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Biomedical subjects

T Held

Publications and source records attributed to T Held.

At least 109 records · Page 6Linked to original sources
PubMed2000

[Clinical characteristics of patients with tardive dyskinesias].

UNLABELLED: Although there is a great number of studies on the relationship between tardive dyskinesia and patient characteristics, too often their validity is impaired by the lack of operationalized criteria for the description of patients and signs. Reliable phenotyping is of utmost importance for linking clinical data with data from methods in neurobiology or molecular genetics. 241 patients with the DSM IV diagnosis "schizophrenia" or "schizoaffective disorder" were examined with the instruments SADS-L, OPCRIT, BPRS and PANSS. Motor phenomena were analyzed on 2 separate days within 3 months with the scales TDRS, AIMS, SAS, BAS. Tardive dyskinesia was diagnosed following the research criteria of Schooler and Kane. Lifetime medication with neuroleptics and anticholinergic drugs was assessed quantitatively. RESULTS: 97 out of 233 patients (= 41.6%) displayed persistent tardive dyskinesia. In univariate analysis, significant associations were found between tardive dyskinesia and the following independent variables (higher values means greater risk): Age (p = 0.0001), years from onset of the disorder (p = 0.001), total length of stay in hospital (p = 0.001), PANSS (single scales and sum score) (p = 0.0001), total amount of neuroleptics expressed as CPZ equivalents (p = 0.004). Logistic regression analysis showed that only the variables "age" and "negative symptoms" expressed as score on the PANSS negative subscale showed an association with tardive dyskinesia that could not be explained by covariation with other variables. The same results were found when, instead of the dichotomous variable "tardive dyskinesia yes/no" the associations with the TDRS score were analyzed. Future research should aim to approach the neurobiological correlates of "age" and "negative symptoms" in relationship to tardive dyskinesia.

Adult↗
PubMed2000

[Family therapy for schizophrenia].

Family therapy has long been conceived and practised under etiological premises. Familial disturbances as pathological regression/fixation (psychoanalytical) and individuation-impairing family dynamics (systemic) were addressed directly in the hope of "curing" the disorder. The efforts to prove the viability of the concepts and/or the efficacy of the therapeutic approach were largely unsuccessful. Newer strategies of family therapy of schizophrenia are both more precise in their theoretical assumptions and more performing in the pursuit of their therapeutic goals. We analyse the basis of modern family therapy in the "Expressed-Emotions"-research and propose a newer, more adequate understanding of the EE phenomenon. From our own studies and from a general review of relevant studies we derive an understanding of the rationale of family work and family therapy of schizophrenia. We discuss the results of a meta-analysis on the active ingredients and the conditions of efficacy of family interventions.

Family Therapy↗
PubMed1999

[Genetics of schizophrenic disorders. New concepts and findings].

Schizophrenia is a genetic complex disease as it does not follow monogenic transmission while non-familial environmental factors have a strong additional impact. A heterogeneous, continuous phenotype is transmitted in families which can now be more precisely characterized. Genes coding for proteins with presumed pathophysiological relevance are apparently not playing a major causal role. However, in the last three years several (currently seven) candidate regions have been identified in a replicable manner by linkage studies. These regions are likely to host susceptibility genes for schizophrenia, but none of them has been identified up to now. Given these findings, polygenic transmission has now become very likely. The candidate regions are currently being narrowed down by various promising techniques.

Biomarkers↗
PubMed1999

Substantial influence of level of endurance capacity on the association of perceived exertion with blood lactate accumulation.

