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Die Negativsymptomatik spielt in der aktuellen Schizophrenieforschung eine grose Rolle, die Zahl der diesbezuglichen Publikationen ist fast unuberschaubar. Dagegen liegen uber das Vorkommen von Negativsymptomatik bei anderen... more
Die Negativsymptomatik spielt in der aktuellen Schizophrenieforschung eine grose Rolle, die Zahl der diesbezuglichen Publikationen ist fast unuberschaubar. Dagegen liegen uber das Vorkommen von Negativsymptomatik bei anderen Diagnosegruppen nur einige wenige empirische Daten vor (6, 20, 23, 24, 28). Ahnliches gilt auch fur die in der deutschen Psychiatrie von G. Huber (15) und L. Sullwold (29) schon vor dem Beginn der angloamerikanischen Negativsymptomforschung herausgearbeiteten selbst erlebten Beeintrachtigungen von Antrieb und Emotionalitat, Denk- und Sprechakten, von Wahrnehmung, Propriozeption und Handlungssteuerung sowie anderen psychischen Funktionen mehr. Bei dieser Basissymptomatik handelt es sich um einen im Zuge langjahriger Verlaufsforschung neu aufgedeckten defizitaren Phanomenbestand und nicht wie bei der Negativsymptomatik — jedenfalls in ihrer heute popularsten, von Andreasen (1) erarbeiteten Fassung — um etwas Altbekanntes, namlich die Bleuler’ schen Grundsymptome in leichter Umverteilung und neu operationalisierter Form. Man kann sie aber in manch anderer Hinsicht durchaus als deutsche Version der Negativsymptomatik betrachten und auch fur sie trifft dann der Einwand von David und Appleby (6), das es zu wenige empirische Studienresultate (7, 23, 25, 27) fur die Beurteilung der Streubreite uber andere Diagnosegruppen gabe, sicherlich zu. Ein kleines solches differentialdiagnostisches Spektrum mit signifikant hoherer Pravalenz bei den schizophrenen Storungen wurde bei jeder der drei Symptomgruppen fur eine gute diagnostische Eignung sprechen.
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Am Anfang dieses Sammelbandes zum 2. Bonner Kraepelin-Symposium ist es vielleicht ganz angebracht, mit einem kurzen Ruckblick auf die Pioniertat des grosen Namengebers der Symposiums-Reihe zu beginnen. Was fand E. Kraepelin 1896... more
Am Anfang dieses Sammelbandes zum 2. Bonner Kraepelin-Symposium ist es vielleicht ganz angebracht, mit einem kurzen Ruckblick auf die Pioniertat des grosen Namengebers der Symposiums-Reihe zu beginnen. Was fand E. Kraepelin 1896 eigentlich vor, als er vor fast 100 Jahren die „Dementia praecox“ schuf, jene neue Krankheitskonzeption, die dann 12 Jahre spater von E. Bleuler erstmals den heute weltweit eingeburgerten Namen der Schizophrenie beigelegt bekam? Es waren dies die Katatonie, die Hebephrenie und die „Dementia paranoides”, und jedes dieser klinischen Bilder hatten die damaligen Erstbeschreiber selbst schon als Krankheitseinheit mit naturlichen symptomatologischen Grenzen und unverwechselbarem Verlauf angesehen (Klosterkotter 1992). Das aber, zeigte nun Kraepelin, war so nicht haltbar. Die drei klinischen Bilder wiesen vielmehr im Langzeitverlauf fliesende Ubergange — Syndromshifts, wie man heute sagen wurde — ineinander auf, und, was noch mehr gegen ihre Eigenstandigkeit sprach, sie mundeten auch oft in die gleichen „eigenartigen Schwachezustande“ aus,Verstandesabnahme, Gemutsabstumpfung sowie Einbusen an Willensfestigkeit und Tatkraft” ein (s. Abb. 1).
