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ABSTRACT: ObjectivesThe purpose of this paper is to demonstrate similarities and differences between bipolar I patients with and without mood-incongruent
symptoms (MIS) over a long period of time, independently of longitudinal syndromatic constellations.
MethodsThe Halle bipolarity longitudinal study (HABILOS) prospectively investigates 182 patients meeting the DSM-IV criteria for
bipolar I disorders over a long period of time (x;− =16.84 years). One thousand five hundred thirty-nine (1,539) episodes have been evaluated with standardized instruments.
Patients and episodes were divided into two groups (with and without MIS) and were compared on various levels.
ResultsIt was found: (1) The majority of the episodes of bipolar I patients during long-term course did not have MIS, but the majority
of patients did. (2) Bipolar I patients with MIS differ from patients without MIS in the following features: (a) Bipolar I
patients with MIS are more frequently males. (b) Bipolar I patients with MIS need treatment at a significantly younger age
than those without MIS. (c) First manifestation of bipolar I disorder with MIS after the age of 50 is extremely seldom. (d)
Bipolar I patients with MIS more frequently have relatives with schizophrenia. (e) Bipolar I patients with MIS more frequently
become disabled and retire at a significantly younger age than patients without MIS and (f) Significantly fewer patients with
MIS than those without MIS live in a stable partnership.
ConclusionsIt can be concluded that bipolar I disorders with MIS are more severe disorders than bipolar I disorders without MIS. This
finding in combination with the above results, however, can give rise to the conclusion that bipolar I disorders with MIS
are the epiphenomenon of the overlap, possibly genetic, of a “schizophrenic spectrum” and a “bipolar spectrum” and their antagonistic
influence creating a “schizo-affective” area between them as a kind of psychotic continuum between prototypes.
European Archives of Psychiatry and Clinical Neuroscience 04/2012; 259(3):131-136. · 3.49 Impact Factor
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ABSTRACT: Reactive delusional disorder (DD) (with a precipitating factor) has been postulated to differ clinically from nonreactive DD and to show a better prognosis. Our study tests this hypothesis in a sample of patients with persistent DD (International Classification of Diseases, 10th Revision) or DD (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) followed during a period of more than 10 years.
As part of a long-term study on DD, 19 patients with DD and a stressful life event preceding the onset of the disorder were compared with 24 DD patients without such a life event. Diagnoses, social and biographical data, life events, and outcome were assessed by a semistructured interview and validated rating scales. Personality features were assessed by the NEO Five-Factor Inventory and by the Inventory of Clinical Personality Accentuations.
Patients with reactive DD tended to be somewhat younger but showed otherwise little differences to patients with nonreactive DD. In particular, there were no differences in the course of the disorder. However, patients with reactive DD were significantly more often in a stable relationship and showed higher values on neuroticism and more pronounced dependent and borderline personality accentuations in dimensional personality measures.
Reactive DD was not found to have a better prognosis than nonreactive DD. However, the results suggest an increased vulnerability for interpersonal conflicts in these patients.
Canadian journal of psychiatry. Revue canadienne de psychiatrie 04/2012; 57(4):216-22. · 2.42 Impact Factor
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Psychopathology 03/2012; 45(3):200-2. · 1.82 Impact Factor
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ABSTRACT: The aim of this work is to investigate differences between two non-schizophrenic, non-organic psychotic disorders, namely persistent delusional disorders (PDD) and acute and transient psychotic disorders (ATPD) according to ICD-10.
In a prospective and longitudinal study, we compared all 43 inpatients with PDD who were treated at Halle-Wittenberg University Hospital during a 14-year period to a previously investigated cohort of 41 patients with ATPD in regard to demography, long-term symptomatic outcome, and social consequences. Sociobiographical data were collected using a semi-structured interview. Follow-up investigations were performed at a mean of 10-12 years after the onset of the disorder using standardized instruments.
With the exception of the duration of the psychotic symptoms, the PDD patients were significantly different from the ATPD patients on various levels, such as sex ratio (female predominance only in ATPD), age at onset (older in PDD), the number of preceding stressful life-events in the index hospitalization (more frequent in ATPD), richness and variety of symptoms (higher in ATPD), and persistence of positive psychotic symptoms (in PDD). Patients with PDD had significantly less re-hospitalizations during the course of their illness. Long-term outcome was marked by chronicity of delusional symptoms and lower global functioning in PDD than in ATPD, while negative symptoms and loss of independence were infrequent in both conditions.
PDD differs from ATPD not only in the duration of the psychotic symptoms, but also in a variety of significant variables. They appear to be two separate entities within a psychotic spectrum.
