Dominique Eich

Obsessive-compulsive severity spectrum in the community: prevalence, comorbidity, and course

Abstract.Objectives :To describe lifetime prevalence rates, course and comorbidity of obsessive-compulsive disorder (OCD), obsessive-compulsive syndromes (OCS) and OC-symptoms (OC-sx) up to age 41.Methods :In the Zurich community cohort study 591 subjects were selected after screening at the age of 19 and studied prospectively by 6 interviews from 20 to 40; they represent 1599 subjects of the normal population. The diagnoses of OCD met DSM-IV criteria.Course was assessed by graphic illustrations and prospective data.Results :The lifetime prevalence rate was 3.5 % for OCD (males 1.7%, females 5.4 %) and 8.7 % for OCS (males 9.9%, females 7.5 %). The onset of OC-sx was 18 years (median); and in 70% before age 20.OCD was treated in one third of cases, OCS in 6.1%. The course of symptoms was chronic in 60%,but OCD and OCS showed in most cases considerable improvements over time. OCD reduced quality of life mostly in the subject’s psychological wellbeing and at work but to a considerable extent also in other social roles. Comorbidity was prominent with bipolar disorder, panic disorder and social phobia and also significant with bulimia, binge eating, generalized anxiety disorder and suicide attempts; there was no association with substance abuse/dependence.Conclusion :OCD and OCD are manifestations of a wide spectrum of severity with high prevalence and strong clinical validity. The long-term course is better than generally assumed.

Obsessive-compulsive syndromes and disorders: significance of comorbidity with bipolar and anxiety syndromes.

ObjectiveTo determine the prevalence and clinical characteristics of comorbid obsessive compulsive disorders and syndromes (OCD/OCS), compared with pure OCD/OCS among adults in the community.MethodData were drawn from the Zurich Study, a longitudinal cohort study of 591 adults in the canton of Zurich. Comorbid OCD/OCS was compared with pure OCD/OCS groups in terms of distress, impairment, family history, suicide behavior and treatment using multivariable logistic regression analyses.ResultsOCD was significantly comorbid with bipolar I/II and minor bipolar disorders, anxiety states (GAD, repeated panic attacks) and social phobia, whereas there was no clear association between OCD and major depressive disorder or phobias other than social phobia. Results suggest that comorbid OCD/OCS is common among adults in the community, with the majority of those with OCD/OCS having at least one comorbid mood or anxiety disorder with a prevalence of 7.4% compared to 4.8% of remaining OCD/OCS. Comorbidity of OCD/OCS and anxiety states was more common among women (85.6 %) and comorbidity with bipolar spectrum was more common among men (69.6%). Comorbid OCD/OCS was associated with significantly higher levels of treatment seeking, impairment,distress and suicidality compared with pure OCD/OCS. Comorbidity with bipolar disorders significantly increased the risk for alcohol abuse/dependence.ConclusionComorbidity of OCD/OCS with bipolar disorder and bipolar spectrum disorders is common and very probably explains the association between OCD and depression found in other studies. The early recognition of bipolar/cyclothymic OCD/OCS may help to prevent the abuse of/dependence on alcohol.

Prevalence of mental disorders in the Zurich Cohort Study: a twenty year prospective study.

BACKGROUND In order to minimise retrospective recall in developing estimates of the prevalence of mental disorders in the general population, we conducted a prospective study of a cohort of youth from Zurich, Switzerland. METHOD A 20 year prospective study of a community-based cohort aged 19-20 from Zurich Switzerland. The sample was enriched by subjects scoring high on the Symptom Checklist 90 R (Derogatis, 1977). A semi-structured diagnostic interview was administered by clinically experienced psychologists and psychiatrists. The six interviews from 1979 to 1999 assessed diagnoses and sub-threshold manifestations of major diagnostic categories (with the exception of schizophrenia) for the past twelve months, depending on the current DSM versions (DSM-III, DSM-III R, DSM-IV). Additional information on symptoms and treatment were collected for the years between the interviews. The reported prevalence rates are weighted for stratified sampling and cumulate the one-year rates of the six interviews. RESULTS The cumulative weighted prevalence rates for any psychiatric disorder were 48.6% excluding, and 57.7% including tobacco dependence. In addition 29.2% and 21.8%, respectively manifested sub-diagnostic syndromes. Overall there were no significant gender differences. The corresponding treatment prevalence rates were 22.4% and 31.1%, respectively for the diagnostic subjects and 6.9% and 6.1%, respectively for the sub-diagnostic groups. The total treatment prevalence rate was 37.2% of the population (males 30.0%, females 44.1%). CONCLUSIONS Our findings reveal that psychiatric disorders are quite common in the general population. When the spectra of mental disorders are considered, nearly three quarters of the general population will have manifested at least one of the mental disorders across their lifetime. LIMITATIONS The data are based on a relatively small sample; a single age cohort, and the study was conducted in Zurich, Switzerland. These study features may diminish the generalisability of the findings.

