Two types of classification for male opioid dependence: identification of an opioid addict with depressive features.

OBJECTIVE: There are similarities between alcoholics and opioid addicts and an overlap between both diagnostic groups. We tested the hypothesis that the type I and II classification, well established in male alcoholism, could also be relevant in a population of male opioid addicts. METHODS: A sample of 100 hospitalized adult opioid dependent men were studied with the help of an extended semi-structured clinical interview, considering four classification criteria sets devised by Cloninger et al. (1981, 1982), von Knorring et al. (1985, 1987), Buydens-Branchey et al. (1989) and Babor et al. (1992). RESULTS: The two types of classification could be confirmed with all four criteria sets. In at least three of four analyses, 52 patients were allocated to the same larger cluster C1, and 25 patients to a smaller cluster C2. These two groups were compared with each other with the help of the stepwise discriminant analysis. Seven variables were identified which excellently discriminate between the groups: The C2 patient is younger, has a history of therapy because of depression and a history of severe suicide attempts, also abuses benzodiazepines and becomes violent while intoxicated. His father suffers from alcoholism and received treatment because of depression. The C1 patient lacks these characteristics. CONCLUSIONS: The hypothesis was confirmed, showing that the two types of classification for male opioid addicts is feasible. A depressive type of male opioid dependent patient was identified. Early identification of patients of this type is clinically important.

Antecedents of opioid dependence and personality disorder: attention-deficit/hyperactivity disorder and conduct disorder.

Both attention-deficit/hyperactivity disorder (ADHD) and conduct disorder (CD) were explored as possible antecedents of opioid dependence and personality disorder. One hundred adult opioid-dependent, treatment-seeking male inpatients were explored; an extended clinical semistructured interview to collect sociodemographic, drug use related, and clinical data and the Structured Clinical Interview for DSM-IV personality disorders SCID-II were carried out. Four groups of patients, namely ADHD alone (4 patients), ADHD + CD (7 patients), CD alone (47 patients) and no ADHD/no CD (42 patients) were identified and compared with each other. The results indicate that ADHD alone does not predispose to the development of opioid dependence in male inpatients. Childhood ADHD may nevertheless be found more frequently in male opioid addicts due to its comorbidity with CD, which was identified in more than half of our sample. Patients with ADHD history seemed to go through the drug abuse career earlier and to develop more frequently histrionic and obsessive-compulsive personality disorder. Over half of the CD patients developed borderline and/or antisocial personality disorder; both ADHD and CD predispose significantly to the PD development. Early substance use preventive measures are necessary in children and adolescents suffering from CD and from ADHD comorbid with CD.

Measurement and meaning of head movements in everyday face-to-face communicative interaction.

Methodological approaches in which data on nonverbal behavior are collected usually involve interpretative methods in which raters must identify a set of defined categories of behavior. However, present knowledge about the qualitative aspects of head movement behavior calls for recording detailed transcriptions of behavior. These records are a prerequisite for investigating the function and meaning of head movement patterns. A method for directly collecting data on head movement behavior is introduced. Using small ultrasonic transducers, which are attached to various parts of an index person's body (head and shoulders), a microcomputer determines receiver-transducer distances. Three-dimensional positions are calculated by triangulation. These data are used for further calculations concerning the angular orientation of the head and the direction, size, and speed of head movements (in rotational, lateral, and sagittal dimensions). Further analyses determine relevant changes in movements, identify segments of movements, and classify the quantifications of movement patterns. The measured patterns of nonverbal behavior can be accurately related to features of verbal communication and other time-related variables (e.g., psychophysiological measures). To estimate the possible meanings of behavioral patterns, a heuristic is proposed that includes the situational context as the basis of interpretation.

Two types classification of male alcoholism confirmed.

In recent years a two types classification of male alcoholism has been proposed by several authors. The study aimed at a testing of type I/type II classification of alcoholism in an independent sample. A total of 351 Research Diagnostic Criteria (RDC) male alcoholics consecutively admitted for an inpatient psychiatric treatment were studied. Type II characteristics were extracted from the pertinent literature; 19 available variables best representing these characteristics were selected. The data was collected using the method of a retrospective evaluation of clinical records. Cluster analysis yielded two clusters which were well separated from each other. Heterogeneity of the male inpatient population of alcoholics was demonstrated and the existence of broadly defined type I and type II alcoholism was confirmed.