Psychiatry and Clinical Neurosciences 02/2012; 66(1):44-52. · 2.13 Impact Factor
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ABSTRACT: This paper presents gender-related features of Delusional Disorder. It is part of the Halle Delusional Syndromes Study (HADES-Study). All inpatients fulfilling the DSM-IV/ICD-10 criteria of Delusional Disorder/Persistent Delusional Disorder (DD) during a 14-year period were included and followed up for an average of 10.8 years. Gender distribution was almost equal, women became ill significantly later than men, and almost all women had a stable diagnosis-in contrast to men. The great majority of women, at the end of the follow-up period, had an unremitted DD. Women more frequently had low social functioning at admission, but then were more compliant and received more frequently pharmacological medication. There were no differences in the delusional topic and no differences regarding long-term disability and autarky. In spite of previous reports, the HADES-Study found no gender difference in the frequency of DD. However, men tended more frequently to change into schizophrenia and schizoaffective disorder. In these cases, the DD might have been a prodrome of schizophrenia or schizoaffective disorder, which manifests later in life. Although in both female and male DD patients, the majority remained unremitted, almost none of them lost their autarky (independent living). While women more frequently received psychopharmacological medication, their DD was usually found to be unremitted.
Archiv f ur Psychiatrie und Nervenkrankheiten 02/2011; 261(1):29-36. · 2.75 Impact Factor
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ABSTRACT: This article tries to give an answer to the question of whether International Classification of Diseases (ICD-10) persistent delusional disorder (PDD) or Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) delusional disorder (DD) is simply paranoid schizophrenia (PS). Because ICD-10 PDD and DSM-IV DD are identical, we use DD as a synonym.
A prospective and longitudinal study compared all inpatients with DD treated at the Halle-Wittenberg university hospital during a 14-year period with a previously investigated selected cohort of patients with PS. Sociodemographic data, symptomatology, course, and outcome parameters were examined using standardized instruments. The duration of the follow-up period in patients with DD was 10.8 years and for the PS patients 12.9 years.
Significant differences between DD and PS were found: DD patients are, in comparison to patients with PS, significantly older at onset. Less of their first-degree relatives have mental disorders. They less frequently come from a broken home situation. First-rank symptoms, relevant negative symptoms, and primary hallucinations did not occur in patients with DD. Patients with DD were less frequently hospitalized, and the duration of their hospitalization was shorter. Their outcome is much better regarding employment, early retirement due to the disorder, and psychopharmacological medication. They more often had stable heterosexual partnerships and were autarkic. They had lower scores in the Disability Assessment Scale and in Positive and Negative Syndrome Scale. The diagnosis of DD is very stable over time.
The findings of this study support the assumption that DDs are a separate entity and only exceptionally can be a prodrome of schizophrenia.
Schizophrenia Bulletin 11/2010; 38(3):561-8. · 8.80 Impact Factor
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Psychopathology 01/2010; 43(4):248-9. · 1.82 Impact Factor
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ABSTRACT: The purpose of this paper is to demonstrate similarities and differences between bipolar I patients with and without mood-incongruent symptoms (MIS) over a long period of time, independently of longitudinal syndromatic constellations.
The Halle bipolarity longitudinal study (HABILOS) prospectively investigates 182 patients meeting the DSM-IV criteria for bipolar I disorders over a long period of time (x;- = 16.84 years). One thousand five hundred thirty-nine (1,539) episodes have been evaluated with standardized instruments. Patients and episodes were divided into two groups (with and without MIS) and were compared on various levels.
It was found: (1) The majority of the episodes of bipolar I patients during long-term course did not have MIS, but the majority of patients did. (2) Bipolar I patients with MIS differ from patients without MIS in the following features: (a) Bipolar I patients with MIS are more frequently males. (b) Bipolar I patients with MIS need treatment at a significantly younger age than those without MIS. (c) First manifestation of bipolar I disorder with MIS after the age of 50 is extremely seldom. (d) Bipolar I patients with MIS more frequently have relatives with schizophrenia. (e) Bipolar I patients with MIS more frequently become disabled and retire at a significantly younger age than patients without MIS and (f) Significantly fewer patients with MIS than those without MIS live in a stable partnership.
It can be concluded that bipolar I disorders with MIS are more severe disorders than bipolar I disorders without MIS. This finding in combination with the above results, however, can give rise to the conclusion that bipolar I disorders with MIS are the epiphenomenon of the overlap, possibly genetic, of a "schizophrenic spectrum" and a "bipolar spectrum" and their antagonistic influence creating a "schizo-affective" area between them as a kind of psychotic continuum between prototypes.