Diagnostic issues in bipolar disorder

Bipolar disorder is a highly recurrent and chronic psychiatric condition that shortens life expectancy, causes functional impairment and disruption to social, work and family life. Several forms of bipolar disorder are recognised, including both bipolar I and bipolar II disorder. Bipolar I is characterised by recurrent episodes of depression and mania whereas bipolar II disorder is characterised by recurrent depression and hypomania, a milder form of mania. There has been debate concerning the definition of hypomania since at least the 1970s. The main areas of argument focus on the minimum duration of hypomania, its stem criteria and the number of symptoms required for diagnosis. Arriving at the correct definition of hypomania is a key diagnostic issue. There is increasing evidence for the existence of a broad spectrum of bipolar disorders, and data demonstrating the clinical validity of modifying some of the criteria for hypomania are reviewed here.

Atypical depressive syndromes in varying definitions

AbstractBackgroundAtypical depression (AD) exhibits distinct patterns of gender,bipolar–II disorder, genetic, and neuro–biological measures. Using prospective data from a community sample, this paper identifies criteria (and correlates) for an AD syndrome that maximizes the association with female sex and bipolar–II.MethodsThe Zurich cohort study is composed of 591 subjects selected from a population–based cohort of young adults in the canton of Zurich in Switzerland, screened in 1978 and followed with six interviews through 1999. Seven definitions of atypical depression were tested, using varying combinations of vegetative symptoms and mood reactivity.ResultsThe atypical definitions using 2 of 3 (fatigue, overeating, oversleeping) or 2 of 2 (overeating, oversleeping) vegetative symptoms showed the strongest association with gender, bipolarity, and family history of mania. The 2/3 definition was chosen for further analysis due to its high sensitivity for identifying these characteristics. This syndrome had cumulated weighted prevalence of 16.4% (males 9.7%, females 23%); when associated with major depressive episodes, 8.2% (males 3.2%, females 15.1%). AD patients were characterized by high treatment rates, severity, and work impairment, early age of onset and long illness. AD was comorbid with social phobia, binge eating, neurasthenia, migraine headache, and subjective cognitive impairment.

The Zurich Study: participation patterns and Symptom Checklist 90-R scores in six interviews, 1979-99.

Objective:  The Zurich study is a longitudinal study in psychiatric epidemiology that started in the late 1970s. The sixth interview in 1999 provides the basis to investigate and update the participation and drop‐out patterns of the Zurich subjects.

Prevalence of exposure to potentially traumatic events and PTSD. The Zurich Cohort Study.

ObjectiveThe aim of this study was to estimate the prevalence rate of exposure to potentially traumatic events (PTE) and posttraumatic stress disorder (PTSD) in a representative sample of the general population.MethodA representative community–based cohort from the canton of Zurich, Switzerland was interviewed in 1993 and 1999 at the age of 34/35 and 40/41 years, respectively, by means of a semi–structured diagnostic interview.ResultsThe weighted lifetime prevalence of PTE in 1999 was 28%. Of the persons who reported exposure to PTE (criterion A), none met all the remaining criteria for PTSD according to the DSM–IV. Eleven persons (2 males and 9 females) met the criteria for subthreshold PTSD. This corresponds to a weighted 12–month prevalence for subthreshold PTSD of 1.30% (0.26 % for males; 2.21 % for females). In 1993, no participant met all criteria for PTSD according to the DSMIII– R. The weighted 12–month prevalence for subthreshold PTSD was 1.90 % (2.9 % for males; 0.9 % for females).ConclusionThe prevalence of exposure to PTE in Switzerland was relatively low. No single case of full PTSD was found in the sample, and even for subthreshold PTSD the prevalence was very low. The relatively stable socio–economic and political climate in Switzerland may contribute to a sense of safeness, which may protect Swiss citizens to some extent from developing PTSD in the aftermath of traumatic experiences.

Diversity and change in suicide seasonality over 125 years

Background: Recent research has corroborated the notion that seasonality in suicide is more heterogeneous and less consistent than postulated by former scholars. This work investigates the smoothing out of suicide seasonality in Switzerland between the late 19th and the end of the 20th century. It includes analyses by region and by suicide method. Methods: Monthly suicide frequencies in Switzerland are available for the period 1876–2000. Data on canton/region are available for the periods 1901–1920 and 1969–2000, and data on suicide method for the periods 1881–1920 and 1969–2000. Analyses focusing on the overall change rely on data aggregated by quinquennia. The Edwards’ test and the peak-low ratio were used in univariate analyses of seasonality. Putative determinants of the peak-low ratio were examined using regression analysis with cantonal data. Results: The decrease of seasonal effects in suicide applies to a period of more than 100 years in Switzerland. Big differences of seasonal effects have existed all the time with regard to specific methods and to specific regions. No seasonality was apparent in poisoning, and in Geneva and Basle City, respectively. However, the seasonal effects have been most impressive in drowning and hanging suicides, and in rural Catholic regions. In regression analysis, the decline in suicide seasonality is associated with the decline in the agricultural work force. Conclusions: The smoothing out of suicide seasonality in Switzerland has been a continuous long term process, which probably started by the end of 19th century. Seasonal effects in suicide will probably fade away in most regions of Switzerland and in most suicide methods. This process is in parallel with the disappearance of the traditional rural society.

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.

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

BackgroundThere 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).MethodData 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.ResultsThere 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.ConclusionsThe 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.