Frauke Schultze-Lutter

Diagnostic validity of basic symptoms

Although the Bonn Scale for the Assessment of Basic Symptoms (BSABS) [13] has come into use in several European countries, its diagnostic validity has not yet been sufficiently examined. That is why we have assessed BSABS items on a sample of 243 consecutive admissions to the Department of Psychiatry at the RWTH University, Aachen, and 79 psychologically healthy persons. Then, a cluster analysis was calculated to identify the empirical item-grouping. Five well-interpretable BSABS subsyndromes were found. In addition, uni- and multivariate analyses were computed to evaluate the diagnostic validity of these subsyndromes. We were able to show that every BSABS subsyndrome separates at least schizophrenic, organic mental and affective disorders from personality, neurotic and substance-induced disorders, as well as from psychological health. Furthermore, the subsyndrome “information processing disturbances” differentiates between schizophrenic and organic mental disorders, on the one hand, and affective disorders, on the other, and additionally, the subsyndrome “interpersonal irritation” between schizophrenics and all other persons examined.

Prevention and Early Treatment

For nearly two decades, prevention, and especially the indicated prevention of severe mental disorders has increasingly become a target of psychiatric research and, consequently, of ethical debates. The main focus and critic of the latter is on the accuracy of prediction and the safety of treatment, though concerns and arguments vary with the different characteristics of the considered disorder. Taking endogenous psychoses, Alzheimer’s disease (AD) and Huntington’s disease (HD) as examples, costs and benefits of an early detection, of an early intervention and of prevention research in the prodromal or premorbid phase, though heavily intertwined, will be examined with special emphasis on aspects of patient’s autonomy including considerations on informed consent and the ethical principles of nonmaleficence and beneficence.

Das Kölner Früh-Erkennungs- & Therapie-Zentrum für psychische Krisen (FETZ)

ZusammenfassungHintergrund und Ziel:Das Kölner Früh-Erkennungs- & Therapie-Zentrum für psychische Krisen (FETZ) wurde Ende 1997 als Erstes seiner Art in Europa eröffnet und widmet sich vorrangig der Früherkennung von Psychosen vor deren Erstmanifestation. Hierbei kommen neben den international verwandten „ultra-high risk“-(UHR-)Kriterien auch die der deutschen Tradition entstammenden Basissymptome, insbesondere feine kognitiv-perzeptive Beschwerden, zur Anwendung.Methodik:Neben einer Analyse der Inanspruchnahme des FETZ in den ersten 6 Jahren (1998–2003) erfolgte zur Abschätzung der Repräsentativität ein Vergleich der soziodemographischen Struktur der FETZ-Stichprobe mit der Kölner Bevölkerungsstatistik.Ergebnisse:Die Anzahl der Erstkontakte stieg über die ersten 3 Jahre kontinuierlich – auch in der Folge einer 2000 gestarteten Awareness-Kampagne. Insgesamt kam es in dem 6-jährigen Zeitraum zu 872 Erstkontakten, wobei bei 326 Personen (37,4%) bereits eine manifeste Psychose diagnostiziert wurde. Von den verbleibenden 546 Personen boten 402 (73,6%) Anhaltspunkte für eine beginnende psychotische Erkrankung. Von diesen berichteten 94,0% über prädiktive Basissymptome, 68,9% über attenuierte und 20,6% über transiente psychotische Symptome. Der Vergleich mit der Kölner Bevölkerungsstatistik zeigte für das FETZ eine deutliche Überrepräsentierung von Personen mit deutscher Staatsbürgerschaft und solchen mit einem höheren Schulabschluss.Schlussfolgerung:Die Ergebnisse weisen darauf hin, dass trotz guter Akzeptanz eines Früherkennungszentrums spezielle zielgruppenorientierte Öffentlichkeitskampagnen notwendig sein könnten, um auch Risikopersonen mit Migrationshintergrund oder geringerer Schulbildung frühzeitig und umfassend zu erreichen.AbstractBackground and Purpose:The Cologne Early Recognition and Intervention Center for mental crises (FETZ) was set up in late 1997 as the first European center dedicated to the early detection of psychosis prior to first episode. Following the German psychopathologic tradition, basic symptoms, especially cognitive-perceptive disturbances, are employed as a means to this aim in addition to the internationally established “ultra-high risk” (UHR) criteria.Methods:Besides analyses of the service use of the first 6 years (1998–2003), sociodemographic data of the FETZ sample were compared with the Cologne demography to give an estimate of its representativeness.Results:The number of first contacts steadily increased over the first 3 years – not least due to an awareness campaign that started in 2000. In all, 872 persons contacted the FETZ during the 6-year period, 326 of them (37.4%) already suffering from frank psychosis. Of the remaining 546 persons, 402 (73.6%) met at least one prodromal criterion, 94.0% by reporting predictive basic symptoms, 68.9% by attenuated and 20.6% by transient psychotic symptoms. The comparison with the Cologne demography revealed significant bias toward persons of German citizenship as well as those of higher education among the service users.Conclusion:Although an early detection center is generally well received, findings indicate the necessity to develop and carry out custom-built public campaigns especially tailored to at-risk persons with migration background as well as those with lower graduation.