[Psychogenic Disorders in German soldiers during World War I and II]. / Psychogene Störungen bei deutschen Soldaten des Ersten und Zweiten Weltkrieges -- Eine vergleichende Betrachtung unter psychotraumatologischen Gesichtspunkten.

In the First and Second World War German soldiers frequently suffered from psychogenic disorders. By comparison a change in the prevalences can be noted: in the First World War dissociative disorders dominated the clinical impression ("shell shock"), in the Second World War they could rarely be seen but were replaced by somatoform and psychosomatic diseases. The discussion about numerous reasons for this development has not been completed yet and is still not free from political attitudes. To achieve a more scientific point of view, the perspective of psychotraumatology might be helpful. According to psychotraumatic research, dissociative and somatoform disorders can emerge in a close relation to a Posttraumatic Stress Disorder. The choice of symptoms depends on personality traits of the victim, but also on specific factors that characterise the situation in which the trauma appears. The mixture of pathogenetic and protective influences includes e. g. the possibility of flight- or fight reactions, feelings of trauma-associated guilt and group cohesion in the military unit. These factors can be useful to help explain the change of symptoms between both wars. In addition the analysis of situational conditions in former wars can give hints to actual planning and prophylaxis strategies in modern military psychiatry, that has to adjust to very different military operation fields.

[Diagnosis of premenstrual disorders]. / Diagnostik prämenstrueller Störungen - Deutschsprachige Fassung und Validierung der "Premenstrual Tension Syndrome Observer and Self-Rating Scale" (PMTS-O und -SR Scale) und der Visuellen Analogskala für prämenstruelle Störungen (VAS-PmS).

BACKGROUND AND OBJECTIVE: There is no valid method in the German literature for assessing premenstrual disorders. This study was undertaken to translate into German, validate and test the reliability of the "Premenstrual Syndrome Tension Observer/Self-Rating Scale" and the "Visual Analogue Scale for Premenstrual Disorders". PATIENTS AND METHODS: 55 patients diagnosed with premenstrual dysphoric disorder took part in the study. After fullfilling the inclusion criteria, sociodemographic and medical data were studied. The self-assessment by PMTS-SR and VAS-PmD was done two days premenstrual and nine days postmenstrual by all 55 patients. The objective assessment (done by a clinical interview and the PMTS-O as the reference standard) was obtained afterwards without knowing the self-assessment. RESULTS: The average age of the tested women was 35 years. The average increase of 85 % in premenstrual symptoms (PMTS-O and PMTS-SR scale) indicates a group with severe premenstrual disorders. The correlation coefficient between PMTS-O and PMTS-SR scale, pre- and postmenstrually, was 0.83 and 0.84, respectively (p < 0.0001 for both). The correlation coefficient between PMTS-O and VAS-PmD, pre- and postmenstrually, was 0.5 and 0.69, respectively (p < 0.0001 for both). This was calculated at 0.64 and 0.67, respectively (p < 0.0001 for both) between PMTS-SR and VAS-PmD. Reliability analysis for PMTS-O was, pre- and postmenstrually, 0.71 and 0.29, respectively, for PMTS-SR 0.77 and 0.78, respectively, and for VAS-PmD it was 0.79 and 0.87, respectively. CONCLUSIONS: The German version of the PMTS-O and the PMTS-SR scale are "application friendly" as well as proven to be a valid and reliable method for supporting the diagnosis, course of disease and research aspects concerning premenstrual disorders. Initially VAS-PmD should be used in combination with PMTS-O and PMTS-SR scale.

Grief after termination of pregnancy due to fetal malformation.

Termination of pregnancy for fetal malformation is a traumatic event which any woman finds hard to withstand and which entails the risk of severe and complicated grieving. This paper presents three cases illustrating the trauma and coping mechanisms. Grieving continued for over 6 months in all cases and included pathological anxiety and depression. We offer advice and counselling to such women.

A genome screen for genes predisposing to bipolar affective disorder detects a new susceptibility locus on 8q.

