Biomedical subjects

R Lieb

Publications and source records attributed to R Lieb.

At least 19 recordsLinked to original sources

PubMed2005

Anxiety disorders: clinical presentation and epidemiology.

This chapter gives an overview of the clinical presentation of anxiety disorders and reviews basic epidemiological knowledge on them. The presented knowledge is largely related to the classification of anxiety disorders as presented by the Diagnostic and Statistical Manual of Mental Disorders since itsthird revision (DSM-III). Without going into detail into the history of the classification of anxiety disorders and into the history and development of the several editions of the Diagnostic Manual of Mental Disorders (DSM) of the American Psychiatric Association (APA) it should just briefly be mentioned that the DSM of the APA has undergone until today four revisions. Within these revisions, the third edition (DSM-III) changed most radically from the forerunning ones. The major change in DSM-III was that the category "anxiety neurosis" was deleted because this term was too general and could not be defined reliably. On the basis of evidence that imipramine can block panic attacks, panic disorder was created as a new diagnosis for the first time in DSM-III. Anxiety states without spontaneous panic attacks were separated from panic disorder and defined as a residual category, generalized anxiety disorder. The revised version of DSM-III, DSM-III-R, was published in 1987, and the fourth and most recent edition, DSM-IV, was published in 1994. More recently, a text revision of DSM-IV has been published that does not entail changes to the diagnostic criteria of disorders, but provides updated empirical reviews for each diagnostic category regarding associated features, cultural, age, and gender features, prevalence, course, familial patterns, and differential diagnosis (DSM-IV-R). Without going into further details of the development and changes across the different editions and revisions of DSM--these have been reviewed comprehensively in other reviews--this chapter gives an overview about the clinical presentations of anxiety disorders by referring mainly to the forth edition of the DSM (DSM-IV 1994). In the second part, the chapter reviews and summarizes selected aspects (prevalence, correlates, risk factors and comorbidity) of epidemiological knowledge on anxiety disorders.

Adolescent↗

PubMed2005

"Anxietas tibiarum". Depression and anxiety disorders in patients with restless legs syndrome.

BACKGROUND: Symptoms of anxiety and depression in patients with restless legs syndrome (RLS) have been observed. However, it is unclear whether rates of threshold depression and anxiety disorders according to DSM-IV criteria in such patients are also elevated. METHODS: 238 RLS patients were assessed with a standardized diagnostic interview (Munich-Composite International Diagnostic Interview for DSM-IV) validated for subjects aged 18-65 years. Rates of anxiety and depressive disorders were compared between 130 RLS patients within this age range and 2265 community respondents from a nationally representative sample with somatic morbidity of other types. RESULTS: RLS patients revealed an increased risk of having 12-month anxiety and depressive disorders with particularly strong associations with panic disorder (OR=4.7; 95% CI=2.1-10.1), generalized anxiety disorder (OR=3.5; 95% CI= 1.7-7.1), and major depression (OR=2.6; 95% CI=1.5-4.4). In addition, lifetime rates of panic disorder and most depressive disorders as well as comorbid depression and anxiety disorders were considerably increased among RLS patients compared with controls. CONCLUSIONS: The results suggest that RLS patients are at increased risk of having specific anxiety and depressive disorders. Causal attributions of patients suggest that a considerable proportion of the excess morbidity for depression and panic disorder might be due to RLS symptomatology.

Adolescent↗

PubMed2004

Prevalence, co-morbidity and correlates of mental disorders in the general population: results from the German Health Interview and Examination Survey (GHS).

