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Biomedical subjects

P Brieger

Publications and source records attributed to P Brieger.

At least 19 recordsLinked to original sources
PubMed2005

[Anxiety disorders comorbid with unipolar depression. Clinical diagnoses versus standardized diagnostic interview].

Anxiety disorders frequently co-occur with affective disorders. It is well-known that such comorbid anxiety disorders are more frequently diagnosed with standardized interviews than during the "daily routine." In 117 consecutive inpatients with major depression we assessed the frequency of DSM-IV anxiety disorders and compared it to the routine diagnoses of the discharge letters to analyze underlying principles of such diagnostic strategies. According to SCID-I (DSM-IV) 36 patients fulfilled criteria for a comorbid anxiety disorder, while this was only true for 17 patients according to discharge letters. Logistic regression revealed that clinically recognized cases had higher anxiety levels (higher diagnostic threshold). At the same time, in patients with higher depression scores anxiety syndromes tended not to be seen as separate disorders. This strategy is in line with "classic psychopathology," where severe depression (or melancholia) "included" anxiety symptoms. The borderline between depressive disorders and anxiety disorders is not as clear-cut as DSM-IV and ICD-10 try to indicate.

Adult↗
PubMed2005

[Bipolar affective and schizoaffective disorders of older age -- classification, symptoms and course].

Bipolar affective and schizoaffective disorders of older age are underdiagnosed, although they are of growing importance for psychiatric services. In this review article, we present and discuss results concerning classification, psychopathology, epidemiology, course, prognosis, neuroimaging, family studies and therapy. Bipolar (schizo)affective disorders of older age are a diagnostic heterogeneous group, especially as secondary manias must be separated from "endogenous" bipolar disorders nosologically. Bipolar (schizo)affective disorders of older age show some peculiarities: Gender ratio, age at onset, mortality and comorbidity with neurological disease are amongst them. Nevertheless, in many other aspects bipolar (schizo)affective disorders of older age do not differ from bipolar disorders of younger patients. For the acute and maintenance treatment there is a dearth of controlled studies. Lithium is of great importance. Other substances, as well as psychoeducation and ECT may be used analogously as in younger patients, if age specific factors are taken into account (as for example the danger of falls).

Aged↗
PubMed2005

[A study of persons living in neglect, filth and squalor or who have a tendency to hoard].

PURPOSE: Who develops neglect, lives in filth and squalor or tends to hoard? What happens to people with such tendencies, after heaving been discovered by community mental health services? MATERIALS AND METHODS: During a two-year observation period it was attempted to study all such persons in the city of Halle/Saale. Life history as well as medical, social and psychiatric variables were assessed. After a mean period of 11 months these persons were re-assessed. RESULTS: 35 persons who lived in squalor and filth or in a neglected condition or who were known to hoard were assessed (60 % male, mean age: 63 years). 17 persons (49 %) suffered from an organic brain disease, 14 (40 %) fulfilled criteria of psychotic illness (mainly schizophrenia). In 9 cases a comorbid physical disorder contributed to the prevailing living conditions. After 11 months, for 21 persons (60 %) no amelioration of neglect, squalor or hoarding was observed, which was especially true for persons suffering from a psychotic illness. The results yielded some evidence that interventions, which aimed at living conditions (such as moving to sheltered accommodation), had positive effects, while this was not true for standard mental health care within community services and hospital treatment. CONCLUSION: Neglect, living in squalor and hoarding are frequently symptoms of an underlying psychiatric or somatic illness. In this respect the results suggest that "standard care" proved to be of limited effect -- especially for subjects with a psychotic illness.

Adult↗
PubMed2005

[Predicting improvement in work status of patients with chronic mental illness after vocational and integrative rehabilitation measurements].

