RESUMEN
The present prospective follow-up study of 163 schizophrenic patients admitted to hospital for the first time examined the relationship between premorbid adjustment and different measures of the 3-year course and outcome. The same instruments had been used in all phases of the study. The Premorbid Adjustment Scale was used to assess premorbid social functioning. Outcome measures were positive symptoms, negative symptoms, social disability and number of rehospitalizations. The results of the multiple regression analyses showed that premorbid adjustment was the strongest overall predictor of outcome. Premorbid adjustment was significantly associated with negative symptoms and social disability over the 3-year course of illness. In a further step, we examined the relationship between good, moderate and poor premorbid adjustment and the course of positive symptoms, negative symptoms and social disability within the first 3 years after index admission. The most important finding was that premorbid functioning showed a stronger correlation with the course of negative symptoms and social disability than with the course of positive symptoms. Poor premorbid social functioning implies a poor social course of the illness. Female subjects showed better premorbid functioning than male subjects. Good premorbid adjustment was strongly associated with an acute onset of the illness, and poor premorbid adjustment with an insidious onset.
Asunto(s)
Admisión del Paciente , Esquizofrenia/diagnóstico , Psicología del Esquizofrénico , Trastorno de la Personalidad Esquizotípica/diagnóstico , Ajuste Social , Adolescente , Adulto , Depresión/diagnóstico , Depresión/psicología , Depresión/rehabilitación , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Readmisión del Paciente , Pronóstico , Escalas de Valoración Psiquiátrica , Rehabilitación Vocacional/psicología , Esquizofrenia/rehabilitación , Trastorno de la Personalidad Esquizotípica/psicología , Trastorno de la Personalidad Esquizotípica/rehabilitación , Conducta Social , Resultado del TratamientoRESUMEN
The Prognostic Scale by Strauss and Carpenter (1974) is thoroughly analysed and its predictive value is compared with other predictors, such as symptomatology, premorbid adjustment and social disability. A sample of 138 first-hospitalized schizophrenic patients serve as database. The total days of stationary treatment, the number of rehospitalizations, a complex criterion regarding the course of illness and the extent of social impairment were selected as outcome criteria. The period of time allowing for predictions was 36 months after index episode. A factor analysis yields results indicating that the Prognostic Scale can be divided into two subscales, namely the "social functioning in the previous twelve months" and the "extent of handicap by psychiatric symptoms". With respect to prognostic aspects it is the first subscale which proves to be especially valuable.
Asunto(s)
Esquizofrenia/fisiopatología , Psicología del Esquizofrénico , Adolescente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Escalas de Valoración PsiquiátricaRESUMEN
Our study investigates whether the distinction between positive and negative symptoms in schizophrenia--as discussed in the literature--can be confirmed by a factor analysis and whether such a distinction proves stability over time. In a further step, symptom factors are correlated to different external variables for the purpose of validation. Processed data cover 36 months obtained from a prospective 5-year follow-up study of 163 initially hospitalized schizophrenics. The results permit for dividing the symptoms into a total of five factors--two representing positive and negative symptoms and one representing the general neurotic syndrome. This factor structure proved to be stable over time. Correlations between symptom factors and external variables justify a trait-interpretation of the negative factor anhedonia.
Asunto(s)
Síntomas Afectivos/clasificación , Deluciones/clasificación , Alucinaciones/clasificación , Hospitalización , Escalas de Valoración Psiquiátrica/estadística & datos numéricos , Esquizofrenia/clasificación , Psicología del Esquizofrénico , Adolescente , Adulto , Síntomas Afectivos/diagnóstico , Síntomas Afectivos/psicología , Síntomas Afectivos/rehabilitación , Deluciones/diagnóstico , Deluciones/psicología , Deluciones/rehabilitación , Análisis Factorial , Femenino , Estudios de Seguimiento , Alucinaciones/diagnóstico , Alucinaciones/psicología , Alucinaciones/rehabilitación , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Trastornos Neuróticos/clasificación , Trastornos Neuróticos/diagnóstico , Trastornos Neuróticos/psicología , Trastornos Neuróticos/rehabilitación , Estudios Prospectivos , Psicometría , Reproducibilidad de los Resultados , Esquizofrenia/diagnóstico , Esquizofrenia/rehabilitaciónRESUMEN
The Patient Rejection Scale (RPS), which was developed to assess rejecting attitudes and feelings of relatives toward mental patients, was administered to a German sample of 44 family members or significant others living with first-admitted schizophrenics. Both at admission (t0) and 6 months later (t6), the PRS was significantly correlated with the number of rehospitalizations during the first 3 years after admission. In comparison, the association between PRS scores and different measures of psychopathology during the 2-year follow-up period was weak. Thus, rejecting attitudes of patients' relatives seem to imply a higher risk of relapse without substantial medication by symptoms. We suspect that relatives with rejecting attitudes towards a patient might tend to apply for readmission more easily than more accepting relatives.