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The aim of this study was to compare resting cerebral blood flow velocity values of unmedicated patients in the acute phase of panic disorder with resting values of healthy control subjects. Nineteen unmedicated panic disorder patients... more
The aim of this study was to compare resting cerebral blood flow velocity values of unmedicated patients in the acute phase of panic disorder with resting values of healthy control subjects. Nineteen unmedicated panic disorder patients were assessed for degree of anxiety using the Hamilton Anxiety Scale. The patients and 20 healthy age-matched control subjects were then insonated at rest using transcranial Doppler ultrasonography (TCD). For TCD, the anterior, the middle, and the posterior cerebral arteries were insonated bilaterally in all patients. Compared with healthy age-matched control subjects, acute unmedicated panic disorder patients showed a significant increase in cerebral blood flow velocity, bilaterally in the middle and the anterior cerebral artery, and unilaterally in the left posterior cerebral artery. Cerebral blood flow velocity in the right middle cerebral artery correlated positively to the item "Fear" on the Hamilton Anxiety Scale, whereas pulsatility index in the posterior cerebral artery bilaterally and in the left middle cerebral artery correlated negatively to the item "Mood." Transcranial Doppler ultrasonography agrees well with validated psychometric methods. If follow-up studies confirm our findings, TCD could allow an objective assessment of the mental state of panic disorder patients and reliably discriminate panic disorder patients from normal control subjects.
Research Interests: Cardiology, Medicine, Anxiety, Biological Sciences, Biological Psychiatry, and 15 moreBrain, Humans, Hemodynamics, Female, Male, Panic Disorder, Adult, ANXIETY, Cerebral Blood Flow, Blood Flow Velocity, Middle Cerebral Artery, acute phase, Medical and Health Sciences, cerebral arteries, and anterior cerebral artery
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Research Interests: Neuroscience, Psychology, Brain Imaging, Neuroimaging, Schizophrenia, and 12 moreNeurochemistry, Medicine, Protein Structure and Function, Humans, Cerebellum, Atrophy, Clinical Study, Brain Function, Neurologic Examination, Forebrain, Psychology and Cognitive Sciences, and Medical and Health Sciences
In den letzten Jahren hat sich ein vermehrtes Interesse der sogenannten Negativ- oder Minussymptomatik zugewendet, die fur die Behandlung und Rehabilitation schizophrener Patienten weit grosere Probleme aufwerfen kann als die mit den zur... more
In den letzten Jahren hat sich ein vermehrtes Interesse der sogenannten Negativ- oder Minussymptomatik zugewendet, die fur die Behandlung und Rehabilitation schizophrener Patienten weit grosere Probleme aufwerfen kann als die mit den zur Verfugung stehenden Behandlungsstrategien relativ gut beeinflusbaren produktiven psychotischen Symptome.
Research Interests: Medicine and Gynecology
Due to the anticipated revisions concerning diagnostic criteria for schizophrenia in DSM-IV, recent Anglo-American research has been particularly concerned with the controversial problem whether positive or negative symptoms are more... more
Due to the anticipated revisions concerning diagnostic criteria for schizophrenia in DSM-IV, recent Anglo-American research has been particularly concerned with the controversial problem whether positive or negative symptoms are more suited for the determination of these criteria. We addressed this problem in an empirical study. A total of 489 consecutive admissions to the Department of Psychiatry at the RWTH University, Aachen were assessed for the distribution of positive, negative and basic symptoms according to six ICD-10 double-digit diagnostic categories. Positive symptoms were shown to be more useful for diagnosis than the negative or basic symptoms. Basic symptoms, however, had a pattern of distribution which supports the notion that they may also be useful for the early diagnosis of schizophrenia.