PURPOSE: Chronically mentally ill patients often need special rehabilitation to be able to re-enter competitive employment. We know only very little about predicting favourable or unfavourable rehabilitation courses. The present study seeks to examine the relationship between successful rehabilitation -- as defined by a progress in professional ability -- and individual parameters obtained at initiation off-take. METHOD: Data of 101 subjects who had completed a rehabilitation programme serve as the basis. At the beginning of rehabilitation, sociodemographic, intellectual, psychopathological and quality of life measures were obtained. Each participant was assigned to one of two rehabilitation outcome groups: progress vs. stagnation, determined by the vocational status after programme termination. Both groups were then compared regarding the aforementioned parameters at programme onset to identify substantial predictors for rehabilitation success via regression analysis. RESULTS: High level of functioning, fewer periods of unemployment, a high level of work-related adaptation, and young age at programme onset were found to be predictive of progress in vocational status. CONCLUSIONS: Objective parameters have a higher predictive potential regarding vocational reintegration of psychologically ill people compared to subjective criteria. Psychiatric diagnoses as defined by DSM-IV do not reveal relevant connections with subsequent vocational successful reintegration, whereas the initial level of functioning has a definite predictive value.

Adult↗
PubMed2004

[Neuropsychological testing in vocational rehabilitation for subjects with schizophrenia].

Until now it is difficult to predict the success of vocational rehabilitation programs for subjects with severe mental illnesses. The growing knowledge about the neuropsychological mechanisms of psychiatric disorders has not been fully integrated into psychiatric rehabilitation research. We reviewed the literature how to use neuropsychological parameters for predicting outcome of vocational rehabilitation programs in subjects with schizophrenia and schizoaffective disorders. Twenty studies were reviewed, which evaluated neuropsychological variables to predict dimensions of rehabilitation success. As a result of this review, we suggest implementing neurocognitive tests, which assess executive functions, working memory, and attention deficits in routine rehabilitation to better plan and coordinate rehabilitation, and to predict rehabilitation outcome.

Cognition↗
PubMed2003

[Temperament and affective disorders--historical basis of current discussion].

The history of the temperament concept begins in ancient Greece. The humoral theory remained influential over the centuries. At the beginning of the 20 th century, both Wilhelm Wundt and his pupil Emil Kraepelin formulated new aspects. Wundt described two dimensions: "speed of variability of emotions" and "intensity of emotions". Kraepelin observed four fundamental states (depressive, manic, irritable and cyclothymic), which he linked to manic-depressive illness. Since then different lines of temperament research have evolved: (1) psychiatric-psychopathological theories (e. g. Ewald, Kretschmer and Sheldon), which tend to see temperament as a dilution of full-blown affective disorders; (2) neurobiological theories (e. g. Pavlov, Eysenck and Gray), which understand temperament as determined by underlying neurobiological processes - especially levels of arousal; and (3) developmental theories (e. g. Chess & Thomas, Rothbart and Kagan), which derived their temperament concept from early childhood observations. Recent theories (e. g. those of Cloninger or Akiskal) combine different aspects. After reviewing the historical temperament concepts we present underlying factors which are linked to affective disorders (such as emotional reactivity, cyclicity or trait affectivity). Finally, we illustrate the importance of temperament concepts for research in affective disorders.

History, 19th Century↗
PubMed2002

[Temperament and affective disorders. The TEMPS-A Scale as a convergence of European and US-American concepts].

In temperament research, three traditions can be found: (1) in psychiatry or psychopathology, (2) in neurobiology, and (3) in developmental psychology. After giving an overview, we present results and theories concerning the relation between temperament and affective disorders. Based on Kraepelin's concept of the fundamental states ("Grundszustände"), we describe four types of temperament: hyperthymic (manic), depressive, irritable, and cyclothymic. A fifth anxious temperament is added. Clinical description and scientific implications are described in the light of recent work by Akiskal and the German version of the TEMPS-A scale, a self-report questionnaire for assessing temperament.

Anxiety Disorders↗
PubMed2002

Personality features of patients with mixed and pure manic episodes.

