. Most of the excess comorbidity (cognitive impairment and depression) was observed among subjects with mild (and not with severe) cognitive impairment.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1995

Mortality risk and mental disorders: longitudinal results from the Upper Bavarian Study.

The object of the study was the assessment of the mortality risk for persons with a mental disorder in an unselected representative community sample assessed longitudinally. Subjects from a rural area in Upper Bavaria (Germany) participated in semi-structured interviews conducted by research physicians in the 1970s (first assessment) and death-certificate diagnoses were obtained after an interval up to 13 years later. The sample consisted of 1668 community residents aged 15 years and over. Cox regression estimates resulted in an odds ratio of 1.35 (confidence interval 1.01 to 1.81) for persons with a mental disorder classified as marked to very severe. The odds ratio increased with increasing severity of mental illness from 1.04 from mild disorders, 1.30 for marked disorders, to 1.64 for severe or very severe disorders. The relative risk (odds ratio) for persons with a mental disorder only and no somatic disorder was 1.22, for persons with only a somatic disorder 2.00, and for those with both a mental and somatic disorder 2.13. The presence of somatic illness was responsible for most of the excess mortality. Somatic disorders associated with excess mortality in mental disorders were diseases of the nervous system or sensory organs, diseases of the circulatory system, diseases of the gastrointestinal tract, and diseases of the skeleton, muscles and connective tissue (ICD-8). Thus, while mental illness alone had a limited effect on excess mortality, comorbidity with certain somatic disorders had a significant effect.

Adolescent↗
PubMed1995

Dementia and cognitive impairment in the oldest old in the community. Prevalence and comorbidity.

BACKGROUND: The study focuses on the prevalence of dementia in the oldest old. METHOD: A community sample (n = 402) of the oldest old in Munich (> or = 85 years) was assessed with different methods. Four instruments and a 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 physicians, who made their diagnoses according to ICD-10 and DSM-III-R. RESULTS: The structured interviews (GMS-A: 25.4%; SIDAM/SISCO: 28.0%; SIDAM/DSM-III-R: 27.8%; SIDAM/ICD-10: 16.1%) gave lower point prevalence rates of dementia than physicians' clinical diagnoses (43.1%). The rates were 21.2% based on the MMSE. Depressive syndromes and anxiety syndromes were the most frequent psychiatric disturbances associated with dementia in the very old. CONCLUSION: Dementia rates were high in the oldest old, showed an increase with age but no sex differences. Interview methodology has a major impact on results.

Activities of Daily Living↗
PubMed1995

Somatoform symptoms in depressive and panic syndromes.

Somatoform symptoms are common features of psychological and psychosomatic disorders. This study addresses the question of whether somatoform symptoms differ in patients with panic syndromes. with depressive syndromes, or with somatization syndromes without depression or panic syndromes. We therefore investigated 135 inpatients o f a psychosomatic clinic and identified 64 patients for the depression group, 31 for the panic subgroup, and 18 for the somatization syndrome group. Neither the number of somatization symptoms nor the pattern of somatoform symptoms differed substantially among the 3 groups, except for higher frequencies of palpitations in the panic group and more abdominal pain symptoms in the depressive group. The 3 groups showed nearly identical frequency distributions of the individual somatoform symptoms. All 3 groups showed elevated hypochondriasis scores. In personality dimensions, depressive patients showed the lowest scores for extraversion. The improvements during inpatient treatment on the somatization variables, as well as general psychopathology, were also comparable. We favor the interpretation that the somatization syndrome is a fairly uniform syndrome whether or not it occurs alone or in combination with depressive syndromes or panic syndromes.

Journal Article↗
PubMed1994

Satiety and cholecystokinin.

