Fabian Friedrich

The criterion validity of the Geriatric Depression Scale: a systematic review

Objective:  The objective was to provide a systematic review of the screening accuracy of both versions of the Geriatric Depressions Scale (GDS‐30, GDS‐15).

Manifest psychosis in neurosyphilis

INTRODUCTION Recent surveys have assessed a remarkable increase in the prevalence of infectious syphilis. If left untreated, 30% of patients may develop tertiary syphilis, which can manifest as neurosyphilis. CASE REPORT The authors present a case of an acute psychosis during and after pregnancy in a 37-year-old woman, which was identified as a manifestation of neurosyphilis after admission to a psychiatric ward. The positive screening test for syphilis provided the first hint of syphilis and gave direction for further diagnosis and specific treatment. Subsequently, the patient was treated with psychotropic medication concurrent with an adequate antibiotic treatment for neurosyphilis and was simultaneously psychologically monitored. An improvement of psychotic symptoms during antibiotic therapy was observed. CONCLUSION This case emphasises that neurosyphilis still has to be considered in the differential diagnosis within the context of psychiatric conditions and diseases. Owing to current epidemiological data and difficulties in diagnosing syphilis, routine screening tests in the psychiatric field are necessary.

Gender aspects of parents' needs of schizophrenia patients.

BackgroundMost studies about the problems and needs of schizophrenia carers included only one care-giving relative, usually the patients’ mothers.Methods101 mothers and fathers of the same patients suffering from schizophrenia were included into this study. Their needs were assessed by means of the “Carers’ Needs Assessment for Schizophrenia”.ResultsMothers reported significantly more often problems than fathers concerning stress due to earlier life events and burn-out. Mothers needed interventions such as individual psychoeducation or family counselling more than twice as often as fathers. Overall, mothers reported higher numbers of problems and needs for intervention than fathers. The number of mothers’ problems was predicted by not living with a partner and by a shorter duration of the patients’ illness. The number of mothers’ needs was predicted by more psychiatric symptoms, not living with a partner and a shorter duration of the patients’ illness. Among fathers we could not identify any predictors, neither for the number of problems nor for the number of needs.ConclusionsFathers and mothers often report problems and frequently need professional support. Overall, mothers exhibited more problems and needs for interventions than fathers. The differences between mothers and fathers indicate the importance of considering the carer’s gender in clinical work.

The impact of temperament in the course of alcohol dependence.

AIMS The aim of this study was to assess the impact of temperamental traits in alcohol dependent patients on the course of illness. METHODS The case files of 116 alcohol dependent patients, according to ICD-10 and DSM-IV-TR, were examined retrospectively. All patients were in treatment between 02/08 and 03/09 at the Psychiatric Department of the General Hospital Vienna, either at the alcohol outpatient clinic or the psychiatric ward, which has the treatment focus on alcohol dependence. The brief TEMPS-M auto-questionnaire was used to assess the temperamental distribution. The dimensions of alcohol dependence have been assessed using the Lesch Alcoholism Typology, a computerized structured interview. The potential effect of temperamental scores on various outcomes describing the course of illness is investigated using multi-variable regression models. RESULTS Cyclothymic score was the only temperament which significantly influenced the age of onset of alcohol abuse and age of onset of alcohol dependence. Backward selection among temperaments exhibits depressive temperament as most important effect regarding the likelihood of suicide-attempts in the patients case history and anxious temperament as most important effect regarding having psychiatric treatment focusing on alcohol dependence prior to current in- or outpatient stay. LIMITATIONS The sample size of this study is small compared to the number of investigated outcomes and temperaments. Further, a healthy control group, matched for age and gender, was not available for comparison of the temperament sub-scores. CONCLUSION Dominant cyclothymic, but also depressive and anxious temperament, seem to be negative predictors for the course of illness in alcohol dependence. Regarding positive long term outcome specific evidence based medical treatment approaches are needed for these patients.

The criterion validity of different versions of the General Health Questionnaire among non-psychiatric inpatients

PurposeWhile the General Health Questionnaire (GHQ) has an excellent screening performance among outpatients and in the community, its accuracy to detect mental disorders among non-psychiatric inpatients was reported to be lower. The aim of the present study was to compare the criterion validity of different scoring methods, i.e. the Bimodal scoring, Likert scoring, Modified Likert scoring and Chronic scoring, of the 30-, 20- and 12-item version of the GHQ.MethodsThe GHQ was available from 511 inpatients recruited from surgical, medical, gynaecological and physical rehabilitation wards. The Clinical Interview Schedule was performed for psychiatric case-identification and was used as external care criterion.ResultsSensitivities of all versions were between 0.612 and 0.701, and specificities between 0.601 and 0.759. The Overall Misclassification Rate (OMR) varied for the Bimodal and the Modified Likert scoring method between 0.257 and 0.281, for the Likert and the Chronic scoring method between 0.325 and 0.386. Overall, the Bimodal and the Modified Likert scoring method showed significantly better specificity and OMR than the Likert and the Chronic scoring method, while we could not find any differences for sensitivity.ConclusionsOverall, the Bimodal and the Modified Likert scoring method seem to be more accurate than the Likert and the Chronic scoring method. Nevertheless, due to the high misclassification, none of these versions can be recommended for routine screening among non-psychiatric inpatients.