BACKGROUND: The German National Health Interview and Examination Survey (GHS) is the first government mandated nationwide study to investigate jointly the prevalence of somatic and mental disorders within one study in the general adult population in Germany. This paper reports results from its Mental Health Supplement (GHS-MHS) on 4-week 12-month, and selected lifetime prevalence of a broad range of DSM-IV mental disorders, their co-morbidity and correlates in the community. METHODS: The sample of the GHS-MHS (n=4181; multistage stratified random sample drawn from population registries; conditional response rate: 87.6%) can be regarded as representative for the German population aged 18-65. Diagnoses are based on fully structured computer assisted clinical interviews (M-CIDI), conducted by clinically trained interviewers. RESULTS: 12-month prevalence for any DSM-IV study disorder is 31% (lifetime: 43%; 4-week: 20%) with anxiety disorders, mood disorders and somatoform syndromes being the most frequent diagnoses. Retrospective age of onset information reveals that most disorders begin early in life. Co-morbidity rates among mental disorders range from 44% to 94%. Correlates of increased rates of mental disorders and co-morbidity were: female gender (except for substance disorders), not being married, low social class, and poor somatic health status. Health care utilization for mental disorders depended on co-morbidity (30% in 'pure', 76% in highly co-morbid cases) and varied from 33% for substance use disorders to 75% for panic disorder. CONCLUSIONS: Results confirm and extend results from other national studies using the same assessment instruments with regard to prevalence, co-morbidity and sociodemographic correlates, covering a broader range of DSM-IV disorders [i.e. somatoform disorders, all anxiety disorders (except PTSD), mental disorders due to substance or general medical factor, eating disorders]. Intervention rates were higher than in previous studies, yet still low overall.

Adolescent↗

PubMed2004

Early maternal stress and health behaviours and offspring expression of psychosis in adolescence.

OBJECTIVE: It has been suggested that influences operating early in life may affect the risk of postpubertal psychosis outcomes. This hypothesis was tested using a broad outcome of psychotic symptoms expressed in adolescence (prevalence: 15.6%). METHOD: Findings are based on a longitudinal, population-based cohort study of 963 adolescents aged 15-20 years and their parents in the area of Munich, Germany. Trained psychologists assessed adolescents with the Munich-Composite International Diagnostic Interview. Independently, direct diagnostic interviews were conducted with the parents. RESULTS: A range of medical complications of pregnancy and delivery, including lower birth weight, were not associated with the psychosis outcome. However, a number of maternal health behaviours and experiences did show associations, independent of confounders. CONCLUSION: Not maternally reported medical complications of pregnancy and delivery, but maternal prenatal health behaviours predicted expression of psychosis along a continuum in adolescence. This effect may either be direct or constitute a proxy for later postnatal maternal behaviours associated with psychosis risk in the offspring.

Adolescent↗

PubMed2003

Recurrent brief depressive disorder reinvestigated: a community sample of adolescents and young adults.

BACKGROUND: This article presents prospective lower bound estimations of findings on prevalence, incidence, clinical correlates, severity markers, co-morbidity and course stability of threshold and subthreshold recurrent brief depressive disorder (RBD) and other mood disorders in a community sample of 3021 adolescents. METHOD: Data were collected at baseline (age 14-17) and at two follow-up interviews within an observation period of 42 months. Diagnostic assessment was based on the Munich Composite International Diagnostic Interview (M-CIDI). RESULTS: Our data suggest that RBD is a prevalent (2.6%) clinical condition among depressive disorders (21.3%) being at least as prevalent as dysthymia (2.3%) in young adults over lifetime. Furthermore, RBD is associated with significant clinical impairment sharing many features with major depressive disorder (MDD). Suicide attempts were reported in 7.8% of RBD patients, which was similar to MDD (11.9%). However, other features, like gender distribution or co-morbidity patterns, differ essentially from MDD. Furthermore, the lifetime co-occurrence of MDD and RBD or combined depression represents a severe psychiatric condition. CONCLUSIONS: This study provides further independent support for RBD as a clinically significant syndrome that could not be significantly explained as a prodrome or residual of major affective disorders.

Adolescent↗

PubMed2003

Primary anxiety disorders and the development of subsequent alcohol use disorders: a 4-year community study of adolescents and young adults.

