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Biomedical subjects

M M Fichter

Publications and source records attributed to M M Fichter.

At least 91 records · Page 5Linked to original sources
PubMed1987

Disturbances of the menstrual cycle in bulimia nervosa.

Blood was obtained three times a week throughout one menstrual cycle or during a 6-week period from 15 patients with bulimia nervosa and from 10 healthy age-matched controls. Of the patients, three had amenorrhoea, eight had oligomenorrhoea and four had regular cycles. Normal follicular development, as judged from continuously low oestradiol (E2) values (less than 120 pg/ml or less than 440 pmol/l), did not occur in seven patients. Compared to patients with increasing E2 values (greater than 120 pg/ml), these seven had a significantly lower body weight. Among the eight patients showing follicular development (E2 greater than 120 pg/ml), four reported regular cycles, but only three developed normal plasma progesterone (P4) values during the luteal phase (P4 greater than 3 ng/ml or greater than 9.5 nmol/l). The luteal phase was of normal length in only one bulimic patient.

Adult↗
PubMed1987

Major affective disorder in anorexia nervosa and bulimia. A descriptive diagnostic study.

DSM-III lifetime diagnoses were assessed in 52 patients with a lifetime history of anorexia nervosa or bulimia by means of a standardised diagnostic interview. It was found that 44.2% had a lifetime diagnosis of DSM-III major affective disorder, with abstaining anorectics having a lower rate of depression than those with bulimic symptoms. In the great majority of cases, the onset of affective disorder post-dated the onset of the eating disorder by at least one year. In patients whose eating disorder was in remission, the rate of depressive symptoms was lower than in those in the acute stage of their illness. These findings, combined with recent studies on biological changes in eating disorders, and psychological theories of depression, suggest that in most cases in which the two conditions are associated, the depression is secondary to the eating disorder.

Adult↗
PubMed1987

[Loss of father or mother in childhood and onset of psychiatric diseases in adulthood].

An overview is given of the methodological problems involved in assessing the relationship between major losses in childhood and psychiatric disorders in adulthood. The findings in field studies of representative samples of the adult population in which this relationship was investigated retrospectively are reviewed. In their own field study of individuals aged 15 and older in three Upper Bavarian towns the authors investigated whether those subjects who had not been raised by both biological parents and especially those who had lost one or both parents through death before age 15 had an increased risk of psychiatric disorders (true prevalence) or of use of psychiatric services as adults. The relative risk of a psychiatric disorder for those not raised by their biological parents was between 1.1 (age at loss: 11-15 years) and 1.5 (age at loss: less than 1 year). The risk of psychiatric treatment was higher for all age groups, between 1.6 and 1.8, and significantly different from the risk without loss. This overall increase is attributable mainly to those subjects who had been raised by a stepparent and those who had been in a children's home between the ages of 11 and 15. The subjects with parental death in childhood had only a slightly increased risk of a psychiatric disorder or use of psychiatric services.

Adolescent↗
PubMed1986

The principal component structure of the General Health Questionnaire among Greek and Turkish adolescents.

The 28-item version of the General Health Questionnaire was administered to Greek and Turkish school pupils in their mother country as well as to Greeks in Munich. Principal component analysis with varimax rotation was carried out separately for both the individual populations and sexes separately. Visual inspection of the matrices suggested overall agreement with the sub-scales obtained by Goldberg and Hillier (1979). The coefficient of factor similarity, calculated between matrices, suggested a highly similar principal component structure between the population samples as a whole and separately for the sexes living in their own country, but not between male and female Greek pupils in Germany. Highly similar component matrices were obtained for Greek males living in Greece with those in Germany, but not for females.

Adolescent↗
PubMed1986

Use of psychiatric facilities in the Upper Bavarian follow-up field study.

Utilization of psychiatric facilities by non-institutionalized persons aged 20 years and older was examined. Data were based on the representative community sample of the Upper Bavarian Follow-up Field Study, the original sample size being 1668 persons. In the 5-year follow-up 1384 (83.0%) subjects were interviewed; 80 subjects (4.8%) had died meanwhile. The follow-up sample contained 44 people who refused the first interview and agreed to participate at the follow-up. The 5-year prevalence of mental illness according to the definition used was 31.4%. The rate for psychiatric treatment (in- or outpatient) was 8.5%. We analyzed which people with mental illness seek help from professionals in psychiatric hospitals, from psychiatrists in private practices and psychosocial services, according to type of diagnosis, course of disorder (incidence, remission, chronic), sociodemographic data and psychosocial factors.

