RESUMEN
BACKGROUND: In schizophrenia research, early detection in the initial prodrome before first psychotic episodes is a major topic. Therefore, the prognostic accuracy of initial prodromal symptoms was examined prospectively. METHODS: The study sample was composed of patients referred to outpatient departments of German psychiatric university departments, because of diagnostic problems, between 1987 and 1991. They were examined with the Bonn Scale for the Assessment of Basic Symptoms and the Ninth Version of the Present State Examination to detect an incipient schizophrenic disorder. Of 385 patients showing no schizophrenia-characteristic symptoms, between 1995 and 1998, 110 with and 50 without initial prodromal symptoms were followed up and reexamined with the same instruments for a transition to schizophrenia. RESULTS: During a mean follow-up period of 9.6 years, 79 (49.4%) of the 160 patients had transited to schizophrenia. The absence of prodromal symptoms excluded a subsequent schizophrenia with a probability of 96% (sensitivity: 0.98; false-negative predictions: 1.3%), whereas their presence predicted schizophrenia with a probability of 70% (specificity: 0.59; false-positive predictions: 20%). Certain disturbances, such as thought interference, disturbances of receptive language, or visual distortions, predicted schizophrenia, even with a probability up to 91% (specificity: 0.85-0.91; false-positive predictions: 1.9%-7.5%). CONCLUSIONS: The Bonn Scale for the Assessment of Basic Symptoms operationalization of prodromal symptoms performed well in the early detection of schizophrenia. It therefore might be useful for the prediction of the disorder, especially if it is further refined to select those items with particularly high prognostic accuracy.
Asunto(s)
Esquizofrenia/diagnóstico , Adulto , Reacciones Falso Positivas , Femenino , Estudios de Seguimiento , Humanos , Modelos Logísticos , Masculino , Trastornos Mentales/diagnóstico , Valor Predictivo de las Pruebas , Probabilidad , Pronóstico , Escalas de Valoración Psiquiátrica/estadística & datos numéricos , Psicometría , Curva ROC , Psicología del Esquizofrénico , Sensibilidad y EspecificidadRESUMEN
UNLABELLED: SPECT/PET studies in schizophrenia revealed inconsistent changes of regional cerebral blood flow (rCBF). Frontal hyperperfusion as well as hypoperfusion are described. This study was undertaken to investigate the relations between rCBF, psychopathology according to PANSS and effects of neuroleptic therapy. METHODS: Twenty-four drug-naive acute patients with a first manifestation of schizophrenia were examined with 99mTc-HMPAO brain SPECT and assessed according to PANSS. Of these, 22 were controlled again after neuroleptic treatment. Following attenuation correction, region-to-cerebellar count ratios were obtained from 98 irregular regions of interest drawn in all slices (6.25 mm). The ratios were compared to 20 control subjects, and changes lying outside of 2 s.d. were considered abnormal. RESULTS: In different drug-naive patients, hyperperfusion as well as hypoperfused patterns were found. In drug-naive patients, the seven subscores of positive symptoms (pos 1-7) in PANSS showed different correlations to rCBF: Formal thought disorders (pos 2) and grandiosity (pos 5) were positively correlated to bifrontal and bitemporal rCBF (r = +0.59 to +0.70). Delusional ideas (pos 1), hallucinatory behavior (pos 3) and suspiciousness (pos 6) demonstrated a negative correlation to bifrontal, cingulate, left temporal and left thalamic rCBF (r = -0.59 to -0.66). Stereotyped ideas (neg 7) as a negative symptom showed a negative correlation to left frontal, left temporal and left parietal rCBF (r = -0.59 to -0.65). No correlations were found between residual positive symptoms and rCBF after neuroleptic treatment and clinical improvement, but all negative symptoms (neg 1-7) had a negative correlation to bifrontal, bitemporal, cingulate, basal ganglia and thalamic rCBF (r = -0.59 to -0.74). CONCLUSION: Our results illustrate that different positive symptoms are accompanied by different rCBF values: some induce hyperperfusion, others hypoperfusion. After therapy (and reduction of positive symptoms), only negative symptoms correlate exclusively to hypoperfusion. This may be the crucial factor in explaining inconsistencies of past results in perfusion pattern in drug-naive schizophrenic patients.
