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W Löffler

Publications and source records attributed to W Löffler.

At least 73 records · Page 4Linked to original sources
PubMed1991

[Sex differences in age of onset, symptomatology and evolution of schizophrenia].

Gender differences in age at onset, symptomatology and course of schizophrenia are examined by analyzing case register data and by direct investigation of a representative sample of first-admitted patients. The main finding that males fall ill at an earlier age than females can be confirmed even after ruling out other interpretations due to sample bias, different time span between real onset and first hospital admission, gender differences in symptom development or other confounding factors. When looking for causes of these gender differences it seems that disturbances in early social development must be understood as a consequence of beginning schizophrenia rather than a prerequisite. The need for explanatory models is stressed that allow for the empirical testing of hypotheses concerning gender specific development of schizophrenia.

Age Factors↗
PubMed1991

[Schizophrenia and age].

The association of age with time of onset, symptomatology and early course of schizophrenia was studied on a large, representative sample of first-admitted patients with a diagnosis of schizophrenia (nuclear and related diagnoses) from a total population of about 1.5 million by using a semi-structured interview (IRAOS) developed specifically for this purpose. As a result an age distribution differing between men and women was obtained when the appearance of the first sign of a mental disturbance was studied. 61.6% of the men and 47.4% of the women fell ill prior to the age of 25. Negative symptoms and the early course of the disease turned out to be relatively independent of age at onset. The few age differences observed with positive and unspecific symptoms seem to be accounted for by factors not specific for schizophrenia, such as slightly increased anxiety at young age, slightly increased depressiveness in early adulthood and slightly increased paranoid delusions later in adulthood. At young age delusional symptoms, probably as an expression of immature personality, are less stable, less differentiated and less systematized, whereas fully developed delusions of persecution become more frequent at higher age. An unexpected finding was a comparatively high proportion of lengthy phases characterized by negative symptoms prior to first admission in late-onset schizophrenia in females. Hence, beginning schizophrenia seems to be a fairly uniform pattern of response at all ages, female sex appearing to be the only factor independent of the disease that influences it to any significant extent by delaying onset.

Adolescent↗
PubMed1990

Behaviour problems and developmental status of 3-month-old infants in relation to organic and psychosocial risks.

In a prospective longitudinal study starting at birth 384 infants and their families were investigated. The subjects were distributed across the nine cells of a two-factorial design (3 x 3), factor 1 representing the degree of organic, factor 2 the degree of psychosocial risk. At age 3 months there was a significant influence of organic risk factors on all developmental parameters. Psychosocial risks were only relevant for cognitive development and behaviour problems. Organic high-risk children who adapted quickly after birth showed an especially good development status.

Asphyxia Neonatorum↗
PubMed1990

The prognostic value of somatosensory evoked potential monitoring and tumor data in supratentorial tumor removal.

The aim of this study was to find appropriate somatosensory evoked potential (SSEP) and tumor data that would predict immediate postoperative outcome. Seventeen patients were evaluated, all with supratentorial mass lesions. Intraoperative SSEP monitoring was carried out, and central conduction time, N20 amplitude, and N20 to N13 amplitude ratio were recorded throughout the operation. The differences between the end and the start of the procedure and between the end of the operation and the most substantial changes during tumor removal were calculated for statistical evaluation. Tumor location and extent were carefully determined and calculated by computed tomographic reconstructions in the axial and sagittal planes. Several tumor parameters were measured: the distances from the midpoint of the tumor to the central sulcus, midline, and base of the skull and the longitudinal and cross-sectional diameters. The electrophysiologic and tumor data sets were correlated with the immediate postoperative neurologic deterioration. For this purpose, patients were divided into two groups: group 1 = no neurologic deterioration after operation (13 patients); group 2 = neurologic deterioration after operation (4 patients). The difference in central conduction times between the end and the start of the procedure was the only variable that exhibited a significant influence on the immediate postoperative condition (P = 0.007), as determined by analysis of variance. The other electrophysiologic data as well as the tumor data failed the significance threshold of P = 0.05. Discriminant analysis was applied to test the classification capacity of the measured variables. Involving all measured variables (electrophysiologic and tumor data), discriminant analysis allowed a correct classification of all 17 patients to their proper neurologic deterioration group. Discriminant analysis for SSEP data alone led to 15 correct classifications. Tumor data, used alone for discriminating procedures, revealed 14 correct classifications. When each variable was analyzed separately, only the difference in central conduction times between the end and the start of the procedure gave significant predictions, namely, 15 correct classifications. This was the same number as achieved by all electrophysiologic variables together. No other variable could on its own yield any valid prognosis for assessment of immediate postoperative neurologic deterioration. The data confirm the importance of central conduction time recovery before the end of the operation on the patient's immediate postoperative neurologic condition.

Adult↗
PubMed1990

[Granulomatous thrombophlebitis in Lyme borreliosis--case report].