Adult↗
PubMed1986

Weight loss causes neuroendocrine disturbances: experimental study in healthy starving subjects.

A variety of endocrine dysfunctions have been reported for anorexia nervosa, protein caloric malnutrition, and depression. The effect of reduced caloric intake and weight loss on endocrine functions was assessed in an experiment with five healthy female subjects during an initial baseline phase, a 3-week phase of complete food abstinence, weight gain to the original level, and a final baseline phase. During fasting, disturbances in hypothalamic-pituitary-adrenal function were observed, with elevated plasma cortisol levels, increase in the number of secretory episodes, increase in cortisol plasma half-life, and insufficient suppression following 1.5 mg dexamethasone. While all dexamethasone suppression tests (DSTs) were normal at baseline, 7 of 14 DSTs showed insufficient suppression in the fasting phase. During fasting, basal thyroid-stimulating hormone (TSH) values were lowered and the TSH response to thyrotropin-releasing hormone (TRH) was blunted. The plasma level of growth hormone (GH) over 24 hours was elevated during fasting and administration of the alpha 2-adrenergic receptor agonist clonidine resulted in a subnormal GH response after restoration of original body weight. One of the five subjects showed increased irritability, distress, anxiety, and depression as measured by various psychological scales. The results show that reduced caloric intake, weight loss, or catabolic state have powerful effects on several endocrine systems. The specificity of measures of endocrine disturbances (DST, TRH tests, and clonidine tests) as biological markers for certain types of depression must be questioned, and the metabolic state should be given more consideration in future studies.

Adult↗
PubMed1986

Effect of experimental and pathological weight loss upon the hypothalamo-pituitary-adrenal axis.

Five healthy female subjects participated in a starvation experiment. After an initial baseline phase (A) they lost about 8 kg in a 3-week phase of complete food abstinence (B); thereafter they recovered to their original body weight (C) and kept this weight stable over more than 4 weeks (D). While all dexamethasone suppression tests (DST's) during the initial baseline were normal, half of the DST's (7/14) in the fasting phase showed insufficient suppression. In the following weight gain phase, all DST's were sufficiently suppressed. Twenty-four hour plasma cortisol patterns during fasting (B) showed a significant increase, as well as increased cortisol half-life, increased time in secretory activity, and increased number of secretory episodes. Administration of the alpha 2-adrenergic receptor agonist clonidine during fasting did not induce a further decrease in plasma cortisol level, whereas it did during baseline. The results demonstrate that weight loss, reduced caloric intake, and catabolic state have a very powerful influence on the hypothalamo-pituitary-adrenal (HPA) axis and other endocrine systems. The results shed new light on endocrine dysfunctions in mental disorders associated with reduced caloric intake, such as anorexia nervosa and depression, and question the specificity of certain endocrine dysfunctions for depression.

Adult↗
PubMed1986

The measurement of body image disturbances in anorexia nervosa. Experimental comparison of different methods.

Body image disturbances in anorexia nervosa patients have been assessed in an experimental study which dealt with the following issues: Three different procedures for the assessment of body image disturbances were compared in a discriminant function analysis: a Video Monitor Procedure, the Movable Caliper Procedure and the Image Marking Procedure. The Image Marking Procedure showed the best discrimination between groups. Anorexia nervosa patients showed a statistically significant overestimation as compared to the control group in the variables 'waist', 'upper thigh' and the compound measure 'soft body parts', while they did not overestimate control variables (Kruskal-Wallis-Rank-Analysis of Variance). A standard liquid meal of 240 Kal. had no statistically significant influence on the estimation of body width, irrespective of the amount of calories consumed and instruction given. Possibilities and limitations of various measurement procedures are discussed.

Acute Disease↗
PubMed1985

Anorexic syndromes in the male.

Forty-two male patients with an anorexic syndrome were assessed personally (n = 29) or by reviewing the case-notes. Twenty-nine male patients were classified as primary anorexia nervosa and they were compared to our series of atypical male patients and a series of 23 female anorexia nervosa patients. There was no difference between male and female patients in the age at onset. Male and female anorexia nervosa cases were very similar in their personality profile and symptomatology; however, male cases were more preoccupied in their thoughts with food, weight etc., and showed more hyperactivity, more achievement orientation and more sexual anxiety than female cases. The mothers' age at the male patients' birth was significantly younger than in the female group. Male anorexia nervosa patients were more extraverted and scored "superfeminine" on the masculinity vs feminity scale (FPI). A continuum from "true" anorexia nervosa to atypical cases and to secondary loss of appetite was observed.

