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Biomedical subjects

M M Fichter

Publications and source records attributed to M M Fichter.

At least 73 records · Page 4Linked to original sources
PubMed1992

[Therapy and course of alcohol dependence. Effects on the patient and family].

100 male and female patients, aged 20 to 60 years with the diagnosis alcohol-addiction (ICD 9 No 303.0) took part in a longitudinal treatment evaluation study. Consecutive admissions from May '83 until July '85 were assessed. All patients participated in a 6-week inpatient group therapy and a 6-week outpatient treatment for alcohol-dependent patients at the Psychiatric University Hospital in Munich. Assessments were performed at the following times: 1. on admission, 2. at the end of inpatient therapy, 3. at the end of outpatient therapy, 4. at a 6-month follow-up and 5. at an 18-month follow-up. The major goals of the study were as follows: 1. Descriptive analysis of the course of illness from admission to the 18-month follow-up; 2. Analysis of the influence of the social setting at home (relationship, attitude of the family towards the patient) (Kreisman's Patient Rejection Scale) and expression of emotions in the family according to the "Camberwell Family Interview" (CFI); 3. Evaluation of the effect of the additional treatment component (A) "Systematic involvement of the significant other" as compared to an alternative component (B) "Systematic encouragement of the patient in self-help initiatives"; 4. Identification of risk factors for relapse and predictors of good prognosis that can be used to improve the therapeutic concept. The sample consisted of 42% women and 58% men, with a mean age of 37.9 years. Only patients who had a spouse or another close relative were accepted for participation in the study. At the beginning of the study 48% of the patients were married, 18% divorced, 27% unmarried and 6% lived separately or were widowed. 95 of the 100 patients could be reassessed at discharge from inpatient therapy, 92 at the end of 6-week outpatient treatment phase, 91 at the 6-month follow-up and 90 at the 18-month follow-up. The additional treatment components (A versus B) showed no major differences in effect. Significant changes in the patients attitude, behaviour and psychopathology were observed for patients receiving either one of the additional treatment components (A or B). The lack of differing effects from the additional treatment components is plausible, because the main part of the therapy (without the additional therapy component) was the same in both groups; this basic therapy took up most treatment time and by itself brought about major changes in personality scales, psychopathology and partnership interactions.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1991

Circadian pattern of large neutral amino acids, glucose, insulin, and food intake in anorexia nervosa and bulimia nervosa.

Insulin, glucose, and large neutral amino acids (LNAA) were studied in 10 patients with anorexia nervosa, 13 patients with bulimia nervosa, and 15 healthy controls. Blood samples were collected at hourly intervals during the day and at two-hour intervals during the night over a 24-hour period. Ad libitum caloric and relative carbohydrate intake was significantly reduced in the anorectic and bulimic patients. Elevated concentrations of beta-hydroxybutyric acid (BHBA) were seen in the bulimic group, and low triiodothyronine (T3) concentrations in the anorectic group. Mean plasma glucose and insulin concentrations were significantly lowered in both groups. The tryptophan (Trp) to LNAA ratio was reduced in anorectic, but not in bulimic patients. These findings suggest that Trp influx into the brain is reduced in anorectic patients, possibly impairing central serotonergic function.

Amino Acids↗
PubMed1991

Fluoxetine versus placebo: a double-blind study with bulimic inpatients undergoing intensive psychotherapy.

In a double-blind trial 40 patients with bulimia nervosa according to DSM III-R criteria were randomly assigned either to a 60 mg fluoxetine group or to a placebo control group. Fluoxetine or placebo was given over a period of 35 days. Parallel to the drug trial, patients participated in an intensive inpatient behavioral psychotherapy program. There were no dropouts at all in the study. Fluoxetine was well tolerated and had only minor adverse effects. In self-ratings and expert ratings concerning attitudes towards eating, eating behavior, and general psychopathology, significant improvements over time were observed in both groups. Using analysis of variance (ANOVA), however, there were no statistically significant "group by time" differences. Results show that the intensive inpatient-care and psychotherapy program was highly effective in changing eating behavior and attitudes as well as general psychopathology. Fluoxetine showed a significant reduction in body weight, especially during the first three weeks of fluoxetine treatment. It was not possible to demonstrate a statistically significant improvement in eating attitudes, eating behavior, and general psychopathology beyond that elicited by intensive inpatient psychotherapy and general inpatient care. These results can possibly be explained by the existence of a "ceiling effect".

Adult↗
PubMed1990

Disturbances in the hypothalamo-pituitary-adrenal and other neuroendocrine axes in bulimia.