BACKGROUND: Cross-sectional findings in community surveys of adults suggest that adolescent anxiety disorders are strong predictors of the subsequent onset of alcohol use, abuse and dependence. However, prospective data that follow a sample of adolescents into adulthood are needed to confirm these associations. METHOD: Baseline and 4-year follow-up data from the EDSP-Study, a prospective community survey of 3021 (2548 at follow-up) adolescents and young adults aged 14 to 24 years at baseline carried out in Munich, were used. DSM-IV anxiety disorders, alcohol use and alcohol use disorders were assessed with the Munich-Composite-International-Diagnostic-Interview (M-CIDI). Multiple logistic regression analysis, controlling for age, gender, other mental disorders, substance use disorders and antisocial behaviour was used to study the associations of baseline anxiety disorders with the subsequent onset and course of alcohol use and alcohol disorders. RESULTS: Baseline social phobia significantly predicts the onsets of regular use and hazardous use and the persistence of dependence. Panic attacks significantly predict the onsets of hazardous use and abuse as well as the persistence of combined abuse/dependence. Panic disorder significantly predicts the persistence of combined abuse/dependence. Other anxiety disorders do not significantly predict any of the outcomes. CONCLUSIONS: Panic and social phobia are predictors of subsequent alcohol problems among adolescents and young adults. Further studies are needed to investigate the underlying mechanisms and the potential value of targeted early treatment of primary panic and social phobia to prevent secondary alcohol use disorders.

Adolescent↗

PubMed2003

Family and high-risk studies of social anxiety disorder.

OBJECTIVE: To present data on the role of familial factors in the etiology of social anxiety disorder. METHOD: Findings presented from a family/high-risk study (the Yale Family Study) and a prospective community study of youth (the Munich Early Developmental Stages of Psychopathology (EDSP) Study). RESULTS: The Yale Family Study demonstrated a substantial degree of familial aggregation of social anxiety disorder and specificity with respect to other anxiety subtypes among adult relatives. The Yale high-risk component and the EDSP Study confirm the association between parental and offspring social anxiety, but did not yield consistent evidence for an association between familial environmental factors and social anxiety. CONCLUSION: Future studies are needed to examine mechanisms for the specificity of social anxiety disorder aggregation, to identify vulnerability factors for its development and to pinpoint environmental conditions that may enhance or suppress expression of underlying vulnerability.

Adolescent↗

PubMed2002

Parental alcohol use disorders and alcohol use and disorders in offspring: a community study.

BACKGROUND: We examined the association between parental alcohol use disorders and patterns of alcohol consumption and DSM-IV alcohol use disorders in their offspring in a community-based sample of young adults. METHODS: Data are based on baseline and 4-year follow-up data of 2427 respondents aged 14-24 at baseline. Alcohol use and disorders in respondents were assessed using the Munich-Composite-international-Diagnostic-Interview with DSM-IV algorithms. Diagnostic information about parents was collected by family history information from the respondents, and by direct interview with one parent (cohort aged 14 to 17 years only). RESULTS: Although the association between maternal and paternal alcohol use disorders and non-problematical drinking in offspring was minimal, there was a strong effect for the transition to hazardous use and for alcohol abuse and dependence; the effect of parental concordance for transition into hazardous use was particularly striking. Maternal history was associated with a higher probability of progression from occasional to regular use, whereas paternal history was associated with progression from regular to hazardous use. Parental alcoholism increased the risk for first onset of hazardous use and alcohol dependence between the ages of 14-17, and for an earlier onset of the alcohol outcomes in offspring. The impact of parental alcohol use disorders was comparable for male and female offspring. CONCLUSIONS: Parental alcoholism predicts escalation of alcohol use, development of alcohol use disorders and onset of alcohol outcomes in offspring.

Adolescent↗

PubMed2002

Prevalence, incidence and stability of premenstrual dysphoric disorder in the community.

BACKGROUND: Despite an abundance of clinical research on premenstrual and menstrual symptoms, few epidemiological data provide estimates of the prevalence, incidence, co-morbidity, stability and correlates of premenstrual dysphoric disorder (PMDD) in the community. AIMS: To describe the prevalence, incidence, 12 co-morbidity factors and correlates of threshold and subthreshold PMDD in a community sample of young women. METHODS: Findings are based on prospective-longitudinal community survey of 1488 women aged 14-24, who were followed-up over a period of 48 months (follow-up, N = 1,251) as part of the EDSP sample. Diagnostic assessments were based on the Composite International Diagnostic Interview (CIDI) and its 12-month PMDD diagnostic module administered by clinical interviewers. Diagnoses were calculated using DSM-IV algorithms, but daily ratings of symptoms, as required, were not available. RESULTS: The baseline 12-month prevalence of DSM-IV PMDD was 5.8%. Application of the diagnostic exclusion rules with regard to concurrent major depression and dysthymia decreased the rate only slightly (5.3%). An additional 18.6 % were 'near-threshold' cases, mostly because they failed to meet the mandatory impairment criterion. Over the follow-up period only few new PMDD cases were observed: cumulative lifetime incidence was 7.4%. PMDD syndrome was stable across 48 months with < 10% complete remissions among baseline PMDD cases. The 12-month and lifetime co-morbidity rates were high (anxiety disorders 47.4%, mood disorders 22.9%; somatoform 28.4%), only 26.5 % had no other mental disorder. Particularly high odds ratios were found with nicotine dependence and PTSD. In terms of correlates increased rates of 4-weeks impairment days, high use of general health and mental health services, and increased rates of suicide attempts were found. CONCLUSION: In this sample of adolescents and young adults, premenstrual symptoms were widespread. However, DSM-IV PMDD was considerably less prevalent. PMDD is a relatively stable and impairing condition, with high rates of health service utilization, increased suicidality and substantial co-morbidity.

