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Biomedical subjects

N U Neumann

Publications and source records attributed to N U Neumann.

At least 19 recordsLinked to original sources
PubMed2001

[Olanzapine and pregnancy. 2 case reports].

We report on two schizophrenic females who both had unexpected first pregnancies in their mid-thirties while being treated with olanzapine. Both patients had histories of psychosis of several years with some relapses and were treated previously with traditional antipsychotics. Since they wished to have children, no contraception had been performed past the age of 30. Both pregnancies occurred within a few months after the drug treatment was switched from traditional agents to olanzapine. Olanzapine was continued throughout the pregnancies, which were without complication. It is well known that treatment with traditional neuroleptics may lead to elevated prolactin levels and thus to relative infertility. Like clozapine, olanzapine has minimal effects on prolactin levels. These cases indicate that after switching from traditional neuroleptics to atypical agents, fertility may normalize and unplanned or even unwanted pregnancies may occur. Since olanzapine is widely prescribed, it is essential to inform women about the increased probability of pregnancy and the need of appropriate contraception.

Adult↗
PubMed2000

[Do cognitive deficits in depressive disorders remit?].

OBJECTIVE: The importance of cognitive deficits concerning schizophrenics is well-known. Much less material of that kind has been collected from patients with affective disorders, which was the aim of this clinical study. METHODS: Inclusion criterions were in- and outpatients with affective disorders (ICD-10: F31-F33) aged < 61. The clinical status was determined by use of the HAMD-21, the subjects were examined by means of standardised computerised cognitive performance tests (CGT-[M], DAUF). The results were correlated with the HAMD and the psychiatric pharmacotherapy. RESULTS: In each of the three subtests the heavily depressive group (HAMD > 24, n = 14) came off significantly (Mann-Whitney-U-Test, p < 0.05) worse than the remitted group (HAMD < or = 8, n = 18) while 8 of the 18 remitted patients showed pathological results in the CGT-(M). Only patients who took tranquilizers performed significantly worse than patients without such medication (p < 0.05). CONCLUSION: In some cases of affective disorders, a "cognitive residual syndrome" persists which is rather part of the disease than pharmacotherapy-associated.

Adult↗
PubMed1999

[Economic aspects of psychotherapy management in psychosomatics and psychiatry. A systematic survey of the literature].

Economic evaluations have become more and more important in the somatotherapeutic field. This survey's objective was to examine if the current economic evaluation techniques can be applied to psychotherapy. 8 data banks, 17 key words from the psychotherapeutic field and 14 economic key words were used, the identified original studies were classified in accordance with Drummond, the methodical quality of each study was assessed at a score between 0 and 10 points. 21 studies were found: 16 cost-benefit analyses, 4 cost-effectiveness analyses and one cost-utility analysis. The quality of the representation of the clinical results (mean value 8.6) was better than that of the economic results (mean value 6.1). It was perfectly possible to evaluate psychotherapeutic interventions with regard to economic aspects by means of the current techniques but in most cases there was a considerable lack of quality in both representation and calculation. Furthermore the evaluation type of cost-utility analysis, which is the only one that takes quality of life aspects into consideration and therewith seems to be the most appropriate approach regarding the psychotherapeutic field, has been greatly ignored.

Cost-Benefit Analysis↗
PubMed1990

[Integration and reintegration of first admission psychiatric patients].

In the framework of a prospective follow-up study, development and outcome of the occupational and social status in 258 first-admission psychiatric patients was investigated. Interviews were made at the time of discharge, 1 year and 5 years later. For that reason prospective data exist on the prehospital and hospital time as well as on short-term and long-term course. Social adjustment, occupational rehabilitation, early retirement, social status and pre- and post-hospital occupational integration were investigated. It must be placed on record, that psychiatric patients are subjected to severe negative changes in their occupational and social life even after the first hospital treatment. Type and quantity of disintegration depended on the diagnostic group. Schizophrenic patients differed from the other patients in every intergration area.

Alcoholism↗
PubMed1989

Work and psychiatric illness: the significance of the posthospitalization occupational environment for the course of psychiatric illnesses.

