Untersuchte Stichproben, Durchführung und Methoden

Stichprobe 1 (Untersuchung der Reliabilitat und Validitat — mit Ausnahme der Anderungssensitivitat):

The Personality Sphere in Patients with Panic Attacks

Primary enduring negative symptoms in schizophrenia and major depression.

Abstract Primary enduring negative symptoms (PENS) were studied in 26 patients with DSM-III-R schizophrenia and in 94 patients with unipolar major depressive episodes 5 years after the index episode. PENS were assessed with the Schedule for Deficit Syndrome (SDS). Negative symptoms were also assessed with the Scale for Assessment of Negative Symptoms (SANS) and subclassified into primary and secondary according to the SDS. The frequency of PENS did not differ significantly between schizophrenics and non-schizophrenic patients. Enduring negative symptoms (regardless of whether primary or not) were more frequently observed in schizophrenia (65% according to the SDS, and 88% according to the S…

Reliability and validity of the Newcastle Scales in relation to ICD-9-classification

The assessment of endogenous depression by means of the Newcastle Scales (1965, 1971) has been validated by their correlation with biological findings in many previous studies. However, reliability and cross validation studies are lacking for these scales. We found the reliability of the Newcastle Scales to be sufficient or at least moderate in a sample of 70 inpatients with major depression. In order to cross validate both scales, the clinical classification according to ICD-9 and the assessment of the Newcastle Scales have been performed independently in a sample of 112 inpatients with Major Depressive Disorder (RDC). The rate of agreement between clinical diagnosis and classification acc…

Identification of minor affective disorders and implications for psychopharmacotherapy.

Five hundred general practice patients with functional complaints were studied with the Polydiagnostic Interview (PODI) to see whether DSM-IIIR criteria were able to specify affective disorders satisfactorily. Almost one third of the patients received the diagnosis of depression not otherwise specified (NOS). When Research Diagnostic Criteria were applied to these patients more than 70% received specific diagnoses. A modification of DSM-IIIR algorithms enabled us to further specify diagnoses in subjects with depression NOS. On the 17-item Hamilton Depression Scale many of these patients reached scores of 13 or more which is severe enough to justify a therapy trial with antidepressants.

Reliabilität und Validität der Hamilton-Depressionsskala und ihrer Subskalen

Die Mittelwerte und Varianzen der Globalsummenscores fur die 17-Item-Version und 21-Item-Version der HAMD (Tab. 19) liegen im Bereich der in anderen Studien angegebenen Normwerte fur depressive stationare Patienten (Baumann, 1975; Maier et al. 1984; Hedlund, 1979).

Reliabilität der diagnostischen Klassifikation

Das Ziel dieser der Untersuchung der Validitat vorgeschalteten Reliabilitatsstudie ist es, den Gebrauch strukturierter Interviews zu legitimieren. Die Hypothese ist, das jedenfalls fur Subtypen depressiver Syndrome durch ein strukturiertes Interview eine hohere Reliabilitat erzielt werden kann als durch die Verwendung von Checklisten.

The concept of major depression. II. Agreement between six competing operational definitions in 600 psychiatric inpatients.

Six operational definitions of the concept of major depression were submitted to empirical evaluation in 600 psychiatric inpatients. Special attention was given to the comparison of major depression in DSM-III-R and ICD-10. The data base created by a polydiagnostic interview revealed relevant classificatory differences between the six definitions under study. Sources of different diagnostic base rates were: inclusion or omission of anhedonia as an obligatory mood criterion; minimal number of syndrome criteria required for the syndrome diagnosis; different width and reference points of time criteria; exclusion rules for co-existing schizophrenic symptoms and for previous nonaffective and man…

Zusammenfassende Wertung und Konsequenzen für die Klassifikationsforschung

Die abschliesende Wertung der 3 Validierungsstudien stost auf das Problem des „multiplen Testens“. Die Klassifikation endogener Depressionen wurde nach dem polydiagnostischen Ansatz durchgefuhrt; weiterhin wurden 6 weitere Subtypisierungen depressiver Syndrome vorgenommen. Wenn aber 20 verschiedene Klassifikationssysteme parallel verwendet werden, und fur jede der 20 diagnostischen Differenzierungen bezuglich eines Kriteriums die Validitat gepruft wird, so sind 20 Signifikanztests durchzufuhren; bereits im Rahmen der zufallsbedingten Variationen ist bei mindestens einem der Klassifikationssysteme ein signifikantes Ergebnis (p=.05) bezuglich eines ausgewahlten Validierungskriteriums zu erwar…

Bestimmt die Episodenzahl den Ausgang unipolarer Depressionen?

