The validity of the ICD-10 classification of recurrent affective disorders: do endogenous and psychogenic depressions form a homogeneous diagnostic group?

Fifty-five hospital-treated patients with the ICD-10 diagnosis of 'recurrent depressive episode(s)' were classified according to the Newcastle Depressive Diagnostic Scale as having either psychogenic (n = 25) or endogenous (n = 30) depression and interviewed using several inventories on personality and psychopathology (Composite International Diagnostic Interview, Symptom Check List, Inventory of Interpersonal Problems, IIP, NEO Five-Factor Personality Inventory, Social Adjustment Scale, Questionnaire of the Motivation to Seek Psychotherapy). Except for the IIP, individual subscales disclosed significant differences between the two groups. In light of these results, the grouping of these two disorders into one diagnostic group in the ICD-10 is critically discussed.

Motivation to seek psychotherapy in patients with recurrent depressive disorder.

Fifty-five hospital-treated patients with the ICD-10 diagnosis of recurrent depressive episode(s) were classified according to the Newcastle Depressive Diagnostic Scale as having either psychogenic (n = 25) or endogenous (n = 30) depression and interviewed using the Composite International Diagnostic Interview and the Questionnaire for Assessment of Motivation to Seek Psychotherapy. The two groups were found to differ significantly from one another in two Motivation to Seek Psychotherapy subscales ("layman's etiology" and "general expectations from therapy"). The motivation to seek psychotherapy was greater in patients with psychogenic depression than in patients with endogenous depression. Nonetheless, psychotherapy is indispensable in treating endogenous depression, especially for patients under situational stress or at risk of suicide.

Vascular dementia versus dementia of Alzheimer's type: do they have differential effects on caregivers' burden?

OBJECTIVES: We investigated homecare patients with dementia of Alzheimer's type (DAT; n = 36) or vascular dementia (VD; n = 36) and their care-providing relatives regarding clinical and psychosocial variables to determine whether DAT and VD impose different burdens on caregivers. METHOD: All patients were diagnosed according to ICD-10 criteria. The diagnoses were confirmed by internal medical, clinical-neurological, and psychiatric parameters. The severity of the dementias was graded according to the Global Deterioration Scale (GDS). Caregiving relatives responded to the Behavioral Pathology in Alzheimer's Disease Rating Scale (BAD), the Blessed Dementia Scale (BDS), and the Screen for Caregiver Burden (SCB). RESULTS: Analyses revealed that caregivers' burden (SCB), disease symptoms and personality changes of patients (BAD), and the patients' inability to cope with everyday tasks (BDS) were sharply higher for DAT than for VD patients in the group with severe dementia. Concerning patients with mild or moderately severe disease, scores in the DAT group were similar or lower than those in the VD group. CONCLUSION: In early stages, VD patients impose a greater burden on relatives than do patients with DAT. In severe stages this relationship undergoes a reversal, with relatives of DAT patients experiencing the burden more adversely than those of VD patients. The differences in the onset and course characteristics, as well as the specific differences between these two types of dementia with respect to caregiver burden factors, call for their diagnostic separation and the development of specific homecare support systems for family caregivers.

First hospitalized versus rehospitalized patients with an affective disorder or schizophrenia: differences in long-term course and outcome.

A comparison of course and outcome in schizophrenics and patients with unipolar affective disorders revealed significant differences not only between the two groups but also between first hospitalized and rehospitalized patients within each group. While schizophrenics fared worse in almost all parameters at the end of the 14-year follow-up period, within each group overall course and outcome were also poorer for rehospitalized versus first hospitalized patients. The poorest course was shown by rehospitalized schizophrenics. Future studies on course and outcome should differentiate between first and rehospitalized patients.

Factors affecting the utilization of homecare supports by caregiving relatives of Alzheimer patients.

Thirty-six homecare patients with dementia of Alzheimer type (DAT) and their caregiving relatives were studied to determine the factors influencing their use or nonuse of available medical, institutional, instrumental, and legal supports. The rate of utilization of homecare support was found to be surprisingly low. Only when the burden of providing care had become intolerable did relatives resort to homecare support (homecare allowance, counseling, outpatient services, etc.). The main reason for the low utilization was poor knowledge regarding the availability of homecare supports. Since all of the DAT patients were under the care of a family doctor, this information deficit could best be overcome by improved counseling from personal physicians.

