[Hormonal treatment of cancer of the prostate: review and present status].
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Administration, Oral↗
Biomedical subjects
W Rössler
Publications and source records attributed to W Rössler.
Asthma and body weight change: a 20-year prospective community study of young adults.
OBJECTIVE: There is increasing evidence for an association between asthma and body weight change. The objectives of these analyses were to examine the temporal relationships of this association and to explore the role of childhood depression as an explanatory factor. METHODS: Data were derived from six subsequent semistructured interviews on health habits and health conditions from a single-age community study of 591 young adults followed up between ages 20 and 40 years. RESULTS: Cross-sectionally (over the whole study period), asthma was significantly associated with obesity (odds ratio=3.9 [95% confidence interval 1.2, 12.2]). Multivariate longitudinal analyses revealed that asthma was associated with increased later weight gain and later obesity among women after controlling for potentially confounding variables, whereas weight gain and obesity were not associated with later asthma. A secondary analysis showed that depressive symptoms during childhood were associated with adult obesity and asthma, partially explaining the asthma-obesity comorbidity. CONCLUSION: This study encourages further research on mechanisms underlying the asthma-obesity comorbidity, particularly on shared psychosocial factors operating during critical periods in childhood and adolescence that may influence the development and persistence of both obesity and asthma during adulthood.
Adult↗
[Expenditures in psychiatric treatment. Is the distribution of funds according to need?].
BACKGROUND: There is no doubt that mental health care should be geared toward evidence, cost-effectiveness, and need. Health care data that allow comparisons of demand and real needs are scarce. This is especially true for outpatient care. METHOD: The aim of this study was to assess and analyze data from health insurance plans and social welfare. RESULTS: The costs of mental health care in Germany amount to 13 mio per year and 100,000 population. Health insurance schemes account for two thirds of total costs and social welfare for one third. The distribution of expenses seems not to be based on need analyses. Especially the chronically mentally ill are disadvantaged. CONCLUSIONS: The redistribution of expenses from inpatient to outpatient care including integrated health care approaches would result in more cost-effective mental health care.
Delivery of Health Care↗
[Innovative care models for treating psychosis].
It is generally accepted that modern mental health care gives community treatment priority over partial or full inpatient treatment. The requirements for community treatment of severely ill and chronic psychiatric patients are complex and, together with financing by the different social insurance providers, may lead to a rather problematic fragmentation of health service supply. Schizophrenia is considered the most expensive mental illness in Germany. It is estimated that indirect costs (expressed in financial terms) are five times higher than the direct costs of treatment and care. Innovative concepts of psychosocial intervention show that case management and assertive community treatment reduce the hospitalisation rate and duration of inpatient treatment, enhance social integration, and find the approval of most patients. However, there is no empirical evidence supporting this "psychiatry with no beds". Consideration should be given to psychosocial interventions as an alternative to inpatient hospital treatment such as day hospital care, crisis houses, or acute home treatment.
Ambulatory Care↗
Do mental health professionals stigmatize their patients?
OBJECTIVE: Assessing stereotypes towards people with mental illness among mental health professionals, comparing their view to the Swiss general population and analysing the influence of demographic factors, profession and work place variables (type of ward, employment time and professional experience). METHOD: Conducting a representative telephone survey (n = 1073). Factor analysis was used to achieve one-dimensional scales, which were analysed by regression analysis. RESULTS: Most positive depictions were regarded as less characterizing people with mental illness, whereas most negative descriptions were viewed as more typing these people. Compared with the Swiss general population, mental health professionals have not consistently less negative or more positive stereotypes against mentally ill people. Of the 22 stereotypes five factors were detected: 'social disturbance', 'dangerousness', 'normal healthy', 'skills' and 'sympathy'. Stereotypes about people with mental illness are influenced by the professional background and if at all only slightly affected by gender, age, ward type, participation rate of the hospital, weekly working hours or years of professional experience. CONCLUSION: Mental health professionals must improve their attitudes towards people with mental illness. Different ways, e.g. improving their professional education or their quality of professional contacts by regular supervision to prevent burn-out, are discussed.
Activities of Daily Living↗
Early detection and treatment of schizophrenia: how early?