Research Interests: Psychology, Psychiatry, Psychometrics, Schizophrenia, Medicine, and 14 moreDelusions, Motivation, Thinking, Humans, Hallucinations, Pubmed, Social Isolation, Differential Diagnosis, Patient Admission, Clinical Sciences, Arousal, Paranoid Schizophrenia, Psychiatric Status Rating Scales, and Affective symptoms
Fur Behandlung und Rehabilitation schizophrener Patienten kann das Vorliegen von Apathie und das Fehlen sozialer Kompetenzen grosere Probleme aufwerfen als das Bestehen von mit den zur Verfugung stehenden Behandlungsmethoden relativ gut... more
Fur Behandlung und Rehabilitation schizophrener Patienten kann das Vorliegen von Apathie und das Fehlen sozialer Kompetenzen grosere Probleme aufwerfen als das Bestehen von mit den zur Verfugung stehenden Behandlungsmethoden relativ gut und schnell beeinflusbaren produktiven psychotischen Symptomen. In den letzten Jahren hat sich daher auf die sogenannte Negativ- oder Minussymptomatik ein intensives Forschungsinteresse gerichtet.
Research Interests: Medicine and Gynecology
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The online version of this article, along with updated information and services, is located on the
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Long-term treatment of patients with chronic schizophrenias requires integration of many therapeutic approaches, co-operation of several professions, and regard for the views of patients and relatives. This review deals with practical... more
Long-term treatment of patients with chronic schizophrenias requires integration of many therapeutic approaches, co-operation of several professions, and regard for the views of patients and relatives. This review deals with practical aspects of pharmacotherapy, psychotherapy, cognitive resp. psychological treatments, social resp. milieu therapy, rehabilitation, interventions based on the concept of Expressed Emotions (EE), psychoeducation and work with relatives. Continuous neuroleptic treatment is indispensable in most cases to achieve social integration. Indications for adding on antidepressants, lithium, carbamazepine, benzodiazepines and other drugs are discussed, as well as treatment of negative symptoms, depression and management of treatment-resistant symptoms. Psychotherapy needs to regard the possibilities of the patient. In the context of a stable long-term relationship, the patient is supported in experiencing himself as a subject capable of action. Effectiveness of cognitive treatments to date is limited. The best results are achieved by social skills training. Social therapy, which aims at the improvement of functional aspects of the patient, is of paramount importance. Improved possibilities for work rehabilitation are contrasted by difficulties in financing long-term social rehabilitation. Interventions based on the EE concept are highly effective, but are rarely used. Programs that merely convey information without targeting behaviour modification are ineffective. The functions of facilities of treatment in the community are explained, the integrative role of case-management is stressed.
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A small number of young mentally ill persons consumes a disproportionate amount of psychiatric service resources. These persons are characterised by emotional instability, aggressive or delinquent behaviour, substance misuse and... more
A small number of young mentally ill persons consumes a disproportionate amount of psychiatric service resources. These persons are characterised by emotional instability, aggressive or delinquent behaviour, substance misuse and personality disorders. They are sometimes referred to as young adult chronic patients (YACP). To date there has been no investigation as to what impact this pattern of problem behaviour has on vocational rehabilitation. The aim of this study was to find out whether belonging to the YACP group, as determined by an operational definition, reduces the outcome of vocational rehabilitation. A chart review was done of the files of all 174 participants of a 15-month vocational training course held between 1.1.1993 and 2.5.1998 in the vocational training centre at Cologne. A 15-item score was used to assess YACP status. 30 % were classified as high scorers, i. e. YACP. 59 % of the high scorers vs. 22 % of the low scorers terminated training prematurely. Of the high scorers who completed training, only 47 (vs. 74 % of low scorers) were judged to be able to work at the end of training. At the very beginning of the vocational training persons in need of a highly individualised format can be discerned by a few, easy to assess items. Concepts of vocational training should be developed to better suit the needs of young mentally ill persons with personality disorders and substance abuse.