OBJECTIVE: To test the hypothesis that patients with a mixed manic episode show different personality features than patients with a pure manic episode. METHOD: Sixteen patients with a mixed manic episode (broad criteria) and 26 patients with a pure manic episode were assessed with diagnostic interviews (SCID I/II) as well as instruments for depression, mania and personality. RESULTS: Even after controlling for age as well as depression and mania score at assessment, no differences between the two groups emerged concerning either personality features as assessed with the NEO-five-factor inventory (NEO-FFI) or personality disorders. CONCLUSION: We found no difference between patients with mixed mania and patients with pure mania concerning their personality features. Possible reasons for this are being discussed.

Adult↗
PubMed2002

[The concept of hyperthymia].

The article reviews the conceptual history of "hyperthymia". Since K. W. Stark had used this term in the early 19(th) century, it has developed in two different directions: (1) to delineate a psychopathological syndrome and (2) to define a type of personality disorder (psychopathy). As Kurt Schneider's personality disorder (psychopathy) concept was easily understood and highly practicable, it became influential during the 20(th) century. Earlier before, psychiatrists such as E. Mendel, C. Wernicke and C. G. Jung had described entities such as "chronic mania", "hypomania" or "sanguinic degeneration", which were rather similar to each other. We analyze the historical development of such concepts. Emil Kraepelin was highly influential, as he introduced "constitutional excitation" into a broad concept of manic-depressive illness and saw it as a very mild form. After Kraepelin such spectrum concept was first forgotten. Only in recent years these historical considerations were confirmed by empirical observations, although a separate hyperthymic disorder is neither part of DSM-IV nor ICD-10. The concept of a hyperthymic temperament or a hyperthymic personality is a trait-marker and should be differentiated from hypomania as a state-marker. Nowadays, the importance of hyperthymia is not so much one of a disorder requiring treatment; rather the concept has interesting genetic, diagnostic and conceptual consequences.

Bipolar Disorder↗
PubMed2001

Affective symptoms at index hospitalization in childhood and depressive symptoms in adulthood: a "catch-up" study.

PURPOSE: To analyze whether affective symptoms during psychiatric treatment in childhood or adolescence could predict the later development of depressive symptoms. METHOD: We used a "catch-up" design. A cohort of former child and adolescent psychiatric patients was assessed in adulthood with standardized instruments according to the criteria of ICD-10 (SCAN) and dimensional values for depression (both self-reported and observer-rated). Initial affective symptoms had been extracted from clinical records according to a standardized system (AMDP). RESULTS: We assessed 164 former patients. Twelve percent of these fulfilled diagnostic criteria of an affective disorder (F3) according to ICD-10. In univariate analyses of variance the depression scores were significantly related to affective symptoms during childhood treatment, even if the presence of an affective disorder at catch-up was considered as an independent covariate variable. Nevertheless, the latter variable explained a large part of the variance of depression scores, while initial affective symptoms explained no more than 6%. CONCLUSION: Affective symptoms in childhood and adolescence may predict the later development of subthreshold depressive symptomatology.

Adolescent↗
PubMed2001

What becomes of children hospitalized for enuresis? Results of a catch-up study.

BACKGROUND: . The purpose of this study was to reassess former child and adolescent psychiatric patients with nocturnal enuresis as young adults and to compare them with former patients without enuretic symptoms and with a comparison group from the general population. METHOD: We used a 'catch-up' design. From a former child and adolescent psychiatric patient cohort we identified all subjects with documented enuretic symptoms in childhood and compared them with two groups matched for gender and age - non-enuretic patients and a comparison group from the general population. Subjects were assessed as adults with standardized instruments according to the criteria of ICD-10 (SCAN, IPDE) and dimensional values for depression, satisfaction with life, global functioning and personality (NEO-FFI). RESULTS: We assessed 55 former patients with nocturnal enuresis (recruitment rate 68%) after a mean interval of 13.1 years. At catch-up the former enuretic patients had a lower frequency of personality disorders (ICD-10), lower mean depression values, higher global functioning and a lower rate of psychiatric treatment after the age of 18 years than did former non-enuretic patients. Former enuretic patients did not differ significantly from the comparison group from the general population concerning any of the outcome variables, although there was a non-significant trend for former enuretic patients to more often fulfill criteria for a psychiatric ICD-10 diagnosis at catch-up. There were no differences concerning personality among the three groups at catch-up. CONCLUSION: Although it may constitute a mild vulnerability factor for further development, nocturnal enuresis had a good long-term outcome in a cohort of treated subjects.