The presented case report shows a patient with Lyme disease who also developed thrombophlebitis saltans. Histopathologically we found a granulomatous perivasculitis, an immunohistological investigation showed deposits of IgG, IgA, IgM, C3 and C4 in the vessels. Antibody titers against Borrelia burgdorferi were elevated, but no anti-cardiolipin antibodies were found. A pathogenetic correlation due to anti-phospholipid antibodies that have been found in thrombosis and borreliosis or a vasculitis vasorum comparable to a previously described vasculitis nervorum might be discussed.

Antibodies, Bacterial↗
PubMed1989

Schizophrenia--a disease of young single males? Preliminary results from an investigation on a representative cohort admitted to hospital for the first time.

The later age at onset of schizophrenia in females, reported in the literature, led to a study of transnational case register data and of a cohort of all patients admitted to hospital for the first time with a non-affective functional psychosis from a defined catchment area. The preliminary analysis of the first representative sample of 86 patients showed that at the time of first admission with a diagnosis of schizophrenia (according to different diagnostic definitions) as well as at the time of onset of the disease (operationalized on different levels) females were on average 5 years older than males. Singles, and even more so young single males, were clearly overrepresented among those first hospitalized in comparison to the population of the same age. To remain single seems to be in most cases a consequence of the disease or of premorbid characteristics in those predisposed to schizophrenia.

Adolescent↗
PubMed1989

On the way to expert systems. Comparing DSM-III computer diagnoses with CATEGO (ICD) diagnoses in depressive and schizophrenic patients.

Operationalized diagnostics deal with the standardized assessment of psychiatric symptoms as well as diagnostic criteria. As a diagnostic system based on criteria, the DSM-III was chosen to identify operationalized diagnoses based on the Present State Examination (PSE-9) and some additional DSM-III specific items. By relating PSE symptoms to the diagnostic criteria of DSM-III, an easily applicable expert system leading to DSM-III diagnoses was developed. In two samples of 30 schizophrenic and 51 depressive patients the DSM-III computer diagnoses are contrasted with the ICD-8 diagnoses of the PSE/CATEGO system. In defining a "case", only minimal differences between the two computer programs were found. In the sample of schizophrenics, CATEGO led to 114 (81%) diagnoses and the DSM-III program to 112 (79%) diagnoses; for the depressive patients 43% cases were identified by CATEGO and 45% by the DSM-III algorithm. Comparing the diagnosis of "acute schizophrenic disorders", both programs arrived at similar percentages. (CATEGO: 51%; DSM-III: 57%). However, CATEGO is limited to two different subtypes (295.2 and 295.3), whereas the DSM-III program covers the total range of possible schizophrenic subtypes. Furthermore, the DSM-III program identified residual subtypes of schizophrenia in 23% of the diagnostic decisions. In the short-term course of the schizophrenic patients, CATEGO identified 27%-43% with affective diagnoses with high stability per cross-section. Using the DSM-III algorithm affective diagnoses were rather rare (maximum of 17%), marking unstable changes from acute to residual states of the psychosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Algorithms↗
PubMed1989

How does gender influence age at first hospitalization for schizophrenia? A transnational case register study.

Numerous studies have reported a lower mean age at first hospitalization for schizophrenia in males than in females. For this finding not only a gender difference in age at first onset of schizophrenia, but also other factors can be responsible. With the aim of providing a comprehensive analysis of gender differences in onset, symptomatology and course of schizophrenia, we started by testing the hypothesis postulating a gender difference in mean age at first hospitalization. By using the Danish and the Mannheim psychiatric case registers we analysed all hospital admissions for schizophrenia and related diagnoses and all previous admissions for other diagnoses of the Danish population in 1976 and those of the inhabitants of the German city of Mannheim in the period of 1978-80. Artefacts were controlled for systematically. The impact of intervening variables such as selection factors as well as the influence of gender on the ascription of a diagnosis of schizophrenia for the first time were assessed. We found a mean difference of 5 to 6 years in age at first hospitalization between males and females in both countries when a broad definition of the diagnosis was used and of 4 to 5 years when a restrictive definition was applied. The higher mean age at first hospitalization among females is not attributable to artefacts, diagnostic procedures or to any essential extent to gender differences in help-seeking behaviour or occupational status. When a distinction was made between 'single' and 'married', the significant difference in age at first hospitalization between the sexes disappeared in singles. With case register data and without knowing the chronological order of marriage and onset of the disease, it remains an open question whether this finding can be explained by purely correlative associations between sex, marital status and age of onset or by causal effects.

Adolescent↗
PubMed1989

[Diagnosis and therapy of chronic rupture of the fibular ligament in children].

74 children with ruptures of lateral ligaments of the ankle were treated surgically between 1979 to 1986. In ten cases we found chronical ligament changes. In these cases periostal flap modified after Kuner was performed. The follow up of our patients showed good results in all, thus we could show that the periostal flap was effective. As the functional conservative ligament rupture therapy increases the periostal flap plastic in the case of children with chronical ligament changes is indicated.

