Besteht ein Zusammenhang von Alkoholkonsum und sexuellem Risikoverhalten? Eine Diskussion konzeptioneller Aspekte am Beispiel HIV-infizierter Männer mit homosexuellem Verhalten

Zusammenfassung: Besteht ein Zusammenhang zwischen Alkoholkonsum und sexuellen Risikokontakten? Führt Alkohol zu Risikokontakten? Es lassen sich zahlreiche Studien finden, die diese Frage bejaht haben. Ebenso lassen sich Studien finden, die mit modifizierten Forschungskonzepten diese Befunde nicht bestätigen konnten. Unter Verwendung von ereignisunspezifischen und situationsspezifischen Konzepten wurden diese Fragen bei einer Stichprobe von 64 HIV-infizierten Männern mit homosexuellem Verhalten untersucht. Einen signifikanten Zusammenhang von Alkoholkonsum und sexuellem Risikoverhalten konnten wir mit dem ereignisun-spezifischen Ansatz nicht feststellen. Auch Personen, die sexuelle Kontakte unter Alkoholeinfluss eingegangen waren (situationsspezifisches Konzept), gingen nicht überdurchschnittlich häufiger Risikokontakte ein. Die Personen hingegen, die unter Alkoholkonsum riskante sexuelle Praktiken eingegangen waren, erreichen sowohl hinsichtlich des Alkoholkonsums als auch des allgemein erfassten Schutz- und Risikoverhaltens lediglich Durchschnittswerte. Erst konkrete Zusatzfragen machen es möglich, sie als Personen mit Risikoverhalten zu identifizieren. Für Untersuchungen zum sexuellen Schutz- und Risikoverhalten erscheint die Kombination sich ergänzender Forschungskonzepte zweckmässi

The spectra of neurasthenia and depression: course, stability and transitions

Background: Neurasthenia has had a chequered history, receiving changing labels such as chronic fatigue or Gulf war syndrome. Neurasthenia is recognized by ICD-10, but not by DSM-IV. Its course, longitudinal stability and relationship to depression is not well understood. Methods: In a stratified community sample (n=591), representative of 2600 persons of the canton of Zurich, Switzerland, neurasthenia and depression were assessed in six structured interviews between ages 20 and 41. Course, stability and comorbidity were examined. A severity spectrum of neurasthenia and depression from symptoms to diagnosis was taken into account. Results: The annual prevalence of a neurasthenia diagnosis increased from 0.7% to 3.8% from age 22-41, while mere symptoms became less prevalent. Intraindividual courses improved in 40% and deteriorated in about 30% of symptomatic cases. The most frequent symptoms overall, besides criterial exhaustion, were increased need for sleep, over-sensitivity, nervousness and difficulty concentrating. Cross-sectional associations and overlap with depression were strong. Longitudinal stability of ICD-neurasthenia was low. Conclusions: Neurasthenia is intermittent, overlaps significantly with depression, and shows improvement and deterioration over time to roughly equal measure

The spectra of neurasthenia and depression: course, stability and transitions

Background: Neurasthenia has had a chequered history, receiving changing labels such as chronic fatigue or Gulf war syndrome. Neurasthenia is recognized by ICD-10, but not by DSM-IV. Its course, longitudinal stability and relationship to depression is not well understood. Methods: In a stratified community sample (n=591), representative of 2600 persons of the canton of Zurich, Switzerland, neurasthenia and depression were assessed in six structured interviews between ages 20 and 41. Course, stability and comorbidity were examined. A severity spectrum of neurasthenia and depression from symptoms to diagnosis was taken into account. Results: The annual prevalence of a neurasthenia diagnosis increased from 0.7% to 3.8% from age 22-41, while mere symptoms became less prevalent. Intraindividual courses improved in 40% and deteriorated in about 30% of symptomatic cases. The most frequent symptoms overall, besides criterial exhaustion, were increased need for sleep, over-sensitivity, nervousness and difficulty concentrating. Cross-sectional associations and overlap with depression were strong. Longitudinal stability of ICD-neurasthenia was low. Conclusions: Neurasthenia is intermittent, overlaps significantly with depression, and shows improvement and deterioration over time to roughly equal measure

The barriers to smoking cessation in Swiss methadone and buprenorphine-maintained patients

BACKGROUND: Smoking rates in methadone-maintained patients are almost three times higher than in the general population and remain elevated and stable. Due to the various negative health effects of smoking, nicotine dependence contributes to the high mortality in this patient group. The purpose of the current study was to investigate Swiss methadone and buprenorphine-maintained patients' willingness to stop smoking and to clarify further smoking cessation procedures. METHODS: Substance abuse history, nicotine dependence, and readiness to stop smoking were assessed in a sample of 103 opiate-dependent patients in the metropolitan area of Zurich, Switzerland. Patients were asked to document their smoking patterns and readiness to quit. RESULTS: Only a small number of patients were willing to quit smoking cigarettes (10.7%) and, even though bupropione or nicotine replacement therapy was included in the fixed daily treatment care, only one patient received nicotine replacement therapy for smoking cessation. A diagnosis of depression in patients' clinical records was associated with readiness to stop smoking. No significant associations were found between readiness to quit smoking and age, methadone treatment characteristics, and presence of co-dependencies. CONCLUSION: The current prescription level of best medicine for nicotine dependence in Swiss methadone and buprenorphine-maintained patients is far from adequate. Possible explanations and treatment-relevant implications are discussed

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

Obsessive-compulsive severity spectrum in the community: prevalence, comorbidity, and course

