Evaluation of the multiaxial system of ICD-10 (preliminary praft): correlations between multiaxial assessment and clinical judgements of aetiology, treatment indication and prognosis.

Forty-five raters in 7 German centres took part in a multicentric field trial of the multiaxial system of ICD-10, delivering a total of 488 multiaxial assessments of 12 written case summaries. In addition to the multi-axial ratings (including main and subsidiary psychiatry diagnoses, level of social dysfunctioning and psychosocial stressors), assessments were made by the raters of the aetiology, treatment indications and prognosis of the main psychiatric disorder. There were significant correlations between these judgements and the measures of the multiaxial ratings: 62% of the cases diagnosed as endogenous were assessed as having a high level of social dysfunctioning (the proportion for all cases being 50.4%) and 63.4% as having a low number of stressors (vs. 52.8% in all cases). In contrast, cases diagnosed as reactive were assessed as having a lower level of social dysfunctioning and more social stressors. Cases whose prognosis was poor showed a higher rate of comorbidity and a high level of social dysfunctioning. The results demonstrate that the multiaxial approach reflects factors important to the process of clinical treatment and decision making and delivers preliminary evidence of this system's treatment and prognostic validity.

[Effects of family-centered group therapy with demented patients and their caregivers]. / Behandlungseffekte einer paartherapeutischen psychoedukativen Gruppenarbeit mit Demenzkranken und ihren pflegenden Angehörigen.

Alzheimer's disease, the most frequent cause of dementia, progressively takes the ability of acting autonomously from the sufferers, makes them more and more dependent from their partners and eventually dissolves their personal identity. The present 2-year study which conducted a novel form of family-centered group therapy with demented patients and their primary caregivers investigated the effects of an open, uncontrolled group therapy approach in 32 families (demented patients and caregivers) over a five-months period with weekly sessions, by using the BEHAVE-AD and the NOSGER for the moderately demented patients and the Befindlichkeits-Skala (BfS) for the primary caregivers. In addition, a structured instrument to determine the patterns of interaction between patient and caregiver was administered prospectively at each of the weekly sessions. The results demonstrate a significant improvement of communication abilities among the patients and a significant reduction of coping problems and of care burden with respect to the caregivers. The present family-centered group therapy shows that over a period of 5 months functional and communication abilities of the moderately demented patients may be maintained and caregiver burden may be significantly reduced.

[Sensorimotor polyneuropathy and systemic amyloidosis as paraneoplastic symptoms of a carcinoid-like well differentiated carcinoma of the breast]. / Sensomotorische Polyneuropathie und systemische Amyloidose als paraneoplastische Symptome eines karzinoidartig differenzierten Mammakarzinoms.

HISTORY AND ADMISSION FINDINGS: A 75-year-old woman was admitted because of weakness and paraesthesias in both legs. 15 years earlier a chest radiogram had shown numerous round foci of uncertain cause. Physical examination confirmed muscular weakness in all limbs, especially the legs, as well as abnormal superficial and deep sensory perception. INVESTIGATIONS: Electromyography registered a patchy pattern of intentional muscular activity and marked denervation activity but largely normal nerve conduction. There was no evidence of inflammatory disease in the laboratory tests, including the CNS. DIAGNOSIS, COURSE AND TREATMENT: The neurological findings indicated progressive axonal sensorimotor polyneuropathy. A paraneoplastic cause was suspected, but search for a primary tumour was unsuccessful. The patient developed a urinary infection from which she died in septic shock. A carcinoid-like well-differentiated carcinoma of the breast with hematogenous metastases to liver, spleen and lung was discovered at autopsy. It also revealed severe systemic AA-type amyloidosis, involving liver, spleen heart and kidneys. In addition there was a severe progressive axonal neuropathy and marked neurogenic atrophy of the peripheral skeletal musculature. No amyloid deposition was seen. CONCLUSION: In case of amyloidosis and polyneuropathy of uncertain cause a paraneoplastic pathogenesis should be considered in the differential diagnosis, even in the absence of proven malignancy.

[Multi-axial system of chapter V (F) of ICD-10. Initial results of a multicenter practicability and reliability study]. / Multiaxiales System des Kapitels V (F) der ICD-10. Erste Ergebnisse der multizentrischen Praktikabilitäts-und Reliabilitätsstudie.

With the introduction of operationalized diagnostic systems the multiaxial approach became a more important issue. The proposed multiaxial system of ICD-10 consists of three axes: on axis I psychiatric diagnoses are made according to the ICD-10 Clinical Guidelines or Diagnostic Criteria for Research. Axis II (Disability Diagnostic Scale, DDS) deals with impairment of psychosocial functioning. On axis III environmental/circumstantial and personal lifestyle management factors are rated. As part of the WHO international field trial, applicability and inter-rater reliability of the system were examined in seven German-speaking centers. In addition axis II was compared with the corresponding axis of DSM-III-R (Global Assessment of Functioning Scale). 45 German clinicians rated 12 case histories written in English (provided by WHO) with 488 ratings altogether. Diagnoses on axis I with an average percentage agreement of 65.6% and a mean kappa of 0.50 showed a moderate inter-rater reliability. For axis II the intraclass coefficient was 0.62, and that for the corresponding DSM-III axis was 0.65: both these axes thus also had a moderate inter-rater reliability. There was a close correlation between the subscales and the global assessment of axis II there was. Wide variation was found in the psychosocial circumstances on axis III, the mean kappa value being 0.16. In the discussion proposals for the revision process for the multiaxial ICD-10 system are made.

The multiaxial system of ICD-10: evaluation of a preliminary draft in a multicentric field trial.

The multiaxial system (MAS) of ICD-10, chapter V (F) consists of three axes: axis I, clinical syndromes (psychiatric disorders including personality disorders and somatic diseases); axis II, disabilities; axis III, environmental/circumstantial and personal life-style/life management factors. Results of a multicentric field trial evaluating a preliminary draft of the MAS are presented. 45 raters in seven German centers made 488 ratings on 12 written case histories. With a mean kappa of 0.50 for 3-character diagnoses interrater reliability for axis I was moderate although lower than expected from previous field trials. On axis II the WHO Disability Diagnostic Scale (WHO-DDS) was compared to the Global Assessment of Functioning (GAF) used in DSM-III-R and DSM-IV. For both scales the intraclass correlation coefficient showed a moderate interrater reliability (WHO-DDS = 0.62; GAF = 0.65). On axis III the number of relevant psychosocial circumstances coded by the different raters varied greatly. Interrater reliability was very poor with kappa values ranging from 0.03 to 0.55 for the different categories and an overall kappa of 0.16.

[The career course of women and men psychiatrists]. / Zu Karriereverlüfen von Psychiaterinnen und Psychiatern.

Data from a survey distributed to all directors of psychiatric hospitals in Germany (n = 286) were used to examine sex differences in rank attainment among psychiatrists. Furthermore the directors were asked to assess differences between male and female psychiatrists concerning their professional activities. A total of 207 directors responded, 10 of them were female. In the rank of assistant doctors male psychiatrists predominated only at the university departments (61%). The position of a registrar was held mainly by male doctors in all types of hospitals: 78% at the university departments, 64% at psychiatric hospitals and 56% at psychiatric departments at general hospitals. 43.9% of the responders assessed women less interested in a professional career than men, 46.5% thought that women are more interested in treatment than in research activities, 43.5% admitted that in case of female applicants their private situation (family, children) is more important for the decision to give a job than in case of male ones. 87% of the directors found that a higher number of women within their teams is very important for a good work climate.