The effect of a fat and protein rich test meal of 800 kcal on subjective satiety ratings and on plasma cholecystokinin (CCK) 8-S was studied in 18 acutely ill patients with anorexia nervosa, 11 former anorectic patients, who were weight recovered for at least 4 years, and in 25 healthy young women. Eleven normal weight patients with bulimia nervosa were studied in the same experiment. Satiety ratings were significantly elevated in acutely ill anorectic and bulimic patients. CCK 8-S values were significantly stimulated by the test meal in all groups except from the bulimic group. Anorectic patients and weight recovered anorectics had normal values before and after the test meal. Bulimic patients had significantly lower values. These data suggest that CCK 8-S is not involved in the regulation of short-term satiety in anorexia and bulimia nervosa.

Adult↗
PubMed1994

Somatostatin in eating disorders.

Somatostatin concentrations in plasma were measured before and after a standardized fat and protein-rich fluid test meal in patients with anorexia nervosa, weight-recovered anorectic patients, obese women, and healthy controls. Somatostatin was significantly elevated in all four groups after the test meals. Hormone levels remained elevated for up to 100 min after the test meal. The area under the response curve was significantly higher (p < .01) in the anorectic patients as compared with healthy controls and weight-recovered anorectics. Obese women had blunted somatostatin responses. The findings may explain alterations in insulin secretion and in gastric emptying described earlier in patients with eating disorders.

Adult↗
PubMed1994

Resting metabolic rate and total energy expenditure in acute and weight recovered patients with anorexia nervosa and in healthy young women.

Because little is known about energy requirements in anorectic patients before and after weight gain we measured resting metabolic rate (RMR) by indirect calorimetry and total energy expenditure (TEE) by the doubly labeled water method in 6 patients with anorexia nervosa (body mass index [BMI] = 15.1 +/- 1.3 kg/m2), in 6 weight-recovered anorectics (BMI = 21.2 +/- 2.1 kg/m2), and in 12 healthy age-matched women (BMI = 20.5 +/- 1.9 kg/m2). No significant differences were found between the weight-recovered anorectic women and the healthy controls in RMR (1,330 +/- 131 kcal/day [weight-recovered]; 1,419 +/- 197 [controls]) and in TEE (2,602 +/- 637 kcal/day [weight-recovered]; 2,596 +/- 493 kcal/day [controls]). The RMR was significantly lower in the acutely ill anorectic patients (1,171 +/- 113 kcal/24 hr) than in weight-recovered anorectics and in healthy controls. The TEE was significantly lower in the anorectic group (1,946 +/- 192 kcal/day) than in the healthy controls.

Adult↗
PubMed1994

Course of multi-impulsive bulimia.

Thirty-two consecutively admitted females with bulimia nervosa (purging type) according to DSM-IV and additional impulsive behaviours (multi-impulsive bulimia (MIB)) and 32 age-matched female controls with DSM-IV bulimia nervosa (purging type) (uni-impulsive bulimia (UIB)) were assessed longitudinally on admission and at discharge following in-patient therapy and at a 2-year follow-up. Multi-impulsive bulimics were defined as presenting at least three of the six of the following impulsive behaviours in their life-time in addition to their bulimic symptoms at admission: (a) suicidal attempts, (b) severe autoaggression, (c) shop lifting (other than food), (d) alcohol abuse, (e) drug abuse, or (f) sexual promiscuity. Multi-impulsive bulimics were more frequently separated or divorced, had less schooling and held less-skilled jobs. Except for interoceptive awareness (EDI), which was more disturbed in multi-impulsive bulimics, there were no differences concerning scales measuring eating disturbances and related areas. Multi-impulsive bulimics showed more general psychopathology--anxiety, depression, anger and hostility, psychoticism--differed in several personality scales from uni-impulsive bulimics (e.g. increased excitability and anger/hostility) and had overall a less favourable course of illness. Multi-impulsive bulimics also received more in- and out-patient therapy previous to the index treatment and during the follow-up period. The data support the notion that 'multi-impulsive bulimia' or 'multi-impulsive disorder' should be classified as a distinct diagnostic group on axis I or that an 'Impulsive Personality Disorder' should be introduced on axis II. The development of more effective treatment for multi-impulsive bulimia is warranted.

