Biomedical subjects

Wulf Rössler

Publications and source records attributed to Wulf Rössler.

At least 19 recordsLinked to original sources

PubMed2007

Mental health care in Germany: current state and trends.

Germany turned towards community-based mental health care in the mid seventies, during a general climate of social and political reform. The continuing deinstitutionalisation process and the implementation of community mental health services was considerably affected by the reunification of East and West Germany in 1990, which required dramatic changes in the structure and quality of the mental health care system of the former German Democratic Republic (GDR). Overall, German mental health care is organised as a subsidiary system, where planning and regulating mental health care is the responsibility of the 16 federal states. So German mental health care provision is spread among many sectors and characterised by considerable regional differences. A key characteristic is the particularly wide gap between inpatient and outpatient services, which are funded separately and staffed by different teams. In 2003 the total number of psychiatric beds was a mere two thirds of the overall bed capacity in 1991, the first year as a re-unified Germany, when psychiatric beds in East and West Germany totalled 80,275. From 1970 onwards the number of psychiatric beds was cut by roughly half. So the momentum of the reform has been strong enough to assimilate the completely different mental health care system of the former German Democratic Republic and, in the course of a decade, to re-structure mental health services for an additional 17-18 million new inhabitants. In an ongoing struggle to adapt to changing administrative set-ups, legal frameworks, and financial constraints, psychiatry in Germany in currently facing specific problems and is seriously challenged to defend to considerable achievements of the past. A major obstacle to achieving this aim lies in the fragmented system of mental health care provision and mental health care funding.

Germany↗

PubMed2006

Seasonal associations between weather conditions and suicide--evidence against a classic hypothesis.

Psychiatrists, epidemiologists, and sociologists have debated the existence of an association between weather conditions and suicide seasonality since the preliminary statistical investigations in the 19th century. Provided that the effect of weather conditions on suicide operates via a dose-response-like mechanism, time-series (Box-Jenkins) analysis permits an indirect test of the hypothesis that temperature or other weather variables promote higher suicide frequencies in late spring and early summer months. The authors modeled monthly data on suicide and climatic conditions (i.e., temperature, sunshine, and precipitation data) in Switzerland. Cross-correlations between the filtered (prewhitened) residual series were calculated for the period 1881-2000, for consecutive 30-year periods, for different suicide methods, and--with regard to the seasonality hypothesis--for series relying on moving 1- and 3-month frames. Positive cross-correlations emerged between suicide and temperature data for the whole time series, as well as in all consecutive 30-year periods. However, cross-correlations of data series based on moving frames showed a minor peak in associations for summer frames and a major peak in associations for winter frames, the latter reflecting suicides performed mainly outdoors (being run over by a train and jumping from high places). The results represent a novel minor effect in seasonality of suicide, which is hardly compatible with the hypothesized role of temperature in suicide seasonality.

Cause of Death↗

PubMed2006

The spectra of neurasthenia and depression: course, stability and transitions.

BACKGROUND: Neurasthenia has had a chequered history, receiving changing labels such as chronic fatigue or Gulf war syndrome. Neurasthenia is recognized by ICD-10, but not by DSM-IV. Its course, longitudinal stability and relationship to depression is not well understood. METHODS: In a stratified community sample (n = 591), representative of 2600 persons of the canton of Zurich, Switzerland, neurasthenia and depression were assessed in six structured interviews between ages 20 and 41. Course, stability and comorbidity were examined. A severity spectrum of neurasthenia and depression from symptoms to diagnosis was taken into account. RESULTS: The annual prevalence of a neurasthenia diagnosis increased from 0.7% to 3.8% from age 22-41, while mere symptoms became less prevalent. Intraindividual courses improved in 40% and deteriorated in about 30% of symptomatic cases. The most frequent symptoms overall, besides criterial exhaustion, were increased need for sleep, over-sensitivity, nervousness and difficulty concentrating. Cross-sectional associations and overlap with depression were strong. Longitudinal stability of ICD-neurasthenia was low. CONCLUSIONS: Neurasthenia is intermittent, overlaps significantly with depression, and shows improvement and deterioration over time to roughly equal measures.