OBJECTIVE: Whereas early detection and therapy of schizophrenic psychoses until some time ago concentrated on frank schizophrenia, during the last years some centres have also started to treat patients even before a clear diagnosis could be established. This paper attempts to discuss if and when this is justified in the light of recent research. METHOD: Mini review of literature. RESULTS: The rationale for early detection and treatment of schizophrenia is based on several observations: diagnosis and treatment of schizophrenia are often seriously delayed. Consequences of the disease are severe already in the early undiagnosed phase of the disorder and early treatment seems to improve the course of the disease. It can therefore be stated quite safely that patients should be treated as early as possible. However, the question of how early has not been sufficiently answered up to now. CONCLUSION: We are at the moment in an ethical dilemma between either diagnosing and treating this disorder too late or too early. The only way and prerequisite for solving this dilemma is a more reliable identification of individuals at risk and the beginning disease process.
Diagnosis, Differential↗
Attitudes and mental illness: consumers and the general public are on one side of the medal, mental health professionals on the other.
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Attitude of Health Personnel↗
A macroglomerulus in the antennal lobe of leaf-cutting ant workers and its possible functional significance.
Ants have a well-developed olfactory system, and pheromone communication is essential for regulating social life within their colonies. We compared the organization of primary olfactory centers (antennal lobes, ALs) in the brain of two closely related species of leaf-cutting ants (Atta vollenweideri, Atta sexdens). Both species express a striking size polymorphism associated with polyethism. We discovered that the ALs of large workers contain a substantially enlarged glomerulus (macroglomerulus, MG) at the entrance of the antennal nerve. This is the first description of an MG in non-sexual individuals of an insect. The location of the MG is laterally reversed in the two species, and workers of different size express a disproportional allometry of glomerular volumes. While ALs of large workers contain an MG, glomeruli in small workers are all similar in size. We further compared electroantennogram (EAG) responses to two common trail pheromone components of leaf-cutting ants: 4-methylpyrrol-2-carboxylate and 2-ethyl-3,6-dimethylpyrazine. At high concentrations the ratio of the EAG signals to 2-ethyl-3,6-dimethylpyrazine versus 4-methylpyrrol-2-carboxylate was significantly smaller in A. vollenweideri compared with the ratio of EAG signals to the same two components in A. sexdens. The differences in EAG signals and the species specific MG location in large workers provide correlative evidence that the MG may be involved in the detection of the trail pheromone.
Animals↗
Depressive symptoms during childhood and adult obesity: the Zurich Cohort Study.
Depression and obesity have become major health problems with increasing prevalence. Given the limited effectiveness of treatment for weight problems, the identification of novel, potentially modifiable risk factors may provide insights on new preventive approaches to obesity. The purpose of this study was to test the hypothesis that depressive symptoms during childhood are associated with weight gain and obesity during young adulthood. Participants were from a prospective community-based cohort study of young adults (N=591) followed between ages 19 and 40 years. The sample was stratified to increase the probability of somatic and psychological syndromes. Information was derived from six subsequent semistructured diagnostic interviews conducted by professionals over 20 years. The outcome measures were body mass index (BMI) and obesity (BMI>30). Among women, depressive symptoms before age 17 years were associated with increased weight gain (4.8 vs 2.6% BMI increase per 10 years) representing greater risk for adult obesity (hazard ratio=11.52, P<0.05). Among men, only after controlling for confounders, depressive symptoms before age 17 years were associated with increased weight gain (6.6 vs 5.2% BMI increase per 10 years) in adulthood but not with occurrence of obesity. These associations between childhood depressive symptoms and adult body weight were adjusted for baseline body weight, a family history of weight problems, levels of physical activity, consumption of alcohol and nicotine, and demographic variables. As the magnitude of the associations was high, and depression during childhood is a prevalent and treatable condition, this finding may have important clinical implications for the prevention and treatment of obesity. Whether the results of this study are limited to populations with elevated levels of psychopathology remains to be tested.
Adult↗
Cost of psychotic disorders in Europe.
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Costs and Cost Analysis↗
Are immigrants at a disadvantage in psychiatric in-patient care?
