Munich Version Research Articles

Course and Outcome of Somatoform Disorders in Non-Referred Adolescents

The author examined the course of somatoform disorders in non-referred adolescents. Somatoform disorders were coded from DSM-IV criteria, using the computerized Munich (Germany) version of the Composite International Diagnostic Interview. About 35.9% of the adolescents with somatoform disorders at the index investigation continued to have the same disorders at the follow-up investigation: 26.7% had anxiety, 17.1% had depression, 22% had substance-use disorders, and 53.7% had no psychiatric disorders. Factors related to the chronicity of somatoform disorders included gender, comorbid depressive disorders, parental psychiatric disorders, and negative life events. Somatoform disorders showed a heterogeneous pattern of course.

The health-related quality-of-life impact of chronic conditions varied with age in general population

Objective To estimate the individual- and population-level impact of major chronic conditions on health-related quality of life (HRQoL) at different ages, to test whether the HRQoL impact of conditions varies with age, and to predict future changes of quality-adjusted life years (QALYs) lost due to morbidity. Study Design and Setting HRQoL was measured using two preference-based instruments, the 15D and the EQ-5D, in a representative sample of 8,028 Finns. Information on chronic somatic conditions was obtained by interviews. Psychiatric disorders were diagnosed using a structured interview (Munich version of the Composite International Diagnostic Interview). Results The impact of chronic conditions on HRQoL increased fourfold when comparing people aged 30–44 years to people over 75 years. This was mostly due to increase in prevalence, but the severity of some conditions also varied with age. Musculoskeletal disorders had the largest and rather stable impact across ages on the population level. Psychiatric disorders placed the largest burden on HRQoL at 30–44 years, but their impact declined after 55 years. The aging of the Finnish population was predicted to increase annual QALYs lost due to morbidity by one quarter by year 2040. Conclusion The impact of conditions on HRQoL varied with age for each condition.

Course and outcome of major depressive disorder in non-referred adolescents

Background Although major depressive disorder (MDD) is one of the most common disorders in adolescence, little is known about its course and outcome in non-referred adolescents. Therefore, the aims of this article were to examine the course and outcome of MDD in non-referred adolescents, and to examine factors related to its stability. Methods Five hundred and twenty-three adolescents were interviewed twice at an interval of about 15 months using the computerized Munich version of the Composite International Diagnostic Interview. Results Of the 90 adolescents who met the diagnosis of MDD at T1, 22 (24.4%) still met the same diagnosis at T2. Sixty-eight (75.6%) of them no longer met the diagnosis of MDD at T2, and in some of these cases, their depression was replaced by several other disorders; 44 adolescents received no diagnostic criteria for any DSM-IV disorders. The factors that were significantly associated with the stability of MDD included the presence of substance use disorders and parental alcohol problems, negative life events and negative coping, past suicidal attempt, suicidal thought, and concrete suicidal plan at the T1-interview. Adolescents with “chronic” (T1 and T2) compared to “transient” (only T1) MDD and those without any disorders were significantly more impaired in various life domains. Limitations This study was based on a small number of adolescents with a chronic MDD. Conclusions The course and outcome of MDD in majority of the adolescents seemed to have a favourable course, whereas in some adolescents, it tended to have a heterogeneous pattern.

Frequency and patterns of mental health services utilization among adolescents with anxiety and depressive disorders

The main aim of this study was to examine the frequency and patterns of mental health services utilization among 12- to 17-year-old adolescents with anxiety and depressive disorders. Another aim was to examine the factors associated with the use of mental health services. The study population comprised 1,035 adolescents randomly recruited from 36 schools. Anxiety and depressive disorders were coded based on DSM-IV criteria using the computerized Munich version of the Composite International Diagnostic Interview. Only 18.2% of the adolescents who met DSM-IV criteria for anxiety disorders, and 23% of those with depressive disorders, used mental health services. Among adolescents with anxiety disorders, mental health services utilization was associated with past suicide attempt, older age, the presence of comorbid disorders, as well as parental anxiety and depression. The only factor that predicts the use of mental health service among adolescents with depressive disorder was a history of suicide attempt. The implication of the results in terms of tailoring services for children and adolescents with anxiety and depressive disorders are discussed.

Comorbidity of anxiety disorders in adolescents.