The value of the reintegration and rehabilitation of inpatients vocationally was studied. Certain of the vocational experiences (unemployment and stressful working conditions) of former psychiatric inpatients were examined, with attention being paid to their stabilizing or destabilizing effect on symptomatic behaviour. A cohort of 230 first-time admissions for treatment of various disorders were interviewed while hospitalized and 1 year later. A 20-item list prepared by INFAS was used for indexing stressful working conditions. Psychopathological states were assessed with the help of the Present State Examination of Wing et al. (1973). The results indicate that mentally ill persons (especially those with organic or affective disorders), when confronted with unemployment after discharge from hospital, will usually respond by developing new or worse syndromes. Stressful working conditions appear to have very different effects in schizophrenia and affective disorders, viz. deterioration and amelioration of psychopathological syndromes respectively.

Humans↗
PubMed1989

Mortality and rate of suicide of first admission psychiatric patients. A 5-year follow-up of a prospective longitudinal study.

Patients who commit suicide in a psychiatric hospital are, in general, patients who have had previous admission or who have already made at least one suicide attempt. The following study focuses upon an earlier time within the course of a psychiatric illness, that is the time of first admission, and examines the rate of suicide of 258 patients after 5 years. Two control groups were selected: first admitted psychiatric patients who did not commit suicide, and patients who died a 'natural death'. We analyzed how the suicides were integrated into the vocational, social and medical areas of life before they were admitted to the hospital. Further it was possible to identify predictors of future suicide.

Female↗
PubMed1988

The problem of readmission with respect to occupational factors. Course and predictive influences after 5 years.

In this study the course of Readmission after one, 2.5 and 5 years was examinated at a sample of 258 first admitted psychiatric patients of different diagnostic groups. In the analysis occupational, soziodemographic and clinical parameters of these patients were related to the readmission after 5 years and studied if these parameters allow a predictive statement. It was shown that 40%-60% (dependent of diagnoses) of the patients were readmitted in a period of 5 years. The course of the readmission also varied in the different diagnostic groups. The most striking result was the rate of readmission of the schizophrenic psychoses which was at the time of the 1 year catamnesis below average after the 2.5 year analysis however above average. Beside these findings occupational and clinical predictors were identified in all diagnostic groups with exception of the schizophrenic psychoses group. The results are discussed and attention is put on possible consequences to prevent rehospitalization.

Follow-Up Studies↗
PubMed1988

[Outcome, course and prognosis of the vocational status of psychiatric patients hospitalized for the 1st time--results of a multiple factor study].

In the framework of a prospective longitudinal investigation, the occupational course of first-admission psychiatric patients was analyzed for the first year (1980) and the fifth (1984) post-discharge from the clinic. Findings indicate that, to quite an important degree, tendencies towards occupational disintegration had existed already immediately after the first in-patient treatment episode. This applied almost totally independent of the clinical diagnosis given at the time of the first hospitalization. Only persons with substance abuse illness had been affected clearly less often, the situation four years later being however comparable. Except for the groups of neurotic and personality disorders, the occupational situation had by then however tightened drastically for all of the diagnostic groups, a structural analysis making it clear that this development had initiated already in the course of the first year. Thus, all patients who had been without work over the entire first year of the five-year period, had already reached the "terminal point" in their employment history. As far as diagnoses are concerned, our study confirms the experience that a schizophrenic illness will by no means always entail a straight course toward an unfavourable outcome. The investigation at the same time however also indicated that non-schizophrenic illnesses take a more unfavourable course than had been expected. In relation to earlier longitudinal catamnestic studies of persons with schizophrenia, the findings for our schizophrenic patients moreover were markedly worse, this discrepancy being presumed to be accounted for by the different methods applied, different selection criteria, as well as differences in economic activity at the time.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

[Readmission of psychiatric patients hospitalized for the first time--course and predictive factors after 5 years].

