Kristina Ritter

Culture and the prevalence of hallucinations in schizophrenia

OBJECTIVE Besides demographic, clinical, familial, and biographical factors, culture and ethnicity may plausibly influence the manifestation of hallucinations. The purpose of this study was to investigate the influence of culture on the frequency of different kinds of hallucinations in schizophrenia. METHOD Patients with a clinical diagnosis of schizophrenia were diagnosed by means of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria. Seven independent samples were consecutively recruited in Austria, Lithuania, Poland, Georgia, Ghana, Nigeria, and Pakistan using identical inclusion/exclusion criteria and assessment procedures (N = 1080 patients total). The association of key demographic factors (sex and age), clinical factors (age at onset and duration of illness), and country of origin with hallucinations of different kinds was examined. RESULTS The prevalence of various kinds of hallucinations was substantially different in the samples; however, the rank order of their occurrence was similar. Auditory hallucinations were relatively infrequent in Austria and Georgia and more prevalent in patients with an early age at onset of disease. Visual hallucinations were more frequently reported by the West African patients compared with subjects from the other 5 countries. Cenesthetic hallucinations were most prevalent in Ghana and in patients with a long duration of illness. CONCLUSION We hypothesize that the prevalence of the different kinds of hallucinations in schizophrenia is the result of the interaction of a variety of factors like cultural patterns as well as clinical parameters. According to our study, culture seems to play a decisive role and should be taken into account to a greater extent in considerations concerning the pathogenesis of psychotic symptoms.

Anxiety and hostility in the manifest dreams of schizophrenic patients.

Aside from delusions, hallucinations, and thought disorders, affective disturbances belong to the most prominent symptoms of the schizophrenic process. However, nearly no empirical work has been done on the systematic investigation of the dream affects of patients with schizophrenia. We compared 96 dreams of 19 patients with schizophrenia and an equal number of dreams of 19 healthy controls collected over an 8-week period by means of the Gottschalk-Gleser Analysis Scales. Additionally, central psychopathological syndromes were measured by means of the AMDP-scales each day a patient reported a dream. Although cluster analyses showed general similarities in the organization of dream affects in the two groups, we found differences between patient and control groups in the frequency and intensity of anxious and hostile affects. As in delusions of persecution, patients experience themselves in their dreams more frequently as victims of hostility from outside, which corresponds well with a significantly higher intensity of threat anxieties (death, mutilation). On the other hand, value anxieties (guilt and separation) are found less frequently in the dreams of patients with schizophrenia pointing, together with a less differentiated organization of the dream affects, to the typical affective flattening of residual syndromes.

Diencephalic Serotonin Transporter Availability Predicts Both Transporter Occupancy and Treatment Response to Sertraline in Obsessive-Compulsive Checkers

BACKGROUND To our knowledge, no studies have investigated the predictive value of central serotonin transporter (SERT) availability for treatment response to serotonin reuptake inhibitors (SSRIs) in patients with obsessive-compulsive disorder (OCD). This study used brain imaging to examine the relationship between pretreatment SERT availability and transporter occupancy as well as treatment response by sertraline in patients displaying prominent behavioral checking compulsions (OC checkers). METHODS Single photon emission computed tomography (SPECT) was used to measure thalamic-hypothalamic SERT availability with [(123)I]-2beta-carbomethoxy-3beta-(4-iodophenyl)-tropane in 28 nondepressed OC checkers at baseline and after 14 weeks of treatment with sertraline (175 mg daily). SERT availability was correlated with OC severity and treatment response as assessed with the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). Associations between individual transporter occupancies and clinical parameters were investigated. RESULTS 1) Correlation analyses between thalamic-hypothalamic SERT availability and OC severity showed significant negative associations at baseline and after treatment with sertraline. 2) Pretreatment SERT availability correlated significantly with both transporter occupancy and treatment response; in addition, a positive association was found between transporter occupancy and treatment response directly. 3) Using multivariate statistical models, the data demonstrated that higher pretreatment SERT availability significantly predicted higher occupancy rates as well as better treatment response 14 weeks later. CONCLUSIONS Higher pretreatment thalamic-hypothalamic SERT availability may predict both higher occupancy rates and better treatment response to sertraline. The data suggest a strong connection between transporter occupancy and treatment response.