Capillary blood lactate assessment is increasingly used by well-trained runners to monitor the intensity of endurance exercise. In order to examine the known association of exercise intensity with blood lactate accumulation also in less trained subjects, we analysed data from a standardized incremental maximal test on the treadmill of 319 men (age 22.9 +/- 5.5 years, [means +/- S.D.]) and 145 women (22.7 +/- 4.5 years) characterized by a wide variation in endurance capacity. Results showed that the running velocity eliciting a blood lactate concentration of 4 mmol/l did not correspond to the same exercise intensity in well endurance-trained vs poorly endurance-trained subjects. At 4 mmol/l blood lactate, the slowest decile of men (i.e. 32 out of 319) ran at 71 +/- 4.7% (corresponding to 2.9 +/- 0.3 m/s) of their maximal treadmill velocity attained during the test (4.1 +/- 0.4 m/s), indicating a rating of perceived exertion (RPE) of 12.3 +/- 1.8 points (Borg scale, range 6-20 points), while the fastest decile of men (n = 32) ran at 91 +/- 3.1% (corresponding to 5.4 +/- 0.2 m/s) of their maximal treadmill speed (5.9 +/- 0.2 m/s), indicating a RPE of 16.6 +/- 1.1 points. Very similar results were observed in women. There was a highly significant, positive correlation between running speed eliciting a blood lactate concentration of 4 mmol/l and RPE when running at this speed, with r = 0.64 in men and r = 0.55 in women. At the same proportional level of maximal running velocity, poorly endurance-trained athletes showed a 2-3 mmol/l higher capillary lactate concentration than well endurance-trained athletes, with both groups indicating the same RPE. These results suggest that fixed blood lactate concentrations not at all mean the same exercise intensity for well vs poorly endurance-trained subjects; this systemic trend should be considered when using blood lactate assessment for individual exercise counselling.

Adult↗
PubMed1999

Family therapy of schizophrenia.

Family therapy of schizophrenia has long been conceived and practised under etiological premises. Familial disturbances as pathological regression/fixation (psychoanalytical) and individuation-impairing family dynamics (systemic) were addressed directly in the hope of "curing" the disorder. The efforts to prove the viability of the concepts and/or the efficacy of the therapeutic approach were largely unsuccessful. Newer strategies of family therapy of schizophrenia are both more precise in their theoretical assumptions and more performing in the pursuit of their therapeutic goals. We analyse the basis of modern family therapy in the "Expressed-Emotions (EE)"--research and propose a newer, more adequate understanding of the EE phenomenon. From our own studies and from a general review of relevant studies we derive an understanding of the rationale of family work and family therapy of schizophrenia. We discuss the results of a meta-analysis on the active ingredients and the conditions of efficacy of family interventions.

Emotions↗
PubMed1998

Burden on the families of patients with schizophrenia: results of the BIOMED I study.

The burden, the coping strategies and the social network of a sample of 236 relatives of patients with schizophrenia, living in five European countries, were explored by well-validated assessment instruments. In all centres, relatives experienced higher levels of burden when they had poor coping resources and reduced social support. Relatives in Mediterranean centres, who reported lower levels of social support, were more resigned, and more often used spiritual help as a coping strategy. These data indicate that family burden and coping strategies can be influenced by cultural factors and suggest that family interventions should have also a social focus, aiming to increase the family social network and to reduce stigma.

Adaptation, Psychological↗
PubMed1998

Social and clinical factors influencing the choice of coping strategies in relatives of patients with schizophrenia: results of the BIOMED I study.

The impact of social and clinical factors on the choice of coping strategies of a sample of 236 relatives of patients with schizophrenia, living in five European countries, was explored using well-validated questionnaires. The adoption of problem-focused coping strategies was more frequent among young relatives and among relatives of younger patients, and was associated with higher levels of practical and emotional social support and of professional help. In contrast, emotion-focused strategies were more frequently adopted by relatives who had been living longer with the patient and who had poorer social support. It is suggested that supportive and educational interventions should be provided as early as possible to relatives of patients with schizophrenia, which, in addition to having a practical focus, should also have a social focus, aiming at extending the family's social network.

Adaptation, Psychological↗
PubMed1998

Reliability and validity of the premorbid adjustment scale (PAS) in a German sample of schizophrenic and schizoaffective patients.