In this study the course of rehospitalisation after one, 2 1/2 and 5 years was examined in a sample of 113 readmitted patients of different diagnostic groups. In a second step of analysis occupational, sociodemographic and clinical parameters of these patients were related to the readmission after 5 years and studied if these parameters allow a predictive statement. It was shown that 40%-60% (dependent of diagnoses) of the patients were readmitted in a period of 5 years. The course of the rehospitalization also varied in the different diagnostic groups. The most striking result was the rate of readmission of the schizophrenic psychoses which was at the time of the 1 year catamnesis below average after the 2 1/2 years analysis however above average. Besides these findings occupational and clinical predictors were identified in all diagnostic groups with exception of the schizophrenic psychoses group. The results are discussed and attention is put on possible consequences to prevent rehospitalization.

Follow-Up Studies↗
PubMed1988

[Rehabilitation of pension--which course do psychiatric patients follow after their first inpatient treatment in a psychiatric hospital? Results of a prospective longitudinal study].

Placing persons having a mental illness in the open labour market has in recent years become increasingly difficult. The question therefore arises whether an attempt should be made to improve occupational access through rehabilitative measures, or whether pensioning would not be the more appropriate action. In the framework of a prospective 5-year catamnestic study of first-admission psychiatric patients, the course taken by them was investigated, as well as the factors that had been relevant in the decision to pension the patients, or to provide rehabilitative services. It was found that pensioning and rehabilitative measures differ in no essential degree as to their shares, and that both types of approach had occurred in only very few cases. Disease-specific factors (psychopathological symptoms, readmission) are suggested to be involved concerning the route taken. Pensioning on the one hand, and rehabilitation service provision on the other, are linked with the age and diagnoses of the patients, as well as the extent of their social activities.

Alcoholism↗
PubMed1987

Prognoses about vocational achievement behavior of first admitted psychiatric patients under special consideration of the diagnoses of depressive illnesses.

In this study prognoses about the posthospital vocational achievement behavior of 55 first admitted depressive patients were made at the time of discharge. With a structured and standardized questionnaire the patients themselves, the treating physicians, and the nurses were interviewed. As a first step of analysis the prognoses of the three groups were compared with each other and tested in respect of differences. This comparison was made with other psychiatric diagnoses too, whereby endogenic depressive patients and neurotic depressive patients were discriminated. In the second step of analysis the prognoses of the three 'rater groups' were compared with the real vocational reintegration of 1 year after discharge. The result was that the prognoses of the treating physicians and the nurses were more compatible with reality than those of the patients themselves.

Achievement↗
PubMed1986

Predictors for the social adjustment of first admitted psychiatric patients.

In a prospectively designed follow-up study of 258 first admitted psychiatric patients, 1 year after discharge 224 patients and 175 significant others were asked about the social adjustment of these patients and some predictors for this aspect of outcome could be identified. The sample consisted of five different diagnostic groups: organically caused psychiatric diseases, schizophrenic psychoses, affective psychoses, neurotic or personality disorders and alcohol or drug dependency. The study shows that statements about the social adjustment of psychiatric patients largely depend on the diagnostic group, both with respect to degree of adjustment and the predictors. Schizophrenic patients were found to be less well socially adjusted than the other patients, with the exception of the alcohol- and drug-addicted patients. For schizophrenic patients, post-hospital social adjustment was primarily determined by indicators of mental illness, such as psychopathological symptoms and length of hospitalization. The social adjustment of addicted patients was primary influenced by vocational variables. For the patients with organic psychiatric disorders, affective psychoses or neurotic/personality disorders, prediction by pre-hospital or hospital variables did not prove to be very useful.

Adolescent↗
PubMed1986

[Occupational reintegration of psychiatric patients hospitalized for the first time in the year following their discharge--results of a prospective longitudinal study].

A short-term occupational prognosis had been given for first-admission psychiatric patients, occasioned by information from the field that, in case of mentally ill persons, measures for their vocational rehabilitation frequently either are started too late, or are inappropriate in scope, because associated impairments are insufficiently dealt with, underrated, or even overlooked at all in the early stages of the illness. Following Wing's concept of disability, an attempt was moreover made to identify barriers for occupational resettlement. The findings provided the basis for considering the question of scope and type of within-clinic or external measures to be initiated, or stepped up, to facilitate these clients' access to gainful employment and, hence, able to positively influence the future course of their condition.

Germany, West↗