Adolescent↗

PubMed2001

The natural course of cannabis use, abuse and dependence over four years: a longitudinal community study of adolescents and young adults.

OBJECTIVES: To determine incidence and patterns of natural course of cannabis use and disorders as well as cohort effects in a community sample of adolescents and young adults. METHOD: Cumulative incidence and patterns of cannabis use and disorders were examined in a prospective longitudinal design (mean follow-up period=42 months) in a representative sample (N=2446) aged 14-24 years at the outset of the study. Patterns of cannabis use, abuse and dependence (DSM-IV) were assessed with the Composite International Diagnostic Interview (M-CIDI). RESULTS: (1) Cumulative lifetime incidence for cannabis use (at second follow-up): 47%; 5.5% for cannabis abuse, 2.2% for dependence. (2) Men used and abused cannabis more often than women. (3) The majority of the older participants (18-24 years at baseline) had reduced their cannabis use at follow-up, while younger participants (14-17 years at baseline) more often had increased their use and developed abuse or dependence. (4) The younger birth cohort (1977-1981) tended to start earlier with substance (ab)use compared to the older birth cohort (1970-1977). (5) Cannabis use was associated with increasing rates of concomitant use of other licit and illicit drugs. CONCLUSIONS: Cannabis use is widespread in our sample, but the probability of developing cannabis abuse or dependence is relatively low (8%). The natural course of cannabis use is quite variable: about half of all cannabis users stopped their use spontaneously in their twenties, others report occasional or more frequent use of cannabis.

Adolescent↗

PubMed2001

Social anxiety disorder and the risk of depression: a prospective community study of adolescents and young adults.

BACKGROUND: Social anxiety disorder (SAD) (also known as "social phobia") is frequently comorbid with major depression, and in such cases, almost always precedes it. This has led to interest in SAD as a possible modifier of the risk and/or course of mood disorders. METHODS: Data come from a prospective, longitudinal epidemiologic study of adolescents and young adults (aged 14-24 years) in Munich, Germany. Respondent diagnoses (N = 2548) at baseline and follow-up (34-50 months later) are considered. The influence of SAD at baseline on the risk, course, and characteristics of depressive disorders (ie, major depression or dysthymia) at follow-up is examined. RESULTS: The baseline prevalence of SAD was 7.2% (95% confidence interval [CI], 6.1%-8.4%). Social anxiety disorder in nondepressed persons at baseline was associated with an increased likelihood (odds ratio [OR] = 3.5; 95% CI, 2.0-6.0) of depressive disorder onset during the follow-up period. Furthermore, comorbid SAD and depressive disorder at baseline was associated with a worse prognosis (compared with depressive disorder without comorbid SAD at baseline). This is exemplified by the greater likelihood of depressive disorder persistence or recurrence (OR = 2.3; 95% CI, 1.2-4.6) and attempted suicide (OR = 6.1; 95% CI, 1.2-32.2). CONCLUSIONS: Social anxiety disorder during adolescence or young adulthood is an important predictor of subsequent depressive disorders. Moreover, the presence of comorbid SAD in adolescents who are already depressed is associated with a more malignant course and character of subsequent depressive illness. These findings may inform targeted intervention efforts.

Adolescent↗

PubMed2000

Parental psychopathology, parenting styles, and the risk of social phobia in offspring: a prospective-longitudinal community study.

