[Show abstract][Hide abstract] ABSTRACT: As part of the development of the Eleventh Revision of International Classification of Diseases and Related Health Problems (ICD-11), the World Health Organization Department of Mental Health and Substance Abuse is conducting a series of case-controlled field studies using a new and powerful method to test the application by clinicians of the proposed ICD-11 diagnostic guidelines for mental and behavioural disorders. This article describes the case-controlled field study for Disorders Specifically Associated with Stress. Using a vignette-based experimental methodology, 1,738 international mental health professionals diagnosed standardized cases designed to test key differences between the proposed diagnostic guidelines for ICD-11 and corresponding guidelines for ICD-10. Across eight comparisons, several proposed changes for ICD-11, including the addition of Complex PTSD and Prolonged Grief Disorder, produced significantly improved diagnostic decisions and clearer application of diagnostic guidelines compared to ICD-10. However, several key areas were also identified, such as the description of the diagnostic requirement of re-experiencing in PTSD, in which the guidelines were not consistently applied as intended. These results informed specific revisions to improve the clarity of the proposed ICD-11 diagnostic guidelines. The next step will be to further test these guidelines in clinic-based studies using real patients in relevant settings.
Full-text · Article · Nov 2015 · International Journal of Clinical and Health Psychology
[Show abstract][Hide abstract] ABSTRACT: For the 11th revision of the International classification of diseases, a general category of posttraumatic stress disorders has been proposed with two distinct sibling disorders: posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD). General population data are examined on evidence for these two disorders. Data were drawn from a 10-year prospective longitudinal, epidemiological study with a representative community sample (N = 3021, 14-24 years at baseline) in Germany. Mixture modelling on latent classes was conducted in a subset of all reported episodes with exposure to interpersonal traumas. Associations between class membership, symptom criteria, and other mental disorders were investigated. Four distinctly interpretable latent classes were found. Class 1 episodes (N = 181) typically included core PTSD symptoms associated with strong impairment (OR 11.68; 95 % CI 4.54-30.05). 18.3 % of these episodes matched the criteria of ICD-11 PTSD. Class 2 episodes (N = 78) had a high probability of PTSD core symptoms and disturbances in self-organization and were associated with strong impairment (OR 38.47; 95 % CI 15.77-93.86). Half of them (49.4 %) matched the proposed ICD-11 criteria of CPTSD. Class 3 (N = 79) was typically characterized by episodes with disturbances in self-organization but a low probability of PTSD core symptoms and impairment. Class 4 (N = 633) was related to a relatively low probability of symptom reports. Membership in class 2 was associated with lower educational attainment, a lower social class, and more other mental disorders. Findings support the ICD-11 proposal to differentiate between PTSD and CPTSD. Further studies should extend exploration to other types of traumatic events in samples covering the full age range.
Full-text · Article · Aug 2015 · European Archives of Psychiatry and Clinical Neuroscience
[Show abstract][Hide abstract] ABSTRACT: Aim of the study:
For the 11th revision of the International Classification of Diseases and Related Health Problems (ICD-11) attitudes of psychologists towards classificatory diagnostics should be considered.
A survey was conducted via the Internet in 22 countries. 1985 psychologists participated with N=170 from Germany and N=37 from Switzerland.
The German participants preferred the ICD. Classificatory diagnostics should inform on treatment as well as serve for communication. The majority argued for a flexible use and guidance towards strict criteria. In contrast to respondents from other countries, a functional status as part of the diagnostic criteria was not considered but in line with them, a dimensional component was endorsed.
Responses of the German psychologists partially differ to those of participants from other countries. Differences and implications are discussed.
No preview · Article · May 2014 · PPmP - Psychotherapie · Psychosomatik · Medizinische Psychologie
[Show abstract][Hide abstract] ABSTRACT: Zusammenfassung
Ziel der Studie:
Für die 11. Revision der Internationalen Klassifikation von Erkrankungen (ICD-11) sollen von Psychologen Einstellungen zur klassifikatorischen Diagnostik berücksichtigt werden.