The traces of violence : Suicide and homicide rates in the former Bloodlands

BACKGROUND Suicide and homicide rates are the ultimate expressions of violence. The rates are globally almost distributed mirror-reverted. Rich, modern democratic countries with a functioning legal system have high suicide and low homicide rates, traditional states with a weak central government high homicide and low suicide rates. Exceptions are some Eastern European countries, in which both, the rates of homicide and suicide are very high. These states are located on the territory of the former Bloodlands (Snyder, Bloodlands: Europa zwischen Hitler und Stalin, 2011), where between 1930 and 1945 14 million people were civilian victims of the Soviets and the National Socialists. We addressed the question of whether these eight countries (Poland, Lithuania, Estonia, Latvia, Moldova, Belarus, Russia and Ukraine) differ from the other European countries of the former East bloc, from the Asian countries of the former USSR and the Western European countries in social, economic and psychosocial factors. METHODS The data used for analyses were taken of various data sets from the WHO, the UN and the CIA. The statistical comparison of the four regions was carried out by nonparametric tests. RESULTS The States on the grounds of the former Bloodlands and the other European countries of the former East bloc are comparable concerning important social and economic parameters such as level of modernization, Democracy-index and Rule of Law-Index. Statistically significant differences were found only in the annual alcohol consumption per capita and the divorce rates. CONCLUSIONS We hypothesize that the high suicide and homicide rates in some Eastern European countries may be the result of the traumatic experience of extreme violence of nearly the entire population between 1930 and 1945. Possible paths of the transgenerational transmission as well as conceivable chains of causality between the trauma in the first generation and suicidal or homicidal behavior in the following generations are presented.

Arbeitslosigkeit, Suizid- und Tötungsraten in den EU-Staaten

BACKGROUND While the link between the unemployment and the national suicide rates is confirmed by various studies, there are few investigations on the impact of unemployment on homicide rates. In particular, it is not known whether suicide and homicide are associated with the same socio-economic factors. METHODS Using linear regression method, the influence of unemployment rates, per capita incomes and annual alcohol consumption on suicide and homicide rates was examined in the 27 EU states. RESULTS We found a positive correlation between suicide and homicide rates. Unemployment among men is a strong predictor not only for suicide- but also for homicide rates. Suicide rates in men are also affected by the annual alcohol consumption. The suicide rates in women, however, correlate neither with socio-economic variables nor with alcohol consumption. CONCLUSIONS Unemployment seems to have a stronger impact on the male than on the female identity. Since the former is still highly dependent on predetermined social roles.ZusammenfassungGrundlagenWährend der Zusammenhang zwischen den Arbeitslosenquoten und den nationalen Suizidraten durch verschiedene Studien belegt ist, gibt es nur wenige Untersuchungen über die Beziehung zwischen Arbeitslosigkeit und Homizidraten. Im Besonderen ist nicht bekannt, ob Selbst- und Fremdtötung durch dieselben sozioökonomischen Faktoren bedingt sind.MethodikMittels statistischer Regressionsverfahren wurde der Einfluss der Arbeitslosenquote, des Prokopfeinkommens und des jährlichen Alkoholkonsums auf die Suizid- und Homizidraten der 27 EU-Staaten untersucht.ErgebnisseEs fand sich eine positive Korrelation zwischen Suizid- und Homizidraten. Bei Männern ist Arbeitslosigkeit ein starker Prädiktor nicht nur für Selbst- sondern auch für Fremdtötung Die Suizidraten der Männer werden auch durch die jährliche Menge an konsumiertem Alkohol beeinflusst. Die Suizidraten der Frauen korrelieren hingegen weder mit den sozioökonomischen Variablen noch mit dem Alkoholkonsum.SchlussfolgerungenArbeitslosigkeit scheint eine stärkere Erschütterung der männlichen als der weiblichen Identitätsentwürfe zu bewirken, da erstere offenbar noch immer in hohem Maße von vorgegebenen sozialen Rollen abhängig ist, in diesem Fall von der Fähigkeit, durch Arbeit sich selbst und eine Familie zu ernähren.SummaryBackgroundWhile the link between the unemployment and the national suicide rates is confirmed by various studies, there are few investigations on the impact of unemployment on homicide rates. In particular, it is not known whether suicide and homicide are associated with the same socio-economic factors.MethodsUsing linear regression method, the influence of unemployment rates, per capita incomes and annual alcohol consumption on suicide and homicide rates was examined in the 27 EU states.ResultsWe found a positive correlation between suicide and homicide rates. Unemployment among men is a strong predictor not only for suicide- but also for homicide rates. Suicide rates in men are also affected by the annual alcohol consumption. The suicide rates in women, however, correlate neither with socio-economic variables nor with alcohol consumption.ConclusionsUnemployment seems to have a stronger impact on the male than on the female identity. Since the former is still highly dependent on predetermined social roles.