Adult↗
PubMed1994

[When patient and therapist disagree--discrepancies in evaluation of change].

The following study concerns the interaction of different measures for therapeutic change. 1377 inpatients of a psychosomatic hospital were examined. Measures for change were the subjective global rating of the inpatient, the subjective global rating the psychotherapist, and the Symptom-Check-List SCL-90-R. To get additional information for possible predictive variables for discrepant judgements, also personality questionnaires and sociodemographic variables were considered. Results demonstrated only medium correlations between subjective ratings for change of the patient and the psychotherapist, although the same categories were used (R = 0.44). The correlations to measures of change of the self-rating-scales are even lower. Therefore we conclude that these measures focus to different information, because the common part of variance is low. Discrepancies between the judgement of therapists and patients can be found after all when the patient makes a negative rating. Predictive variables for discrepancies of the judgements for change of the psychotherapists and patients are: age, sex, phobic anxiety and bodily complaints. While younger patients tend to make better judgements than their therapists we find the contrary for elder patients. Women tend to make better judgements than their psychotherapists. We find also discrepancies in patients with multiple syndromes, when phobic anxiety and bodily complaints exist and are perhaps not adequately concerned in the psychotherapy.

Adult↗
PubMed1993

Recurrent overeating: an empirical comparison of binge eating disorder, bulimia nervosa, and obesity.

The goal of the study was to contribute empirical data to the discussion of appropriate diagnostic classification of obese and nonobese, binging, and nonbinging eating disordered patients. The study consists of two parts: (1) patients with binge eating disorder (BED) (N = 22) are compared to a matched sample of patients with bulimia nervosa (BN) and to 16 patients with obesity (body mass index [BMI] > 30). These patient groups were cross-sectionally assessed using expert ratings (interview) and self-ratings. (2) A sample of 68 patients with BED were assessed longitudinally on admission and discharge of inpatient treatment and at a 3-year follow-up using the same instruments as in the first study. The study is the first to report longitudinal data on patients with BED. The general pattern of the cross-sectional data was that patients with BN not only had higher scores concerning disturbances of eating behavior and attitude but also for general psychopathology when compared to patients with obesity without marked binges. The scores of patients with BED had an intermediate position between BN and obesity but were closer to BN than to obesity. The BED group (and the obesity group) showed a high degree of body dissatisfaction, which, however, was accounted for by their high body weight. Concerning general psychopathology BED as well as BN had significantly higher scores than the obesity group in the Hopkin's Symptom Checklist (SCL) subscale anger and hostility, in the Complaint List, the PERI Demoralization Scale, and the Beck Depression Inventory. Results of the longitudinal study with BED showed marked improvement in specific and general psychopathology over time. Except for body weight this improvement largely persisted over the 3-year follow-up period. Severity of depression did not predict the course of body weight over time. Data are presented concerning the design of diagnostic criteria for eating disturbed patients not fitting criteria for BN or anorexia nervosa (AN). Arguments pro and contra the introduction of a new BED category in psychiatric diagnostic criteria are discussed. Although there is generally a need for developing or revising the diagnostic criteria for recurrent bingers, our data do not support inclusion of BED (as presently defined) as a separate diagnostic category in DSM-IV.

Adult↗
PubMed1993

The key relative's impact on treatment and course of alcoholism.

One hundred alcoholics participated in a 6-week inpatient and a 6-week outpatient therapy programme and a 6-month and 18-month follow-up. Major goals of the study were a descriptive analysis of the course of illness over time, the evaluation of the effects of therapy in general and concerning the specific effects of additional (A) systematic inclusion of the key relative versus (B) systematic involvement in self-help, and identification of predictors for relapse. While therapy as such was quite effective and resulted in significant changes in symptomatology and the scores on personality scales, the additional involvement of the key relative showed no substantial additional treatment effects. Partnership interactions showed a deterioration during therapy, with temporary increased frictions. Based on conservative calculations, 40% of all patients remained abstinent until the 6-month follow-up and 30% until the 18-month follow-up.