Ein Survey wurde via Internet in 22 Ländern durchgeführt. 1985 klinischen Psychologen, davon 170 Deutsche und 37 Schweizer nahmen teil.
Die deutschen Teilnehmer bevorzugten die ICD. Klassifikatorische Diagnostik sollte der Entscheidungsfindung und Vorgehensweise für die Therapie sowie der Kommunikation dienen. Die Mehrheit sprach sich für eine flexible Anleitung gegenüber strengen Kriterien aus. Im Unterschied zu den Befragten anderer Länder wurde die Berücksichtigung des funktionalen Status bei den diagnostischen Kriterien abgelehnt, einer dimensionalen Komponente aber mit ihnen zugestimmt.
Die Antworten deutscher Psychologen unterscheiden sich teilweise von denen anderer Länder. Die Implikationen werden diskutiert.
For the 11(th) revision of the International Classification of Diseases and Related Health Problems (ICD-11) attitudes of psychologists towards classificatory diagnostics should be considered.A survey was conducted via the Internet in 22 countries. 1985 psychologists participated with N=170 from Germany and N=37 from Switzerland.The German participants preferred the ICD. Classificatory diagnostics should inform on treatment as well as serve for communication. The majority argued for a flexible use and guidance towards strict criteria. In contrast to res-pondents from other countries, a functional status as part of the diagnostic criteria was not considered but in line with them, a dimensional component was endorsed.Responses of the German psychologists partially differ to those of participants from other countries. Differences and implications are discussed.
[Show abstract][Hide abstract] ABSTRACT: We address the general perspective of the World Health Organization towards the classification process of the 11th revision of the International Classification of Diseases and Related Health Problems (ICD-11); give a short description of the ICD-11 proposals related to “disorders specifically associated with stress” and the differentiation between posttraumatic stress disorder, complex posttraumatic stress disorder, and prolonged grief disorder; and comment on the most important aim of classifying mental disorders—to provide the best treatments available.
Full-text · Article · Oct 2013 · Journal of Traumatic Stress
[Show abstract][Hide abstract] ABSTRACT: Background:
Numerous studies have documented an association between mental disorders and onset of cigarette smoking. Yet, there is little understanding of the potential impact of mental disorders on trajectories of smoking over time. The objective of this study was to investigate this relationship among adolescents over a 10-year span.
Data were drawn from the Early Developmental Stages of Psychopathology Study, a 10-year prospective investigation of youth in Germany. Growth mixture modeling was used to identify smoking trajectories and logistic regression analyses were used to examine relationships between mental disorders and subsequent trajectories.
Four trajectories were identified: non-users; increasing use; decreasing use; persistent use. Alcohol/drug use disorders, stress disorders, anxiety disorders, somatoform disorder and nicotine dependence were associated with nicotine use (as compared to the non-smoker class). However, comparisons between trajectories of nicotine use showed that any stress disorder predicted only decreasing use compared to the other two trajectories; nicotine dependence, alcohol/illicit drug use disorders as well as panic disorder and somatoform disorders were inversely associated with increasing use; nicotine dependence and alcohol/drug use disorders were associated with persistent use.
Several mental disorders appear to be non-specific markers of the range of smoking trajectories while others predict specific trajectories. Numerous disorders (e.g., alcohol/drug use disorders) do not appear to occur only prior to and predict increased smoking trajectory as had been previously suggested, but rather they also occur concurrently, with high levels of smoking and in some cases smoking persists at a steady level over time.