Das Chamäleon der Psychiatrie – Psychiatrische Manifestationsformen der Neurosyphilis

OBJECTIVE Recent epidemiological data have shown a significant increase in the prevalence of syphilis. If left untreated, up to 30 % of patients may develop tertiary syphilis, which can manifest as neurosyphilis. The aim of our review is to evaluate psychiatric manifestations of neurosyphilis according to ICD-10. METHODS A systematic electronic search for published studies (1995-2010) was performed using the databases Medline, Embase, Cochrane as well as the search engines Scopus and Google Scholar. RESULTS 113 studies were used for detailed analysis. Clinical manifestations of various forms of neurosyphilis are protean, numerous and non-specific and could be on the differential diagnosis for many psychiatric presentations according to ICD-10. CONCLUSION Due to our results, the difficulties in diagnosing syphilis and current epidemiological data, routine screening tests are still mandatory in the psychiatric field. Further, neurosyphilis still has to be considered in the differential diagnosis within the context of psychiatric conditions and diseases.

Amino-Terminal Pro-B-Type Brain Natriuretic Peptide: Screening for Cardiovascular Disease in the Setting of Alcoholism

AIMS N-terminal pro-BNP (NtBNP) has attracted attention as a biomarker for heart failure. The aims of our study are (a) to characterize the role of NtBNP as a biological marker in the setting of alcoholism; (b) to describe potential gender differences with respect to NtBNP; (c) to correlate NtBNP with other clinical and haemodynamic variables. METHODS We examined 83 alcohol-dependent patients according to International Classification of Disease 10th Revision (ICD-10) and Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV; 59 males and 24 females, age: 50 ± 10.5 years) referred to the department of psychiatry for alcohol withdrawal therapy. In these patients, we determined NtBNP, markers of alcohol abuse and transthoracic echocardiography to determine systolic left ventricular ejection fraction (EF). These measurements were repeated after alcohol withdrawal. RESULTS At Day 1 of alcohol withdrawal, 43 patients (52%; 27 males and 16 females) had elevated NtBNP levels (394.4 ± 438.7 pg/ml) despite normal EF (64.7 ± 6.2%). After withdrawal therapy (16.6 ± 7.8 days), NtBNP decreased significantly (228.6 ± 251.2 pg/ml; P < 0.01), despite unchanged EF (65.0 ± 5.8%; P = ns). This was the case in both males and females (328.9 ± 235.5 to 216.7 ± 194.3 pg/ml; P < 0.05 vs. 492.7 ± 635.7 to 246.6 ± 327.7 pg/ml; P < 0.05). Elevated NtBNP levels were related significantly to the history of arterial hypertension (P < 0.05). CONCLUSION This study highlights the fact that NtBNP can be elevated in the setting of alcoholism. The elevation in NtBNP is unrelated to EF and is reversible after alcohol withdrawal. We suggest a subclinical detrimental effect of alcohol abuse on cardiac function.

Psychiatric illness and length of stay in general hospitals: do case finding methods matter?