OBJECTIVE: To assess the utilization of psychiatric in-patient care among immigrants, and to compare immigrants and natives with respect to sociodemographic and clinical characteristics. METHOD: Analysing a sample of 23 377 consecutive referrals to psychiatric hospitals of a catchment area in 1995-2001. RESULTS: Within this sample, 20% were foreign nationals. Rates of psychotic disorders were similar in immigrants and natives. Regarding other diagnoses, sociodemographic and clinical measures, there were significant differences. Most immigrant groups had higher rates of compulsory admission, were more likely to be admitted with lower illness severity and not to be readmitted, and spent significantly shorter time in hospital, compared with Swiss in-patients. Some of these differences were clearly gender-specific. CONCLUSION: Service utilization and psychiatric treatment decisions are not explained merely by illness-related aspects in immigrants. Social and cultural factors have to be recognized in order to prevent disadvantages in psychiatric care.
Adolescent↗
Internet forums: a self-help approach for individuals with schizophrenia?
OBJECTIVE: To study if and how online self-help forums for individuals with schizophrenia are used. METHOD: We analysed 1200 postings of 576 users in 12 international schizophrenia forums regarding communicative skills [fields of interest and self-help mechanisms (SHM)]. RESULTS: The forums were predominantly used by affected individuals, few relatives or friends. The fields of interest of the users concern daily problems of the illness like symptoms and emotional involvement with the illness. Self-help mechanisms mostly used are disclosure and providing information. Emotional interaction e.g. empathy or gratitude were comparatively rare. CONCLUSION: Individuals suffering from schizophrenia participate in online self-help forums using the same SHM, discussing similar topics as do individuals with other psychiatric disorders as well as not affected relatives and caregivers. Therefore, this tool seems to be a useful approach to cope with alienation and isolation, albeit only a small number of schizophrenia forums are found in the Internet.
Communication↗
[Cannabis and psychosis--a review].
The present review focuses on articles dealing with clinical or epidemiological studies on the association between cannabis use and psychoses. Included are all articles published since 1990 that were located by a Medline or Psyclit data-base research and those earlier articles that are needed for a correct understanding of studies published during the index episode. The three main topics found are 1) is there evidence for a so called cannabis psychosis 2) do cannabis users exhibit a higher risk of developing a psychotic disorder or 3) does its use worsen the course in established schizophrenia spectrum disorders. The review concludes that very high doses of cannabis can induce a brief psychosis but that this condition is extremely rare. Therefore, such a diagnosis should only be made after careful exclusion of other etiologies. The actual evidence regarding the impact of cannabis use on persons vulnerable to psychosis is not conclusive. Cannabis use seems to worsen the course of schizophrenia spectrum disorders. Adolescents run a higher risk from using cannabis than older people. They should be strongly advised not to indulge in such behaviour.
Cannabinoids↗
Occupation, social support and quality of life in persons with schizophrenic or affective disorders.
BACKGROUND: Most people suffering from severe mental illness (SMI) lack paid employment. This study investigates the relationship between work status and objective as well as subjective quality of life (QoL) in people with SMI. METHODS: The sample consists of 261 subjects (102 women, 159 men) aged 35 (men) and 38 (women) years on average, of whom 158 suffer from a schizophrenic disorder (ICD-10: F2) and 103 were diagnosed as having an affective disorder (ICD-10: F3). Subjective QoL was assessed with the WHOQOL-BREF scale. RESULTS: Subjects with an occupation in general have a larger social network at their disposal and receive more social support. With regard to income, few (12%) of the subjects with a job on the open labour market live below the poverty level, but many (28-38%) of those engaged in sheltered or other work-like activities do. Occupation ameliorates satisfaction with life domains referring to social integration (social relationships, environment), whereas the individual's well-being (psychological, physical) is hardly affected. Social support is an important mediator of the relationship between occupation and subjective QoL. Income is weakly and negatively related to subjective QoL. CONCLUSIONS: Supportive relationships to colleagues at the workplace mainly explain the better subjective QoL of SMI people with an occupation. When designing specific employment possibilities for people with SMI, we should take notice of the social support dimension at the workplace. Mentally ill people have a substantial poverty risk, even when they are working. In particular, payment for sheltered work should be ameliorated.
Adult↗
The associations between psychopathology and being overweight: a 20-year prospective study.