Premorbid functioning seems to be a phenomenological marker that possibly distinguishes a subtype of schizophrenia. The Premorbid Adjustment Scale (PAS) is an instrument for measuring premorbid functioning. It has gained international acceptance, although little is known about the reliability and validity of the test. Here data on the reliability and validity of the test derived from a German sample of schizoaffective and schizophrenic subjects (n = 86) and their healthy parents (n = 38) is presented. The DSM-IV diagnosis, PAS and Positive and Negative Syndrome Scale (PANSS) data were used as well as data on the course of the disorder. The estimation of the reliability per scale by internal consistency showed high positive values of Cronbach's alpha between 0.809 and 0.931. High scores in PAS representing a bad premorbid social adjustment correlated significantly with a low age of onset, high PANSS scores, an insidious onset and a long period of hospitalisation. The disorganised DSM-IV subtype of schizophrenia showed a trend towards higher mean PAS scores. In the presented sample, the threshold between schizophrenics and healthy individuals is at 0.23. The PAS values higher than 0.53 appeared in patients with an unfavourable course of the disorder. These findings correspond with previous reports in the literature.

Adolescent↗
PubMed1998

[Violent and non-violent methods of parasuicide: what determines the choice?].

UNLABELLED: Patients with violent methods of parasuicide share a number of common characteristics with those who complete suicide. They can be differentiated from patients with non-violent methods. Whereas surgery is usually the first-line care in cases of violent parasuicide, detoxification and/or psychiatric hospitalisation are first employed with non-violent parasuicide. Therefore it is important to know the specific needs and characteristics of both patient groups, as it may be hypothesised that patients with violent methods are at specifically high risk of committing suicide. As part of the WHO/EURO Multicentre Study on Parasuicide, we examined 120 cases of parasuicide in hospitals of the Bonn area with the instrument EPSIS 1. Violent and non-violent methods were differentiated following the WHO X-classification. RESULTS: The following independent variables differentiate between violent and non-violent methods and predict the choice of violent methods: Diagnosis (schizophrenia vs. other diagnoses, p = 0.00027), gender (male, p = 0.04), high score of anger as a trait in State-Trait-Anger Scale (p = 0.017), poor mental health within the last 3 months (p = 0.058), time of parasuicide after 6 p.m. (p = 0.024). A higher number of previous parasuicides (p = 0.008) and unemployment (p = 0.047) were predictive of the choice of non-violent methods. A logistic regression analysis generated a model including the independent variables diagnosis, gender and "anger". Suicidal intent, sociodemographic variables, motives of parasuicides and "life events" did not discriminate between violent and non-violent methods.

Adult↗
PubMed1998

Optimal treatment strategies to enhance recovery from schizophrenia.

OBJECTIVE: The aim of this paper is to examine the base for integrating biomedical, psychological and social strategies in the management of schizophrenia. METHOD: A review of the literature on schizophrenia with particular emphasis in management considerations. RESULTS: Effective treatment components include psychoeducation, medication strategies, career-based stress management training, community-based intensive treatment, living skills training, and specific drug and cognitive-behavioural strategies for residual symptoms. CONCLUSIONS: Treatment for schizophrenia is best provided by integrating the various and specific psychosocial intervention strategies in addition to the optimal use of medication. Methods for implementing these strategies in outpatient settings include the use of a comprehensive assessment and treatment plan, the training of mental health professionals, and periodic review with assessment packages.

Activities of Daily Living↗
PubMed1998

[Quality indicators of patient treatment of schizophrenic patients. Results of a pilot study for external quality assurance using tracer diagnosis].

PURPOSE: In Germany, measures for assuring the quality of inpatient treatment are regulated by legislation. Treatment quality must be presented in comparison with other hospitals. Tracer diagnosis is an established method for external quality assurance in the sphere of somatic medicine. METHOD: To evaluate this method of external quality assurance in psychiatry, the German Society for Psychiatry, Psychotherapy and Nervous Diseases (DGPPN) defined and operationalised quality indicators for the treatment of schizophrenic inpatients. RESULTS: of a multicentre project supported by the German Federal Ministry of Health (BMG) using this inventory in 96 schizophrenic inpatients (ICD-10) from 4 hospitals are presented. The qualification of these indicators of structure, process and outcome while comparing the treatment quality of different hospitals as well as their applicability for internal quality management are discussed.