Bei affektiven Psychosen wissen wir noch nicht ausreichend, wie eng die verschiedenen Parameter des Verlaufs und des Ausgangs miteinander korreliert sind. Eine wichtige, bisher nicht geklarte Frage ist, ob die psychosoziale Anpassung bei unipolaren Depressionen von einem phasenhaften Krankheitsverlauf abhangig ist. Ziel unserer Untersuchung war es, zu prufen, ob Patienten mit der Erstmanifestation einer Major Depression funf Jahre nach Indexuntersuchung eine bessere psychosoziale Anpassung erreichen als Patienten mit fruheren Episoden.

Ziel der eigenen vorliegenden Arbeiten

Ziel dieser Untersuchung ist es, die verschiedenen Versionen der Hamilton-Depressionsskala (17-Item-Version, 21-Item-Version, die isolierten Subskalen der HAMD) und die neuen alternativen Skalen MADRS und BRMS an demselben Kollektiv depressiver Patienten vergleichend auf ihre Reliabilitat und Validitat zu prufen. Vergleichende Analysen von Schweregradskalen sind notwendig, um unter den konkurrierenden Schweregradskalen jene zu finden, die am besten als Indikator fur die Intensitat depressiver Syndrome geeignet ist. Mit Ausnahme der Arbeit von Maier und Philipp (1985a) vergleichen die in der Literatur verfugbaren Arbeiten maximal 2 Skalen; die verwendeten Reliabilitats- und Validitatskriteri…

One-year follow-up of cardiac anxiety syndromes. Outcome and predictors of course.

In a representative sample (n = 31) of patients with panic attacks and a cardiac anxiety syndrome, a prospective follow-up study after a 1-year interval was performed. At the follow-up assessment 33% of the patients were in remission, whereas the majority of patients had an unfavorable course. Avoidance behavior and female sexual status were found to be predictive for an unfavorable course. Within a matched-pair design controlled for age and sex, no difference between panic disorder with and without cardiac anxiety syndrome was observed in any psychosocial or psychopathological outcome variable. This result is an argument against the validity of the subtype cardiac anxiety syndrome.

Abschließende Diskussion zur Reliabilität und Validität der Schweregradbeurteilung

In Ubereinstimmung mit anderen Untersuchungen (Bech et al. 1976, 1981, Maier und Philipp, 1985a, Cichetti und Prusoff, 1982, Rehm und O’Hara, 1984) belegen die vorgelegten Untersuchungen Mangel in der Reliabilitat und Validitat der gangigen Versionen der Hamilton-Depressionsskala (21-Item-Version und 17-Item-Version). Insbesondere die unzureichende interne Konstruktvaliditat belegt, das der Globalsummenscore dieser Skala in unterschiedlichen Stichproben depressiver Patienten eine unterschiedliche Bedeutung haben kann; so reprasentiert der Globalsummenscore in der Stichprobe von leichteren depressiven Syndromen vorwiegend die mit der depressiven Symptomatik assoziierte korperliche Symptomati…

Untersuchungen mit dem Validierungskriterium „Langzeitverlauf“

Untersuchungsziel ist die vergleichende Validierung unterschiedlicher Subtypisierungen depressiver Syndrome am Kriterium des Langzeitverlaufs. Dabei werden fur die Validierungsprufung die beiden in der neueren Literatur gangigen Teilkriterien „Dauer der Indexepisode“ und „Dauer des episodenfreien Intervalls“ verwendet. Um die Anzahl wesentlicher Validierungskriterien moglichst gering zu halten, wird dem zuletztgenannten Teilkriterium die Prioritat gegenuber dem erstgenannten Teilkriterium gegeben. Diese Rangordnung rechtfertigt sich aus den Schwierigkeiten zur Messung der Dauer der Indexepisode (s. u.).

Reliabilität und Validität der Montgomery-Asberg-Ratingskala und der Bech-Rafaelsen-Melancholieskala

Die Mittelwerte und Standardabweichungen der Globalsummenscores der MADRS und der BRMS sind mit den in der Literatur angebenen Werten vergleichbar (Tab. 29).