Adolescent↗
PubMed1983

Psychotherapy services and the prevalence of mental disorders in urban and rural areas.

This study addresses the issue of need for and provision of psychotherapy care in urban and rural areas. In the first part, prevalence of mental disorders based on epidemiological field studies in the county of Traunstein and the city of Mannheim are discussed. Among patients of general practitioners the prevalence of mental disorders was slightly higher in Mannheim than in Traunstein. Concerning the provision of care, results of a questionnaire survey of a random sample of 1542 nonmedical counsellors or psychotherapists in Traunstein, Mannheim and the metropolitan area of West Berlin are presented. The rate of nonmedical therapists/100,000 inhabitants was the same for Traunstein and Mannheim. A more detailed analysis of their service capacity revealed that it was by 17% to 20% higher for Mannheim than for Traunstein; the prevalence of mental disorders in patients of general practitioners was shown to be about 10% higher in Mannheim than in Traunstein. Under the assumption that there is a linear relationship between prevalence and need for care, there appears to be a slight, but not marked undersupply of services by doctors and nonmedical counsellors or psychotherapists in Traunstein as compared to Mannheim. In comparison, the districts of West Berlin were classified into those with high and those with a low percentage of blue collar workers. The rate of nonmedical counsellors or psychotherapists in the "upper class" districts in West Berlin was almost four times higher than that for the "lower class" districts of West Berlin, in Mannheim and Traunstein. The rate/100,000 for the service capacity of nonmedical counsellors or psychotherapists in the "upper class" districts of West Berlin was much higher, and in the "lower class" districts of West Berlin much lower, than in Traunstein or Mannheim. Our data show that there are some discrepancies in the provision of care between rural and urban areas, which however are not large when Traunstein is compared with Mannheim; there were however, substantial discrepancies in the provision of care between cities (Mannheim and West Berlin) and between districts within the same city (West Berlin).

Community Health Services↗
PubMed1982

Behavior, attitude, nutrition and endocrinology in anorexia nervosa.

Twenty-four anorexia nervosa patients participated in an inpatient broad spectrum behavior therapy program. The changes in body weight, anorectic behaviors and attitudes and endocrine variables (24-h plasma cortisol, dexamethasone suppression test, 24-h plasma luteinizing hormone) were measured. Data indicate that specific anorectic behaviors and attitudes showed significant improvement during inpatient treatment, while attitudes of a more general neurotic scope such as the feeling of insufficiency, general distress, (sexual) anxieties and anancasm did not. On admission 24-h plasma cortisol levels were elevated, episodic secretory spikes occurred at unusual times and the number was increased, cortisol plasma half-life was increased and non-suppression of cortisol secretion following the application of dexamethasone was observed. All these parameters normalized already after 10% weight gain. 24-h plasma LH pattern showed a close relationship with body weight. Our data suggest that the dysfunctions in anorexia nervosa patients in the hypothalamo-pituitary-adrenal and -gonadal axis have little specificity for this disease and are mainly a consequence of nutritional factors and starvation. The relationship between cortisol and HL-secretion, behavioral and attitudinal variables and weight gain was more complex than previously suggested by others and a positive relationship between the LH secretory pattern and anorectic symptomatology could be established.

Adolescent↗
PubMed1980

[The anorexia nervosa inventory for self-rating (ANIS) (author's transl)].

The Anorexia Nervosa Inventory for Self-Rating (ANIS) was developed as a reliable and valid instrument for diagnostic purposes and for longitudinal assessments in the course of therapy of anorexic patients. Appropriate items, which were selected from a larger pool of items by expert ratings, were subjected to factor analyses. The analyses were based on self-ratings of a sample of 101 patients suffering from anorexia nervosa and a sample of 118 high school students comparable in sex and age. The factor analytic studies based on maximum likelihood procedures resulted in a 31-item self-rating scale consisting of six interpretable factors. The rotated factor structure was stable for the different patient and student samples. The factors identified were labeled: (1) figure consciousness; (2) feeling of insufficiency; (3) anancasm; (4) adverse effect of meals; (5) sexual anxieties and (6) bulimia. The first two factors are discussed in the context of concepts formulated by Bruch (1973) concerning 'disturbances in body image' and an 'all-pervasive feeling of ineffectiveness' in anorexic patients. The usefulness of the ANIS scale to discriminate between healthy and anorexic subjects and for self-assessment of patients during the process of therapy is demonstrated.

Adolescent↗