Die Spuren der Gewalt

BACKGROUND Suicide and homicide rates are the ultimate expressions of violence. The rates are globally almost distributed mirror-reverted. Rich, modern democratic countries with a functioning legal system have high suicide and low homicide rates, traditional states with a weak central government high homicide and low suicide rates. Exceptions are some Eastern European countries, in which both, the rates of homicide and suicide are very high. These states are located on the territory of the former Bloodlands (Snyder, Bloodlands: Europa zwischen Hitler und Stalin, 2011), where between 1930 and 1945 14 million people were civilian victims of the Soviets and the National Socialists. We addressed the question of whether these eight countries (Poland, Lithuania, Estonia, Latvia, Moldova, Belarus, Russia and Ukraine) differ from the other European countries of the former East bloc, from the Asian countries of the former USSR and the Western European countries in social, economic and psychosocial factors. METHODS The data used for analyses were taken of various data sets from the WHO, the UN and the CIA. The statistical comparison of the four regions was carried out by nonparametric tests. RESULTS The States on the grounds of the former Bloodlands and the other European countries of the former East bloc are comparable concerning important social and economic parameters such as level of modernization, Democracy-index and Rule of Law-Index. Statistically significant differences were found only in the annual alcohol consumption per capita and the divorce rates. CONCLUSIONS We hypothesize that the high suicide and homicide rates in some Eastern European countries may be the result of the traumatic experience of extreme violence of nearly the entire population between 1930 and 1945. Possible paths of the transgenerational transmission as well as conceivable chains of causality between the trauma in the first generation and suicidal or homicidal behavior in the following generations are presented.

Unemployment, suicide- and homicide-rates in the EU countries

BACKGROUND While the link between the unemployment and the national suicide rates is confirmed by various studies, there are few investigations on the impact of unemployment on homicide rates. In particular, it is not known whether suicide and homicide are associated with the same socio-economic factors. METHODS Using linear regression method, the influence of unemployment rates, per capita incomes and annual alcohol consumption on suicide and homicide rates was examined in the 27 EU states. RESULTS We found a positive correlation between suicide and homicide rates. Unemployment among men is a strong predictor not only for suicide- but also for homicide rates. Suicide rates in men are also affected by the annual alcohol consumption. The suicide rates in women, however, correlate neither with socio-economic variables nor with alcohol consumption. CONCLUSIONS Unemployment seems to have a stronger impact on the male than on the female identity. Since the former is still highly dependent on predetermined social roles.ZusammenfassungGrundlagenWährend der Zusammenhang zwischen den Arbeitslosenquoten und den nationalen Suizidraten durch verschiedene Studien belegt ist, gibt es nur wenige Untersuchungen über die Beziehung zwischen Arbeitslosigkeit und Homizidraten. Im Besonderen ist nicht bekannt, ob Selbst- und Fremdtötung durch dieselben sozioökonomischen Faktoren bedingt sind.MethodikMittels statistischer Regressionsverfahren wurde der Einfluss der Arbeitslosenquote, des Prokopfeinkommens und des jährlichen Alkoholkonsums auf die Suizid- und Homizidraten der 27 EU-Staaten untersucht.ErgebnisseEs fand sich eine positive Korrelation zwischen Suizid- und Homizidraten. Bei Männern ist Arbeitslosigkeit ein starker Prädiktor nicht nur für Selbst- sondern auch für Fremdtötung Die Suizidraten der Männer werden auch durch die jährliche Menge an konsumiertem Alkohol beeinflusst. Die Suizidraten der Frauen korrelieren hingegen weder mit den sozioökonomischen Variablen noch mit dem Alkoholkonsum.SchlussfolgerungenArbeitslosigkeit scheint eine stärkere Erschütterung der männlichen als der weiblichen Identitätsentwürfe zu bewirken, da erstere offenbar noch immer in hohem Maße von vorgegebenen sozialen Rollen abhängig ist, in diesem Fall von der Fähigkeit, durch Arbeit sich selbst und eine Familie zu ernähren.SummaryBackgroundWhile the link between the unemployment and the national suicide rates is confirmed by various studies, there are few investigations on the impact of unemployment on homicide rates. In particular, it is not known whether suicide and homicide are associated with the same socio-economic factors.MethodsUsing linear regression method, the influence of unemployment rates, per capita incomes and annual alcohol consumption on suicide and homicide rates was examined in the 27 EU states.ResultsWe found a positive correlation between suicide and homicide rates. Unemployment among men is a strong predictor not only for suicide- but also for homicide rates. Suicide rates in men are also affected by the annual alcohol consumption. The suicide rates in women, however, correlate neither with socio-economic variables nor with alcohol consumption.ConclusionsUnemployment seems to have a stronger impact on the male than on the female identity. Since the former is still highly dependent on predetermined social roles.