No preview · Article · Jan 2013 · Drug and alcohol dependence
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: There is little prospective-epidemiological information on symptoms of DSM-IV-alcohol use disorder (alcohol abuse and dependence; AUD) that may be typical for early AUD stages or the developmental periods of adolescence and early adulthood. AIMS: To investigate AUD symptoms (AUDS) cross-sectionally at three subsequent assessment waves regarding prevalence rates, symptom counts, associated drinking patterns, positive predictive values (PPV) for DSM-IV-alcohol dependence (AD), and AUDS stability over time. METHODS: N=2039 community subjects (baseline age 14-24 years) participated in a baseline and two follow-up assessment(s) over up to ten years. DSM-IV-AUDS, DSM-IV-AUD and craving were assessed with the DSM-IV/M-CIDI. RESULTS: Over the assessment waves, tolerance and much time were most and role obligations and withdrawal least frequent. Most subjects with DSM-IV-AUDS reported only one symptom (47.2-55.1%). PPV for DSM-IV-AD only exceeded 70% for activities, problem, withdrawal, and desired control; PPV were lowest for tolerance and hazardous use. For most AUDS, AUDS report compared to non-report was associated with elevated drinking frequency and amounts. Stability of baseline AUDS at four-year and ten-year follow-up did not exceed 36.4% for any symptom. CONCLUSIONS: The overall pattern of most/least frequent AUDS reported in adolescence and early adulthood resembles findings in older adults and does not suggest a developmentally specific symptom pattern. Moderate AUDS-stability and considerable remission rates indicate that AUDS in this age group are transient for a considerable proportion of subjects. However, the associations with elevated consumption indicate that AUDS reports early in life need to be taken seriously in prevention and intervention.
No preview · Article · Jan 2013 · Drug and alcohol dependence
[Show abstract][Hide abstract] ABSTRACT: In 2005, findings of the first "cost of disorders of the brain in Europe" study of the European Brain Council (EBC) showed that these costs cause a substantial economic burden to the Swiss society. In 2010 an improved update with a broader range of disorders has been analysed. This report shows the new findings for Switzerland and discusses changes.
Data are derived from the EBC 2010 census study that estimates 12-month prevalence of 12 groups of disorders of the brain and calculates costs (direct health-care costs, direct non-medical costs and indirect costs) by combining top-down and bottom up cost approaches using existing data.
The most frequent disorder was headache (2.3 million). Anxiety disorders were found in 1 million persons and sleep disorders in 700,000 persons. Annual costs for all assessed disorders total to 14.5 billion Euro corresponding to about 1,900 EUR per inhabitant per year. Mood, psychotic disorders and dementias (appr. 2 billion EUR each) were most costly. Costs per person were highest for neurological/neurosurgery-relevant disorders, e.g. neuromuscular disorders, brain tumour and multiple sclerosis (38,000 to 24,000 EUR).
The estimates of the EBC 2010 study for Switzerland provide a basis for health care planning. Increase in size and costs compared to 2005 are mostly due to the inclusion of new disorders (e.g., sleep disorders), or the re-definition of others (e.g., headache) and to an increase in younger cohorts. We suggest coordinated research and preventive measures coordinated between governmental bodies, private health-care and pharmaceutical companies.
Full-text · Article · Jan 2013 · Schweizerische medizinische Wochenschrift
[Show abstract][Hide abstract] ABSTRACT: A younger age at onset of use of a specific substance is a well-documented risk-factor for a substance use disorder (SUD) related to that specific substance. However, the cross-substance relationship between a younger age at onset of alcohol use (AU) and nicotine use (NU) and the risk of cannabis use disorders (CUD) in adolescence and early adulthood remains unclear.
To identify the sequence of and latency between initial AU/NU and initial cannabis use (CU). To investigate whether younger age at AU- and NU-onset is associated with any and earlier CU-onset and a higher risk of transition from first CU to CUD, taking into account externalizing disorders (ED) and parental substance use disorders as putative influential factors.
Prospective-longitudinal community study with N=3021 subjects (baseline age 14-24) and up to four assessment waves over up to ten years with additional direct parental and family history information. Substance use and CUD were assessed with the DSM-IV/M-CIDI.
Most subjects with CU reported AU (99%) and NU (94%). Among users of both substances, 93% reported AU prior to CU (87% for NU). After adjustment for ED and parental substance use disorders younger age at AU-onset was associated with any CU. Younger age at NU-onset was associated with earlier CU initiation. Younger age at AU- and NU-onset was not associated with a higher risk of CUD.
The cross-substance relevance of younger age at first AU and NU for the risk of CUD is limited to early CU involvement.