Dose escalation vs. continued doses of paroxetine and maprotiline: a prospective study in depressed out-patients with inadequate treatment response

In view of the fact that controlled prospective studies on the benefits of dose escalation of the selective serotonin re-uptake inhibitor (SSRI) paroxetine are lacking, we conducted a double-blind, randomized, parallel-group multicentre study designed to compare the possible benefits of dose escalation of paroxetine and maprotiline in patients suffering from major or minor depression according to modified Research Diagnostic Criteria (RDC) with inadequate treatment response. The study sample consisted of 544 out-patients with different degrees of severity of depression. Patients received either 20 mg paroxetine (n = 271) or 100 mg maprotiline (n = 273) for the first 3 weeks in a double-blin…

Multisteroid analysis after DST in depressed patients — A controlled study

Abstract 111 consecutively admitted in-patients with a depressive syndrome received a dexamethasone suppresion test (DST) after all known factors which might confound the test results had been carefully excluded. Plasma concentrations of cortisol, corticosterone and dexamethasone were compared with several diagnostic evaluations (RDC, DSM-III, ICD-9) in a controlled study. The positive predictive value of nonsuppressed corticosteroid levels was only moderate for each diagnostic category. Diagnostic specificities were 84.6% for major depression, endogenous subtype (RDC), 71.2% for melancholia (DSM-III) and 86.8% for endogenous depression (IDC-9) when using a post-DST cortisol value above 50 …

The use of research assistants in polydiagnostic research.

Untersuchungen mit dem Validierungskriterium „Therapieansprechen“

Untersuchungsziel ist der Vergleich der Validitat von unterschiedlichen Verfahren zur Subklassifikation depressiver Syndrome bezuglich des Kriteriums „Ansprechen auf antidepressive Therapie mit Trizyklika“. Das Ansprechen auf antidepressive Therapie wird durch Schweregradskalen fur die depressive Symptomatik gemessen. Neben der Hamilton-Depressionsskala werden noch 2 weitere Depressionsskalen (Montgomery-Asberg-Depressions-Ratingskala, Bech-Rafaelsen-Melancholieskala) verwendet. Um die Anzahl der Indikatoren fur die Validitat bezuglich des Kriteriums „Therapieanspechen“ moglichst gering zu halten, wird der mit der Hamilton-Depressionsskala erfaste therapeutische Effekt als das vorrangige Va…

Comparison of Paroxetine and Maprotiline in Minor Depression

Whilst the efficacy of paroxetine has been demonstrated in MDD, its clinical utility in minor depression has not been established. This study assesses the antidepressant efficacy of paroxetine in patients meeting RDC criteria for minor depression. All patients scored 13 points on the 17-item Hamilton Depression Rating Scale (HAMD) at baseline. After a 3 day washout period, patients were randomised to receive paroxetine 20–40mg/day or maprotiline 100-150mg/day, dose being titrated according to clinical response after 3 weeks treatment at the lower doses. Assessments conducted at baseline (day 0) and at weekly intervals for 6 weeks included the 17-item HAMD, the Montgomery-Asberg Depression R…

Comparative analysis of observer depression scales

Abstract The Hamilton Depression Scale (HAMD), Bech Rafaelsen Melancholia Scale (BRMS) and Montgomery Asberg Depression Rating Scale (MADRS) are analyzed according to mean discriminatory power, internal consistency, homogeneity and transferability. The analysis was done separately in different samples of patients with depressive syndromes: a) operationally defined depressive syndrome; b) Major Depressive Disorder (RDC); c) Major Depressive Disorder, endogenous type (RDC). BRMS and MADRS were superior to HAMD in all evaluated aspects. Further, the BRMS was superior to MADRS according to the criteria of homogeneity and transferability.

A multi-country test of brief reappraisal interventions on emotions during the COVID-19 pandemic

© The Author(s), under exclusive licence to Springer Nature Limited 2021, corrected publication 2022

The impact of the endogenous subtype on the familial aggregation of unipolar depression.