Ankle Injuries↗
PubMed1988

A study of dose-response relationships of allopurinol in the presence of low or high purine turnover.

Effects of allopurinol (125-500 mg/m2 body surface) were studied in normal subjects during periods of 18 days both during a purine-free, isoenergetic liquid formula diet and additional intake of ribonucleic acid, 4 g/day. Plasma uric acid and renal excretion of uric acid, oxypurines (hypoxanthine plus xanthine) and orotic acid were measured and total purine excretion calculated. Effects of allopurinol were evaluated by comparison of the results obtained in the steady state during diet alone (average of days 7-10) with those during allopurinol administration (days 16-18). During the purine-free diet, plasma uric acid was lowered more than urinary uric acid by allopurinol on doses of 250-500 mg/m2 (44%-54% of control values on 500 mg/m2), demonstrating an increase in renal clearance. At the same dose, the uric acid lowering effect of allopurinol was more pronounced with than without purine loads (plasma 41%, urine 32% of control on 500 mg/m2 during purine intake), while renal uric acid clearance was decreased. The more pronounced reduction of uric acid excretion during purine administration was balanced to the greater part by a more pronounced increase in oxypurine excretion. Total purine excretion was reduced by about 20% during the purine-free diet irrespective of dose. The size of this purine deficit was doubled, but was also independent of dose during addition of purines. Orotic acid excretion increased with dose during allopurinol treatment and was reduced by addition of purines.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

[Need for social psychiatric services--a management model in scientific evaluation].

Social-psychiatric services have for a long time been a focus in the controversial discussion about the further development of outpatient mental health care. Presented is the Baden-Württemberg Social Psychiatric Services model, which is oriented towards outpatient social welfare provision of persons with chronic mental illness, complementing the medical-psychiatric treatment provided by office-practice psychiatrists. Evaluation of the Social Psychiatric Service for its first year of full operation, 1984, has shown that this type of service delivery organization is capable, above all, of reaching persons with "recently" chronic mental illness, who are serviced in the framework of community mental health care systems mainly on an outpatient basis. Provision of care, i.e. of social welfare and counselling measures, may in this group constitute an efficient contribution towards their social rehabilitation. Effective functioning of this organizational model presupposes sufficiently well-established cooperation with other facilities and services involved in service provision, which, as the Baden-Württemberg trial has shown, can in actual fact be ensured.

Chronic Disease↗
PubMed1987

[Value of early acoustic and somatosensory evoked potentials in monitoring and prognostic assessment of coma in barbiturate therapy--comparison with clinical aspects and EEG].

25 comatose patients suffering from severe cerebral lesions of different etiology were examined during barbiturate-therapy by Glasgow-Pittsburg-Coma-Scoring-System (GPCS), EEG, somatosensory and brainstem acoustic evoked potentials. The findings were correlated in view of prognostic prediction and importance for monitoring. A modified form of the Glasgow-Outcome-Score (GOS; independent-survival, dependent-survival, dead) was used for evaluating the outcome. In case of an initial GPCS less than 10 points none of the patients survived, in case of GPCS greater than 10 points 11 out of 19 patients survived. The latter relation of survival was also found in patients with improving or impairing scores during the observation period. In case of initial burst-suppression pattern in the EEG 7 out of 11 patients survived, in case of diffuse abnormalities with or with-out additional focal signs - 4 out of 10 patients survived, but in the latter there was none with an outcome of independent survival. All patients with an isoelectric EEG died. In case of bilateral recording of scalp- SEP 7 out of 11 patients survived, in case of unilateral loss of scalp-EP 4 out of 8 patients survived, but in the latter cases none with an outcome of independence. All patients with initial bilateral failure of scalp-SSEP or loss during the observation period died. In case of bilateral registrable BAEP (wave I to V) 11 out of 17 patients survived. All patients with initial uni- or bilateral failure of those potentials or loss during the observation period died.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

[Intraoperative somatosensory evoked potentials (SSEP) in surgery of cerebral aneurysms: topographical information].

Out of 114 patients who were operated because of cerebral aneurysms, 16 patients were monitored by means of Somatosensory Evoked Potential (SSEP) during the operation. In 9 of these, successful monitoring was possible during the whole duration of the surgical procedure. In the remaining seven, monitoring was impossible over a long period so that these patients were excluded from the present study. Monitoring of the cerebral functions by means of SSEP provides help in aneurysm surgery as follows: Objective evaluation of the function of the somatosensory system. The induced arterial hypotension--usually done in our department--implies danger for the brain, particularly, if rupture of the aneurysm occurs at the same time. In this case, Somatosensory Evoked Potentials provide the possibility to detect lesions of somatosensory neurons at different levels. This makes prognostic conclusions possible. Pathological changes of some SSEP components during temporary occlusion of arteries of the Circle of Willis indicate developing lesions of brain structures. Intraoperative SSEP data were correlated with the postoperative course in all 9 patients. Prognostic conclusions derived from these data are discussed.

Adult↗