Asunto(s)
Antipsicóticos/farmacología , Encéfalo/diagnóstico por imagen , Circulación Cerebrovascular , Esquizofrenia/diagnóstico por imagen , Esquizofrenia/tratamiento farmacológico , Tomografía Computarizada de Emisión de Fotón Único , Adulto , Antipsicóticos/uso terapéutico , Encéfalo/irrigación sanguínea , Encéfalo/efectos de los fármacos , Encéfalo/fisiopatología , Circulación Cerebrovascular/efectos de los fármacos , Femenino , Humanos , Masculino , Variaciones Dependientes del Observador , Compuestos de Organotecnecio , Oximas , Flujo Sanguíneo Regional/efectos de los fármacos , Esquizofrenia/fisiopatología , Índice de Severidad de la Enfermedad , Estadística como Asunto , Exametazima de Tecnecio Tc 99mRESUMEN
There is some empirical evidence that selective serotonin reuptake inhibitors reduce suicidal ideas faster than other antidepressants. These findings are well in line with the theory of a serotonergic hypofunction in suicidal patients. To test this hypothesis the data of a 6-week double-blind control-group study comparing paroxetine versus amitriptyline were analyzed with respect to suicidality. The global antidepressive efficacy was comparable under dosages of 30 mg paroxetine or 150 mg amitriptyline per day. A differentiated analysis failed to confirm the hypothesis of a faster reduction of suicidal cognitions by paroxetine.
Asunto(s)
Paroxetina/uso terapéutico , Inhibidores Selectivos de la Recaptación de Serotonina/uso terapéutico , Suicidio/psicología , Adulto , Trastorno Depresivo/tratamiento farmacológico , Trastorno Depresivo/psicología , Método Doble Ciego , Humanos , Escalas de Valoración PsiquiátricaRESUMEN
The items of the HAM-D(17-item version) were analyzed by a nonmetric (ordinal) multi-dimensional scaling procedure (Smallest Space Analysis, SSA-I) and the structure of the test items characterized within the framework of Guttman's facet theory. Two systematic components (facets) were discerned: 'centrality' and 'aspect'. Properties of the facets as well as their relations were assessed and examined empirically by analyzing the inter-relations among different items. The spatial configurations obtained by the scaling procedure were found only partially to fit the expectations derived from the facet-theory model. The facet 'centrality' was found to have a strong overriding influence over the 'aspect' facet. The results suggest the value of a new combination and selection of items reflecting different facets of depression consistently over time.
Asunto(s)
Amitriptilina/uso terapéutico , Antidepresivos/uso terapéutico , Trastorno Depresivo/tratamiento farmacológico , Inventario de Personalidad/estadística & datos numéricos , Piperidinas/uso terapéutico , Antagonistas de la Serotonina/uso terapéutico , Adolescente , Adulto , Anciano , Amitriptilina/efectos adversos , Antidepresivos/efectos adversos , Trastorno Depresivo/diagnóstico , Trastorno Depresivo/psicología , Método Doble Ciego , Análisis Factorial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Modelos Estadísticos , Paroxetina , Piperidinas/efectos adversos , Estudios Prospectivos , Psicometría , Antagonistas de la Serotonina/efectos adversosRESUMEN
Affective instability in borderline personality disorder is due to a marked reactivity to environmental events. The present study focused on the relationship between affective instability and impulsivity in personality disorder. It used an experimental approach in the form of an affect-stimulation design based on the presentation of a short story which allowed for an analysis of affective responses in regard to quality, intensity, and alterations over time. Impulsive personalities showed a strong intensity of affective responses us well as a tendency towards rapid affect alterations supporting the theory of poor affect regulation in subjects with impulsive self-harming behaviour. Results suggest that affective instability is a crucial part of impulsive personality functioning.
Asunto(s)
Trastorno de Personalidad Limítrofe/complicaciones , Conducta Impulsiva/complicaciones , Trastornos del Humor/complicaciones , Adulto , Trastorno de Personalidad Limítrofe/psicología , Femenino , Humanos , Conducta Impulsiva/psicología , Trastornos del Humor/psicología , Conducta Autodestructiva/complicacionesRESUMEN
Single photon emission computed tomography with technetium-99m-d,l-hexamethylpropyleneamine oxime (99mTc-HMPAO) was used to assess regional cerebral blood flow (rCBF) during both florid and remitted stages of schizophrenia. Forty schizophrenic patients in an active phase of illness (diagnosis by DSM-III-R) were examined in two clinical states (ill vs. improved). At study entry, 24 patients were drug-naive, five were currently drug-free, and 11 were being treated with antipsychotic medication. Twenty medical patients who suffered from non-specific headaches but were free of neurological and psychiatric symptoms served as control subjects. At initial examination during the active phase of illness, cerebral perfusion patterns in the schizophrenic patients were characterized by both hypofrontality and hypotemporality. After remission, hypofrontality was no longer apparent in two of four frontal regions, and hypotemporality disappeared completely. As assessed with the Positive and Negative Syndrome Scale (PANSS), formal thought disorders, hallucinations, and ideas of grandiosity correlated with rCBF in the active phase of illness, but not after remission. In the remitted but not in the florid state, blunted affect, difficulties in abstract thinking, lack of spontaneity, and stereotyped thoughts correlated with rCBF. Correlations of five symptoms with rCBF changed significantly from first to second examination. The present study suggests that correlations between single psychotic symptoms and rCBF differ significantly in florid vs. remitted phases of schizophrenia.