Asunto(s)
Actitud Frente a la Salud , Familia , Rechazo en Psicología , Esquizofrenia/rehabilitación , Deseabilidad Social , Adolescente , Adulto , Emociones , Hospitalización , Hospitales Psiquiátricos , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Readmisión del Paciente , Recurrencia , Psicología del EsquizofrénicoRESUMEN
On the basis of reaction time measurement, two well-known experimental indicators of attentional dysfunctions in schizophrenia were studied. These are the crossover effect (COE), induced by alternating preparatory intervals, and the modality shift effect (MSE), induced by alternating stimulus modalities. For the first time, the relationship between these indicators was examined. Correlations of both indicators with clinical variables such as psychopathology, subjective complaints, duration of illness and medication were also analyzed. Subjects were 50 schizophrenic inpatients and 50 healthy controls, 21 women and 29 men in each group. While earlier results for COE and MSE were replicable, no correlation between the two was found, leading to the conclusion that they involve different aspects of attention not necessarily impaired to the same extent in all patients.
Asunto(s)
Esquizofrenia/fisiopatología , Adolescente , Adulto , Antipsicóticos/efectos adversos , Antipsicóticos/uso terapéutico , Atención , Femenino , Humanos , Masculino , Persona de Mediana Edad , Escalas de Valoración Psiquiátrica , Tiempo de Reacción , Esquizofrenia/tratamiento farmacológico , Psicología del EsquizofrénicoRESUMEN
The usefulness of self-rating instruments for measuring the emotionality of elderly and/or physical ill individuals is discussed. Therefore, 99 inpatients of internal wards (mean age: 65) were examined with the German form of the State-Trait Anxiety Inventory (Laux et al., 1981). All the problems which arose when the test sheet was filled out were recorded and subsumed into one of the following categories: comprehension problems, problems with the answer categories, answer tendency, problems with layout. As expected, we were able to show that practical problems increase as patients become older. None of the patients over 80 years was able to complete the scale without considerable help in a standardized manner. We recommend to use structured interviews for assessing the emotional state of elderly patients.
Asunto(s)
Anciano/psicología , Ansiedad/psicología , Hospitalización , Inventario de Personalidad , Anciano de 80 o más Años , Ansiedad/diagnóstico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Psicometría , Reproducibilidad de los ResultadosRESUMEN
Since we face considerable practical problems in the assessment of elderly subjects with self-rating instruments (paper-pencil tests) measuring anxiety and, since we lack norms for the age of 65 and above, we developed a structured inventory (SAIS) for the assessment of anxiety in the elderly. The instrument comprises three components, anxiety normally is expressed in; all have been verified by empirical personality research: the cognitive, the physiological and the behavioural component. In a pilot study, we determined themes of anxiety relevant to elderly people. When the items were developed, we took into account aspects of the typical environment of the elderly and their comprehensive ability. In a reliability study 54 subjects (mean age: 72 years) were investigated. Item analyses showed low to average item difficulties and average selectivity. The split-half-reliability coefficient was rtt = .95; the internal consistency-coefficient was rtt = .91 (Kuder-Richardson). In a factor analysis five factors were extracted. They were interpreted as 'general' anxiety ("allgemeine Angstlichkeit"), as nervousness ("Neigung zu Nervosität"), fear of physical disability ("Furcht vor motorischer Behinderung"), personal insecurity ("persönliche Unsicherheit") and fear of helplessness ("Furcht vor Hilflosigkeit"). Finally, aspects of internal validity are discussed.