Adult↗
PubMed1997

[Heart rate, blood lactate concentration and subjective stress perception in submaximal running: new nomograms for assessment of endurance capacity].

Considering the protective effect of physical activity against coronary heart disease, the estimation of endurance capacity is not only recommended for sportsmen but is also useful for exercise counselling of unfit persons. Endurance capacity can be estimated with test protocols leading to complete exhaustion, or by submaximal test procedures. Submaximal tests have the advantage of putting less stress on subjects than maximal test protocols; on the other hand, they are less accurate. As a complement to traditional submaximal test protocols based on heart rate analysis, a new submaximal protocol is proposed based on measurements of capillary blood lactate concentration during exercise. Incremental tests of 319 men with wide variation of endurance capacity were used to calculate nomograms of the typical pattern of exercise-induced increase in capillary blood lactate concentration, heart rate, and rating of perceived exertion in relation to endurance capacity. The running velocity eliciting a capillary blood concentration of 4 mmol/l lactate was selected as the parameter for endurance capacity. With the help of these nomograms, the 4 mmol/l-velocity could be estimated with submaximal values of lactate, heart rate or rating of perceived exertion. The appropriateness of the nomograms was checked against the data of 100 independent maximal treadmill tests. Estimation of 4 mmol/l-velocity with submaximal lactate values showed good precision (with a small standard deviation of +/-0.17 m/s); in contrast, the estimation of endurance capacity with submaximal values for heart rate and rating of perceived exertion showed substantially larger standard deviations (approximately +/-0.56 m/s). We conclude that, for estimation of endurance capacity from submaximal running values, the nomogram for blood lactate concentrations can be recommended.

Adolescent↗
PubMed1995

[Training counseling in general practice].

The general practitioner is increasingly confronted with questions of sports medicine due to the increasing importance of exercise and sport in our society. This article gives a short summary of important knowledge concerning the components of physical activity, the possibilities for testing and training and the planning of training. Some simple ways of exercise counselling for patients are shown. According to its importance, most emphasis is put on the discussion of endurance capacity.

Counseling↗
PubMed1994

Use of a receiver operating characteristic in the evaluation of two commercial enzyme immunoassays for detection of Helicobacter pylori infection.

Two novel commercial IgG enzyme immunoassay (EIA) systems based on acid-glycine-extracted (Pyloriset IgG EIA, Orion Diagnostica) or fast protein liquid chromatography-purified (Cobas Core Anti-H. pylori EIA, Roche Diagnostic Systems) Helicobacter antigens were evaluated in a prospective study involving 127 patients. All patients underwent upper endoscopy with biopsy, and biopsies were examined for the presence of Helicobacter pylori by a rapid urease test, microscopy and culture. Of the 71 patients found to be infected with Helicobacter pylori, 69 (97.2%) and 65 (91.5%) tested positive with the Cobas Core and Pyloriset test, respectively. A detailed receiver operating characteristic analysis of the two tests showed that the Cobas Core assay was more sensitive and specific at every possible cut-off level; gave a better resolution of individual results, indicating a greater fine-sensitivity; and had no grey zone compared to a large grey zone encompassing 13.4% of the serum samples tested with the Pyloriset EIA. The Cobas Core assay appears to be a valuable tool for epidemiological purposes as well as for pre-endoscopic screening of dyspeptic patients.

Antigens, Bacterial↗
PubMed1994

Complicated tuberculosis and residual disease.

Complicated and extrapulmonary manifestations of tuberculosis (TB) may cause prolonged suffering for the individual patient and represent a high economic burden for the society concerned. Complications of pulmonary TB may be the consequence of reduced individual resistance, immunosuppression or specific immune defects. In HIV patients, pulmonary TB is often associated with extrapulmonary lesions, while the radiologic appearance of lung infiltrates may be less prominent compared to HIV negative persons. The present review summarizes data obtained during a 12-year study of extrapulmonary TB in Berlin, Germany, and outlines the role of residual TB lesions for disease reactivation in later life. Indications and limitations of INH preventive chemotherapy will be discussed.

HIV Seropositivity↗