Adult↗
PubMed1993

Effects on mortality of alcohol consumption, smoking, physical activity, and close personal relationships.

The study analyses the risks of mortality associated with alcohol consumption and smoking, as well as possible counteracting effects of physical activity and social support through close personal relationships. Data are based on the Upper Bavarian Study, a longitudinal epidemiological study of a representative community sample (n = 1668) in a rural area. Extensive semistructured psychiatric interviews by research physicians were conducted between 1975 and 1977 (n = 1536). Thirteen years after psychiatric assessment, information was obtained from the community register concerning death in the interval, data of death and cause of death according to ICD 9. This information could be ascertained for 93.1% (n = 1430) of those who had been interviewed, thus providing a good basis for generalizing the findings. Results indicate that alcohol intake and cigarette smoking increased mortality while physical activity and the availability of a steady partner had protective effects. There were no interactive effects between the four variables studied, except for a dramatically increased risk for women drinking more than 20 ml of pure alcohol a day and reporting no physical exercise at wave one assessment. The relative risks of alcohol intake and smoking, and the counteracting effects of physical activity and partnership, are exemplified in the cases of a 40-year-old female and a 40-year-old male. Specific analyses of the relationship between alcohol consumption, smoking, physical exercise and personal relationships, on the one hand, and, on the other, different causes of death, are presented.

Adolescent↗
PubMed1993

[Drug treatment of anorexia nervosa and bulimia nervosa. A review].

With the apparent increase in prevalence of anorexic and bulimic eating disorders, the search for effective treatments for these disorders has been intensified in recent years. In this review the results of psychopharmacological studies of patients with anorexia or bulimia nervosa are presented and analysed. The focus of this review is on controlled studies. Although a variety of psychopharmacological substances has been tested in patients with anorexia nervosa, the outcome of controlled studies has been generally disappointing. A possible differential therapy effect of cyproheptadine needs replication: in one study it enhanced body weight gain in non-bulimic anorexics, while it appeared to hinder weight gain in bulimic anorexics. The issue of prophylaxis of osteoporosis in chronic low-weight anorexics has received increasing attention in recent years, and pharmacological prophylaxis appears indicated in this patient group. The results of psychopharmacological treatment studies of patients with bulimia nervosa have overall been more favourable than those of anorexic patients. Statistically significant effects concerning the reduction of bulimic or depressive symptoms in bulimia nervosa has been demonstrated for tricyclic antidepressants (imipramine, desipramine), serotonergic agents (fluoxetine, d-fenfluramine), non-selective monoamine-oxydase-inhibitors (isocarboxazide, phenelzine) and trazodone. The antibulimic effect appears not to be associated with the antidepressant effect. Theoretical, methodological and practical issues concerning pharmacological treatment of anorexic and bulimic eating disorders are presented and discussed.

Anorexia Nervosa↗
PubMed1992

Lifetime diagnoses in patients with somatoform disorders: which came first?

Thirty inpatients with somatoform disorders were examined with the structured clinical interview SCID for psychiatric lifetime diagnosis. In the present diagnoses, we found a concordance of 63% for somatoform and affective disorders and the lifetime comorbidity of both disorders was 87%. Additionally, patients with somatoform disorders frequently had a history of other psychiatric disorders (for example, anxiety disorders, 40%). For 73% of patients with somatoform disorders and a history of affective disorders, the onset of the somatoform disorder was prior to the onset of another psychiatric disorder. The time interval between the onsets of somatoform disorders and affective disorders was greater than 1 year for most patients; for 46% of the patients with a history of both disorders, the time interval between the two disorders was more than 5 years. The course of illness for somatoform and affective disorders was quite different; while affective disorders tended to episodic periods with interim remissions, the somatoform disorders usually showed long, chronic courses (mean duration of the current somatoform disorder was 11.9 years). Finally, the Symptom Check List SCL-90R demonstrated good discrimination between patients with affective and anxiety disorders. However, the SCL-90R failed to discriminate patients with somatoform disorders from affective- and anxiety-disordered subjects. Therefore, the development of other psychometric scales is necessary for the evaluation of patients with somatoform disorders.