Asunto(s)
Circulación Cerebrovascular , Esquizofrenia/diagnóstico por imagen , Adulto , Encéfalo/diagnóstico por imagen , Femenino , Humanos , Masculino , Tomografía Computarizada de Emisión de Fotón ÚnicoRESUMEN
Categorical and dimensional models of personality, and personality disorders and their interrelationships, are discussed. A facet theoretical analysis of the structural relationships between personality factors and disorders is described. It is hypothesized that higher-order personality traits organize the personality of both the psychically healthy and the psychically ill, and that personality disorders represent maladaptive variants of traits that are evident in all persons to varying degrees. Data were collected from a clinical (n = 165) and a nonclinical sample (n = 100). Results show that the two classes of variables (personality factors and disorders) have similar relationships to each other, and can be structured in the form of a radex in both samples. Finally, the compatibility of the radex structure with other models is examined, comparing facet theory with factor analytical techniques. The results of the facet theoretical analysis further support the hypothesis of a universal personality model, and a continuous transition from normal personalities to personality disorders.
Asunto(s)
Trastornos de la Personalidad/diagnóstico , Personalidad , Teoría Psicológica , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trastornos de la Personalidad/psicología , Escalas de Valoración PsiquiátricaRESUMEN
Based on a sample of 325 inpatients we present the subjective experiences during simple partial seizures. In a majority of cases, auras comprised composed forms of different symptomatic qualities. We describe rules which seem to govern sequences of aura phenomena. Autonomous and vestibular sensations were shown to have preceding positions related to others, olfactory and gustatory sensations preferred a following position. The tentative explanation of the findings favours the idea of heterogeneity rather than the concept of a focal discharge in a simple partial seizures.
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Epilepsias Parciales/diagnóstico , Epilepsia Parcial Compleja/diagnóstico , Epilepsia Tónico-Clónica/diagnóstico , Enfermedades del Sistema Nervioso Autónomo/clasificación , Enfermedades del Sistema Nervioso Autónomo/diagnóstico , Epilepsias Parciales/clasificación , Epilepsia Parcial Compleja/clasificación , Epilepsia Tónico-Clónica/clasificación , Humanos , Examen Neurológico , Trastornos de la Percepción/clasificación , Trastornos de la Percepción/diagnóstico , Estudios Retrospectivos , Enfermedades Vestibulares/clasificación , Enfermedades Vestibulares/diagnósticoAsunto(s)
Trastornos del Humor/diagnóstico , Trastornos de la Personalidad/diagnóstico , Adulto , Trastorno Bipolar/clasificación , Trastorno Bipolar/diagnóstico , Trastorno Bipolar/psicología , Trastorno Ciclotímico/clasificación , Trastorno Ciclotímico/diagnóstico , Trastorno Ciclotímico/psicología , Trastorno Depresivo/clasificación , Trastorno Depresivo/diagnóstico , Trastorno Depresivo/psicología , Femenino , Humanos , Masculino , Trastornos del Humor/clasificación , Trastornos del Humor/psicología , Neurastenia/clasificación , Neurastenia/diagnóstico , Neurastenia/psicología , Trastornos de la Personalidad/clasificación , Trastornos de la Personalidad/psicología , Escalas de Valoración Psiquiátrica/estadística & datos numéricos , Psicometría , Reproducibilidad de los ResultadosRESUMEN
Regional cerebral blood flow (rCBF) was analysed in 24 neuroleptically never treated schizophrenics by 99m-Tc-HMPAO-SPECT. Psychopathological symptoms (PANSS) were correlated with rCBF-measures using multidimensional scaling (MDS). Highest degrees of correlation were found for ideas of grandiosity and formal thought disorders compared to different regions of interest (ROIs). An adynamic cluster was defined by basic symptoms which showed signs of deficiency. This cluster was by the highest degree correlated with a cluster defined by rCBF compared to four different clusters of basic symptoms. A fMRI-study was performed in schizophrenic patients with auditive hallucinations in comparison to healthy controls. We offered simple acoustic stimuli perceived as coming from the outside versus inside. For the outside condition, controls activated the medial temporal gyrus on the left side and the rightsided precuneus and postcentral gyrus which represent the auditive source locating and the stimulus processing systems, for inside, they activated the left insula. Hallucinating schizophrenic neither activated the one nor the other system. We discussed the findings as a possible explanation of the schizophrenics' tendency to misinterpret hallucinations as real perceptions.
