Zur Erfassung der Multiplen Sklerose in der schweizerischen Todesursachenstatistik: Mortalitäts-Follow-Up der Berner MS-Prävalenzstudie aus dem Jahr 1986

Zusammenfassung: Ausgehend von einer Prävalenzuntersuchung zur Multiplen Sklerose (MS) im Kanton Bern aus dem Jahr 1986 wurde eine Nacherhebung im Hinblick auf die Mortalität der MS-Patientlnnen durchgeführt. Dazu wurden per Stichdatum 01. 01. 1996 Auskünfte über den Aufenthalt/Tod der erfassten Personen bei den Zivilstandesämtern eingeholt. Zudem wurden ein Record-Linkage mit Daten aus der schweizerischen Todesursachenstatistik unternommen. Von den ursprünglich dokumentierten Fällen waren es 10 Jahre später etwas mehr als 80% deren Verbleib eruiert werden konnte. Unter den eindeutig linkbaren Fällen waren in diesem Zeitraum 21% der Patientlnnen gestorben. Dabei wurde bei etwas mehr als 70% der verstorbenen MS-Patientlnnen die MS in der Todesursachenstatistik mitcodiert; 6 von 7 Eintragungen entfallen auf die Haupttodesursache. Der Vergleich mit der Todesursachenstatistik weist aber auch darauf hin, dass ein grosser Teil der nicht eruierten Fälle in Zusammenhang mit der Mortalität steht. Somit bieten die im Follow-Up konsolidierten Informationen für viele weitere Fragestellungen eine wenig befriedigende Grundlage. Es zeigt sich, dass sich die Ausfälle nur durch eine kontinuierliche Aktualisierung und Überprüfung der Personalienangaben aus der Prävalenzstudie vermeiden lasse

Methods of suicide used by children and adolescents

Although relatively rare, suicide is a leading cause of death in children and adolescents in the Western world. This study examined whether children and adolescents are drawn to other methods of suicide than adults. Swiss suicides from 1998 to 2007 were examined. The main methods of suicide were analysed with respect to age and gender. Of the 12,226 suicides which took place in this 10-year period, 333 were committed by children and adolescents (226 males, 107 females). The most prevalent methods of suicide in children and adolescents 0-19years were hanging, jumping from heights and railway-suicides (both genders), intoxication (females) and firearms (males). Compared to adults, railway-suicides were over-represented in young males and females (both P<.001). Jumping from heights was over-represented in young males (P<.001). Thus, availability has an important effect on methods of suicide chosen by children and adolescents. Restricting access to most favoured methods of suicide might be an important strategy in suicide preventio

Classification of mood disorders

This paper looks at some recent developments in the official diagnostic definitions (DSM-5) and in the research domain. The spectrum concept of mood disorders consists of the components of depression and mania, alone or in combination, on a continuum. Its international operational classification changes regularly, being based on symptoms, their duration and consequences. Causation is as yet unknown.DSM-5 excludes unipolar mania and mania with mild depression as separate diagnoses (they come under bipolar I and bipolar II disorders) and introduces a new hierarchy of manic symptoms, placing energy/activity above mood (elated, irritable). This is shown to be problematic on the basis of recent data. The validity of the duration criteria for mania (1 week), hypomania (4 days) and depression (2 weeks) is also seriously questioned. Shorter episodes are clinically very relevant. The definition of mania/hypomania is a persistent problem, contributing to frequent un- derdiagnosis of bipolar disorder in depressed patients. Other contributory factors include that patients often do not feel ill or seek treatment for the consequences of their high mood, and that hypomania can be hidden by substance use disorders (SUD). Hidden hypomanic syndromes are important because associated with treatment resistance, high comorbidity with anxiety/panic and SUD, psychotic and cognitive symptoms, dementia and higher mortality. Anxiety, too, is doubtless a mood disorder but there is still no concept which integrates anxiety with bipolar disorder and depression. Classification involves the definition of artificial subgroups and is necessary for treatment and communication but clinicians, when in doubt, (...)