Bipolar affective disorder (BPAD), also known as manic depressive illness, is a severe psychiatric disorder characterized by episodes of mania and depression. It has a lifetime prevalence of approximately 1% in all human populations. In order to identify chromosomal regions containing genes that play a role in determining susceptibility to this psychiatric condition, we have conducted a complete genome screen with 382 markers (average marker spacing of 9.3 cM) in a sample of 75 BPAD families which were recruited through an explicit ascertainment scheme. Pedigrees were of German, Israeli and Italian origin, respectively. Parametric and non-parametric linkage analysis was performed. The highest two-point LOD score was obtained on 8q24 (D8S514; LOD score = 3.62), in a region that has not attracted much attention in previous linkage studies of BPAD. The second best finding was seen on 10q25-q26 (D10S217; LOD score = 2.86) and has been reported in independent studies of BPAD. Other regions showing 'suggestive' evidence for linkage localized to 1p33-p36, 2q21-q33, 3p14, 3q26-q27, 6q21-q22, 8p21, 13q11 and 14q12-q13. In addition, we aimed at detecting possible susceptibility loci underlying genomic imprinting by analyzing the autosomal genotype data with the recently developed extension of the GENEHUNTER program, GENEHUNTER-IMPRINTING. Putative paternally imprinted loci were identified in chromosomal regions 2p24-p21 and 2q31-q32. Maternally imprinted susceptibility genes may be located on 14q32 and 16q21-q23.

A possible susceptibility locus for bipolar affective disorder in chromosomal region 10q25--q26.

In an attempt to identify susceptibility loci for bipolar affective disorder, we are currently conducting a systematic genome screen with highly polymorphic microsatellite markers at an average marker spacing of 10 cM in a series of 75 families, comprising 66 families from Germany, eight families from Israel, and one family from Italy. The families were ascertained through index cases with bipolar affective disorder. The distribution of diagnoses is as follows: 126 individuals with bipolar I disorder, 40 with bipolar II disorder, 14 with schizoaffective disorder of the bipolar type, 40 individuals with recurrent unipolar depression, 51 with a minor psychiatric diagnosis, and two individuals with a diagnosis of schizophrenia. One hundred and seventy-one individuals are unaffected. Here, we present results from chromosome 10. Linkage analyses using a total of 33 microsatellite markers with parametric and non-parametric methods provided evidence for linkage at chromosomal region 10q25--q26. The highest two-point LOD score (2.86, theta = 0.05) was obtained for D10S217 using a dominant genetic model and a broad definition of affection status. The GENEHUNTER program localized the putative susceptibility locus within a ca 15-cM interval between markers D10S1483 and D10S217 with a maximum NPL(all) score of 3.12 (P = 0.0013). Positive linkage findings that have been reported by two independent studies further support the hypothesis of a susceptibility gene for bipolar affective disorder on 10q25-q26.

Systematic screening for DNA sequence variation in the coding region of the human dopamine transporter gene (DAT1).

The dopamine transporter (DAT) plays a central role in dopaminergic neurotransmission in the human brain. Genetic association studies have used a variable number of tandem repeat (VNTR) polymorphism in the 3'-flanking region of the dopamine transporter gene (DAT1) to implicate the DAT in the development of various neuropsychiatric disorders. In this study, we have examined the possibility that a mutation exists in the coding region of the DAT1 gene which through linkage disequilibrium accounts for the observed associations. The complete coding region, as well as exon-intron boundaries, was screened in 91 unrelated individuals including 45 patients with bipolar affective disorder and 46 healthy control individuals by the means of single strand conformation analysis. Our findings suggest that the DAT1 gene is highly conserved since we detected only two rare missense substitutions (Ala559Val, Glu602Gly) and three silent mutations (242C/T, 1342A/G, and 1859C/T) in the whole coding region. Five sequence variants were observed in intronic sequences but none affects known splice sites. The lack of frequent variants of possible functional relevance indicates that genetic variation in the coding region of the DAT1 gene is not responsible for the previously observed associations with neuropsychiatric disorders. The two rare missense substitutions were found in single bipolar patients but not in controls. Investigation of the patients' families revealed independent segregation between the Ala559Val variant and affective disorder. The Glu602Gly variant was inherited by the proband from an affected father. It therefore remains possible that Glu602Gly may be a rare cause of bipolar affective disorder.

[Dementia of the Alzheimer type in women]. / Demenz vom Alzheimer-Typ bei Frauen.