Adolescent↗
PubMed2001

[Psychiatric care in Sachsen-Anhalt: a survey of institutions and services with the "European Services Mapping Schedule" ESMS].

OBJECTIVE: To describe the availability of outpatient, inpatient and community based psychiatric care in 21 rural districts and 3 cities of Sachsen-Anhalt, one of the federal states of eastern Germany, with rapid changes and developments in psychiatric care over the last ten years. METHOD: Information about services was obtained from files of the "Committee for Issues of Psychiatric Care in Sachsen-Anhalt", which was established in 1992 with six multiprofessional "visitation groups" to perform inspections of all institutions providing psychiatric service to the community. Reports about these regular visits followed semi-standardized protocols. The ESMS was used to classify 365 institutions visited between 1996 and 1998, and numbers of places per 100 000 inhabitants were used to compare the 24 regions of the state. RESULTS: The visitation protocols as the main source of information and the ESMS as a classification tool proved to be useful. The interrater-reliability was high, and the validity of the data was supported by other official statistics. Outpatient care was provided by 4 psychiatrists and 3 psychologists in private practice per 100 000 inhabitants, which is low compared to the German mean. 10 secure beds (forensic psychiatry), 48 acute beds, 13 elective beds and 13 day hospital places per 100 000 inhabitants were available for inpatient care, with a marked shortage of beds in the southern and eastern regions of the state. Non-acute non-hospital residential services with indefinite stay and 24 hour support accumulated to 240 places per 100 000, with regional differences ranging from less than 100 to more than 1000. About 80 % among the residents of these institutions were considered as suffering from "mental retardation", suggesting some persisting institutionalism. All other residential services taken together (time-limited or with less than 24 hour support) came to 24 places per 100 000. Sheltered workshop places corresponded to the number of persons in residential homes. Other facilities offering paid work or work-related activities were scarce; some services providing structured activity or social contact were available in urban agglomerations. The data about the frequency of contacts in outpatient and community services are limited. CONCLUSIONS: Psychiatric care in Germany is fragmentary, as regards providers and funding. Information collected by the "Committee for Issues of Psychiatric Care in Sachsen-Anhalt", taken mainly from visitation protocols, was sufficient to establish a general survey over 24 regions of this federal state. We propose to repeat this approach regularly to monitor developments in the field of social psychiatry for further planning and interventions. Overall, our results show that the aims formulated in the German "Inquiry into Psychiatry" ("Psychiatrie-Enquete") have not been fully accomplished (e.g. the preferential status of outpatient versus in-patient services).

Community Mental Health Services↗
PubMed2001

A catch-up study of former child and adolescent psychiatric inpatients: psychiatric status in adulthood.

BACKGROUND: The purpose of this study was to reassess former child and adolescent psychiatric patients as adults with regard to their further development. METHODS: We used a 'catch-up' design. A former child and adolescent psychiatric patient cohort and controls (matched for sex and age) were assessed as adults with standardized instruments (Schedules for Clinical Assessment in Neuropsychiatry, International Personality Disorder Examination, biography, psychiatric history, Global Assessment Scale, Satisfaction with Life Scale). RESULTS: We assessed 164 former patients and 80 controls. The mean catch-up period was 13.2 years, and the subjects had a mean age of 24.8 years. Thirty-nine percent of the former patients and 25% of the controls fulfilled criteria for an ICD-10 diagnosis (present state) at catch-up, with a clear excess of personality disorders in the former patient group (13 vs. 3%). Using a survival analysis we estimated that 38% of the former patients and 10% of the controls would undergo psychiatric treatment between the ages of 18 and 31 years. CONCLUSIONS: Most former child and adolescent psychiatric patients did not come into contact with psychiatric treatment facilities again in their twenties, although they had a higher risk for a psychiatric disorder than controls. Nevertheless, the risk of later developing a personality disorder according to ICD-10 seems to be markedly raised for former child and adolescent psychiatric patients.