Asunto(s)
Encéfalo/patología , Encéfalo/fisiopatología , Circulación Cerebrovascular/fisiología , Trastornos Psicóticos/patología , Trastornos Psicóticos/fisiopatología , Encéfalo/diagnóstico por imagen , Alucinaciones/diagnóstico por imagen , Alucinaciones/fisiopatología , Humanos , Imagen por Resonancia Magnética , Trastornos Psicóticos/diagnóstico por imagen , Psicología del Esquizofrénico , Tomografía Computarizada de Emisión de Fotón ÚnicoRESUMEN
The items of the Beck Depression Inventory are reanalyzed by a non-metric multidimensional scaling procedure (Smallest Space Analysis, SSA-I). The structure of the test items is characterized within the framework of Guttman's facet theory. Two systematic components (facets) are discerned: "centrality" and "aspect". Properties of the facets as well as their relations are assessed and examined empirically by analyzing the interrelations among the items. The spatial configurations obtained by the scaling procedure fit the expectations derived from the facet-theoretic model. The facet "centrality" was found to have a strong overriding influence over the "aspect" facet. The results suggest the introduction of a new combination and selection of items reflecting different facets of depression consistently over time.
Asunto(s)
Trastorno Depresivo/diagnóstico , Inventario de Personalidad/estadística & datos numéricos , Antidepresivos/uso terapéutico , Trastorno Depresivo/clasificación , Trastorno Depresivo/tratamiento farmacológico , Trastorno Depresivo/psicología , Análisis Factorial , Estudios de Seguimiento , Humanos , Programas InformáticosRESUMEN
With the help of an analytical path structure model (causal analysis) the aim of the study was to elucidate further, in female patients with various depressive disorders, some correlations of causal interdependencies between changes both in basal secretion of anterior pituitary hormones and in their responses to the (combined) insulin tolerance test (ITT) with extraneous factors--such as age, deviation from ideal body weight (in percentage), severity of depression and score in the Newcastle Scale (NCS)--that may influence these abnormalities. In various depressive subgroups the strength of influence and the different importance of deviation from ideal body weight and basal growth hormone (GH) concentration (as exclusion criteria) for their neuroendocrine reactivity in the combined ITT was shown. The hypothesis that cortisol hypersecretion may be the primary disturbance and the other possible neuroendocrine changes such as blunted GH, cortisol and TSH responses to stimuli in some depressive patients all may be secondary to the (elevated) cortisol level could not be corroborated. The endogenous mono- and bipolar subtypes of major depressive disorders showed intimate connections between the various neuroendocrine functional systems and the above mentioned extraneous factors resulting in a narrowed variability and a stronger coupling in the reactivity of these hormonal functional systems, a condition which can be seen as analogous to experimental results at the psychophysiological level in these nuclear groups of depressed patients, whose psychopathological state is also characterized by similar limitations in their "degree of freedom" (Heimann).
Asunto(s)
Trastorno Bipolar/sangre , Glucemia/metabolismo , Trastorno Depresivo/sangre , Hormonas/sangre , Insulina , Adulto , Trastorno Bipolar/diagnóstico , Trastorno Depresivo/diagnóstico , Femenino , Hormona Liberadora de Gonadotropina , Hormona del Crecimiento/sangre , Humanos , Hidrocortisona/sangre , Cinética , Persona de Mediana Edad , Prolactina/sangre , Tirotropina/sangre , Hormona Liberadora de TirotropinaRESUMEN
Statistical time-series analyses of single case data allow a sophisticated person-centered evaluation of therapeutic effects. The possibilities and limitations of a new method of time series analysis are shown by the example of mood curves of neurotic depressive patients. The HTAKA model seems advantageous, because this procedure is less restrictive than other methods as regards the data basis. The cluster-analytical agglomeration of the single-case results indicates a sufficient response to antidepressants in about 40% of the patients who were treated with antidepressants in addition to psychotherapy.