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Abuse of natural products was frequently noticed among young patients with multiple substance abuse. 180 patients of a rehabilitation clinic for young addicts filled out a questionnaire regarding their regularly consumed drugs. Ayahuasca... more
Abuse of natural products was frequently noticed among young patients with multiple substance abuse. 180 patients of a rehabilitation clinic for young addicts filled out a questionnaire regarding their regularly consumed drugs. Ayahuasca and cactus, the natural drugs of the 70's are rarely found. The patients frequently consumed psilocybin, amanita and datura. We inform about the toxicological basis of the used drugs. A specific exploration of patients with multiple substance abuse in regard to the use of biological drugs is an necessary as random and multicentre follow-up-studies.
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The legal basic principles of community mental health services or sociopsychiatric services (SpDi) in the Federal Republic of Germany are state, not federal laws, namely laws on help and protective measures for mentally disordered people... more
The legal basic principles of community mental health services or sociopsychiatric services (SpDi) in the Federal Republic of Germany are state, not federal laws, namely laws on help and protective measures for mentally disordered people (PsychKG) and laws on Public Health Services (ÖGDG) as SpDi are all integral parts of Community Public Health Authorities in most places. State laws of the 16 German states differ considerably. Earlier research on PsychKG focussed exclusively on involuntary hospitalisation, this work is the first to address PsychKG as related to the work of SpDi and to consider ÖGDG as well. Based on an internet-based literature review the expedient laws of the 16 German states were systematically reviewed and compared. There is an ÖGDG in 15/16 states, a PsychKG in 12/16 and some laws concerning SpDi in 13/16. Where ÖGDG has health support to socially disadvantaged people, there is also a law on SpDi. SpDi are mainly part of the municipal or county health authoriti...
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Structural and functional brain imaging have contributed significant data to our understanding of schizophrenia, but we are still unable to understand the presumably heterogeneous neuronal dysfunctions of schizophrenic disorders. Current... more
Structural and functional brain imaging have contributed significant data to our understanding of schizophrenia, but we are still unable to understand the presumably heterogeneous neuronal dysfunctions of schizophrenic disorders. Current disease models define schizophrenia as an exclusively forebrain disorder. Nevertheless, morphological and functional data support the authors' view that cerebellar dysfunction may contribute to schizophrenic disorders. This article presents a critical review of neurological signs, including results of a clinical study performed by the authors, as well as postmortem and neuroimaging findings of cerebellar pathology in schizophrenia patients and studies on other psychiatric features associated with cerebellar lesions. In addition, anatomical, physiological, and behavioral data are reviewed that argue in favor of cerebellar involvement in nonmotor brain functions. A particular cerebellar region, the anterior vermis and corresponding fastigial nucleus, is assumed to be important in schizophrenic disorders, and the neurochemistry and vermian-fastigial-forebrain pathways are shown to correspond well with current hypotheses on neurotransmitter imbalances in schizophrenia. Therapeutic implications are outlined.
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Neurological soft signs are considered to be non-localizing findings and clinical neurodysfunctional correlates of schizophrenia. Sensory signs in 21 chronic schizophrenic patients were compared with those of healthy subjects. The... more
Neurological soft signs are considered to be non-localizing findings and clinical neurodysfunctional correlates of schizophrenia. Sensory signs in 21 chronic schizophrenic patients were compared with those of healthy subjects. The schizophrenic patients differed significantly from the controls in graphesthesia testing; there was no clear-cut impairment of other somatic sensory modalities. The graphesthesia learning effect was weaker in the patient group. No unequivocal correlation could be found between psychopathology or course variables and dysgraphesthesia. The authors hypothesize that an impairment in graphesthesia testing may reflect a working memory deficit in schizophrenics.