Disturbances in the hypothalamo-pituitary-adrenal (HPA) and other endocrine axes were assessed in 24 women with bulimia and healthy controls. Overnight blood samples for measuring nocturnal plasma cortisol, prolactin (PRL), growth hormone (GH), luteinizing hormone (LH), and follicle stimulating hormone (FSH) were obtained at 30-min intervals. A 1.5 mg dexamethasone suppression test (DST) and a TRH-test were performed. Patients were monitored closely while their nutritional intake was recorded over 21 days. Compared with healthy controls, nocturnal cortisol plasma levels were not elevated in the bulimics. There was a trend toward insufficient cortisol suppression in the DST in patients with bulimia, which was most pronounced in patients with signs of restricted caloric intake. Plasma dexamethasone levels were significantly reduced in bulimics compared with healthy controls. There was a trend for blunted thyrotropin stimulating hormone (TSH) responses to thyrotropin releasing hormone (TRH) in bulimia. The prolactin response to TRH was significantly reduced in bulimics with a history of anorexia nervosa. Plasma LH and plasma FSH were significantly reduced in bulimics with signs of reduced caloric intake [low T3, high levels of beta-hydroxy-butyric acid (BHBA), reduced daily caloric intake, high number of fasting days] as compared with healthy controls. Bulimics with high BHBA levels had significantly reduced nocturnal prolactin plasma levels. Results show that multiple neuroendocrine disturbances exist in bulimia in a milder form than in anorexia nervosa. Evidence for the impact of caloric intake on endocrine functions is presented. Endocrine dysfunctions in our bulimic sample did not show a positive association with the presence of depressive symptoms.

Adult↗
PubMed1990

[Dermatologic aspects of anorexia and bulimia nervosa].

Anorexia and bulimia nervosa are common in western civilized countries. They are frequently associated with disorders of the skin. Up to now, no dermatological studies of large numbers of patients with eating disorders have been published. We examined 145 patients with eating disorders (65 anorexia nervosa, 80 bulimia nervosa) regarding skin alterations. Simultaneously we controlled the moisture content and the superficial lipids of the skin. Several symptoms relevant to dermatology were found. In detail we report on: xerosis, hair changes, nail disorders, pathognomonic hand lesions, sialadenosis, lesions of the oral mucosa and the teeth, peripheral oedema, acrocyanosis, petechiae and artefacts.

Adult↗
PubMed1990

[Dental and periodontal sequelae of bulimia nervosa].

Twenty-eight women with established bulimia nervosa according to the US psychiatric diagnostic criteria DSM III R with periods of morbidly increased appetite and vomiting, as well as 35 psychically and somatically healthy women were subjected to dental examination. The bulimic patients revealed a significantly poorer dental status (DMFS rate) than the control group. Within the patient group a deterioration of the DMFS rate was observed parallel with an increase in the frequency of vomiting and bulimic attacks, in sugar consumption and duration of the disease, as well as a decrease in salivary flow. Causes and implications for treatment and prevention are discussed.

Adolescent↗
PubMed1989

Psychotropic drug use in a representative community sample: the Upper Bavarian study.

A sample of 1979 community residents aged 15 years and above was assessed in a major survey of health status and consumption of psychotropic medication. Interviews were conducted in the subjects' home by a psychiatrically trained physician, who actually inspected the subjects' medical supplies. Of all subjects 6.9% (4.3% of the males and 9.0% of the females) had used a drug containing a benzodiazepine at least once in the 4 weeks preceding the interview. In the same period 3.6% had taken a medication containing a barbiturate, 2.2% a medicine containing an opioid (mainly codeine), 1.8% had taken a neuroleptic drug, 1.5% an antidepressant, 0.8% a carbamine-acid derivative and 0.1% lithium. High use of psychotropic medication was associated with higher age, female sex, higher psychiatric morbidity, higher somatic morbidity, reduced work capacity and higher neuroticism but not with social class and not with the personality factor extra- or introversion.

Adolescent↗
PubMed1989

Cerebral atrophy and vigilance performance in patients with anorexia nervosa and bulimia nervosa.

The relationship between ventricular size, as a measure of brain atrophy, and performance on a vigilance task was investigated in 39 patients with anorexia or bulimia nervosa during the acute stage of their illness. Compared to normal controls, the patients performed significantly more poorly in the cognitive task. Half of the patients displayed enlarged ventricles. However, the patients with ventricular dilatation did not perform worse in the cognitive test than patients with normally sized ventricles. Other clinical characteristics, such as symptom severity or duration of illness, were also not correlated with ventricular size. These results support the interpretation that cerebral atrophy per se does not have severe consequences on the neuropsychological or psychopathological status in eating disorder patients.

Adult↗
PubMed1989

The role of the general practitioner in the care of mentally disturbed subjects in the general population--results of the Upper Bavarian Study.

The role of the general practitioner in the care of mentally disturbed non-institutionalised persons aged 20 years and older was examined. Data were based on the representative community sample of the Upper Bavarian Field Study with a sample size of 1495 interviewees--aged 20 years and older. The 5-year prevalence of mental illness according to the definition used was 32.8%. 38.5% of all persons, identified as cases, consulted their general practitioner because of psychiatric or emotional problems. Females and the elderly were most likely to have received treatment by their general practitioner. The majority of treated persons were neurotic and psychosomatic patients. The general practitioner provided care for more psychiatric patients than the psychiatrist and for 25% of all "cases", without additional psychiatric consultation.

Adult↗
PubMed1988

Anorexia nervosa in Greek and Turkish adolescents.