Patterns of Substance Abuse in Offenders With Schizophrenia— Illness-Related or Criminal Life-Style?

Objective: The impact of substance abuse on violent behavior in patients suffering from schizophrenia is well-known. However, the association between the pattern of substance abuse and certain aspects of criminal behavior like the severity of offense, the previous history of violence and the age at onset of the criminal career is still unclear. Method: To assess the relationship between substance abuse, schizophrenia and violent behavior we examined healthy non-offenders; healthy offenders; non-offenders suffering from schizophrenia; and offenders suffering from schizophrenia, with respect to different patterns of substance abuse (none, alcohol only, illicit drugs only, and multiple substances). Results: Healthy offenders as well as offenders and non-offenders suffering from schizophrenia are characterized by increased rates of alcohol and illicit drug abuse. Especially multiple substance abuse appears to lower the threshold of aggression and illegal behavior. This effect is more pronounced in subjects suffering from schizophrenia. In both offender groups the abuse of psychoactive substances is associated with an earlier onset of the criminal career, but has no impact on the severity of the offenses. Conclusion: Our results point to the need for a differentiated view on the contribution of substance abuse to the criminality of subjects suffering from schizophrenia.

Einführung in die Ethnomedizin – Ethnomedizinische Kenntnisse können ärztliches Handeln verbessern

Die Ethnomedizin ist ein transdisziplinares Fach, angesiedelt zwischen Medizin und Ethnologie bzw. Kulturanthropologie. Die ethnomedizinischen Forschungsmethoden beinhalten die teilnehmende Beobachtung, das narrative Interview, quantitative Verfahren und die Literaturanalyse. In diesem Artikel werden die diversen kulturspezifischen Krankheitskonzepte (Krankheiten mit naturlicher und ubernaturlicher Ursache) sowie Grundprinzipien traditioneller Behandlungskonzepte (ethnopharmakologische und diatetische Verfahren, magisch-spirituelle Methoden sowie magisch-materielle Methoden) erklart. Den Abschluss bildet die synoptische Darstellung komplexer ausereuropaischer Medizinsysteme (Traditionelle Chinesische Medizin, Ayurveda sowie Unani-Medizin). Ethnomedicine is a discipline panel, located between medicine and ethnology. The ethnomedical research methods comprise participating observation, the narrative interview, quantitative methods and literature analysis. Culture-specific illness-concepts (illnesses of natural and supernatural cause) and basic principles of traditional treatment-concepts (ethno-pharmacological and dietetic methods, magic-spiritual methods and magic-material methods) are illustrated. Finally, a synoptic description of complex Eastern medical systems (Traditional Chinese Medicine, Ayurveda, Unani-medicine) is given.

Die Gestaltungen des Wahnsinns bei William Shakespeare@@@The representation of madness in William Shakespeare's characters

SummaryShakespeare is one of the great creators of human characters of the 16th century. Like for many of his contemporaries madness was a central topic of his work. The first part of this paper discusses the sociocultural environment and the semantic field of madness in the Elizabethan age, which forms the background for Shakespeares characters. In the second part we try to analyze the clinical pictures of the fictive characters of Othello, Hamlet, Lear and Macbeth. While we find melancholy, delusions and hallucinations, other diseases such as schizophrenia are missing entirely. Schizophrenia only appears in the literature more than two hundred years later, in the beginning of modern age.ZusammenfassungShakespeare gilt als der große Menschenbeschreiber am Beginn der Neuzeit. Wie bei vielen seiner Zeitgenossen war der Wahnsinn ein ganz zentrales Thema seines Schaffens. Diese Arbeit geht der Frage des kulturgeschichtlichen und gesellschaftlichen Umfeldes nach, aus dem heraus Shakespeare Figuren entwickelt hat, die aus diesem Kontext weit herausragen. Dabei liegt ein wesentlicher Schwerpunkt auf der historischen Semantik des Wortfelds des Wahnsinns. Danach wird exemplarisch an der Interpretation der Figuren von Othello, Hamlet, Lear und Macbeth dargestellt, welche klinischen Bilder Shakespeare entwickelt. Während sich Darstellungen von Melancholie, Wahn und Halluzinationen finden, fehlen andere auffällige Krankheitsbilder wie die Schizophrenie, die in der Literatur erst mehr als zwei Jahrhunderte später mit Anbruch der Moderne auftaucht.