We examined the comorbidity of anxiety disorders and their clinical consequences in adolescents. The 1,035 adolescents, aged 12 to 17 years old, were randomly selected from 36 schools in the province of Bremen, Germany. Anxiety disorders and other psychiatric disorders were coded based on DSM-IV criteria using the computerized Munich version of the Composite International Diagnostic Interview. The comorbidity rate within the anxiety disorders was relatively low (14.1%). However, the comorbidity of anxiety disorders with other psychiatric disorders was high. Approximately half (51%) of the anxious adolescents had other psychiatric disorders. The most common comorbid pattern was that of anxiety and depressive disorders. Among those with both anxiety and depressive disorders, a majority of them (72%) had anxiety before that of depression. Anxious adolescents with comorbid disorders were significantly more psychologically distressed, as assessed using the SCL-90-R, and used more mental health services than adolescents with anxiety disorders only. The effect of comorbidity on mental health services utilization was stronger in males than females. The findings suggest the need to design intervention strategies to deal with cases with multiple disorders.

Course and outcome of anxiety disorders in adolescents

The aim of this article was to examine the course and outcome of anxiety disorders in German adolescents. Anxiety and other psychiatric disorders were coded based on DSM-IV criteria using the computerized Munich version of the Composite International Diagnostic Interview. About 22.6% of the adolescents who fulfilled DSM-IV criteria of any current anxiety disorders at the index investigation (T1) continued to have anxiety at the follow-up investigation (T2), 17.7% had depression, 27.4% somatoform, 6.5% substance use disorders, and 41.9% had no disorders. The factors that were significantly associated with the persistence of anxiety disorders included older age, presence of somatoform and substance use disorders, as well as a high number of negative life events at the T1-interview. Adolescents with “chronic” compared to “transcient” anxiety disorders and those without any disorders were significantly more impaired in various life domains. Despite these high levels of psychosocial impairment, only a few of them did seek professional help in the last 12 months before the T2-interview.

Frequency, Comorbidity, and Psychosocial Impairment of Depressive Disorders in Adolescents

The frequency, comorbidity, and psychosocial impairment of depressive disorders among adolescents was estimated from a survey of 1,035 students aged 12 to 17 years. The adolescents were randomly selected from 36 schools in the province of Bremen, Germany. Depressive disorders and other psychiatric disorders were coded based on DSM-IV criteria using the computerized Munich version of the Composite International Diagnostic Interview. A high proportion of our adolescents met the lifetime criteria for depressive disorders according to DSM-IV criteria, with a rate of 17.9%. Depressive disorders were significantly higher in females than in males. The rates for all of the disorders increased with age, with the greatest increase occurring mostly between the ages of 14 and 15; such increase was more prominent in females than in males. Our results imply the importance of identifying depressive disorders in adolescence and the need for preventive and intervention strategies.

Frequency, Comorbidity, and Psychosocial Impairment of Anxiety Disorders in German Adolescents

The frequency, comorbidity, and psychosocial impairment of anxiety disorders among German adolescents was estimated from a survey of 1,035 students aged 12–17 years. The adolescents were randomly selected from 36 schools in the province of Bremen, Germany. Anxiety disorders and other psychiatric disorders were coded based on criteria from the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, using the computerized Munich version of the Composite International Diagnostic Interview. Anxiety disorders occurred frequently in our sample of adolescents, with a rate of 18.6%. When considering the subtypes of anxiety disorders, phobia was the most common. Posttraumatic stress disorder and obsessive-compulsive disorder occurred less frequently with rates below 2%. Panic disorder and generalized anxiety disorder were the least common, with rates well below 1%. Anxiety disorders were significantly higher in girls than in boys, and that the rates increased with age. Comorbidity occurs quite frequently, both within the anxiety disorders and also with other psychiatric disorders. The most common pattern of comorbidity was that of anxiety and depressive disorders. Although a high number of anxiety cases were psychosocially impaired, at least during the worst episode of their disorders, only a few of them sought treatment for their problems. We conclude by discussing some research priorities in the area of anxiety disorders in children and adolescents.

Frequency, Comorbidity, and Psychosocial Impairment of Specific Phobia in Adolescents

Investigated the frequency, comorbidity, and psychosocial impairment of specific phobia and specific fears among 1,035 adolescents 12 to 17 years old. The adolescents were recruited from 36 schools in the province of Bremen, Germany. Specific phobia and other psychiatric disorders were coded based on Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994) criteria using the computerized Munich version of the Composite International Diagnostic Interview (Wittchen & Pfister, 1996). Thirty-six (3.5%) of the adolescents met DSM-IV criteria for specific phobia sometime in their life. Of all the subtypes of specific phobia, animal and natural environment phobia were the most common. More girls than boys received the diagnosis of specific phobia. One third of the adolescents with specific phobia also had depressive and somatoform disorders. Despite the high level of psychosocial impairment experienced by individuals with specific phobia both during the worst episode of their disorder and in the last 4 weeks, only a small portion of them sought professional help.