High prevalence of mental disorders and comorbidity in the Geneva Gay Men's Health Study

Background: Several large surveys have suggested high prevalence of psychiatric disorders among gay men and other men who have sex with men. Methods: In 2002, a comprehensive health survey was conducted among 571 gay men in Geneva, Switzerland, using probability-based time-space sampling. The Composite International Diagnostic Interview Short-Form (CIDI-SF) was used to assess 12-month prevalence of major depression, specific phobia, social phobia, alcohol dependence, and drug dependence. Results: Nearly half (43.7%, 95% CI=39.0-48.4) of the sample fulfilled the criteria for at least one of the five DSM-IV disorders: 19.2% had major depression, 21.9% had specific and/or social phobia, and 16.7% had an alcohol and/or drug dependence disorder in the past 12months. Over one quarter of the cases were comorbid with another kind of disorder, and 35.7% of cases consulted a health care professional in the past 12months for mental health. Like cases, screen-positives for mood and/or anxiety disorders (24.7%) also reported significantly greater disability and lower quality of life. Conclusions: Nearly two-thirds of this community sample of gay men was affected by psychiatric morbidity with new evidence for comorbidity, subthreshold disorders, and low levels of awareness of psychiatric disorders and their treatment. This population needs to be a priority in psychiatric epidemiology and mental public healt

The generalized anxiety spectrum: prevalence, onset, course and outcome

Background: Generalized anxiety disorder (GAD) is generally considered to be a chronic condition, waxing and waning in severity; however prospective investigation of the course of GAD in community samples is lacking. This study seeks to fill that gap, by identifying the whole spectrum of generalized anxiety syndromes, sub-typing them according to their duration and frequency of occurrence, and evaluating their long-term course and outcome in the community. Method: The prospective Zurich Study assessed psychiatric and somatic syndromes in a community sample of young adults (N=591) (aged 20years at first interview) by six interviews over a period of 20years (1979-1999). GAD syndromes were defined by DSM-III symptom criteria without applying any exclusion criteria. A spectrum of generalized anxiety was defined by duration: 6months (DSM-IV), 1month (DSM-III), ≤2weeks (with weekly occurrence over one year), and anxiety symptoms. From 1978 (screening) to 1999 the annual presence of symptoms and treatment was assessed. Persistence of anxiety was defined by the almost daily presence of symptoms over the previous 12months. Results: The annual incidence of DSM-III GAD increased considerably between the ages of 20 and 40. The average age of onset of symptoms was 15.6years; in 75% of cases it occurred before the age of 20. 75 of 105 DSM-III GAD cases had at least one follow-up. At their individual last follow-up, 12 of those 75 subjects (16%) were re-diagnosed as having GAD, 22 (29%) manifested subthreshold syndromes or anxiety symptoms, while 39 cases, the majority, (52%) were symptom-free; 5 of the 12 re-diagnosed GAD cases were persistent (corresponding to 7% of all 75 initial GAD cases). In their twenties they were treated at some time in 6% of all years, but in their thirties this figure rose to 12%. At their individual last follow-up 26% of 6-month GAD subjects and 22% of 1-month GAD subjects were still being treated. Treated vs. non-treated subjects did not differ in terms of gender but did differ in severity, persistence and in comorbidity with bipolar-II disorder, social phobia, obsessive-compulsive syndromes and substance-use disorders. Limitations: Results are based on a relatively small sample and cannot be generalized to adults aged over 40years. Conclusions: The course of DSM-III-defined GAD may not be chronic, as previously suggested, but mainly recurrent with intervening symptom-free periods of recovery in about half of cases. Over a period of 20years there was more improvement than progression within the anxiety spectru

A new rating scale for adult ADHD based on the Symptom Checklist 90 (SCL-90-R)

Attention deficit hyperactivity disorder (ADHD) in adults is increasingly recognized as a clinically important syndrome. The aim of this study was to evaluate the psychometric performance of a new scale for adult ADHD based on the widely used Symptom Checklist 90 Revised (SCL-90-R). Scale performance was assessed in a clinical study including 100 ADHD patients and 65 opiate-dependent patient controls, and in the Zurich study, an epidemiological age cohort followed over 30years of adult life. Assessments included a ROC analysis of sensitivity and specificity, internal consistency, test-retest reliability, external validity and measurement invariance over nine testing occasions. The new scale showed a sensitivity and specificity of 75 and 54%, respectively, internal consistency over 0.8 (McDonald's omega, Cronbach's alpha), one-year test-retest reliabilities over 0.7, statistically significant and substantial correlations with two other validated self-rating scales of adult ADHD (R=0.5 and 0.66, respectively), and an acceptable degree of longitudinal stability (i.e., measurement invariance). The proposed scale must be further evaluated, but these preliminary results indicate it could be a useful rating instrument for adult ADHD in situations where SCL-90-R data, but no specific ADHD assessment, are available, such as in retrospective data analysis or in prospective studies with limited methodical resource