Adult↗

PubMed2006

Attitudes to antipsychotic drugs and their side effects: a comparison between general practitioners and the general population.

BACKGROUND: Attitudes towards antipsychotic medication play an important part in the treatment for schizophrenia and related disorders. We aimed measuring general practitioners' attitudes to antipsychotic drugs and their adverse side effects and comparing these with the attitudes of the general population. METHODS: Analysis and comparison of two representative samples, one comprising 100 General Practitioners (GPs), the other 791 individuals randomly selected from the general population. The setting was the German speaking cantons of Switzerland. RESULTS: General practitioners have significantly more positive attitudes towards anti-psychotic drugs than the general public. They reject widespread prejudices about the use of anti-psychotic medication significantly more than the general population. In particular the risk of dependency was assessed as 'low' by GP's (80%), in contrast to only 18% of the general population sample. In no instance did a majority of the GPs advise not tolerating any of the 10 possible adverse effects presented in this study. This is in marked contrast to the general population sample, where a majority recommended discontinuation for movement disorder (63%), strong tremor (59%), risk of dependency (55%) and feelings of unrest (54%). CONCLUSION: As well as effective management of side-effects being a vital aspect of patient and carer education, prescribing doctors need to be aware that their mentally ill patients are likely to be confronted with extremely negative public attitudes towards antipsychotic medication and with strong pressures to stop taking their medication in the event of side-effects.

Adolescent↗

PubMed2006

The use of complementary and alternative medicine in the general population: results from a longitudinal community study.

BACKGROUND: Many patients with psychological or physical problems are interested in non-medical approaches. The reasons for the growing popularity of complementary and alternative medicine (CAM) are not well understood considering that evidence of the effectiveness of conventional therapies is greater than ever before. We have examined data from the Zurich Study to determine trends and predictors of CAM use in Switzerland. METHOD: The Zurich Study is a longitudinal community study that was started in 1979 with a sample of 591 participants born in 1958 and 1959. In 1999, the last of six interview waves with face-to-face interviews was conducted. CAM use was analyzed with data from interviews in 1993 and 1999. Polytomous logistic regression analysis focused on the personal, demographic and sociocultural background of CAM users. RESULTS: CAM use in the last 12 months was reported by 21.9% of the participants in 1993 and by 29.5% in 1999. CAM use among those exhibiting either physical or psychological problems was in the ratio of two to one. There was a trend from alternative variants of CAM (homeopathy) to complementary ones (massage, osteopathy, acupuncture). The vast majority of CAM use was in addition to conventional therapies. Predictors of CAM use were, among others, attribution of physical complaints to stress and other psychological variables, very low education level in parents, and lacking political interest. CONCLUSIONS: Besides the sociocultural background, characteristics such as the psychological attribution style play an important role in CAM use. CAM use in Switzerland is mainly of a complementary rather than an alternative nature.

Complementary Therapies↗

PubMed2006

Pharmacological treatment of acute mania in psychiatric in-patients between 1994 and 2004.

