D. von Zerssen

Lifetime and six-month prevalence of mental disorders in the Munich Follow-up Study

SummaryThe Lifetime and 6 month DSM-III prevalence rates of mental disorders from an adult general population sample of former West Germany are reported. The most frequent mental disorders (lifetime) from the Munich Follow-up Study were anxiety disorders (13.87%), followed by substance (13.51%) and affective (12.90%) disorders. Within anxiety disorders, simple and social phobia (8.01%) were the most common, followed by agoraphobia (5.47%) and panic disorder (2.39%). Females had about twice the rates of males for affective (18.68% versus 6.42%), anxiety (18.13% versus 9.07%), and somatization disorders (1.60% versus 0.00%); males had about three times the rates of substance disorders (21.23% versus 6.11%) of females. Being widowed and separated/divorced was associated with high rates of major depression. Most disordered subjects had at least two diagnoses (69%). The most frequent comorbidity pattern was anxietyand affective disorders. Simple and social phobia began mostly in childhood or early adolescence, whereas agoraphobia and panic disorder had a later average age of onset. The majority of the cases with both anxiety and depression had depression clearly after the occurrence of anxiety. The DIS-DSM-III findings of our study have been compared with both ICD-9 diagnoses assigned by clinicians independently as well as other epidemiological studies conducted with a comparable methodology.

The Use of Sodium Valproate, Carbamazepine and Oxcarbazepine in Patients with Affective Disorders

During recent years alternatives to lithium prophylaxis have been developed using primary dipropylacetamide and, later on, sodium valproate, as a mono-therapy as well as in combination with low-dosage lithium treatment. It has been shown in a placebo-controlled ABA design that sodium valproate exerts an acute antimanic effect and a prophylactic action of sodium valproate has also been established. Carbamazepine represents another important contribution to the arsenal of drugs to be used as alternatives for the prophylactic treatment in patients not responding to lithium and/or experiencing too many side effects. The keto-derivative of carbamazepine, oxcarbazepine, has been shown to exert acute antimanic effects in a similar way to carbamazepine itself.

Anxiety and depression in a community sample: The influence of comorbidity on social functioning☆

The main aim of the present study was to examine whether the well-established association between depression and social dysfunction still remains when effects of a coexistent anxiety disorder are eliminated from the data. As these effects strongly depend on the proportion of depressed subjects suffering simultaneously from an anxiety disorder, we first examined the frequency of mixed and pure depressive disorders and that of pure anxiety disorders (control subjects) in a community sample (n = 483). Using DIS/DSM-III criteria (reference period 6 months), pure anxiety disorders were most frequent (6%), followed by pure depressive disorders (3%) and the coexistence of anxiety and depression (2%). Cases suffering from both disorders were most severely afflicted in terms of psychopathology (persistence of symptoms, comorbidity regarding other mental disorders). At the diagnostic level, the association between depression and social dysfunction was only slightly influenced by effects resulting from comorbidity; at the level of actual symptoms, however, we found that cases suffering simultaneously from severe depression and severe anxiety were significantly more handicapped in their social lives than depressive subjects with only mild anxiety symptoms.

Personality differences between patients with major depression and bipolar disorder : the impact of minor symptoms on self-ratings of personality

The study explores whether minor symptoms of patients in recovery from a mood disorder have an impact on self-ratings of personality with special consideration of potential differences between diagnostic groups. 90 recovered DSM-III-R major unipolar depressives and 167 recovered bipolars were compared with respect to scale values of the Munich Personality Test (MPT). Major depressives showed significantly higher scores on the MPT scales Rigidity and Orientation towards Social Norms, and lower scores on Extraversion than the bipolar patients. Using a LISREL-model, psychopathology was found to have a significant impact on Neuroticism and Extraversion, but not on Rigidity and on Orientation towards Social Norms. Controlling for symptomatology, the differences in the MPT scale values of the two diagnostic groups remained significant and can hardly be sufficiently explained by residual symptomatology.

Therapeutic effects of GABA-ergic drugs in affective disorders. A preliminary Report

A possible antimanic efficacy of the GABA-ergic anticonvulsant valproate was examined by use of a double-blind, placebo-controlled ABA design. A marked improvement was observed after valproate medication in a group of 5 acutely ill manic patients. Similar results were obtained in 7 trials examining the antimanic property of the keto-derivative of carbamazepine (oxcarbazepine) in 6 patients with acute mania, whereas no antimanic effect could be observed in a treatment with diazepam and with THIP. Combination of THIP and diazepam in another patient showed a slight antimanic effect. Additionally, a possible prophylactic effect of long-term treatment using valproate was examined. In 8 of 9 patients exhibiting a bipolar affective or schizoaffective psychosis, who did not properly respond to lithium treatment, a prophylactic effect of valproate medication could be demonstrated. The results point to the view that anticonvulsants, possibly due to GABA-ergic effects, may be beneficial in affective disorders.