Archiv f ur Psychiatrie und Nervenkrankheiten 03/2009; 259(3):131-6. · 2.75 Impact Factor
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ABSTRACT: The longitudinal course of bipolar I disorders is often characterized by a polymorphism, which means that different kinds of episodes develop during the illness. This study investigated the characteristics, similarities and differences of the long-term course of bipolar I patients regarding the dominance of various kinds of episodes.
One hundred eighty-two (182) patients with DSM-IV bipolar I disorder were longitudinally investigated (approximately 17 years duration of the illness) with standardized instruments. The dominance of mood, schizo-affective and schizophreniform episodes was estimated by means of a mathematic formula. According to that dominance, the patients were divided into three groups (mood-dominated, schizo-affective-dominated, schizophreniform-dominated), and these groups were compared to each other at various levels.
The long-term course of bipolar I patients is usually polymorphic showing not only mood episodes, but also schizo-affective and schizophreniform episodes. Nevertheless it is mainly mood-dominated. There are significant differences between patients with mood-dominated and patients with schizo-dominated course, especially in regard to age at first treatment, family history, global functioning, frequency of disability and age at retirement due to the mental illness. Patients with schizo-affective-dominated course occupy a position in-between, but showing stronger similarities with mood-dominated patients.
The investigation is not blind; therefore, bias cannot be excluded. Retirement due to the mental illness is strongly connected with specific national features.
The polymorphic long-term course of bipolar disorders and the differences and similarities between mood-dominated, schizo-affective-dominated and schizo-dominated types of course could support the argument that a distinction between the prototypes "mood disorder" and "schizophreniform disorder" is not always possible, but that there is an overlap of affective and schizophreniform spectra and an "antagonistic influence" between them. Clinicians need to consider the polymorphism of the bipolar disorder in order to provide adequate treatment and prophylaxis. Researchers have to consider that the boundaries of diagnostic categories are very elastic and permeable, making a psychotic continuum possible.
Journal of Affective Disorders 05/2008; 107(1-3):117-26. · 3.52 Impact Factor
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ABSTRACT: Personality and temperament are supposed to have an impact on the clinical expression and course of an affective disorder. There is some indication, that mixed episodes result from an admixture of inverse temperamental factors to a manic syndrome. In a preliminary report [Brieger, P., Roettig, S., Ehrt, U., Wenzel, A., Bloink, R., Marneros, A., 2003. TEMPS-a scale in 'mixed' and 'pure' manic episodes: new data and methodological considerations on the relevance of joint anxious-depressive temperament traits. J. Affect. Disord. 73, 99-104] we reported support for this assumption. The present study completes the preliminary results and compares patients with and without mixed episodes with respect to personality and personality disorders in addition.
Patients who had been hospitalized for bipolar I disorder were reassessed after 4.8 years. We examined temperament (TEMPS-A), personality (NEO-FFI) and frequency of personality disorders (SCID-II). Furthermore, illness-related parameters like age at first treatment, depressive and manic symptomatology, frequency and type of episodes and level of functioning were obtained and patients with and without mixed episodes were compared.
Patients with (n=49) and without mixed episodes (n=86) did not differ significantly with regard to the illness-related parameters and personality dimensions. The frequency of personality disorders was significantly higher in patients with prior mixed episodes. With respect to temperament, scores of the depressive, cyclothymic, irritable and anxious temperament were significantly higher in patients with mixed episodes.
We were not able to assess premorbid temperament and premorbid personality.
The findings of the present study support the assumption of Akiskal [Akiskal, H.S., 1992b. The distinctive mixed states of bipolar I, II, and III. Clin. Neuropharmacol. 15 Suppl 1 Pt A, 632-633.] that mixed episodes are more frequent in subjects with inverse temperament.
Journal of Affective Disorders 01/2008; 104(1-3):97-102. · 3.52 Impact Factor
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Andreas Marneros
World psychiatry: official journal of the World Psychiatric Association (WPA) 07/2007; 6(2):96-7. · 6.23 Impact Factor
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Andreas Marneros
Current Opinion in Psychiatry 06/2007; 20(3):206-7. · 3.05 Impact Factor
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ABSTRACT: Various subjective and objective criteria are used to assess outcome in bipolar disorder. In this study, we explored to what extent they reflect distinct categories and whether underlying dimensions can be identified.