BACKGROUND: In a cross-section approach we investigated prescription practice in acute mania in 63 German, Swiss and Austrian hospitals between 1994 and 2004. METHODS: Our data were gathered from a large drug safety program (AMSP) within which on two reference days each year all administered drugs are recorded. For the present study, all cases with a primary diagnosis of acute euphoric mania (n=1291) or mixed-state mania (n=143) were identified. Prescription rates from two periods, 1994 to 1999 and 2000 to 2004, were compared. RESULTS: In euphoric mania, prescription of lithium decreased by about one-fifth (43.3% to 34.5%, p<0.01), while prescription of anticonvulsants increased by one-half (from 40.0% to 60.7%, p<0.001). Administration of atypical antipsychotics more than doubled (18.5% to 43.9%, p<0.001), while use of typical antipsychotics decreased significantly (56.9% to 27.8%, p<0.001). Overall prescription rates of antipsychotics (79.6% vs. 81.6%) and antidepressants (14.0% vs. 15.5%) remained stable, while administration of tranquilizers increased significantly (26.3% to 34.3%, p<0.01). In mixed-state mania, similar trends over time to those seen in euphoric mania were observed for lithium (43.2% to 33.3%), anticonvulsants (50.0% to 69.7%, p<0.05) and tranquilizers (22.7% to 40.4%). Prescription rates of antipsychotics slightly increased (63.6% to 72.7%), while prescription of antidepressants slightly decreased (54.5% to 46.5%). Polypharmacy was a common phenomenon: patients with euphoric mania were treated with a mean number of 2.9+/-1.2 psychotropic agents, and patients with mixed-state mania with 3.3+/-1.5 psychotropic agents. Both groups showed a significant increase over time. Second-generation atypical antipsychotics were adopted quite rapidly for the treatment of acute mania considering the availability of the scientific evidence at that time. Off-label use was a common phenomenon. Deviations from recommended guidelines were found mainly in the use of antidepressant and antipsychotic drugs both in mixed-state and euphoric mania. CONCLUSIONS: Naturalistic prescription studies like this may encourage a critical scrutiny of clinical treatment habits and may also drive further research thus moderating potential differences between evidence-based knowledge and everyday clinical practice.

Acute Disease↗

PubMed2006

How ubiquitous are physical and psychological complaints in young and middle adulthood? A longitudinal perspective.

OBJECTIVES: To investigate continuity and change of self-reported physical and psychological complaints in young adults over a period of 20 years. STUDY DESIGN AND SETTING: The Zurich Study--a long-term panel survey in psychiatric epidemiology--is based on a stratified sample of 591 subjects born in 1958 (women) and 1959 (men). The sample strata combine SCL-90-R high-scorers and low-scorers in a 2:1 ratio. Up to now, the Zurich Study has included six interviews between 1979 and 1999, i.e. 20 years of life in young adults. We analysed the longitudinal frequency data of a variety of physical and psychological complaints, as well as information about subjective suffering and use of professional help. The analyses utilised on the McNemar's test, the Q-test and Markov chain models. RESULTS: Sleep disorders, depression, menstruation, backache, headache, stomach and bowel complaints yielded cumulative prevalence rates of 80% or higher. Physical and psychological complaints systematically differ with respect to the change patterns between 1979 and 1999. Moreover, strong differences were found in view of subjective suffering and use of professional help. CONCLUSIONS: Even though many self-reported physical and psychological complaints are very common in young adulthood, the underlying dynamics and the implications largely differ. It seems to be crucial whether respondents use somatic glasses or psychological lenses.

Adult↗

PubMed2006

Changing times: a longitudinal analysis of international firearm suicide data.

We investigated changes in the proportion of firearm suicides in Western countries since the 1980s and the relation of these changes to the change in the proportion of households owning firearms. Several countries had an obvious decline in firearm suicides: Norway, United Kingdom, Canada, Australia, and New Zealand. Multilevel modeling of longitudinal data confirmed the effect of the proportion of households owning firearms. Legislation and regulatory measures reducing the availability of firearms in private households can distinctly strengthen the prevention of firearm suicides.

Australia↗

PubMed2006

Is the association of alcohol use disorders with major depressive disorder a consequence of undiagnosed bipolar-II disorder?

BACKGROUND: There is emerging evidence that there is a spectrum of expression of bipolar disorder. This paper uses the well-established patterns of comorbidity of mood and alcohol use disorder to test the hypothesis that application of an expanded concept of bipolar-II (BP-II) disorder might largely explain the association of alcohol use disorders (AUD) with major depressive disorder (MDD). METHOD: Data from the Zurich study, a community cohort assessed over 6 waves from ages 20/21 to 40/41, were used to investigate the comorbidity between mood disorders and AUD. Systematic diagnostic criteria were used for alcohol abuse, alcohol dependence, MDD, and BP-II. In addition to DSM criteria, two increasingly broad definitions of BP-II were employed. RESULTS: There was substantially greater comorbidity for the BP-II compared to major depression and for alcohol dependence compared to alcohol abuse. The broadest concept of BP-II explained two thirds of all cases of comorbidity of AUD with major depressive episodes (MDE). In fact, the broader the definition of BP-II applied, the smaller was the association of AUD with MDD, up to non-significance. In the majority of cases, the onset of bipolar manifestations preceded that of drinking problems by at least 5 years. CONCLUSIONS: The findings that the comorbidity of mood disorders with AUD was primarily attributable to BP-II rather than MDD and that bipolar symptoms usually preceded alcohol problems may encourage new approaches to prevention and treatment of AUD.