Clinical and psychosocial variables in different diagnostic groups: their interrelationships and value as predictors of course and outcome during a 14-year follow-up.

A 14-year follow-up study was conducted on 214 patients from the diagnostic groups schizophrenia, affective psychosis, and neurosis to determine the relationships between various clinical and psychosocial variables and to assess their value as predictors of long-term course and outcome. Particular emphasis was placed on ascertaining the interrelationships between the variables within the individual diagnostic groups. The results indicate that for schizophrenia, severity of disease at discharge from index hospitalization was the principal predictor of the number and duration of further hospitalizations. Furthermore, it predicted the severity of illness and social functioning at follow-up. For affective psychosis, the Global Assessment Scale score predicted the number and duration of further hospitalizations. Severity of illness, social functioning, and age at first hospitalization were predictors of occupational development. For neurotic disorders, severity of disease and social adjustment at discharge from index hospitalization were each predictors of themselves at final follow-up. In addition, age at first hospitalization was an important predictor of most course and psychosocial variables. Among the endogenous course variables within the schizophrenic group, the number and duration of further hospitalizations had a substantial bearing on severity of illness and social functioning at follow-up. For affective psychoses, indicators of occupational development and number of hospitalizations had an impact on severity of illness and social functioning at follow-up. Our findings reveal a good overall predictive value for the clinical and psychosocial variables within each of the diagnostic categories studied.

[Individual differences in solving spatial problems of the IST and IST-70 subtest on "cube problems"]. / Individuelle Unterschiede beim Lösen von Raumvorstellungsaufgaben aus dem IST-bzw. IST-70-Untertest "Würfelaufgaben".

Spatial ability is one of the primary mental abilities which has been subject of many empirical studies--especially in the factor analytical research. Analysing the mental processes when solving space tasks, e. g. by means of retrospective verbal reports, two different strategies can be distinguished. The first strategy (called "holistical" strategy) can be described as a mental rotation of the given stimulus, the second one (called "analytical" strategy) is characterised by nontransformal mental processes, e. g. pattern matching processes. In order to identify those different strategies, test items are required, which have different solution probabilities when being solved with different strategies. The "cube tasks" of the IST and IST-70 by Amthauer (1953, 1970) are of this type, as Putz-Osterloh (1977) has found in an experiment. The hypothesis of individual differences in solving space tasks was tested in two different samples. First the "cube tasks" of the IST-70 were administrated to 264 applicants for the pilot job. Data analyses using the mixed-Rasch-model (Rost, 1990) confirmed the hypothesis of an "analytical" and "holistical" strategy. In the second study 2558 pupils of the 7th grade were tested with the "cube tasks" of the IST. A latent class analysis of their response patterns revealed basically the "holistical" and "analytical" strategy and, in addition, four strategies which can be explained by motivational factors.

Stability of diagnoses in various psychiatric disorders: a study of long-term course.

The frequency of diagnostic shift was investigated in 267 patients diagnosed with various psychiatric disorders according to the 9th revision of the International Classification of Diseases (ICD-9). Forty-six patients fulfilled the diagnostic criteria for schizophrenic psychosis, 71 for affective psychosis, 66 for neurotic disorder, 24 for personality disorder, and 40 for psychogenic reaction. The remaining 20 patients were diagnosed with heterogenous disorders. The mean follow-up time was 12.5 years. Every episode of inpatient treatment was diagnosed cross-sectionally. Patients with an initial episode of schizophrenic psychosis showed by far the greatest stability (93%). A high stability was found in patients diagnosed with neurotic disorders (79%). Forty-two patients with an index diagnosis of affective psychosis suffered more than one type of episode during the course of disease. The lowest stability was noted in patients with a psychogenic reaction (10%). Eleven percent of patients with a final diagnosis of schizophrenia had an index diagnosis of psychogenic reaction. Our findings demonstrate that the course of disease should be considered in making the final diagnosis.

[Duration of inpatient treatment of various psychiatric disease categories. A follow-up study]. / Stationäre Behandlungsdauer verschiedener psychiatrischer Krankheitsgruppen. Eine Verlaufsuntersuchung.