Asunto(s)
Afecto/efectos de los fármacos , Antidepresivos/uso terapéutico , Análisis por Conglomerados , Trastorno Depresivo/tratamiento farmacológico , Modelos Estadísticos , Interpretación Estadística de Datos , Humanos , Escalas de Valoración PsiquiátricaRESUMEN
So far, little systematic work had been done to investigate how information regarding psychiatric cases should best be presented in order to facilitate important medical decisions. For each of three groups of diseases: (a) schizophrenic reaction, paranoid, (b) manic-depressive, depressed, and (c) anxiety neurosis, we have described four different cases, systematically varying both quantitatively and qualitatively the information in each description. Categorical judgement was given by 15 psychiatrists on a nine-step rating scale with regard to three dimensions. In order to investigate the constancy of the judgements, the method of scaled pair comparisons was used according to the law of comparative judgement. After examination of the adequacy of the scaling models, the following results, among others, were obtained from the scale scores: the discrimination of the two cases of psychoses was highly significant, that of the anxiety neurosis was not significant.
Asunto(s)
Trastornos Mentales/diagnóstico , Trastornos de Ansiedad/diagnóstico , Trastorno Bipolar/diagnóstico , Toma de Decisiones , Humanos , Entrevista Psicológica , Esquizofrenia Paranoide/diagnósticoRESUMEN
After a short overview about the use of audiovisual methods in psychiatry and psychotherapy we present a single case study of a young woman suffering from anorexia nervosa. In a typical way the patient could not accept the idea that she had an emotional disorder and did not accept being admitted to hospital or to come as an outpatient to psychotherapeutic treatment. We used the method of audiovisual heteroconfrontation, i.e., she was confronted with the videotape of another patient suffering from the same disorder. After four sessions of confrontation she was extremely occupied with herself, she suffered more from her condition and was motivated to undergo psychotherapy. Finally, the process of heteroconfrontation is discussed.
Asunto(s)
Anorexia Nerviosa/terapia , Recursos Audiovisuales , Psicoterapia/métodos , Adulto , Anorexia Nerviosa/psicología , Imagen Corporal , Peso Corporal , Negación en Psicología , Dieta Reductora/psicología , Femenino , Humanos , MotivaciónRESUMEN
Schizoaffective disorders take a position between schizophrenia and affective disorders regarding outcome in the sense of psychological residuum and social consequences. What prognosis a schizoaffective illness has depends mainly on intrasymptomatological factors: Melancholic episodes during course seem to predict a good long-term outcome, schizophrenia-typical symptoms in the opposite predestinate to the development of residuum and disability. Non-symptomatological factors do not have any direct influence on the development of a residuum and disability. The comparison of course studies is limited by severe difficulties based on methodological and definitional shortcomings. Such shortcomings are (a) broad definition of schizoaffective but also of schizophrenic psychoses, (b) globalization of the term "outcome", (c) partialization of the term "prognosis", (d) equalization of the terms "course" and "outcome", (e) ignoring of inhomogeneity and polymorphism of schizoaffective disorders, (f) global evaluation of "outcome", (g) short follow-up periods. Some suggestions how to limitate the mentioned methodological shortcomings are discussed.