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The activity of phospholipase A2 (PLA2), an enzyme that, besides a number of other functions, is involved in prostaglandin synthesis, regulation of membrane stability, and presynaptic neurotransmitter release, has been reported to be... more
The activity of phospholipase A2 (PLA2), an enzyme that, besides a number of other functions, is involved in prostaglandin synthesis, regulation of membrane stability, and presynaptic neurotransmitter release, has been reported to be greater in the serum and plasma of schizophrenic patients than in that of other psychiatric patients and normal controls. Furthermore, it is said to be significantly reduced by haloperidol treatment. We decided to replicate these findings in an independent sample of patients by using a highly sensitive assay for determining PLA2 activity.-- Of 167 consecutive male admissions giving informed consent 35 were found never to have received neuroleptics previously. Ten had DSM-III diagnoses of schizophrenia, schizophreniform disorder, or atypical psychosis, eight of other psychiatric disorders and 17 of alcohol or drug dependence (Table 1). Blood samples were drawn before medication was initiated. For patients still in hospital (Table 3), this was repeated after 21 days of treatment (n = 10). Samples from 10 healthy subjects were also obtained. PLA2 activity was determined according to Märki and Franson (1986), using a radiochemical assay.-- On day 0, there were no statistically significant intergroup differences in PLA2 serum activity. After 21 days, it was not possible to detect any significant decrease in PLA2 activity (Table 4). The PLA2 activity of the patient groups did not differ from that of the group of healthy subjects (Table 5).-- It was not possible to replicate the finding of increased PLA2 activity in schizophrenic patients in our sample of patients never treated with neuroleptics before.(ABSTRACT TRUNCATED AT 250 WORDS)
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The aim of this study was to compare resting cerebral blood flow velocity values of unmedicated patients in the acute phase of panic disorder with resting values of healthy control subjects. Nineteen unmedicated panic disorder patients... more
The aim of this study was to compare resting cerebral blood flow velocity values of unmedicated patients in the acute phase of panic disorder with resting values of healthy control subjects. Nineteen unmedicated panic disorder patients were assessed for degree of anxiety using the Hamilton Anxiety Scale. The patients and 20 healthy age-matched control subjects were then insonated at rest using transcranial Doppler ultrasonography (TCD). For TCD, the anterior, the middle, and the posterior cerebral arteries were insonated bilaterally in all patients. Compared with healthy age-matched control subjects, acute unmedicated panic disorder patients showed a significant increase in cerebral blood flow velocity, bilaterally in the middle and the anterior cerebral artery, and unilaterally in the left posterior cerebral artery. Cerebral blood flow velocity in the right middle cerebral artery correlated positively to the item "Fear" on the Hamilton Anxiety Scale, whereas pulsatility index in the posterior cerebral artery bilaterally and in the left middle cerebral artery correlated negatively to the item "Mood." Transcranial Doppler ultrasonography agrees well with validated psychometric methods. If follow-up studies confirm our findings, TCD could allow an objective assessment of the mental state of panic disorder patients and reliably discriminate panic disorder patients from normal control subjects.
Research Interests: Biological Sciences, Biological Psychiatry, Brain, Humans, Hemodynamics, and 14 moreUltrasonography, Female, Male, Panic Disorder, Pulsatility Index, Velocity, Transcranial Doppler, Adult, Blood Flow Velocity, Middle Cerebral Artery, Posterior Cerebral Artery, acute phase, Psychology and Cognitive Sciences, and Medical and Health Sciences
Research Interests: Depression, Schizophrenia, Humans, Chronic Disease, Female, and 15 moreMale, Depressive Disorder, Aged, Middle Aged, Adult, Reproducibility of Results, Psychotic Disorders, Psychiatric, Adjustment Disorders, Reference Values, Psychiatric Status Rating Scales, Antipsychotic agents, Psychology and Cognitive Sciences, Medical and Health Sciences, and Antidepressive agents
Research Interests: Psychometrics, Schizophrenia, Evolution, Adolescent, Humans, and 15 moreFemale, Male, Exploration, Clinical Sciences, Association, Aged, Middle Aged, Adult, Blood Flow, Cerebral Blood Flow, Blood Flow Velocity, Neurosciences, Posterior Cerebral Artery, Acute Disease, and Cardiovascular medicine and haematology
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