BACKGROUND: This article examines the associations between DSM-IV social phobia and parental psychopathology, parenting style, and characteristics of family functioning in a representative community sample of adolescents. METHODS: Findings are based on baseline and first follow-up data of 1047 adolescents aged 14 to 17 years at baseline (response rate, 74.3%), and independent diagnostic interviews with one of their parents. Diagnostic assessments in parents and adolescents were based on the DSM-IV algorithms of the Munich-Composite International Diagnostic Interview. Parenting style (rejection, emotional warmth, and overprotection) was assessed by the Questionnaire of Recalled Parental Rearing Behavior, and family functioning (problem solving, communication, roles, affective responsiveness, affective involvement, and behavioral control) was assessed by the McMaster Family Assessment Device. RESULTS: There was a strong association between parental social phobia and social phobia among offspring (odds ratio [OR], 4.7; 95% confidence interval [CI], 1.6-13.5). Other forms of parental psychopathology also were associated with social phobia in adolescents (depression: OR, 3.6; 95% CI, 1.4-9.1; any anxiety disorder other than social phobia: OR, 3.5; 95% CI, 1.4-8.8; and any alcohol use disorder: OR, 3.0; 95% CI, 1.1-7.8). Parenting style, specifically parental overprotection (OR, 1.4; 95% CI, 1.0-1.9) and rejection (OR, 1.4; 95% CI, 1.1-1.9), was found to be associated with social phobia in respondents. Family functioning was not associated with respondents' social phobia. CONCLUSIONS: Data suggest that parental psychopathology, particularly social phobia and depression, and perceived parenting style (overprotection and rejection) are both associated with the development of social phobia in youth.

Adolescent↗

PubMed2000

The Early Developmental Stages of Psychopathology Study (EDSP): a methodological update.

The objectives of the community-based Early Developmental Stages of Psychopathology (EDSP) Study are described along with a detailed account of the overall design, special design features, sample characteristics and instruments used. The EDSP employed a prospective-longitudinal design to study substance use and other mental disorders in a representative population sample of 3,021 subjects aged 14-24 years (birth cohorts 1970-1981) at 'baseline' - the outset of the study. Two follow-up investigations were conducted after the baseline investigation covering an overall period of 3-4 years. Special design features are the linkage with a family supplement (EDSP-FS) as well as neurobiological laboratory studies of high-risk subjects.

Adolescent↗

PubMed2000

Somatoform syndromes and disorders in a representative population sample of adolescents and young adults: prevalence, comorbidity and impairments.

OBJECTIVE: To present prevalence findings of DSM-IV somatoform symptoms, syndromes and disorders in a representative sample of adolescents and young adults. METHOD: Data come from the Early Developmental Stages of Psychopathology (EDSP) study, in which a total of 3021 respondents aged 14-24 years were assessed by the Munich-Composite International Diagnostic Interview. RESULTS: Although specific DSM-IV somatoform disorders were relatively rare with a lifetime rate of 2.7%, a considerably higher proportion of respondents met criteria for clinically significant somatoform syndromes as defined by the Somatic Symptom Index SSI4, 6 (lifetime: 1.7%), as well as the undifferentiated somatoform/dissociative syndrome USDS (lifetime: 9.1%), resulting in an overall prevalence rate of 12.6%. Somatoform conditions are often comorbid with other mental disorders and were found to be associated with remarkable impairments and disabilities. CONCLUSION: Somatoform disorders and syndromes in young adults are frequent, impairing and often associated with the development of other mental disorders.

Adolescent↗

PubMed1999

Patterns of cannabis use, abuse and dependence over time: incidence, progression and stability in a sample of 1228 adolescents.