Frequency and comorbidity of social phobia and social fears in adolescents

This report presents findings on the frequency, comorbidity and psychosocial impairment of social phobia and social fears among 1035 adolescents, aged 12–17 years. The adolescents were randomly selected from 36 schools in the province of Bremen, Germany. Social phobia and other psychiatric disorders were coded based on DSM-IV criteria using the computerized Munich version of the Composite International Diagnostic Interview. Seventeen (1.6%) of the adolescents met the DSM-IV criteria for social phobia sometimes in their life. More girls than boys received the diagnosis of social phobia and the frequency of the disorder increased with age. The lifetime frequency of social fears were much higher than that of social phobia. The most common types of feared social situations were fear of doing something in front of other people, followed by public speaking. Social phobia comorbid highly with depressive disorders, somatoform disorders and substance use disorders. Despite the high level of psychosocial impairment experienced by cases with social phobia and those with any social fears, only a small portion of them did receive professional help.

Prevalence, comorbidity and psychosocial impairment of somatoform disorders in adolescents

The frequency, comorbidity and psychosocial impairment of somatoform disorders among adolescents was estimated from a survey of 1,035 students aged 12-17 years. The adolescents were randomly selected from 36 schools in the province of Bremen, Germany. Somatoform disorders and other psychiatric disorders were assessed using the computerized Munich version of the Composite International Diagnostic Interview (CIDI). About 13.1% of the adolescents met the DSM-IV criteria for any somatoform disorders, with significantly more girls than boys being affected by these disorders. Of the sub-types of somatoform disorders, the most common was that of undifferentiated somatoform disorders, followed by pain disorder, and conversion disorder. On the symptom level, the most common were headache, lump in throat, and abdominal pain. Almost half of those with somatoform disorders met the criteria for at least one other disorder covered in our study. Although most of these adolescents were psychosocially impaired, only a small proportion of them did receive treatment.

Incidence of post-traumatic stress disorder in adolescents: results of the Bremen Adolescent Study

The frequency and comorbidity of posttraumatic stress disorders (PTSD) were assessed together with the resultant psychosocial impairment in 1035 adolescents between the ages of 12 and 17 years. Posttraumatic stress disorder and other psychiatric disorders were coded on the basis of the DSM-IV criteria using the computerized personal interview of the Munich version of the Composite International Diagnostic Interview (CIDI). A total of 17 (1.6%) adolescents met the DSM-IV criteria for PTSD at some point in their life. Slightly more girls than boys met the criteria for the disorder, whose frequency increased with age. The lifetime prevalence of traumatic events is much higher still: 233 (22.5%) adolescents reported one or more traumatic events in their life. The types of traumatic events experienced by the greatest number of adolescents were: physical attack, injury, and serious accident. Boys experienced significantly more traumatic events than did girls. The occurrence of a traumatic event was mostly associated with hypervigilance and recurrent and intrusive psychological distress upon exposure to cues which symbolized the event itself or resembled an aspect thereof. PTSD occurred in highly frequent comorbidity with depressive disorders, somatoform disorders, and substance abuse. Over 90% of those with posttraumatic stress disorder were severely impaired in their daily life and activities. Despite the high-grade psychosocial impairment, only a small number sought professional help.

Frequency of panic attacks and panic disorder in adolescents

By using data from the Bremer Adolescent Study, this report presents findings on the frequency, comorbidity, and psychosocial impairment of panic disorder and panic attacks among 1,035 adolescents. The adolescents were randomly selected from 36 schools in the province of Bremen, Germany. Panic disorder and other psychiatric disorders were coded based on DSM-IV criteria using the computerized-assisted personal interview of the Munich version of the Composite International Diagnostic Interview. Panic disorder occurred rather rare, with only 0.5% of all the adolescents met the DSM-IV criteria for this disorder sometimes in their live. Panic attack occurred more frequently, with 18% of the adolescents reported having had at least one panic attack. Slightly more girls than boys had panic attack and panic disorder. The occurrence of panic attack and panic disorder were the greatest among the 14–15 year olds. The experience of having a panic attack was associated with a number of problems, the most frequent being avoiding the situation for fear of having another attack. Four most common symptoms associated with a panic attack were that of palpitations, trembling/shaking, nausea or abdominal distress, and chills or hot flushes. Panic disorder comorbid highly with other psychiatric disorders covered in our study, especially with that of major depression. Among those with a panic disorder, about 40% of them were severely impaired during the worst episode of their illness. Only one out of five adolescents with panic disorder sought professional help for emotional and psychiatric problems. The implication of our findings for research and clinical practice are discussed. Depression and Anxiety 9:19–26, 1999. © 1999 Wiley-Liss, Inc.