No preview · Article · Nov 2011 · Drug and alcohol dependence
[Show abstract][Hide abstract] ABSTRACT: Among adolescents and young adults with DSM-IV alcohol use disorders (AUDs), there are inter-individual differences in the speed of transition from initial alcohol use (AU) to AUD. AUDs are highly co-morbid with other mental disorders. The factors associated with rapid transition from first AU to AUD remain unknown and the role of mental disorders in rapid transitions is unclear. Given this background we examined (1) whether prior anxiety, mood, externalizing and non-alcohol substance use disorders are related to the risk and speed of transition from first AU to DSM-IV alcohol abuse (AA) and alcohol dependence (AD) and (2) whether early age of onset of prior mental disorders (PMDs) is a promoter of rapid transition.
A total of 3021 community subjects (97.7% lifetime AU) aged 14-24 years at baseline were followed up prospectively for up to 10 years. AU and mental disorders were assessed with the DSM-IV/M-CIDI.
Among subjects with lifetime AU, several PMDs, such as specific phobia, bipolar disorder and nicotine dependence, were associated with an increased risk of AUD independent of externalizing disorders. Associations of PMDs with the speed of transition to AUDs were mostly weak and inconsistent. Only social phobia and externalizing disorders were associated with faster transitions to AD even after adjustment for other PMDs. Earlier age of onset of PMD was not associated with rapid transition.
Mental disorders are associated with the risk of AUD. With the possible exception of social phobia and externalizing disorders, they do not promote rapid transition, even if they occur particularly early. Future research needs to identify factors relevant to rapid transition to AUD.
Full-text · Article · May 2011 · Psychological Medicine
[Show abstract][Hide abstract] ABSTRACT: To investigate the association between use of cocaine, amphetamines, or psychedelics and psychotic symptoms.
Cumulated lifetime data from a prospective, longitudinal community study of 2588 adolescents and young adults in Munich, Germany, were used. Substance use at baseline, 4-year and 10-year follow-up and psychotic symptoms at 4-year and 10-year follow-up were assessed using the Munich-Composite International Diagnostic Interview. Data from all assessment waves were aggregated, and multinomial logistic regression analyses were performed. Additional analyses adjusted for sociodemographics, common mental disorders, other substance use, and childhood adversity (adjusted odds ratios, AOR).
After adjusting for potential confounders, lifetime experience of two or more psychotic symptoms was associated with lifetime use of cocaine (AOR 1.94; 95% CI 1.10-3.45) and psychedelics (AOR 2.37; 95% CI 1.20-4.66). Additionally, when mood or anxiety disorders were excluded, lifetime experience of two or more psychotic symptoms was associated with use of psychedelics (AOR 3.56; 95% CI 1.20-10.61).
Associations between psychotic symptoms and use of cocaine, and/or psychedelics in adolescents and young adults call for further studies to elucidate risk factors and developmental pathways.
No preview · Article · Nov 2010 · Acta Psychiatrica Scandinavica
[Show abstract][Hide abstract] ABSTRACT: Cannabis use (CU) and disorders (CUD) are highly prevalent among adolescents and young adults. We aim to identify clinically meaningful latent classes of users of cannabis and other illegal substances with distinct problem profiles.
N=3021 community subjects aged 14-24 at baseline were followed-up over a period ranging up to 10 years. Substance use (SU) and disorders (SUD) were assessed with the DSM-IV/M-CIDI. Latent class analysis (LCA) was conducted with a subset of N=1089 subjects with repeated illegal SU. The variables entered in the LCA were CU-related problems, CUD, other SUD, and other mental disorders.
Four latent classes were identified: "Unproblematic CU" (class 1: 59.2%), "Primary alcohol use disorders" (class 2: 14.4%), "Delinquent cannabis/alcohol DSM-IV-abuse" (class 3: 17.9%), "CUD with multiple problems" (class 4: 8.5%). Range and level of CU-related problems were highest in classes 3 and 4. Comorbidity with other mental disorders was highest in classes 2 and 4. The probability of alcohol disorders and unmet treatment needs was considerable in classes 2-4.