SummaryObjectiveSeveral prior studies have investigated whether patients with “non-cognitive” mental disorders (i.e., organic disorders, substance abuse, delirium, and psychotic disorders excluded) have longer Length Of Stay (LOS) than mentally healthy individuals in nonpsychiatric hospital settings. These studies yielded contrasting results. The present paper aims to examine whether methods of psychiatric case finding can explain these differences.MethodsUsing the Clinical Interview Schedule (CIS) and the General Health Questionnaire (GHQ), 462 in-patients of medical, surgical, gynecological, and rehabilitation departments were assessed for the presence of psychiatric disorders.ResultsIn multiple regression analysis, all CIS-cases together did not show an association with LOS. Of the diagnostic groups assessed by CIS only major depression showed a significantly prolonged LOS. Using the GHQ sum-score as a continuous variable, LOS was significantly increased while using the GHQ as a dichotomous variable did not show such an association. After removing those suffering from multiple psychiatric diagnoses (such as major depression co-morbid with organic mental illness), none of the case definitions showed a significant association with LOS.ConclusionsIt seems that different case finding methods yield different results concerning the association of psychiatric disorders with LOS. When interpreting these results the small size of some subsamples must be taken into consideration.ZusammenfassungZielDie Frage, ob Patienten von nicht-psychiatrischen Krankenhausabteilungen, die unter “nicht-kognitiven” psychischen Erkrankungen leiden, einen längeren Krankenhausaufenthalt als psychisch Gesunde haben, wurde mehrfach untersucht. Die Studien lieferten aber widersprüchliche Ergebnisse. Die vorliegende Auswertung geht der Frage nach, ob verschiedene Methoden der Fallfindung die unterschiedlichen Ergebnisse verursachen.MethodikDie Clinical Interview Schedule (CIS) und der General Health Questionnaire (GHQ) wurden bei 462 stationären Patienten von internen, chirurgischen, gynäkologischen und somatisch-rehabilitativen Abteilungen verwendet, um das Vorhandensein von psychischen Krankheiten zu erfassen.ErgebnisseAlle CIS-Fälle zusammen zeigten in multiplen Regressionsanalysen keinen signifikanten Zusammenhang mit der Aufenthaltsdauer. Von allen diagnostischen Kategorien, die mittels CIS erfasst wurden, zeigte ausschließlich die Major Depression eine signifikant verlängerte Aufenthaltsdauer. Wenn der GHQ-Summenscore als kontinuierliche Variable verwendet wurde, zeigte sich ein signifikant positiver Zusammenhang mit der Aufenthaltsdauer. Wenn der GHQ aber dichotomisiert verwendet wurde, konnte ein solcher Zusammenhang nicht gefunden werden. Wenn Patienten mit multiplen psychiatrischen Diagnosen (beispielweise Depression plus psycho-organische Erkrankung) ausgeschlossen wurden, verschwanden alle Zusammenhänge mit der Aufenthaltsdauer, unabhängig von der verwendeten Falldefinition.SchlussfolgerungenDie vorliegenden Ergebnisse bestätigen die Vermutung, dass unterschiedliche Methoden der psychiatrischen Fallfindung die statistischen Zusammenhänge mit der Aufenthaltsdauer beeinflussen. Allerdings muss berücksichtigt werden, dass manche Teilstichproben in den vorliegenden Auswertungen relativ klein waren.

Rationale, Component Description and Pilot Evaluation of a Physical Health Promotion Measure for People with Mental Disorders across

Introduction: The HELPS project aimed at developing a toolkit for the promotion of physical health in people with mental disorders to reduce the substantial excess morbidity and mortality in the target group. Methods: The HELPS toolkit was developed by means of national and international literature reviews, Delphi rounds with mental health experts and focus groups with mental health experts and patients/ residents in 14 European countries. The toolkit was translated into the languages of all participating countries, and usability of toolkit modules was tested. Results: The toolkit consists of several modules addressing diverse somatic health problems, lifestyle, environment issues, patient goals and motivation for health-promotion measures. It aims at empowering people with mental illness and staff to identify physical health risks in their specific contexts and to select the most appropriate modules from a range of health promotion tools. Discussion: The HELPS project used an integrative approach to the development of simple tools for the target population and is available online in 14 European languages. Preliminary evidence suggests that the toolkit can be used in routine care settings and should be put to test in controlled trials to reveal its potential impact.

Do patients with different psychiatric disorders show altered social decision-making? A systematic review of ultimatum game experiments in clinical populations

ABSTRACT Background: Impairments in social functioning are a common feature of psychiatric disorders. Game paradigms pose a unique way for studying how people make decisions in interpersonal contexts. In the last decade, researchers have started to use these paradigms to study social decision-making in patients with psychiatric disorders. Purpose: The aim of this systematic literature review is to summarise the currently available evidence on the behaviour of patients with psychiatric disorders in the commonly used Ultimatum Game (UG). Method: A systematic literature search including MEDLINE, PsycINFO, PSYNDEXplus Tests, PSYNDEXPLUS Literature, EBM Reviews—Cochrane Central Register of Controlled Trials, Embase and PASCAL was performed via the Ovid interface. Results: We found evidence for alterations in UG behaviour for patients with frontotemporal dementia, schizophrenia, affective disorders, alcohol, cocaine, heroin and 3,4-methylenedioxymethamphetamine consumption, alcohol dependence, anxiety disorders, borderline personality disorder, autism, Tourette syndrome and oppositional defiant disorder. Conclusion: There is some evidence that different psychiatric disorders might go along with alterations in social decision-making. However, in general, data are currently limited and studies are hard to compare due to differences in methodologies.