One-hundred and twenty-one subjects with at least three episodes of bipolar I disorder (DSM-IV) were assessed on average 4.8 years after hospitalization. We assessed 14 variables reflecting different outcome criteria including subjective quality of life (SQOL), self-rated and observer-rated psychopathology, and functioning and disability. A principal component analysis was computed across all outcome variables. Identified dimensions were correlated with sociodemographic characteristics, illness history, premorbid adjustment and personality traits.
Three outcome dimensions were identified, i.e. a 'general subjective', a 'functioning/disability' and a 'manic/psychotic symptoms' dimension. Together they explain 69% of the total variance. The 'general subjective' dimension consists of SQOL scales and self-rated depressive symptoms. It is associated with comorbid anxiety disorders and personality disorders, high neuroticism and not having been in hospital in the last year. The 'functioning/disability' dimension comprises of criteria reflecting negative symptoms, disability and low functioning. It is associated with more prior illness episodes and low premorbid adjustment. The 'manic/psychotic symptoms' dimension consists of observer-rated manic and positive psychotic symptoms. It is correlated with not currently taking a specific medication.
Cross-sectional design with a limited sample size.
The findings indicate that outcome criteria in bipolar I disorder can be grouped into three distinct dimensions reflecting (1) subjective appraisals, (2) functioning/disability and (3) manic/psychotic symptoms. While measurement of psychotic/manic symptoms has become a matter of course, until now few studies have assessed disability or subjective appraisal in bipolar illness. Therefore important aspects of bipolar illness might be overseen. For a better understanding, we suggest that longitudinal studies of bipolar I disorders should consider all three dimensions of outcome and measure them separately.
Journal of Affective Disorders 05/2007; 99(1-3):1-7. · 3.52 Impact Factor
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ABSTRACT: To clarify the prevalence of mental diseases including personality disorders in a sample of German prisoners regarding delinquency and gender specificity.
Crime history, present state and lifetime mental disorders, as well as personality disorders, were assessed amongst 415 inmates and compared regarding gender and type of delinquency.
Female offenders more often committed homicide while male offenders more frequently committed assault and robbery. Men had a higher prevalence of alcohol abuse and dissocial PD while women more often showed depression, anxiety disorders and Borderline PD. Violent offences were related to a higher prevalence of alcohol abuse and dissocial PD, as well as higher comorbidities of mental disorders.
Results emphasize the complexity of the needs and requirements of imprisoned offenders. Our findings reveal an urgent need for psychiatric-psychotherapeutic services to provide suitable care to inmates in order to contribute to a more favorable legal prognosis.
European Archives of Psychiatry and Clinical Neuroscience 11/2006; 256(7):414-21. · 3.49 Impact Factor
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ABSTRACT: This case report draws attention to the dramatic consequences of the consumption of Angel's Trumpet. Angel's Trumpet contains alkaloids (especially scopolamine, as well as hyoscyamine, atropine and other alkaloids) in a relatively high concentration. When intoxicated with Angel's Trumpet, patients can suffer hallucinations, motoric restlessness, overtalkativeness, convulsive sobbing and sexual excitement, as well as aggressive and autoaggressive behaviour. Somatic symptoms are tachycardia, mydriasis, hypertonia, respiratory disturbances and vomiting, as well as a potentially life-threatening anticholinerg syndrome. In this paper, we report on a young man who amputated his penis and his tongue after having consumed Angel's Trumpet tea, illustrating that consuming this beautiful flower with the name of an angel and the poison of the devil can be very dangerous.
European Archives of Psychiatry and Clinical Neuroscience 11/2006; 256(7):458-9. · 3.49 Impact Factor
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ABSTRACT: This case report draws attention to the dramatic consequences of the consumption of Angel’s Trumpet. Angel’s Trumpet contains
alkaloids (especially scopolamine, as well as hyoscyamine, atropine and other alkaloids) in a relatively high concentration.
When intoxicated with Angel’s Trumpet, patients can suffer hallucinations, motoric restlessness, overtalkativeness, convulsive
sobbing and sexual excitement, as well as aggressive and autoaggressive behaviour. Somatic symptoms are tachycardia, mydriasis,
hypertonia, respiratory disturbances and vomiting, as well as a potentially life-threatening anticholinerg syndrome. In this
paper, we report on a young man who amputated his penis and his tongue after having consumed Angel’s Trumpet tea, illustrating
that consuming this beautiful flower with the name of an angel and the poison of the devil can be very dangerous.