Demenz, Depressionen und Aktivitäten des täglichen Lebens als Risikofaktoren von Stürzen bei Betagten

Summary: Objectives: Falls among elderly are a well-recognised public health problem. The purpose of the present study was to explore the relation between dementia, number of depressive symptoms, activities of daily living, setting, and risk of falling. Methods: Data for the analysis came from a cross-sectional study about dementia, depression, and disabilities, carried out 1995/96 in Zurich and Geneva. The random sample stratified, by age and gender consisted of 921 subjects aged 65 and more. The interview was conducted by means of the Canberra Interview for the Elderly, extended by short questionnaire. The subject was classified as a faller if the subject and/or the informant had reported a fall within the last 12 months prior to the interview. Logistic-regression analysis was used to determine the independent impact of dementia, depressive symptoms, and ADL-score on risk of falling. Results: The stepwise logistic regression analysis has revealed a statistically significant association between dementia (OR 2.14, 95% Cl 1.15-3.96), two resp. three depressive symptoms (OR 1.64, 95% Cl 1.04-2.60) as well as four or more depressive symptoms (OR 2.64, 95% Cl 1.39-5.02) and the risk of falling. There was no statistically significant relationship between studied risk factors and the risk of being one-time faller. However, we found a strong positive association between dementia (OR 3.92, 95% Cl 1.75-8.79), four or more depressive symptoms (OR 3.90, 95% Cl 1.55-9.83) and the risk of being recurrent faller. Moreover, residents of nursing homes (OR 8.50, 95% Cl 2.18-33.22) and elderly aged 85 or more (OR 2.29, 95% Cl 1.08-4.87) were under statistically significant higher risk of sustaining recurrent falls. Conclusions: The results of the present study confirm that dementia and depression substantially increase the risk of fallin

How ubiquitous are physical and psychological complaints in young and middle adulthood?: A longitudinal perspective

Objectives: To investigate continuity and change of self-reported physical and psychological complaints in young adults over a period of 20years. Study design and setting: The Zurich Study - a long-term panel survey in psychiatric epidemiology - is based on a stratified sample of 591 subjects born in 1958 (women) and 1959 (men). The sample strata combine SCL-90-R high-scorers and low-scorers in a 2:1 ratio. Up to now, the Zurich Study has included six interviews between 1979 and 1999, i.e. 20 years of life in young adults. We analysed the longitudinal frequency data of a variety of physical and psychological complaints, as well as information about subjective suffering and use of professional help. The analyses utilised on the McNemar's test, the Q-test and Markov chain models. Results: Sleep disorders, depression, menstruation, backache, headache, stomach and bowel complaints yielded cumulative prevalence rates of 80% or higher. Physical and psychological complaints systematically differ with respect to the change patterns between 1979 and 1999. Moreover, strong differences were found in view of subjective suffering and use of professional help. Conclusions: Even though many self-reported physical and psychological complaints are very common in young adulthood, the underlying dynamics and the implications largely differ. It seems to be crucial whether respondents use somatic glasses or psychological lense

Predictors for early and long-term readmission in involuntarily admitted patients

BACKGROUND It is a common aim to reduce psychiatric readmissions. Although risk factors for readmissions were described, specific data in the group of patients with potentially aversively experienced involuntary admissions are lacking. To better understand underlying mechanisms, it is important to identify factors that are linked to readmissions in this specific patient group, which is the purpose of the current paper. METHODS A four-year cohort of N = 3575 involuntary admissions (IA) was followed-up for subsequent re-hospitalization. Demographic, administrative and clinical factors associated with short- (within 30 days) or long-term (> 30 days) readmissions were examined using logistic regression modelling. RESULTS Almost half of all IA cases were readmitted within the observation period, whereof every fifth readmission was within the first month after discharge from the involuntary index hospitalization. Adjusted regression modelling revealed problematic substance use at admission and assisted living or homelessness as risk factors for readmission, while high functioning at discharge, anxiety disorders, no subsequent treatment after discharge or IA due to danger to others were negatively associated with readmission. Factors specifically linked to short-term readmission were substance use and personality disorders, abscondence or discharge by initiation of the clinic, as well as being discharged to any place except the patient's home. There were no specific risk-factors for long-term readmission. CONCLUSIONS To prevent readmissions after IA, especially for patients at risk, the aim of treatment strategies should be to focus on intensive discharge planning, enable continuous treatment in the outpatient setting, and provide social support