Adult↗
PubMed1992

Cortisol levels and vigilance in eating disorder patients.

Elevated plasma levels of cortisol, as well as deficits in cognitive processes such as attention, have been observed in patients with eating disorders. The association between plasma cortisol and performance in vigilance task was studied in 17 patients with bulimia nervosa or anorexia nervosa during the acute phase of their eating disorder. In comparison to normal young women, the patients had a significantly lower hit rate in a discrimination task and showed an impaired perceptual sensitivity index. They also displayed significantly longer reaction times to hits, but not to false alarms. Cortisol levels of the patients were significantly higher than those of the normal controls. When patients were divided according to their median cortisol level, the patients with higher levels performed significantly more poorly than did the patients with lower levels. In the total patient sample, cortisol levels showed a significant negative correlation with hit-rate (r = -.54) and a significant positive correlation with reaction time to hits (r = .70). Other clinical characteristics were not related to cognitive performance. These results suggest a possible role of cortisol in the development of attentional deficits in eating disorder patients.

Adult↗
PubMed1992

Gonadotropin secretion in bulimia nervosa.

Twenty-two normal weight women with bulimia nervosa (BN) were studied (mean age, 25 +/- 5 yr; body mass index, 20.2 +/- 2.6 kg/m2). Sixteen of them reported menstrual cycles in the range of 21-42 days, and 6 had experienced absence of menstruation for at least 3 months. Twenty-one healthy women with regular menstrual cycles (mean age, 23 +/- 2 yr; body mass index, 20.7 +/- 1.4) served as the control subjects. Frequent morning blood samples for estradiol (E2) and progesterone (P4) determinations were obtained for the duration of 1 menstrual cycle or for 6 weeks in the case of amenorrhea. LH, FSH, cortisol, and insulin secretion were studied on day 3, 4, or 5 after the onset of a menstrual cycle or on a random day in the 6 BN women with amenorrhea. Blood samples were collected at 15-min intervals from 1800-0600 h for LH and FSH and at 30-min intervals from 2400-0600 h for cortisol and insulin. Nineteen of the 21 controls, but only 10 of the 22 BN women, fulfilled the following standard criteria: maximum E2 above 440 pmol/L, maximum P4 above 19 nmol/L, and luteal phase length of 9 days or more. The 10 BN women with normal menstrual cycles had lower mean insulin concentrations than the controls (70 +/- 20 vs. 120 +/- 30 pmol/L; P less than 0.01), but gonadotropin secretion, cortisol, and T3 concentrations were similar. The 8 BN women with amenorrhea or ovulatory dysfunction (maximum E2, less than 440 pmol/L; maximum P4, less than 6 nmol/L) displayed decreased mean LH pulse frequency (2.6 +/- 2.4 vs. 5.7 +/- 2.0 pulses/12 h; P less than 0.01), increased mean cortisol (120 +/- 40 vs. 80 +/- 20 nmol/L; P less than 0.01), decreased mean insulin (90 +/- 40 vs. 120 +/- 30 pmol/L; P less than 0.05), and decreased mean T3 concentrations (1.5 +/- 0.3 vs. 1.8 +/- 0.2 nmol/L; P less than 0.01). The data suggest that BN in normal weight women is associated with an increased rate of ovarian dysfunction; decreased pulsatile LH secretion seems to be an important mechanism. Increased cortisol in the disturbed subgroup indicates that activation of the hypothalamic-pituitary-adrenal axis may play a role in the pathogenesis of gonadal dysfunction in bulimia nervosa.

Adult↗