Within the different kinds of dementia, Alzheimer's Disease (AD) obviously is the only one showing relevant gender differences, concerning epidemiology, risk factors and cognitive deficits. Women more often suffer from AD, achieve lower Mini Mental Status Test scores when demented and show lower verbal skills. The possibility of using estrogen as a therapeutic agent, either only or as an augmentation to acetylcholinesterase inhibitors, could become more important for clinical practice, as it is said to cause distinct improvements of cognitive skills. Epidemiological studies were able to show that estrogen replacement therapy in menopausal women lowers risk of AD.

Delusion of infestation with post-partum onset: case report.

Compared with men, women have a greater lifetime risk of delusions of infestation, with the risk appearing to increase around the menopause, when the blood levels of reproductive hormones are decreasing. Women also have a greater lifetime risk of depression and an increased incidence of depressive symptoms post partum, when the blood levels of these hormones are decreasing as well. The first case of a delusion of infestation with post-partum onset is described, and possible associations with reproductive function in women are discussed.

[Postpartum dysphoric syndrome. Psychopathology, diagnosis and etiology]. / Das postpartale dysphorische Syndrom. Psychopathologie, Diagnostik und Atiologie.

About half of newly delivered mothers suffer a transient phase of emotional lability or sadness a few days after parturition around the 2nd and 5th day after delivery. The transitory psychopathology of the postpartum blues is similar to premenstrual tension, whose main symptom is irritability. The essence of the postpartum blues is not depression, but a sudden, fleeting and unexpected mood change with anxiousness, low spirits, tearfulness, confusion, poor concentration and forgetfulness. The aetiology of this disorder is unknown. It is well known that oestrogens and progesterone modify catecholamine concentration and the density of adrenergic, noradrenergic und dopaminergic receptors in the limbic structures of the central nervous system. But most of the neurochemical studies have not distinguished between postpartum blues and other forms of depression found in women and occurring postpartum. Those research groups who defined a group with a dysphoric peak in the early puerperium could not find a significant correlation between sex hormone levels, neurobiochemical data, and postpartum mood changes.

[Psychopharmacotherapy during pregnancy and lactation. 1: Pregnancy]. / Psychopharmakotherapie während Gravidität und Laktation. Teil 1: Gravidität.

Approximately one-third of all pregnant women take psychotropic drugs at least once during pregnancy. At the same time, there are no preparations on the market that can be considered entirely appropriate for expectant mothers. The effects of psychopharmacological therapies have exclusively been discussed in the context of their risk during the first trimester. However, treatment after this phase is not absolutely without risk, and it is striking that there are grave differences between various substances. There are currently controversial discussions going on in literature as far as the teratogenicity of lithium is concerned, especially during the formation of the heart. It is suggested that the risk for congenital malformations is increased after intrauterine lithium exposure, whereas such a risk cannot be proved for most of the antidepressants and neuroleptics. Still, it should be noted that psychopharmacology is not harmless even after the organogenesis, as intrauterine exposure during the 2nd and 3rd trimester can lead to postnatal complications. For example, floppy-infant syndrome after taking benzodiazepines, and the extrapyramidal-motor effects on the newborn after neuroleptic therapy during pregnancy should be mentioned.

[Psychopharmacotherapy in pregnancy and lactation. 2: Lactation]. / Psychopharmakotherapie während Gravidität und Laktation. Teil 2: Laktation.

Whilst the incidence of psychiatric disorders decreases during pregnancy, the risk during the postpartum period increases significantly, often leading to the necessity of psychopharmacological intervention during the puerperium, and subsequently during lactation and breast-feeding. The necessity for lithium prophylaxis in manic-depressive women after childbirth has been identified, and it is recommended that weaning rather than omission of psychopharmacological treatment is preferable during the puerperium.

Apolipoprotein E genotype distribution in schizophrenia.

We examined the hypothesis that apolipoprotein E (apoE) isoforms-besides their well-established role in the aetiology of early and late onset Alzheimer's disease (AD)-may be involved in the development of schizophrenia. We determined apoE genotypes in 98 schizophrenic patients and 98 sex and age matched controls. No significant difference in apoE allele frequencies were observed between schizophrenic patients, subpopulations of schizophrenics, or controls. There was also no difference in the mean age at onset depending on the number of apoE epsilon 4 alleles found in the patients. Our data do not support an association between AD and schizophrenia based on apoE acting as a common denominator in the pathogenesis of both diseases.