Depressive neurosis. A long-term prospective and retrospective follow-up study of former inpatients.

ABSTRACT– The results of a 7‐year follow‐up study of 50 former psychiatric inpatients with a diagnosis of depressive neurosis (ICD 300.4) who met the RDC criteria for Major Depression are reported. The follow‐up assessment of the patients included the use of standardized social, psychological and psychopathological instruments. In addition, the course of illness as well as the utilization of medical services and periods of working disability was evaluated. The results indicate a rather unfavourable course and outcome in terms of symptoms for approximately 40% of the sample, including six patients who had committed suicide after index discharge. Almost 40% of the sample showed mild chronic symptoms with persistent impairments in social functioning especially in the area of social interaction, whereas only 20% of the sample were classified as satisfactorily improved or completely remitted.

Cortisol response to various stressful situations: relationship to personality variables and coping styles.

Studies on personality traits and coping styles as determinants of interindividual differences in neuroendocrine responses to stress have not yet yielded conclusive results. In a previous investigation, strong hints to distinct interindividual differences in the susceptibility of the HPA axis of 12 male volunteers aged 27 +/- 5 years exposed to five different stress situations were found. In the present report, psychometric variables (personality traits and coping styles) assessed in the same subjects before the study were analyzed to test whether specific psychometric variables were related to the interindividual differences in the susceptibility of the HPA axis. The results revealed that interindividual differences in the frequency of cortisol responses to stress situations could not be predicted by any of the psychometric variables investigated. The question if psychological factors contribute to neuroendocrine stress response and to what degree warrants further interest. These preliminary findings suggest, however, that nonpsychological factors should be considered more seriously as determinants of interindividual differences in neuroendocrine stress responses in healthy subjects as well as in psychiatric patients.

The effect of neuroleptic treatment and of high dosage diazepam therapy onβ-endorphin immunoreactivity in plasma of schizophrenic patients

In 14 schizophrenic patients, treated with neuroleptic drugs, and in 7 patients, treated with high-dosage diazepam,β-endorphin-like immunoreactivity in plasma has been measured by use of a highly sensitive and relatively specific radioimmunoassay. Neuroleptic treatment induced a significant increase ofβ-endorphin-like immunoreactivity (β-ELI). The pharmacological and clinical implications of this finding are discussed. High-dosage diazepam treatment induces a slight reduction of plasmaβ-ELI, a finding which is attributed to antistress effect of diazepam.

Self-Rating Procedures in the Evaluation of Antidepressants

Self-ratings are very practical and economical procedures to measure the severity of depression in intraindividual comparisons. They are sensitive to change induced by therapy and provide findings concerning the global result of therapy and its time course, which are similar to data based on ratings by psychiatrists. Due to their practicability, self-rating procedures contribute to an exact description of the time course of depression in multiple measurement designs. However, the limitations of the validity of self-rating procedures should not be neglected.

Diurnal variation of mood and the cortisol rhythm in depression and normal states of mind

SummaryA large scale chronobiological investigation was undertaken in 20 drug-free psychiatric inpatients displaying RDC major depression (endogenous subtype) in comparison to 10 healthy control subjects and 10 of the patients after clinical recovery. A series of measurements was taken 6 times a day and, in 8 of a total of 14 variables, also once a night over a period of 10 to 14 days. The following variables were assessed: mood (three different scales), performance (two tests), motor activity (three measures), salivary flow, urinary excretion of water, sodium, potassium, and free cortisol (UFC), and rectal temperature. A phase chart of the acrophases of the 8 variables with measurements taken during day and night revealed two clusters in the depressives and three in the non-depressed subjects. In the depressives, the acrophases of the mood scales clustered around the time of awakening in the morning, together with the acrophase of UFC, whereas all other acrophases clustered in the afternoon. In the non-depressed subjects, however, the mood scales reached their circadian maxima in the middle of the night around the time when sleep was interrupted to take measurements. All other acrophases corresponded roughly with those found in the depressives. The coincidence of the time course of depressed mood and cortisol excretion in the patients was interpreted as reflecting a temporal relationship between diurnal mood swings in depression and the cortisol rhythm. This interpretation was supported by the significant correlation between the acrophases of the two respective rhythms in patients showing a significant diurnal variation in mood. The mood curves of non-depressed subjects seemed unrelated to the cortisol rhythm. Probably, they mirror diurnal fluctuations of vigilance rather than fluctuations of mood. According to the literature, this rhythm is temporally related to the rhythm of melatonin secretion.