Adolescent↗
PubMed2000

[Comorbidity in psychiatric diseases. Theoretical considerations].

During the last 10 years, comorbidity has become an important topic in psychiatric research, leading to a growing number of publications. We discuss the theoretical and historical background of this development and present definitions and models for the phenomenon. Methodological difficulties have to be stated: considering its clinical consequences, we conclude that (1) comorbidity is an inevitable methodological consequence of the diagnostic strategies and continued diversification of DSM-IV and ICD-10, (2) there is little doubt of its relevance in the clinical context, and (3) the diagnostic strategies of DSM-IV and ICD-10 concerning comorbidity are difficult to follow in clinical reality.

Comorbidity↗
PubMed2000

The relationship between five-factor personality measurements and ICD-10 personality disorder dimensions: results from a sample of 229 subjects.

This article examines the relationship between the five-factor model (FFM) and dimensional ICD-10 personality disorders. In a follow-up study of a child and adolescent psychiatric cohort, former patients and controls were assessed with NEO-FFI and the IPDE interview (CD-10 personality disorder). Full data were available for 229 subjects (149 former patients, 80 controls). Multiple regression analysis showed that the five factors of the FFM as independent variables explained between 5% (schizoid personality disorder) and 32% (anxious personality disorder) of the variance of ICD-10 dimensional personality disorder scores. For the two types of emotionally unstable personality disorder dimension (impulsive and borderline), for anxious (avoidant) personality disorder dimension and for the total score of any personality disorder dimension, FFM explained between 17% and 32% of the variance with almost identical results for the former patient group and the control group. High neuroticism was a feature of paranoid, emotionally unstable, histrionic, anankastic, anxious (avoidant), and dependent personality disorder dimensions, whereas low agreeableness was found in dissocial, emotionally unstable and histrionic personality disorder dimensions. Low extraversion was found in schizoid, anxious (avoidant) and dependent personality disorder dimensions, whereas histrionic PD dimension correlated with high extraversion. We find that the FFM is valuable for the further understanding not only of DSM-IV but also of ICD-10 personality disorder dimensions. The differences between ICD-10 and DSM-IV in this respect seem to be small.

Adult↗
PubMed1999

[Psychotic symptoms as initial manifestation of a multiple system atrophy].

Multiple system atrophy is a disease characterised clinically by any combination of parkinsonian, pyramidal, autonomic or cerebellar symptoms and signs. This neurological status is often complicated by associated mental disturbances such as deficits in concentration, memory or learning. There are only very few reports in the literature describing cases of multiple system atrophy associated with psychotic symptoms. We report on two cases in which psychotic symptoms were the initial manifestation of multiple system atrophy. In view of the known neuropathologic and biochemical changes in multiple system atrophy the concurrent incidence of paranoid-hallucinatoric symptoms seems not uncommon and should be studied further.

Adult↗
PubMed1998

[Dysthymia and cyclothymia--serious consequences of rarely diagnosed disorders].

Dysthymia and cyclothymia are chronic affective disorders with a minimum duration of 2 years. Both ICD-10 and DSM-IV define cyclothymia as a bipolar disorder with low intensity. This disorder is rare and little research has been done on it. Its economic and social consequences vary from case to case. In contrast dysthymias, chronic depressive disorders, are frequent (prevalence 3-6%) and cause considerable distress. They have serious economic and social consequences, which are comparable to those caused by other chronic conditions such as arthritis or diabetes mellitus. Despite widely held conviction a majority of dysthymias improves under consequent pharmaco- and psychotherapy.

Cyclothymic Disorder↗