Failure to identify a male winter-born schizophrenia subgroup clinically.

The distribution of 282 Research Diagnostic Criteria (RDC) and of 224 DSM-III-R schizophrenic patients, respectively, by month of their birth was studied. The winter-spring birth rate excess was confirmed with a maximum from January to March. Winterborn and summer-born schizophrenics were compared. No convincing differences were found with regard to a larger set of demographic, psychosocial and clinical variables in univariate comparisons, nor did we succeed in separating and identifying a special winter-born schizophrenia subgroup using the method of cluster analysis. Negative results were obtained in spite of the fact that many of the included variables reflected the course of the illness and the degree of chronicity. Either the set of the variables we used has not been 'correct' enough or the separation of a winter-born subgroup is not clinically feasible.

Season of birth: comparison of patients with schizophrenia, affective disorders and alcoholism.

The distribution of patients suffering from schizophrenia, affective disorders and alcoholism by months of their birth was studied, all patients having been reliably diagnosed using Research Diagnostic Criteria. Significant differences were found between the three groups. The winter-spring birth rate excess in schizophrenia was confirmed, a spring-summer birth rate excess in alcoholics was demonstrated. Different distributions are due to different reasons: for schizophrenic patients the harmful effects hypothesis and for alcoholics the procreational hypothesis seem to be appropriate explanations.

Differences between long-stay and short-stay inpatients and estimation of length of stay. A prospective study.

To find possible differences between new long-stay inpatients and patients with shorter lengths of stay, a prospective study of 340 inpatients in the 4th week of hospitalization was carried out. The new long-stay patients differed from the others in diagnoses, symptoms, duration of prior hospitalizations, and socio-demographic data. On the basis of the data assessed in the 4th week of hospitalization, we tried not only to predict future new long-stay patients, but also to estimate the length of stay for all 340 patients. A time-function model was employed with length of stay as a continuous variable, and this resulted in correct allocation to the quartiles in 38-48% of the cases. Six variables proved to be important for estimating length of stay: emotional withdrawal, blunted affect, mannerisms, duration of previous hospitalizations, living conditions (prior to admission), and marital status.

[Prescribing practice of psychotropic drugs in a psychiatric university clinic]. / Die Verschreibepraxis von Psychopharmaka in einer psychiatrischen Universitätsklinik.

An investigation on the use of psychotropic drugs in a Swiss university psychiatric hospital shows that compared with other drug surveys drugs were prescribed to relatively fewer patients and polypharmacy was used in less than 50% of the patients. The most frequently administered drugs were neuroleptics, among which, surprisingly. Clozapine ranked first. Antidepressants were prescribed in relatively low doses. A drug survey like ours can provide a basis for the critical discussion of prescribing habits.

Therapy factors in treating severely ill psychiatric patients.

We studied therapeutic factors influencing suicide during out-patient treatment in severely ill discharged psychiatric in-patients. A subsample of 25 suicide and 27 control patients were all treated by psychiatrists at the time of their suicide or at a corresponding point of time. We were not able to identify any significant psychosocial or clinical pre-discharge differences between the two groups. After discharge, the patients of the control group were treated by psychiatrists with substantially longer professional training-plus-experience, the therapist's experience being the most important therapy factor contributing to the different outcome. On the whole, the contribution of the therapy factors was modest, however, explaining only 26 per cent of the group variance.

Role of modelling in in-patient suicide: a lack of supporting evidence.

An analysis of the temporal distribution of 115 in-patient suicides that occurred in two Swiss psychiatric hospitals in the years 1977-86 failed to reveal any statistically significant clustering of suicides. Thus, the modelling effect does not generally play a decisive role in psychiatric in-patient suicide.

[Experimental examination on the development of altered states of consciousness by autogenic training in comparison to sensory deprivation]. / Eine experimentelle Untersuchung über das Auftreten veränderter Bewusstseinszustände bei autogenem Training im Vergleich mit sensorischer Deprivation.

In a sample of 32 trainees of autogenic training the alterations of the state of consciousness during the exercises were recorded by means of a questionnaire (APZ). To check the influence of acoustic stimulation the subjects were exposed to various sounds by headphone. The data were compared with the results of an experiment with sensory deprivation. A significant correspondence was found between the altered states of consciousness through sensory deprivation and autogenic training under usual low stimulus condition. According to these results autogenic training can be understood as a technique of self-induced sensory deprivation.