Asunto(s)
Anciano/psicología , Ansiedad/psicología , Entrevista Psicológica , Inventario de Personalidad , Anciano de 80 o más Años , Ansiedad/diagnóstico , Femenino , Hospitalización , Humanos , Cuidados a Largo Plazo/psicología , Masculino , Persona de Mediana Edad , Psicometría , Reproducibilidad de los ResultadosRESUMEN
The developmental prolactin-releasing effect of Tryptoline (T), Methoxytryptoline (MT) and Hydroxytryptoline (OHT) was examined comparatively in male and female rats. A single injection of T 15 mg/Kg increased serum prolactin in both sexes; the increase was significant from day 20 onwards. OHT evoked a sharp rise in 12 day-old rats and the releasing effect increased with age, both in males and females. No significant sex differences were observed in T or OHT treated rats. MT caused an increment in prolactin secretion in male rats and this action increased with age. The releasing effect of MT was not significant in females, even at 38 postnatal days. In adult animals, the tryptolines (15 mg/Kg) were able to increase serum prolactin in males and in females in diestrous; a dose of 5 mg/Kg of T was only effective in adult male rats. The prolactin-releasing effect was drastically reduced by orchidectomy and by ovariectomy. LH, FSH and TSH were not modified by any treatment. The present results show for the first time the ontogeny of the prolactin-releasing effect of tryptolines in male and female rats and that this effect depends on the presence of gonadal secretions in adults.
Asunto(s)
Envejecimiento/fisiología , Carbolinas/farmacología , Prolactina/metabolismo , Envejecimiento/sangre , Animales , Castración , Femenino , Masculino , Prolactina/sangre , Ratas , Ratas Endogámicas , Caracteres Sexuales , Maduración Sexual/fisiologíaRESUMEN
In 61 male and female patients, the influence of the preoperative emotional state on vasovagal syncopes and anxiolytic medication during spinal anaesthesia for elective orthopaedic surgery was investigated. Male patients pretended to feel emotionally better than female patients, but had higher rates of anxiolytic medication and vasovagal syncopes. Patients in a bad (n = 8) and in a good emotional state (n = 3) received more anxiolytic medication than those with a mean emotional state. Vasovagal syncopes were registered in patients who pretended to feel good (n = 6), in those who felt bad (n = 4) and only in one patient of the mean group. The factors anxiety and depression were the most responsible for this result. The importance of coping-mechanisms for the development of psychological and psychophysiological reactions is discussed. Vasovagal syncope is interpreted as a psychophysiological reaction. In consequence it needs psychoprophylaxis.
Asunto(s)
Anestesia Raquidea/psicología , Síncope/psicología , Adolescente , Adulto , Anciano , Anestesia Raquidea/efectos adversos , Ansiolíticos/uso terapéutico , Ansiedad/psicología , Astenia/psicología , Depresión/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Síncope/etiología , Síncope/prevención & controlRESUMEN
In 29 male patients undergoing arterial bypass operations of the lower limb, psychological and physiological stress parameters were investigated. They received no premedication. We found an increase of heart rate (HR), arterial blood pressure (BP), plasma cortisol (Cort), free fatty acids (FFA), ventricular ectopic beats (VEB) and supra-ventricular ectopic beats (SVEB) (registered with a 24 hour ECG). The physiological dynamics were different, depending on the results of the psychological tests (MMQ and ESB): Repressor had higher HR and increased significantly more than sensitizer. Depressive patients had higher Cort levels the day before surgery compared to hopeful ones, but remained at these levels, whereas hopeful patients had a significant increase of Cort immediately before operation. They had also higher BP's and HR's. Patients with sthenic affections increased significantly more with FFA levels than asthenic ones. Anxious and asthenic patients had significantly more VEB than non anxious and sthenic ones. These results can well be interpreted in terms of dynamic psychophysiological stress reactions. We propose the use of psychological and physiological stress parameters for investigations of methods for the reduction of preoperative stress.