Adult↗

PubMed2006

Varying temporal criteria for generalized anxiety disorder: prevalence and clinical characteristics in a young age cohort.

BACKGROUND: This study questions the 6-month duration criterion for generalized anxiety disorder (GAD) used in DSM-III-R and DSM-IV. METHOD: In adults from age 20/21 to 40/41 in the prospective Zurich Cohort Study, four groups of generalized anxiety syndromes defined by varying duration (2 weeks, 1 month, 3 months and 6 months) were compared. RESULTS: Applying DSM-III (1979-1999) and DSM-III-R (1986-1999) criteria, there were no significant differences between the four groups in terms of family history of anxiety, work impairment, distress, treatment rates or co-morbidity with major depressive episodes (MDEs), bipolar disorder or suicide attempts. Only social impairment related to the length of episodes. The 6-month criterion of DSM-III-R and DSM-IV GAD would preclude this diagnosis in about half of the subjects treated for generalized anxiety syndromes. CONCLUSIONS: In this epidemiological sample, the 6-month duration criterion for GAD could not be confirmed as clinically meaningful. GAD syndromes of varying duration form a continuum with comparable clinical relevance.

Adult↗

PubMed2006

Utilisation of inpatient psychiatric services by people with illicit substance abuse in Switzerland.

QUESTIONS UNDER STUDY: The study aims to examine the utilisation of inpatient psychiatric services by people with substance use disorders (SUD), and to identify factors that predict inpatient service use. METHODS: Out of a sample of consecutively referred first-admitted patients from a catchment area in Switzerland, a cohort of 563 individuals with behavioural and mental disorders due to (illicit) substance use was followed over a period of 5 years by means of register data. RESULTS: Every fourth individual of the first-admission sample was admitted for a SUD. Over the 5-year period, average number of inpatient episodes (1.7) was comparable to that of patients with other diagnoses; time in hospital, however, was by far shorter (cumulative: 21 days). 61.6% of the individuals with SUD were treated as inpatients only once; 41.4% were not regularly discharged. Clinical patient characteristics (psychiatric co-morbidity, admission state, clinical improvement during first inpatient stay) and treatment measures (psychotherapy during first inpatient stay, planned aftercare) were the most important predictors of inpatient psychiatric service use over the 5-year period. Associations with sociodemographic background factors were only weak. CONCLUSIONS: These findings suggest that a high number of patients with SUD are contacting inpatient services, but retention in treatment so far is not sufficient for an adequate drug treatment. Efforts need to be intensified to advance the diagnostic process and to improve current treatment strategies in order to achieve better clinical outcomes.

Adolescent↗

PubMed2006

Length of first admission and treatment outcome in patients with unipolar depression.

BACKGROUND: Unipolar depression is among the most common reasons for psychiatric hospitalisation. But only few studies focussed on inpatient treatment and its impact on short- or long-term outcome in these patients. Thus, we studied as to what extent patients with unipolar depression use psychiatric inpatient resources, and examined whether the length of stay is associated with short-term improvement and rehospitalisation. Finally, we analysed if there is an 'optimal' length of first hospitalisation. METHODS: In a catchment area in Switzerland, psychiatric inpatient utilisation over 5 years was analysed in 458 first-ever admitted patients with unipolar depressive disorder (ICD-10, F32 and F33). RESULTS: 365 patients (79.7%) were admitted only once. Patients with a first inpatient stay of 15-30 days had the shortest cumulative length of further inpatient treatment. Symptom improvement during first hospitalisation was immediately linked to the length of stay (first and further episodes) and to a regular discharge from first admission. Higher symptom improvement predicted shorter length of stay and less rehospitalisations. Demographic (age, gender, employment, living situation) and clinical variables (dual diagnosis, one or multiple episodes of unipolar depression, illness severity) did not significantly influence short-term outcome and long-term service use. LIMITATIONS: The study is biased towards the more severely ill as we only included inpatients. CONCLUSIONS: Variables describing the first hospitalisation of patients with unipolar depression are more appropriate for clinical prognosis than sociodemographic or diagnostic factors. Moreover, improving clinical symptoms is more important for long-term outcome than the length of inpatient stay.