The frequency and duration of in-patient treatment in psychiatric and general hospitals was observed over an average 14-year period for 328 patients with different psychiatric diseases. Schizophrenics were more frequently admitted and spent longer in psychiatric institutions than all other diagnostic groups, but were admitted less frequently and for shorter periods to general hospitals. Patients suffering from organic mental illness and those with neurotic disorders had more frequent and longer periods of general hospital care. Drug dependent and neurotic patients were hospitalised more frequently and longer for psychiatric rather than for medical reasons in general hospitals. The total frequency and duration of psychiatric in-patient treatment was distinctly less frequent and of shorter duration for neurotic disorders as compared with schizophrenic or affective psychoses.

Psychiatric and somatic hospitalisations of different diagnostic groups: a long-term follow-up study.

Out of 328 cases with different diagnoses, including those without pathological findings at follow-up, the frequency and duration of in-patient treatment in psychiatric and somatic institutions was observed over an average 14-year period. Schizophrenics were more frequently and longer in psychiatric institutions, but they were less frequently and for shorter periods in somatic care compared with all other diagnostic groups. Patients suffering from affective psychosis had comparatively long psychiatric and somatic periods of hospitalisation. Dependents were hospitalised more frequently and longer for psychiatric rather than for medical reasons in somatic institutions. The total psychiatric in-patient treatment time was distinctly shorter for neurotic disorders compared with schizophrenic psychosis or affective psychosis cases.

Mumps mistaken for rubella in the first trimester of pregnancy. The role of the microbiology laboratory in the diagnosis of the infection. A case report.

A case of mumps with an exanthema is described. However, the parotid swelling was mistaken for enlarged lymph nodes, and the case was described as one of "typical rubella". As the patient was pregnant in her first trimester, an induced abortion was considered. Serum specimens for rubella antibody testing had been taken, but the information given by the consulting physician was incorrect and led to testing for past infection and immunity. After re-examination of the patient by a gynaecologist, mumps was suspected and the diagnosis verified serologically. The present case shows that in certain situations adequate information must be given to the laboratory in order to ensure a meaningful interpretation of the results of the serological examination.

Maternal hemoglobin concentration is closely related to birth weight in normal pregnancies.

Maternal Hb levels during the third trimester were studied in relation to certain maternal and fetal parameters in 877 apparently normal pregnancies. Low Hb levels at term were closely associated with increased frequency of newborns in the heavy weight-for-date group. Conversely, high maternal Hb levels were closely associated with an increased frequency of newborns in the light weight-for-date group. The maternal Hb levels both in the early third trimester and at term were significantly higher in mothers of small-for-date newborns than in those with newborns of normal weight. In both groups the maternal Hb levels increased significantly during the third trimester of pregnancy. High maternal Hb levels both early and late in the third trimester of pregnancy should be a matter of concern rather than of reassurance.

The predictive value of total estriol; HPL and Hb on perinatal outcome in severe pre-eclampsia.

The prognostic value of total maternal plasma estriol, human placental lactogen (HPL) and hemoglobin (Hb) with regard to perinatal outcome was compared in 74 cases of severe pre-eclampsia. No combination of the tests predicted all cases of fetal and newborn pathology. HPL was the most reliable single test in cases of intra-uterine growth retardation, while Hb was the best predictor of severe fetal pathology and perinatal distress. In cases of severe fetal and neonatal pathology, the prognostic value of the combination of HPL and Hb was more reliable than the combination of all the three tests.

Haemoconcentration in severe pre-eclampsia.

The last maternal haemoglobin (Hb) concentration before delivery was related to the perinatal outcome in 87 non-anaemic women suffering from severe pre-eclampsia. Abnormally high Hb concentrations were found in most women with evidence of placental dysfunction. An inverse correlation was found between the centile weight of the newborn and the maternal Hb. Significantly higher Hb levels were found in pregnancies complicated by fetal growth retardation and perinatal distress compared with those in pregnancies with good outcomes. Particularly high levels were found in pregnancies that ended in perinatal deaths. The hypothesis is put forward that raised haemoconcentration during severe pre-eclampsia causes increased blood viscosity which predisposes to placental pathology and initiates a vicious circle.