Asunto(s)
Cuidados Preoperatorios , Estrés Psicológico/fisiopatología , Presión Sanguínea , Electrocardiografía , Ácidos Grasos no Esterificados/sangre , Frecuencia Cardíaca , Hemodinámica/efectos de los fármacos , Humanos , Hidrocortisona/sangre , MMPI , Masculino , Persona de Mediana Edad , Medicación Preanestésica , Cuidados Preoperatorios/psicología , Estrés Psicológico/psicologíaRESUMEN
In three prospective randomized studies six substances for intramuscular premedication were investigated and compared to placebo (NaCl 0.9%): diazepam (10-20 mg), flunitrazepam (1-2 mg), droperidol (2.5-5 mg), triflupromazin (10-20 mg), pethidin (50-100 mg) and buprenorphin (0.15-0.3 mg). The effects on preoperative stress were evaluated with psychometrical methods (ESB), heart rate, blood pressure and plasma-cortisol levels. Degree of sedation and side effects were recorded. Good effects on anxiety were found after flunitrazepam, diazepam and triflupromazin. The worst effects were found after droperidol and pethidin. Good effects on depression were found after pethidin, buprenorphin, diazepam and triflupromazin. The worst effects were found after droperidol. Asthenic patients were improved with diazepam and flunitrazepam, but deteriorated after placebo, pethidin, triflupromazin and droperidol. The physiological stress parameters were positively influenced by diazepam and flunitrazepam, but not after placebo and droperidol. Nausea and vomitus were found after buprenorphin, pethidin and droperidol; psychological and neurological problems occurred after droperidol. The highest degree of sedation was found after flunitrazepam, diazepam and droperidol. The day after surgery the patients found placebo, flunitrazepam, diazepam and triflupromazin to be the best premedications, pethidin and buprenorphin were inferior and droperidol was the poorest premedication.
Asunto(s)
Anestesia de Conducción , Anestesia General , Medicación Preanestésica/métodos , Estrés Psicológico/prevención & control , Adolescente , Adulto , Anciano , Buprenorfina/farmacología , Sistema Cardiovascular/efectos de los fármacos , Ensayos Clínicos como Asunto , Diazepam/farmacología , Droperidol/farmacología , Femenino , Flunitrazepam/farmacología , Humanos , Inyecciones Intramusculares , Masculino , Meperidina/farmacología , Persona de Mediana Edad , Triflupromazina/farmacologíaRESUMEN
In 379 patients prior to surgery the psychological state was determined using a self evaluation inventory. Correlations were sought to heart rate and blood pressure readings at different times before and during anaesthesia. Patients in a poor psychological state had higher heart rates before and during anaesthesia. Before anesthesia heart rate increase correlated to the degree of anxiety. During intubation patients previously having felt markedly depressed or hopeful showed higher heart rates than those having felt moderately depressed. Asthenic patients also had high heart rates during anaesthesia. There results were statistically significant (F-Test). The quality of sleep on the night preceding surgery was rated poor by 31% of patients. This observation underscores the need for solving this problem on organizational and pharmacotherapeutic levels. 18% of patients complained of lacking or poor effects of preanaesthetic medication consisting of analgetics, neuroleptics and vagolytics. Among these anxious, depressed and hopeful patients were significantly overrepresented, comprising those groups who exhibit unfavourable psychophysical reactions as well. This observation clearly demonstrates the need for individualized preanaesthetic medication. It is suggested that in evaluating drugs used in premedication their effect on psychological and psychophysical parameters be scrutinized.
Asunto(s)
Anestesia General , Nivel de Alerta/efectos de los fármacos , Estrés Psicológico/complicaciones , Procedimientos Quirúrgicos Operativos/psicología , Adolescente , Adulto , Anciano , Ansiedad/complicaciones , Presión Sanguínea/efectos de los fármacos , Depresión/complicaciones , Femenino , Frecuencia Cardíaca/efectos de los fármacos , Humanos , Masculino , Persona de Mediana Edad , Medicación Preanestésica/psicologíaRESUMEN
Activity of platelet monoamine oxidase (MAO) has repeatedly been reported to be associated with various forms of psychopathology. This investigation was designed to reexamine the "biochemical high-risk paradigm" developed by Buchsbaum et al. (1976). In 383 healthy students (193 males, 190 females) platelet MAO activity was measured. The 35 students with the lowest and 37 with the highest enzyme activities were then examined with three personality tests (16 PF of Cattell, Freiburger Persönlichkeitsinventar, Eysenck Personality Questionnaire). Furthermore, biographic data with respect to psychosocial problems were explored. There were no consistent differences between subjects with low or high MAO. Therefore, we could not confirm any correlation between psychopathology and platelet MAO in this study.