AIMS: To present data on the incidence of cannabis use at follow-up, and its progression, stability, abuse and dependence in a representative sample of adolescents (N = 1228), aged 14-17 years at "baseline"--the outset of the study--in Munich, Germany. DESIGN: The study employed a prospective longitudinal design using a representative population sample. The mean follow-up time was 19.7 months. The Composite International Diagnostic Interview (M-CIDI) was used to assess patterns of use, abuse and dependence according to DSM-IV criteria. FINDINGS: (1) In our sample, 34.8% of males and 30.2% of females had tried cannabinoids at least once. (2) Of those who used cannabis repeatedly (two or four times) at baseline, 26.1% stopped using by follow-up; the majority went on to regular use in the follow-up period. Similarly, only 17.7% of the regular users at the outset stopped using cannabis completely; 74.2% continued their pattern of regular use. Thus, the higher the baseline use pattern, the higher was the probability of continued or heavier use during follow-up. (3) Although the cumulative life-time incidence for DSM-IV cannabis abuse (3.5%) in this age group was low, it is noteworthy that complete diagnostic remissions were relatively rare (31.7% for dependence, 41.1% for abuse). (4) There was considerable concurrent use of other drugs. CONCLUSIONS: Cannabis use was almost as widespread in this sample of adolescents in Germany as in similar age groups in metropolitan areas of North America. There was a relatively low spontaneous remission rate among regular and repeated users. Cannabis use in adolescence appears to be less transient than many people would believe.

Adolescent↗

PubMed1999

Covariates of cannabis use progression in a representative population sample of adolescents: a prospective examination of vulnerability and risk factors.

UNLABELLED: AIMS/DESIGN: This study reports findings concerning risk factors for first, "repeated" and "regular" use of cannabis in respondents (N = 1228) who were aged 14-17 years at the outset (i.e. at "baseline") as part of a longitudinal prospective community study (EDSP). Risk factors were assessed at baseline or by separate interviews with the respondents' parents. Cumulative life-time cannabis use was the main outcome measure in this study--assessed by information from both the baseline and the follow-up investigation at an average of 19.7 months later. A cumulative logistic regression model was used to estimate associations. FINDINGS: Using seven of a total of 25 variables examined, the final model classified 72.1% of respondents correctly. Family history of substance use disorders, self-esteem and competence, unconditional commitment to not using drugs, immediate availability of drugs, peer group drug use and previous history of nicotine dependence and alcohol use disorders all contributed significantly to the final model, predicting the progression to cannabis use from "no use", to "one time only", "repeated use", and "regular use". CONCLUSION: In addition to well-documented risk factors such as peer group pressure, availability, low self-esteem and competence, findings suggest that family history and prior experiences with legal drugs play a significant role in the early development of cannabis consumption in teenagers.

Adolescent↗

PubMed1999

Comorbidity in primary care: presentation and consequences.

Comorbidity is a well-established phenomenon in depressive disorders, and it is widely agreed that the majority of depressive disorders examined in both primary care and the general population are not "pure." This article reviews comorbidity findings in general population and primary care surveys. The implications of comorbid depressive disorders are discussed in terms of their presentation and recognition in primary care, patterns of course and outcome, and associated impairments and disabilities. Data from a World Health Organization study, conducted in primary health clinics in 15 countries, demonstrate that 62% of all depressive cases also suffer from at least one other current mental disorder and that the primary reason for patient visits is rarely of a psychological nature, with the majority of attendees complaining primarily of somatic symptoms (41%), pains (37%), and fatigue and sleep problems (12%). Similar results are presented from 2 recent large representative population surveys, the National Comorbidity Survey and the Early Developmental Stages of Psychopathology Study. The implications of such comorbidity are viewed from various perspectives: the form of depressive presentations in primary care, the recognition of depression in health care, and health services utilization, impairments and disabilities, and course and outcome.

Adolescent↗

PubMed1998

Substance use, abuse and dependence in Germany. A review of selected epidemiological data.

To provide background information about previous findings about the prevalence of use, abuse and dependence of various substances (nicotine, alcohol, prescription and illicit drugs) findings of available epidemiological studies in Germany from the 1980s and 1990s are summarized and critically evaluated. Focusing on findings of substance use surveys in adolescents and young adults the review indicates: (a) a considerable number of large scale questionnaire surveys in general population samples documenting the frequency of use and patterns of use of most substances; (b) indications of increasing rates of drug use particularly in East Germany; (c) high rates of illicit drug use, mainly of cannabinoids, but also stimulants and hallucinogens, among young age groups. No data are available from substance use surveys or from clinical epidemiological studies allowing the determination of how frequent substance abuse and substance dependence diagnoses are in the general population or in adolescents and young adults. Priorities for future research to ameliorate this unsatisfactory situation are outlined with emphasis on research in adolescents and young adults.

Adolescent↗