M. Musalek

Rapid decrease of serum cholesterol concentration and postpartum depression.

On the basis of studies of pharmacological reduction of serum lipid concentrations, it has been suggested that reduction in serum cholesterol and triglyceride is associated with occurrence of depressive symptoms, suicides, and violent deaths.1 2 3 Pregnancy induces a physiological rise in both serum cholesterol and triglyceride concentrations, with peak concentrations at term and a rapid decrease within a few days after delivery. Maternity blues is a common complication of the puerperium independent of obstetric variables.4 We postulated that the sudden fall in blood lipids after delivery could serve as a “natural” model to test the suggested association between serum lipids and mood. We studied 20 healthy primiparous women (mean age 25.3, SD 3.7, range 19-34 years) without substantial marital, health, or socioeconomic problems and without a history of psychiatric disorders who registered consecutively for obstetric …

The position of delusional parasitosis in psychiatric nosology and classification.

Discussions on the nosological position of delusional parasitosis (DP) have resulted in a wide range of opinions. In the present study in 34 patients with DP, the various and contradictory opinions concerning DP positioning in psychiatric nosology were examined through clinical, psychopathological, and polydiagnostic analyses using VRC, DSM-III, DSM-III-R and ICD-9. The psychopathological analyses with VRC as well as the polydiagnostic comparisons with other classification systems indicated that DP is neither a nosological entity nor due to a specific psychiatric illness. As our results showed, DP is a nosologically unspecific syndrome, which may occur superimposed on all psychiatric disorders.

Psychopathological Concepts of Dysphoria

Dysphoric conditions are increasingly postulated as representing independent mood disorders. However, despite much effort at clarification, their psychopathological definitions remain unclear and variable. This paper reviews some examples of these divergent definitions, most of which are based on quality of mood, as well as responsiveness to external stimuli. The paper then introduces a strategy in possible solution of the above-mentioned definition problems. Setting out from restriction of the term dysphoria to conditions of a morose, tense and irritated mood, as suggested by Snaith and Taylor, we support the opinion that dysphoria should be accepted as a third possibility of mood swing, as a psychopathological disturbance which can be well distinguished from stable and unstable mixed states.

Delusional Theme, Sex and Age

In a retrospective study of 865 delusional syndromes, connections were investigated between delusional themes and the sex of patients, and the ages in which these themes extensively occurred. According to previous reports, the results of this investigation indicated that differences exist between the ages of manifestation regarding the themes of hypochondria, persecution, love and jealously. Furthermore, differences could be observed between males and females in relation to the frequency of choice of particular themes, as well as the age of occurrence. Based on psychological studies concerned with the contents dependence on motives we conclude that the age distribution of delusional themes corresponds to the main existential concerns in different life periods.

Neurophysiological Aspects of Auditory Hallucinations

In a symptom-oriented study 17 patients suffering from chronic auditory hallucinations were investigated by means of 99mTc-HMPAO-SPECT and compared with healthy controls. The results confirm the relative frontal hypoactivity in junction with a relative hyperactivity in the basal ganglia and mesial limbic structures in both hemispheres found in a previous pilot study in auditorily hallucinating patients. Our results should fortify the symptom-oriented approach in psychiatric research.

A Contribution to Classification of Hallucinations

Proceeding from the hypothesis that auditory hallucinations in psychotic patients have another biological basis than hallucinations provoked by hypnotic suggestion in healthy persons, we performed a symptom-comparative study by means of 99mTc-HMPAO single photon emission computed tomography. The results confirm the importance of pathogenesis in symptom-oriented psychiatric research.

Dysphoria from a Transnosological Perspective

The objective of our psychopathological analyses is to shed light on the position of irritable mood (dysphoria) in psychiatric diagnostics and nosology. In today’s most commonly applied classification systems, the ICD-10 and the DSM-IV, dysphoria is mentioned mostly in the context of diagnostic criteria of personality and affective disorders. Other authors have emphasized the importance of dysphoric states in organic psychoses and delusional disorders. Summarizing the various publications on the nosological position, dysphoria is a nosological nonspecific syndrome which may occur in the course of all psychiatric disorders and illnesses. According to the results of our psychopathological analyses, the pathogenesis of dysphoria has to be considered as a multidimensional circular process in which various mental, physical and social factors act as predisposing, triggering and disorder-maintaining factors. Stressors induced by particular experiences and perceptions and by impaired health may lead to a dysphoric state if adequate coping mechanisms are missing. Dysphoria itself usually leads to a deterioration in the mental and physical state of the patient, and shows a clear impact on the patient’s social network. The reactions of people close to the patient combined with the impaired mental and physical conditions of the patient cause the circle to restart. As contemporary diagnostic entities do not refer to pathogenesis, classical categorical diagnostics cannot provide the basis for effective pathogenesis-oriented therapy. A change of paradigm in diagnostics from a categorical to a dimensional approach thus becomes necessary. Following a dimensional diagnostic approach based on a dynamic model of vulnerability, a precise differential diagnosis of the complex constellation of conditions and their interactions becomes necessary in order to develop effective treatment strategies. Disorder-maintaining factors determine the treatment of the acute symptomatology, whereas predisposing and triggering factors serve as the basis for the prophylactic treatment.

Psychosozialer Dienst Burgenland: Organisation und Eigenreflexionen

Der heutige Psychosoziale Dienst Burgenland wurde von Hofrat Dr. Braun und Dr. Demel bereits im Jahre 1959 gegrundet. Diese Pionierleistung bewahrte sich so gut, das im Jahre 1965 bereits drei Beratungsstellen existierten. Bis zum Jahre 1968 wurden dort ausschlieslich Alkoholkranke behandelt. Danach erfolgte die Offnung dieser Institution auch fur Patienten mit anderen psychiatrischen Erkrankungen. Durch die gute Zusammenarbeit mit den niedergelassenen praktischen Arzten und den noch immer viel zu wenigen Facharzten in diesem Gebiet sind wir heute in der Lage, in den derzeit bestehenden Beratungsstellen Neusiedl, Eisenstadt, Mattersburg, Oberpullendorf, Oberwart, Gussing und Jennersdorf unseren Patienten nicht nur Behandlung, sondern auch Vor- und Nachsorge anzubieten.