Asunto(s)
Evaluación de la Discapacidad , Trastornos Psicóticos , Trastornos Psicóticos/rehabilitación , Esquizofrenia/rehabilitación , Psicología del Esquizofrénico , Estudios de Seguimiento , Humanos , Pronóstico , Trastornos Psicóticos/psicología , InvestigaciónRESUMEN
This report describes the results obtained in a double-blind, six week, prospective, randomized multicenter study. The efficacy, tolerability, and safety of moclobemide (300-600 mg/d) were compared to those of maprotiline (75-150 mg/d) in parallel groups of patients with a Major Depressive Episode (DS-III). In addition, participants were required to have a minimum baseline total score of 17 on the 17-item Hamilton Depression Rating Scale (HAMD) (no run-in), 115 male or female outpatients (aged over 18 years) were randomly allocated to moclobemide t.i.d. (n = 58) or to maprotiline t.i.d. (n = 57). Demographic and illness characteristics were comparable in both treatment groups upon study entry. During the study the patients were not required to avoid tyramine-rich foods but they were advised to take trial medication after meals. Patients were assessed for efficacy and tolerability on days 4, 11, 18, 25, 32, 39, and 46. Efficacy was judged primarily on the HAMD, the investigator's final overall assessment, and on the number of premature terminations associated with insufficient efficacy. No significant difference was observed between both groups. The mean % reduction of the HAMD at the end of treatment was 62.2 in the moclobemide group and 61.2 in the maprotiline group. The percentage of patients in whom efficacy was globally judged as "good" or "very good" was 63.0% in the moclobemide group and 58.5% in the maprotiline group. Seventeen percent moclobemide patients and 21% of maprotiline patients did not complete because of insufficient efficacy.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Benzamidas/uso terapéutico , Trastorno Depresivo/tratamiento farmacológico , Maprotilina/uso terapéutico , Inhibidores de la Monoaminooxidasa/uso terapéutico , Adolescente , Adulto , Anciano , Benzamidas/efectos adversos , Trastorno Depresivo/psicología , Método Doble Ciego , Femenino , Humanos , Masculino , Maprotilina/efectos adversos , Persona de Mediana Edad , Moclobemida , Inhibidores de la Monoaminooxidasa/efectos adversos , Estudios Prospectivos , Escalas de Valoración PsiquiátricaRESUMEN
Although DSM-III-R and ICD-10 suggest the assignment of multiple personality diagnoses, a high degree of overlap may be an indicator of insufficiently distinct and too inclusive types of personality. We studied this problem with a new inventory in an unselected clinical sample. The Aachen List of Items for the Registration of Personality Disorders (AMPS) integrates the different types of disordered personality according to DSM-III-R, ICD-10, and four subaffective categories, which largely follow the typologies of Kraepelin, K. Schneider, and Kretschmer. The prevalence rate of each personality disorder was calculated in a consecutive group of 231 patients. Patterns of comorbidity were computed using odds ratios. More than one personality disorder was found in 41% according to DSM-III-R. ICD-10 showed a significantly higher degree of overlap. Interesting comorbidity patterns are discussed in comparison with several North American studies. Results indicate that clear-cut categorical personality diagnoses are not likely to be set up.
Asunto(s)
Trastornos Mentales/epidemiología , Trastornos de la Personalidad/epidemiología , Inventario de Personalidad/estadística & datos numéricos , Escalas de Valoración Psiquiátrica/estadística & datos numéricos , Adulto , Comorbilidad , Comparación Transcultural , Femenino , Alemania/epidemiología , Humanos , Masculino , Trastornos Mentales/clasificación , Trastornos Mentales/diagnóstico , Persona de Mediana Edad , Oportunidad Relativa , Trastornos de la Personalidad/clasificación , Trastornos de la Personalidad/diagnóstico , Psicometría , Estados Unidos/epidemiologíaRESUMEN
The present study reports on findings in international literature regarding premorbid and social factors of schizoaffective patients and also own findings of the Cologne study (72 schizoaffective patients with a mean follow-up period of 25.6 years). Altogether it can be said that more women suffer from schizoaffective disorders than men. The mean age at first manifestation is higher than that of schizophrenic patients and lower than that of affective disorders, although schizoaffective disorders can occur at any age. Premorbid social adjustment and ability to form a stable heterosexual partnership before onset are good in schizoaffective patients. There seems to be no special premorbid personality of schizoaffective patients. Education and level of vocational training are generally good. Only a few schizoaffective patients belong to the lower social classes. Most schizoaffective patients do not come from a "broken home". Although "life events" are frequent in a schizoaffective population, the relevance of this finding has to be limited: If we evaluate "life events" in regard to single episodes, we find that most episodes, especially episodes occurring during the later course, do not have precipitating factors. In conclusion, it can be said that - besides the already known better prognosis of schizoaffective disorders - several differences exist regarding premorbid and social factors, between schizoaffective disorders and schizophrenia.
Asunto(s)
Acontecimientos que Cambian la Vida , Trastornos Psicóticos/psicología , Ajuste Social , Adolescente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Desarrollo de la Personalidad , Trastornos Psicóticos/genética , Factores de Riesgo , Psicología del Esquizofrénico , Medio SocialRESUMEN
Modern statistical approaches to the analysis of single cases have so far been rarely employed in psychiatric therapy research. The recently developed Hierarchical Trend-Segment Component Analysis (HTAKA) seems to be an adequate and practicable method for the field of therapy evaluation, not only under sophisticated research conditions, but also under routine treatment conditions, but analysis data of the effects of sleep-deprivation therapy as an example, the results of nonparametric time-series analyses performed according to HTAKA are presented. The statistical agglomeration of the single case results demonstrated that in most cases undergoing repeated sleep deprivation a long-term antidepressive effect related to this therapy could be proven.