Adolescent↗

PubMed2006

Prediction of in-patient use in first-admitted patients with psychosis.

PURPOSE: The aim of this study is to examine the utilization of psychiatric services for inpatients with psychosis over a period of five years after first admission, and to identify factors that contribute to intensive service use in terms of cumulative length of in-patient treatment and readmission rate. METHODS: A cohort of 424 patients with psychotic disorders (out of a sample of 2565 first-admitted patients from a catchment area in Switzerland) was examined by means of register data. RESULTS: Patients admitted for psychosis spent the longest time in hospital compared to other diagnoses, but there was considerable within-sample variation, and most patients (60.4%) had only one in-patient episode. Of the total time accumulated in this sample, 50.5% was 'consumed' by 10.7% of patients. Regarding the overlap between 'heavy use' and 'frequent use' (those 10% of the sample with the longest/ most frequent hospitalizations), only 39.5% of the 'frequent users' were also 'heavy users' (vice versa: 38.6%). 'Clinical' measures were the main predictors of the overall time spent as an in-patient (schizophrenia diagnosis, therapeutic measures, clinical improvement). Concerning 'heavy use', homelessness was yet another important risk factor. Sociodemographic variables (age, level of education, living alone) particularly influenced the number of hospitalizations. A younger age at first admission was predictive of 'heavy' and 'frequent' use. DISCUSSION: Clinical and sociodemographic factors explain differences in in-patient service consumption among patients with psychosis. Efforts to devise effective interventions have to take both into account, but different measures are needed to address 'heavy' and 'frequent' use.

Adult↗

PubMed2006

Attitudes of mental health professionals toward people with schizophrenia and major depression.

Several studies reveal poor knowledge about mental illness in the general population and stigmatizing attitudes toward people with mental illness. However, it is unknown whether mental health professionals hold fewer stigmatizing attitudes than the general population. A survey was conducted of the attitudes of mental health professionals (n = 1073) and members of the public (n = 1737) toward mental illness and their specific reaction toward a person with and without psychiatric symptoms ("non-case" as a reference category). Psychiatrists had more negative stereotypes than the general population. Mental health professionals accepted restrictions toward people with mental illness 3 times less often than the public. Most professionals were able to recognize cases of schizophrenia and depression, but 1 in 4 psychiatrists and psychologists also considered the non-case as mentally ill. The social distance toward both major depression and the non-case was lower than toward schizophrenia. However, in this regard, there was no difference between professionals and the public. The study concludes that the better knowledge of mental health professionals and their support of individual rights neither entail fewer stereotypes nor enhance the willingness to closely interact with mentally ill people.

Adult↗

PubMed2006

Patterns of inpatient care for immigrants in Switzerland: a case control study.

BACKGROUND: Migration has become a major political and social concern in West European societies. METHODS: A case-control method was used to analyse the utilisation of inpatient mental health services by immigrants from a catchment area in Switzerland over a 7-year period. RESULTS: Compared to natives, immigrants had fewer psychiatric hospitalisations, but more emergency and compulsory admissions. During inpatient treatment, they received less psycho-, ergo- and physiotherapy. Other therapies as well as compulsory measures were at comparable rates, as was the frequency of irregular discharge. They spent shorter periods as inpatients and the rate of psychiatric readmissions was significantly lower. Comparison of different countries of origin revealed that only patients from West and North Europe were comparable to natives regarding type of referral, inpatient treatment, and longitudinal measures of service utilisation. Even after accounting for effects of social class, immigrants from South Europe, former Yugoslavia, Turkey, East Europe and more distant countries spent significantly shorter time in inpatient treatment, compared to Swiss control patients. CONCLUSIONS: Results of this study clearly point to an underutilisation of inpatient facilities among immigrants with mental disorders, and to disadvantages in psychiatric inpatient care. This, however, does not pertain to all foreign patients to the same extent: inequalities of mental health service use are particularly pronounced in immigrants from more distant countries.