BACKGROUND: Psychiatric disorders and being overweight are major health problems with increasing prevalence. The purpose of this study was to test the hypothesis that being overweight is associated with a range of psychiatric conditions including minor and atypical depressive disorders, binge eating, and aggression. METHOD: Prospective community-based cohort study of young adults (n = 591) followed between ages 19 and 40. Information derived from six subsequent semi-structured diagnostic interviews conducted by professionals over twenty years. Outcomes were being overweight [body-mass index (BMI)> 25] and average yearly weight change between ages 20 and 40 (BMI slope). RESULTS: 18.9 % of the participants were classified as being overweight. Being overweight turned out to be a stable trait: 77.7% of subjects were assigned to the same weight class at each interview. Atypical depression and binge eating were positively associated with both, increased weight gain and being overweight, while psychiatric conditions associated with aggressive behaviors (aggressive personality traits, sociopathy) were positively associated with being overweight, but were not related to the rate of weight change. Generalized anxiety disorder was negatively associated with overweight. These results persisted after controlling for substance use, levels of physical activity, demographic variables and family history of weight problems. CONCLUSIONS: This study shows relatively strong associations between eating-related and aggressive psychopathology and being overweight. Given the high prevalence rates of these conditions, this study encourages further research on the causality of psychopathology-overweight associations that might provide insight on novel preventive approaches for major health problems.
Adult↗
[Defining quality in psychiatric care].
Since the report of an expert commission in 1975 concerning the situation of psychiatric care in Germany, the public has become aware of the need of reforms. In spite of sustainable improvements in mental health care, there is ongoing skepticism and fundamental criticism about what has been achieved. The following considerations of what constitutes quality in mental health care are directed strictly toward structure quality, which is not sufficient in itself but rather a prerequisite for good treatment and care. As such, structure quality includes health policy and organisational, financial, and human resources as a whole. The concept of need-led care, manifold aspects determining the utilisation of mental health care facilities, and the potential influence of the public on mental health institutions are described and critically discussed. In doing so, it becomes clear that mental health care today is always embedded in superordinate societal values.
Germany↗
[Reducing the risk of superficial bladder cancer recurrence with 5-aminolevulinic acid-induced fluorescence diagnosis. Results of a 5-year study].
A prospective monocentre randomized parallel-group Phase III trial was performed to investigate whether primary transurethral resection (TUR) with 5-aminolevulinic acid induced Fluorescence diagnosis (FD) allows for a more thorough TUR of superficial Bladder Carcinoma compared to conventional white light (WL). Evaluation of residual tumor rate and recurrence free survival were defined as the two primary study endpoints. The residual tumor rate was 25.2% in the WL arm (n=103) vs. 4.5% in the (n=88) FD arm (p<0.0001). Median follow up of the patients in the WL arm was 42 months (range 25-61) compared to 43 (range 24-61) in the FD arm. Recurrence free survival in the fluorescence diagnosis group was 90.9%, 90.9% und 85 % after 12, 24 and 48 months compared with 78.6%, 69.9% und 60.7 %, respectively, in the white light group (p=0.0005). This superiority proved to be independent of risk group. The adjusted hazard ratio of fluorescence diagnosis versus white light transurethral resection was 0.29 (95% CI: [0.15; 0.56]). ALA induced FD is statistically significantly superior to conventional WL TUR with respect to both residual tumor rate and recurrence-free survival. The differences in RFS imply that FD offers a clinically relevant procedure to reduce the number of tumor recurrences.
Adult↗
Lay beliefs about causes of depression.
OBJECTIVE: Assessing lay beliefs about causes of depressive behaviour and analysing the influence of labelling and demographic factors on causal attributions. METHOD: In Switzerland we conducted a representative telephone survey with 873 interviewees. A vignette depicting a man with depression satisfying the Diagnostic and Statistical Manual (DSM)-III-R criteria was presented. Content analysis of up to three answers about assumed causes was conducted. RESULTS: For more than half the respondents (56.6%) difficulties within the family or the partnership are causal for depression. Occupational stress is the second most-mentioned cause (32.7%), whereas unspecified further stress is in third place (19.9%). Traumatic events (17.9%), depressive disorder (14.1%) and further unspecified illnesses (11.6%) follow. Few correlations were found between causal attributions, labelling and demographic factors. CONCLUSION: The respective causal attributions are mainly independent of demographic factors, thus generalizable for the population. The attributions are shaped primarily by psychosocial ideas about aetiology. Nevertheless, one-third of the interviewees holds biological or disease-related beliefs about causes of depression. The respective illness models cannot be neglected in the therapeutic relationship.
Data Collection↗