Five samples of adolescents were assessed in three countries: (1) 867 Greek pupils in Munich (Germany), (2) 2,700 Greek pupils in Veria (Greece), (3) 567 girls in Ioannina (Greece), (4) 2,783 adolescents in Istanbul (Turkey), and (5) 157 adolescents in Upper Bavaria (Germany). A two-stage procedure was used for samples one, two and four using the Anorexia Nervosa Inventory for Self-rating (ANIS) for screening and a standardized interview (Structured Interview for Anorexia Nervosa and Bulimia) for personal exploration of possible cases and final case identification. Results of all samples were compared. Greek girls in Germany scored higher than Greek boys in Germany and Greek boys and girls in Germany scored lower than Greek girls in Veria in the ANIS factors figure consciousness, insufficiency, anancasm, negative effect of meals and bulimia in practically all age groups. The frequency distribution of the ANIS main factor figure consciousness was the same for both Greek samples in Greece, while the Turkish sample and the Greek sample in Munich had significantly lower scores. In the second stage the prevalence rates for anorexia nervosa according to Feighner criteria (modified for the purpose of a field study) were: 1.10% for Greek girls in Munich, 0.41% for Greek girls in Veria and 0.35% for Greeks in Ioannina. Thus, while Greek girls in Germany had lower scores in ANIS factors and other self-ratings (General Health Questionnaire) the actual rate of anorexic syndromes was highest among Greek girls in Munich. Socio-cultural influences and selection factors are discussed.

Adolescent↗
PubMed1988

Mental illness in Greek and Turkish adolescents.

Samples of 867 Greek adolescents in Munich, 2,702 Greek adolescents in Greece and 2,780 Turkish adolescents in Turkey were assessed concerning mental health in a two-stage procedure. In the first stage the General Health Questionnaire (GHQ) was used for screening. Significant age differences in the GHQ 28-item scale and most of its subscales were observed mainly for the samples in the homeland. Male adolescents had lower scores than female adolescents in the GHQ 28-item scale and its sub-scales while social class appeared to be of little influence. Significantly higher GHQ-28 scores were obtained for Greeks and Turks in their homeland as compared to Greeks in Turks in their homeland as compared to Greeks in Munich. The GHQ-28 correlations with the Anorexia Nervosa Inventory for Self-Rating were fairly high. A principal component analysis with Varimax rotation showed fairly consistent results for this age group when compared with the results of Goldberg and Hillier (1979). With the exception of the GHQ factor social dysfunction Greek adolescents in their homeland had significantly higher scores in the total GHQ-28 and its sub-scales than Greeks in Germany. Thus, our data do not confirm the acculturation-stress hypothesis. The data would be consistent with the hypothesis of selective migration which states that Greek adolescents in Germany constitute a positive selection with respect to risk for mental illness.

Acculturation↗
PubMed1988

[Franz Kafka's anorexia nervosa].

The evidence for the hypothesis that the poet Franz Kafka had suffered from an atypical anorexia nervosa is presented. Kafka was slim and underweight throughout his life and showed an ascetic attitude and abjuration of physical enjoyment and pleasure (fasting, vegetarianism, sexual abstinence, emphasis on physical fitness). The analysis is mainly based on Kafka's own descriptions in his letters, diaries, and literary work. Kafka was achievement oriented, reported many sadomasochistic fantasies, and had an anancastic (obsessive-compulsive) depressive personality. In addition there is evidence for a disturbed psychosexual and gender identity development. Our results concerning Kafka's psychopathology do not question his genius as a poet.

Anorexia Nervosa↗
PubMed1988

Gonadotrophins, oestradiol and progesterone during the menstrual cycle in bulimia nervosa.

Gonadotrophins and gonadal hormones were studied during the menstrual cycle or during 5 weeks when no cycles occurred in 15 patients who were diagnosed as having bulimia by DSM III criteria. Nine healthy age-matched women served as controls. Based on plasma oestradiol (E2) values patients were divided into two groups. Group I (n = 8) did not show E2 increases greater than 444 pmol/l indicating that no follicular development took place. Group II showed normal follicular hormone production during the follicular phase but impaired progesterone (P4) levels during the luteal phase. Studies of episodic gonadotrophin secretion during the follicular phase revealed low average LH and FSH values and reduced amplitude but no significant changes of frequency in group I. Our data indicate that impaired follicular maturation as seen in about half of the bulimic patients is caused by impaired gonadotrophin secretion.

Adult↗
PubMed1987

Symptomatology, psychosexual development and gender identity in 42 anorexic males.

Forty-two male patients with an anorexic syndrome were assessed. Twenty-nine of them had a primary anorexia nervosa (most of them also had bulimic symptoms). They were compared with a series of 23 female anorexia nervosa patients. The males scored more highly than female patients on a number of symptoms, but generally more similarities than differences in symptomatology were apparent. Male patients with primary anorexia nervosa also showed several signs of a disturbed psychosexual and gender identity development. The data support the hypothesis that males with atypical gender role behaviour have an increased risk for developing anorexia nervosa or bulimia in adolescence.

Adolescent↗