While the majority of subjects with repeated illegal SU did not experience notable problems over the 10-year period, a large minority (40.8%) experienced problematic outcomes, distinguished by clinically meaningful profiles. The data underline the need for specifically tailored interventions for adolescents with problematic CU and highlight the potentially important role of alcohol and other mental disorders.
No preview · Article · May 2009 · Drug and alcohol dependence
[Show abstract][Hide abstract] ABSTRACT: We reviewed epidemiological findings for the diagnosis of posttraumatic stress disorder (PTSD) and its core diagnostic features, focusing on whether epidemiology has been helpful in clarifying some of the critical diagnostic issues relevant to the revision of the Diagnostic and Statistical Manual of Mental Disorders and the International Statistical Classification of Diseases. Though epidemiology has provided increasingly rich data and knowledge regarding prevalence and incidence, patterns of onset and course, comorbidity, and risk factors for traumatic experiences and posttraumatic stress, little systematic research has been performed specifically addressing such critical diagnostic issues. Particularly, unresolved concerns remain regarding the definition of trauma, duration and impairment/distress criteria, the distinctiveness of the PTSD-syndrome, and even the position of PTSD in the classification system of mental disorders. A further exploitation of the existing data, and an improvement of existing epidemiological methods, strategies, and assessments are likely to substantially contribute to the clarification of unresolved diagnostic issues.
[Show abstract][Hide abstract] ABSTRACT: Aim: To investigate remission without formal help (natural recovery; NR) from DSM-IV substance-use disorders among adolescents and young adults. Method: A representative community sample of adolescents and young adults from Munich, Germany, who were aged 14-24 years at baseline (N = 3,021), were followed in a prospective-longitudinal, epidemiological study. The course of DSM-IV substance use disorders and remission from them were assessed in face-to-face interviews using the Munich Composite International Diagnostic Interview. Results: 28.3 % of the sample met the criteria for nicotine dependence, 11.4 % for alcohol dependence, and 4.6 % for an illicit substance-use disorder at the final follow-up. Only a small proportion of the sample (3.5 %) had received formal help. Among the respondents who had received no formal help, dependence symptoms had first occurred, on average, before the age of 18 years and had continued for approximately 5 years at the time of the final follow-up. 20.2 % of the respondents had remitted. The highest rate of NR (37.4 %) was from illegal substance dependence. Cumulative probabilities according to length of dependence revealed patterns of probability of remission that depended on substance type and respondents' gender. Conclusions: Although remission without formal help appears relatively common during adolescence and young adulthood, rates are markedly lower than in adult populations. In addition to improving substance-use treatment and other services, it is necessary to support young people in their ability to change themselves during the early stages of their dependence. Specific interventions are needed for this.
[Show abstract][Hide abstract] ABSTRACT: There is evidence from cross-sectional studies that posttraumatic stress disorder (PTSD) may be associated with obesity. The aim of this study was to examine prospective longitudinal associations between PTSD and obesity in a community sample.
A prospective, longitudinal, epidemiologic study with a representative community sample of adolescents and young adults (N=3021, aged 14-24 years at baseline) was conducted in Munich, Germany. Participants were assessed four times between 1995 and 2005 with the Munich-Composite International Diagnostic Interview. Associations between obesity (BMI > or =30) and DSM-IV PTSD were evaluated in 2007, using cross-sectional and prospective data during young adulthood.
The cumulative lifetime incidence of obesity in the sample at 10-year follow-up during young adulthood was 4.3% (women, 4.6%; men, 4.0%). Among women but not among men, obesity was associated with a lifetime history of PTSD (OR=3.8; 95% CI=1.4, 10.7) in the cross-sectional analyses. Prospective longitudinal analyses from 4-year follow-up to 10-year follow-up confirmed that obesity was predicted by antecedent subthreshold and full PTSD (OR=3.0; 95% CI=1.3, 7.0) among women but not among men. There were no associations between other mental disorders and obesity in the prospective analyses.
The findings indicate a possible causal pathway for the onset of obesity in females with PTSD symptoms. These findings need replication with regard to the pathophysiologic and behavioral mechanisms underlying this relationship.