Adolescent↗

PubMed2006

Homeless people at disadvantage in mental health services.

OBJECTIVE: The aims of this study are threefold: to depict characteristics of homeless at discharge from a psychiatric hospital; to describe the utilisation of inpatient care and treatment measures during hospitalisation; and to analyse to what extent psychiatric disorders and clinical variables contribute to the risk for homelessness at discharge. METHODS: Based on case register data we analysed all 28,204 people consecutively referred in 1996-2001 to psychiatric hospitals of a well-defined catchment area in Switzerland. RESULTS: 1% (N=269) of all admissions were homeless at discharge (mean age: 32.0 years; women: 27.9 %). Compared to other psychiatric inpatients, we found among the homeless more males, more people with younger age and lower education. Regarding treatment measures during the inpatient stay, homeless received less often psychopharmacotherapy, ergotherapy and physiotherapy, but more vocational training, occupational therapy and support by social workers. There was no difference between homeless and others regarding compulsory medication or seclusion. Homeless had a shorter length of inpatient stay. Risk factors for being homeless at discharge were: being homeless at admission, not living in a relationship, having a multiple substance abuse or a dual diagnosis, low clinical improvement during inpatient treatment and discharge against medical advice. DISCUSSION: To prevent homelessness at discharge, it is important to consider all independent contributors, i. e. the living situation before admission, health care inequalities during inpatient treatment (care received, low clinical improvement, discharge planning) and psychopathology.

Adult↗

PubMed2006

Community psychiatry: results of a public opinion survey.

BACKGROUND: Mental health authorities must know the public's attitude to community psychiatry when planning community mental health services. However, previous studies have only investigated the impact of demographic variables on the attitude to community psychiatry. AIM: To assess the influence of psychological and sociological parameters on the public opinion of community psychiatry in Switzerland. METHOD: Linear regression analyses of the results of a public opinion survey on a representative population sample in Switzerland (n = 1737). RESULTS: Most respondents have positive attitudes to community psychiatry. In the regression analysis (R2 adjusted = 21.2%), negative emotions towards mentally ill people as depicted in the vignette, great social distance, a positive attitude to restrictions, negative stereotypes, high rigidity and no participation in community activities significantly influenced negative attitudes to community psychiatry. Additionally, other parameters, e.g. contact with mentally ill people and the nationality of the interviewee, have a significant influence. CONCLUSIONS: In planning psychiatric community services, general individual traits and emotive issues should be considered because they influence the response towards community psychiatry facilities in the host community.

Aged↗

PubMed2006

Inconsistency in reporting potentially traumatic events.

BACKGROUND: Research on post-traumatic stress disorder (PTSD) relies mainly on self-reports of exposure to trauma and its consequences. AIMS: To analyse the consistency of the reporting of potentially traumatic events (PTEs) over time. METHOD: A community-based cohort, representative of the canton of Zurich, Switzerland, was interviewed at the ages of 34-35 years (in 1993) and 40-41 years (in 1999). A semi-structured diagnostic interview, including a section on PTSD, was administered. RESULTS: Of the 342 participants who attended both interviews, 169 reported some PTE (1993, n=110; 1999, n=120). In 1999, 56 participants (33.1%) reported for the first time PTEs that actually occurred before 1993, but which had not been reported in the 1993 interview. In total, 68 participants (40.2%) who had reported a PTE in 1993 did not report it in 1999. The overall frequency of inconsistent reporting was 63.9%. CONCLUSIONS: The high level of inconsistency in the reporting of PTEs has implications for therapy as well as for research.

Adult↗