Abstract. : Objectives : : To describe lifetime prevalence rates, course and comorbidity of obsessive-compulsive disorder (OCD), obsessive-compulsive syndromes (OCS) and OC-symptoms (OC-sx) up to age 41. Methods : : In the Zurich community cohort study 591 subjects were selected after screening at the age of 19 and studied prospectively by 6 interviews from 20 to 40; they represent 1599 subjects of the normal population. The diagnoses of OCD met DSM-IV criteria.Course was assessed by graphic illustrations and prospective data. Results : : The lifetime prevalence rate was 3.5 % for OCD (males 1.7%, females 5.4 %) and 8.7 % for OCS (males 9.9%, females 7.5 %). The onset of OC-sx was 18 years (median); and in 70% before age 20.OCD was treated in one third of cases, OCS in 6.1%. The course of symptoms was chronic in 60%,but OCD and OCS showed in most cases considerable improvements over time. OCD reduced quality of life mostly in the subject's psychological wellbeing and at work but to a considerable extent also in other social roles. Comorbidity was prominent with bipolar disorder, panic disorder and social phobia and also significant with bulimia, binge eating, generalized anxiety disorder and suicide attempts; there was no association with substance abuse/dependence. Conclusion : : OCD and OCD are manifestations of a wide spectrum of severity with high prevalence and strong clinical validity. The long-term course is better than generally assume

Bone Mineral Density in Young Women on Methadone Substitution

Little is known about bone mineral density (BMD) in patients with heroin addiction and subsequent methadone substitution. The goal of this study was to compare bone mass density of young HIV-negative women on long-term methadone treatment to a local group of young healthy women. Eleven women (aged 20-29) with previous heroin dependence and current methadone substitution (20-140mg, median 60, daily) for 1.5-9 (median 3) years were compared to 30 healthy women (aged 20-28). Participants were examined with dual-energy X-ray absorptiometry of the lumbar spine (L2-L4), of the total proximal hip area, and of the femoral neck. Patients and controls had neither current nor lifetime underweight condition, had comparable ages at menarche, and did not differ significantly in current body mass index (21.9±4.0, respectively, 20.5±1.5kg/m2) in spite of a largely unhealthy lifestyle (cigarette, alcohol, and cocaine consumption in patients). Patients' total-hip parameters were marginally lower than those of controls (BMD P=0.054, T score P=0.049), whereas the femoral neck and lumbar spine parameters did not differ significantly between the two groups. Long-term methadone substitution in HIV-negative women seems to slightly affect bone mass densit

Is depression a risk factor for heart complaints?: Longitudinal aspects in the Zurich study

Background: The objective of this longitudinal study was to assess the association between major depression and heart complaints in a population of young and healthy adults. Methods: Starting at the age 20/21, participants of the Zurich Study underwent 6 structured, psychological interviews during a span of 20years. We evaluated longitudinal data from 277 persons who participated in all 6 interviews including questions about heart complaints. Results: Over 20years, heart complaints were reported by two thirds of participants, and the frequency of depression was 11.4%. At the age of 40/41, heart complaints were significantly associated with earlier heart complaints and major depression, both more often in women. Recurrent brief depression showed a tendency, but neither minor depression nor depressive symptoms were predictive for later heart complaints. Conclusions: This study suggests that major depression is a predictor for heart complaints at the age of 40 and that the severity of depressive disorder in younger age has an effect on subsequent heart complaints. Follow-up data will help to elucidate whether these subjective heart complaints show any correlation with a later coronary heart diseas

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

Prevalence of mental disorders in the Zurich Cohort Study: a twenty year prospective study

Background — In order to minimise retrospective recall in developing estimates of the prevalence of mental dis-orders in the general population, we conducted a prospective study of a cohort of youth from Zurich, Switzerland. Method — A 20 year prospective study of a community-based cohort aged 19-20 from Zurich Switzerland. The sample was enriched by subjects scoring high on the Symptom Checklist 90 R (Derogatis, 1977). A semi-structured diagnostic interview was administered by clinically experienced psychologists and psychiatrists. The six interviews from 1979 to 1999 assessed diagnoses and sub-threshold manifestations of major diagnostic categories (with the exception of schizophrenia) for the past twelve months, depending on the current DSM versions (DSM-IH, DSM-HI R, DSM-IV). Additional information on symptoms and treatment were collected for the years between the interviews. The reported prevalence rates are weighted for stratified sampling and cumulate the one-year rates of the six interviews. Results — The cumulative weighted prevalence rates for any psychiatric disorder were 48.6% excluding, and 57.7% including tobacco dependence. In addition 29.2% and 21.8%, respectively manifested sub-diagnostic syndromes. Overall there were no significant gender differences. The corresponding treatment prevalence rates were 22.4% and 31.1%, respectively for the diagnostic subjects and 6.9% and 6.1 %, respectively for the sub-diagnostic groups. The total treatment prevalence rate was 37.2% of the population (males 30.0%, females 44.1%). Conclusions — Our findings reveal that psychiatric disorders are quite common in the general population. When the spectra of mental disorders are considered, nearly three quarters of the general population will have manifested at least one of the mental disorders across their lifetime. Limitations — The data are based on a relatively small sample; a single age cohort, and the study was conducted in Zurich, Switzerland. These study features may diminish the generalisability of the findings. Declaration of Interest: this work was supported by Grant 3200-050881.97/1 of the Swiss National Science Foundation, and Research Scientist Development Awards (MH 46376 and DA00293) from the US National Institutes of Health (Dr. Merikangas