Frequency of panic attacks and panic disorder in adolescents

By using data from the Bremer Adolescent Study, this report presents findings on the frequency, comorbidity, and psychosocial impairment of panic disorder and panic attacks among 1,035 adolescents. The adolescents were randomly selected from 36 schools in the province of Bremen, Germany. Panic disorder and other psychiatric disorders were coded based on DSM-IV criteria using the computerized-assisted personal interview of the Munich version of the Composite International Diagnostic Interview. Panic disorder occurred rather rare, with only 0.5% of all the adolescents met the DSM-IV criteria for this disorder sometimes in their live. Panic attack occurred more frequently, with 18% of the adolescents reported having had at least one panic attack. Slightly more girls than boys had panic attack and panic disorder. The occurrence of panic attack and panic disorder were the greatest among the 14-15 year olds. The experience of having a panic attack was associated with a number of problems, the most frequent being avoiding the situation for fear of having another attack. Four most common symptoms associated with a panic attack were that of palpitations, trembling/shaking, nausea or abdominal distress, and chills or hot flushes. Panic disorder comorbid highly with other psychiatric disorder covered in our study, especially with that of major depression. Among those with a panic disorder, about 40% of them were severely impaired during the worst episode of their illness. Only one out of five adolescents with panic disorder sought professional help for emotional and psychiatric problems. The implication of our findings for research and clinical practice are discussed.

Self-Reports in Chronic Schizophrenic Patients with Primary Negative Symptoms: Preliminary Results

The Frankfurt well-being scale (FBS), an instrument for evaluating the global inner state in schizophrenic patients, was used in a pilot study with 26 chronic schizophrenic inpatients simultaneously with the Munich version of the Andreasen scale (SANS). 11 of 26 patients were able to complete the FBS questions. These patients had weaker negative symptomatology (SANS total score) and the difference was highly significant (p less than 0.01) for the score "alogia". The major goal of the investigation was to contribute to the identification of those subgroups of schizophrenic patients who are not capable of filling in a self-report questionnaire. The results suggest that self-reports of actual mood in chronic schizophrenic patients are possible only in a subgroup of patients with no more than moderate primary negative symptoms, particularly those with a low alogia score. Further efforts to evaluate the subjective well-being of chronic patients differing in severity of negative symptoms complexes, could improve methods for evaluating the effect of psychotropic drugs.

Bilateral brain dysfunction during motor activation in type II schizophrenia measured by EEG mapping

In this final electroencephalographic (EEG) mapping study of our series on motor dys-function in neuroleptic-treated schizophrenic patients, we studied 10 right-handed patients with marked negative symptomatology [type II; raw score on the SANS (Munich version) 31.4 ± 5.1]. Simple and multisensorimotor tasks involving both the dominant and non-dominant hand were used for cortical activation. All tasks were referred to resting states obtained after specially designed relaxation procedures. In contrast to predominantly type I patients (SANS-MV score 12.3 ± 4.9) of our previous EEG mapping studies, we found for resting states minor evidence (only) of increased power values in the frequency bands delta and theta. Furthermore, in contrast to signs of “left hemisphere dysfunction” and possible “compensatory right hemisphere overactivation” during motor tasks, which we discussed previously for our type I patients, we found for the type II schizophrenics a bilateral brain dysfunction. This consisted of “nonreactivity” in all frequency bands except alpha, in which, on the contrary, a “hyperreactivity” seemed to be present. In combination with evidence of bilateral hemispheric dysfunction in type II patients reported by other authors using EEG, evoked potentials, regional cerebral blood flow (rCBF) and magnetic resonance imaging (MRI) methods, this suggests that marked bilateral brain dysfunction may be correlated in schizophrenia with a clinical syndrome corresponding rather to the “negative pole” of the positive-negative dimension. In contrast, “left hemisphere dysfunction” and “signs of compensatory overactivation” seem to be linked more to a “positive” symptomatology. Finally, discrepancies of our EEG mapping and rCBF findings during motor activity suggest, speculatively, “uncoupling” between electrical and circulatory parameters in schizophrenia involving both hemispheres in type II, and predominantly the left hemisphere in type I, patients.