Full-text · Article · Oct 2008 · American journal of preventive medicine
[Show abstract][Hide abstract] ABSTRACT: For a better understanding of the evolution of addictive disorders and the timely initiation of early intervention and prevention, we have to learn when and how quickly the critical transitions from first substance use (SU) to regular use and from first SU and regular SU to abuse and dependence occur. Little data are currently available on the transitions to substance use disorders (SUDs) across the spectrum of legal and illegal drugs taking into account gender differences. It is the aim of this paper to describe the high density incidence and transition periods of SU and SUD for alcohol, nicotine, cannabis and other illicit drugs for young males and females.
A sample of (N = 3021) community subjects aged 14-24 at baseline were followed-up prospectively over 10-years. SU and SUD were assessed using the DSM-IV/M-CIDI.
Ages 10-16 are the high risk period for first alcohol and nicotine use (up to 38% of subjects start before age 14). Onset of illegal SU occurs later. Substantial proportions of transitions to regular SU and SUD occur in the first three years after SU onset. Only few gender differences were found for time patterns of SU/SUD incidence and transition.
Except for alcohol the time windows for targeted intervention to prevent progression to malignant patterns in adolescence are critically small, leaving little time for targeted intervention to prevent transition. The fast transitions to abuse and dependence in adolescence may be indicative for the increased vulnerability to substance effects in this time period. Basic research on the determinants of transitions should thus target this period in adolescence.
Full-text · Article · Jun 2008 · International Journal of Methods in Psychiatric Research
[Show abstract][Hide abstract] ABSTRACT: There has been little available information on the long-term natural course, persistence and remission of cannabis use, abuse and dependence. The current study estimated rates and risk factors associated with stability and variation in cannabis use patterns, cannabis abuse and cannabis dependence in a community sample over a 10-year period.
Prospective longitudinal, epidemiological study with a 4- and 10-year follow-up of a community sample (n = 3021) aged 14-24 years at baseline in Munich, Germany.
Cannabis use, abuse and dependence and associated risk factors were assessed by face-to-face interviews using the Munich Composite International Diagnostic Interview. Findings At baseline, one-third of the sample (34.2%) had used cannabis at least once. The cumulative incidence of cannabis use 10 years later was 50.7%. Fifty-six per cent of all repeated users (five times or more) at baseline reported cannabis use at 4-year follow-up. Ten years later, this proportion had decreased slightly to only 46.3%. Repeated (five times or more) users were almost three times more likely to report repeated use at 10-year follow up (OR = 2.8, 95% CI = 1.6-4.7), compared with those who had used cannabis fewer times. Peer use of cannabis, life-events and alcohol dependence also predicted use of cannabis at 10-year follow-up.
Among youth who have used cannabis repeatedly (five times or more) cannabis use is fairly stable and rates of remission relatively low until age 34 years. Patterns of progression suggest that early targeted preventive measures should delay first use and reduce the number of experiences using cannabis, as these factors appear critical in progression to persistent cannabis use and cannabis dependence.
[Show abstract][Hide abstract] ABSTRACT: Aims: The study presents an innovative approach how to improve the provision of substance abuse services in a region by a stepwise comprehensive evaluation of patients' needs and services. Methods: Expert-rated need evaluation of epidemiological findings and consensus based development of new structures and processes for substance abuse care. Results: Findings of a longitudinal, epidemiological community study refer to an increased need of new allocation structures and intervention strategies for youth in early stages of cannabis dependence and for youth with alcohol abuse and alcohol dependence is stated. The commission suggests improving preventive and early intervention structures and -processes for substance use and risk factors as well as the inclusion of other health care services in the region. Specifically, new strategies to transfer new knowledge to parents and other key persons as well as structures and strategies for early diagnostic assessment and early interventions are needed. They should be based on new interfaces and an improved network with general health care. Conclusions: The unidirectional allocation of resources to care for severe addicts should be suspended without limiting care and quality of care for this group. Extension and optimization of resources is needed to improve prevention and early intervention strategies.
No preview · Article · Jan 2008 · Suchtmedizin in Forschung und Praxis