Linkage studies of bipolar disorder in the region of the Darier's disease gene on chromosome 12q23-24.1.

We have recently described a family in which there is cosegregation of major affective disorder with Darier's disease and have mapped this autosomal dominant skin disorder to 12q23-q24.1. This has provided an interesting candidate region for genetic studies of bipolar disorder. We have studied the segregation of seven markers spanning the Darier's disease locus in 45 bipolar disorder pedigrees and found modest evidence in support of linkage under heterogeneity for 5 of these markers. Nonparametric analyses were suggestive of linkage with a marker at the gene encoding a secretory form of phospholipase A2. Our sample has relatively low power to detect linkage under heterogeneity and independent researchers should examine markers from this region in further samples of bipolar pedigrees.

Cholinergic neurotransmission seems not to be involved in depression but possibly in personality.

Concordant with the adrenergic-cholinergic imbalance hypothesis of affective psychosis, there is a cholinergic supersensitivity in depression. Thus, the anticholinergic properties of some antidepressants might contribute to their efficacy. However, in the present double-blind studies (n = 20) with mianserin and viloxazine, respectively, which lack anticholinergic properties, adjunctive treatment with the anticholinergic biperiden versus placebo did not enhance the antidepressive efficacy. Therefore, we hypothesized that cholinergic supersensitivity might be linked to some possibly predisposing dimension of personality. Indeed, in healthy male volunteers (n = 11) the behavioral and cardiovascular sensitivity to physostigmine correlated significantly with "irritability" and "emotional lability" as well as with habitually passive strategies in stress coping. The rise in plasma cortisol and norepinephrine correlated with "retardation"; that of epinephrine with active coping. Thus, the cholinergic supersensitivity in affective psychoses might be linked to a personality dimension like stress sensitivity rather than to the diagnostic category itself.

Carbamazepine as adjunct or alternative to lithium in the prophylaxis of recurrent affective disorders.

Patients with affective disorder insufficiently responding to prophylactic lithium present a major problem to maintenance pharmacotherapy. The present retrospective study tested the efficacy of carbamazepine in 73 such patients. The patients who were switched from lithium to carbamazepine monotherapy had additional benefit, but not those switched to combined lithium plus carbamazepine. This failure to replicate a number of recent pilot studies showing synergistic effects of lithium and carbamazepine may however have been due to a heterogeneity concerning the combined effects of some negative response predictors, although none of these was significant in itself. Nevertheless, synergism cannot be taken as guaranteed. Prospective controlled trials are needed.

Postpartum blues: relationship between not-protein bound steroid hormones in plasma and postpartum mood changes.

The relationship between non-bound steroid hormone levels in plasma and the occurrence of postpartum mood changes was investigated in 26 newly delivered mothers throughout the first 5 days postpartum. Studies with saliva samples had reported higher concentrations of 17 beta-estradiol and progesterone on the days of symptoms in women experiencing postpartum blues. As there had been a controversy as to how far saliva concentrations reflect free hormone levels in plasma, free hormone levels of 17 beta-estradiol and progesterone were determined in plasma using ultrafiltration. No significant difference concerning free hormone levels could be found between women with and without postpartum blues.

An association study of debrisoquine hydroxylase (CYP2D6) polymorphisms in schizophrenia.

The cytochrome P450 mono-oxygenases are a group of enzymes that metabolize a variety of exogenous and endogenous compounds, some of which are potentially toxic. Individual variations in the metabolism of potential toxins could influence susceptibility to disorders having genetic and environmental components, such as schizophrenia. The frequency of two common mutant alleles of the gene for the cytochrome P450 enzyme debrisoquine-4-hydroxylase (CYP2D6) was determined in 264 Caucasian schizophrenic patients and 217 controls, using the polymerase chain reaction and restriction enzyme digestions. The patient and control samples showed no significant deviation from Hardy-Weinberg equilibrium and the frequency of each mutant allele (CYP2D6A and CYP2D6B) did not differ between patients and controls.