European Archives of Psychiatry and Clinical Neuroscience 09/2006; 256(7):458-459. · 3.49 Impact Factor
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ABSTRACT: We prospectively studied the long-term course of individuals with acute and transient psychotic disorders and a control group with positive schizophrenia matched for age and gender. Follow-up investigations using standardised instruments were performed at three time-points covering 7 years after the index episode or 12 years after the first episode. During follow-up, those with positive schizophrenia experienced a deterioration in their general functioning whereas those with acute and transient psychotic disorders retained their high level of functioning. At the end of the observation period, 12 out of 39 (31%) of those with acute and transient psychotic disorders were functioning well without medication compared with 0 out of 38 with positive schizophrenia.
The British Journal of Psychiatry 10/2005; 187:286-7. · 6.62 Impact Factor
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ABSTRACT: This study explores psychopathological aspects of acute and transient psychotic disorders (ATPD), a diagnostic category introduced with ICD-10, to elucidate its relationship with schizophrenia and schizoaffective psychoses.
We recruited all consecutive inpatients fulfilling the ICD-10 criteria of ATPD (F23) during a 5-year period as well as control groups with "positive" schizophrenia (PS) and bipolar schizoaffective disorder (BSAD) matched for gender and age at index episode. For the evaluation of psychopathological parameters during index episode a standardized symptom list was used. Prepsychotic (prodromal) symptoms were also assessed.
During the prepsychotic period few differences between the groups were detected. The most important difference between ATPD and the other two other psychotic disorders regarding phenomenology of the full-blown episodes was a higher frequency of "rapidly changing delusional topics", "rapidly changing mood" and anxiety in ATPD.
ATPD show a characteristic psychopathological picture consistent with earlier concepts such as cycloid psychoses and bouffée délirante. Nevertheless, psychopathology alone is not enough to establish ATPD as an independent nosological entity.
European Psychiatry 07/2005; 20(4):315-20. · 2.77 Impact Factor
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ABSTRACT: The purpose of the study was to evaluate the psychometric properties of the German version of the TEMPS-A questionnaire. Besides the reliability of the temperament scales, validity was the focus of interest. Therefore, the relationship between the TEMPS-A and the well-established personality questionnaire NEO-FFI, whose factors show theoretical overlap with temperaments, was investigated.
A total of 227 students aged between 20 and 42 years were asked to fill in both instruments. Reliability coefficients for the five temperament scales and correlations among the scales of both questionnaires were calculated, as well as multiple linear regression analysis with the five personality factors and gender as independent, and the five temperaments as dependent variables.
Reliability indices for the five temperament scales were satisfactory, with values ranging between 0.63 (depressive) and 0.76 (anxious). Women scored higher on depressive and anxious scales, whereas men had higher scores on hyperthymic temperament. Correlations within the temperament scales showed close relationships between depressive, anxious and cyclothymic temperaments; cyclothymic and irritable temperament were also related. The personality factors of the NEO-FFI predicted temperaments fairly well and explained between 41% and 58% of the variance; the main effects were exerted by neuroticism and extraversion, while the irritable temperament was primarily explained by low agreeableness.
The study sample was relatively small and selected.
The TEMPS-A scale has sufficient reliability and good validity in a non-clinical sample. It opens new possibilities for clinical research at the interface of mental disorders, temperament and personality. Such research is in progress.
Journal of Affective Disorders 04/2005; 85(1-2):77-83. · 3.52 Impact Factor
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ABSTRACT: To assess subjective quality of life (QOL) of subjects with unipolar depressive and bipolar affective disorders.
153 consecutive psychiatric in-patients were assessed with standardized interviews. Prior to discharge QOL was assessed with WHOQOL-bref. With the help of multivariate statistics, the effect of illness and biographical factors on four domains of QOL (physical health, psychological, social relationships and environment) was analyzed.
103 patients suffered from unipolar depression, 51 from bipolar affective disorder (30 fulfilled criteria for a mixed or pure manic episode). With the exception of the domain environment for (mixed) manic patients, all patients reported lower QOL in all domains than was reported for the general population according to the German test manual. Multivariate analyses revealed that the chosen variables explained between 11.1 % (social relationships) and 33.6 % (psychological) of the variance of the QOL domains. The domains "psychological" and "environment" were first of all explained by the presence of a (mixed) manic episode, while the best variable to predict "physical health" was presence of comorbid neurotic disorder. The depression score had little additional effects on QOL.
We found little support that the QOL domains of the WHOQOL-bref in affective disorder are only hidden depression scores, as has been argued before. Therefore, QOL could be an interesting construct to better understand differences between subjective evaluation and (supposedly) objective psychopathology in bipolar affective disorders.
Psychiatrische Praxis 10/2004; 31(6):304-9. · 1.64 Impact Factor