The endogenous/non-endogenous distinction of unipolar major depression is widely accepted, as is the family study approach to the validation of diagnostic distinctions. Rates of affective disorders were examined in 689 first-degree relatives of 184 patients with unipolar major depression and were compared with 312 first-degree relatives of 80 healthy controls. Only unipolar depression and alcoholism were more common in families of depressed probands compared with families of healthy controls. As a variety of diagnostic definitions of endogenous depression have been proposed, probands and relatives were diagnosed in a polydiagnostic manner. None of the five diagnostic definitions of endogeno…

Psychotropic Drugs in the Management of Chronic Pain Syndromes

Psychotropic drugs have been integrated into the management of chronic pain syndromes for more than 30 years. Numerous open and controlled studies have taken place evaluating especially the antinociceptive efficacy of antidepressive drugs. This survey comprises the results of clinical reports, open clinical studies, placebo-controlled studies, and comparative studies of different substances. It will be shown that antidepressants are by far the best evaluated psychopharmacological substances, showing superiority against placebo in 70% of a total of 67 placebo-controlled studies. The synopsis of controlled comparison studies of different antidepressants tends to demonstrate a superiority of c…

A polydiagnostic scale for dimensional classification of endogenous depression. Derivation and validation.

Several operational diagnoses (OPD) for endogenous depression have been proposed. However--though aiming at similar clinical concepts--the amount of association and agreement between different OPD is rather low. In this study the relationship between eight OPD (Research Diagnostic Criteria, DSM-III, Michigan Discrimination Index, Newcastle Scale I, Newcastle Scale II, Taylor-Abrams Criteria, Vienna Research Criteria, Hamilton Endogenomorphy Index) was assessed by applying latent trait analyses to the classificatory data of these eight OPD which were rated simultaneously in a sample of 173 depressive inpatients. According to these analyses six OPD (RDC, DSM-III, NCS-I, NCS-II, TAC and VRC) a…

Reliability of DSM-III Anxiety Disorders - Check-List Versus Structured Interview

The concept of major depression. III. Concurrent validity of six competing operational definitions for the clinical ICD-9 diagnosis.

The comparative validity of six operational diagnoses of major depression was evaluated in 600 psychiatric inpatients using the independently assessed clinical ICD-9 diagnoses as a yardstick. Agreement with, and positive predictive value for the ICD-9 categories of pure (endogenous and psychogenic) depression served as validation criteria; sensitivity of major depression diagnoses for detecting ICD-9 bipolar depressions was additionally used for examining the adequacy of width, time and exclusion criteria of the competing operational definitions. Three essential results were found. First, the "old" diagnostic definitions of RDC and FDC are superior to all newer definitions because they defi…

Zusammenfassung der Untersuchungen zur Klassifikation und Schweregradbeurteilung depressiver Syndrome

Die Entwicklung und die Bewertung (Validierung) von Diagnosesystemen und Schweregradbeurteilungen depressiver Syndrome sind mit dem Problem der unbekannten Atiologie und Pathophysiologie depressiver Syndrome konfrontiert. Daher mussen Beurteilungssysteme zur Diagnosestellung und Schweregradmessung weitgehend auf psychopathologische Merkmale gestutzt werden; die Validierung dieser Beurteilungssysteme mus sich auf indirekte Indikatoren (Validierungskriterien) der Atiologie und der Intensitat des zugrunde liegenden Krankheitsprozesses stutzen. Klassifikationssysteme und Schweregradskalen fur depressive Syndrome beziehen sich gleichermasen auf psychopathologische Querschnittssymptome (von Vorve…

Amisulpride versus flupentixol in schizophrenia with predominantly positive symptomatology - a double-blind controlled study comparing a selective D 2 -like antagonist to a mixed D 1 -/D 2 -like antagonist

The benzamide amisulpride (ASP) is a selective D2-like dopamine antagonist, while flupentixol (FPX), a thioxanthene, blocks D2-like, D1-like and 5-HT2 receptors. To evaluate efficacy and safety of ASP and to investigate the importance of an additional D1-like antagonism for antipsychotic effects and extrapyramidal tolerability, a randomized double-blind multi-center study versus FPX as reference drug was performed for 6 weeks in 132 patients suffering from acute schizophrenia (DSM-III-R) with predominant positive symptomatology. Doses were initially fixed (ASP: 1000 mg/day; FPX: 25 mg/day) but could be reduced by 40% in case of side effects (mean daily doses: ASP: 956 mg; FPX: 22.6 mg). Int…

Mortality in affective disorders.

Abstract Background : To investigate the mortality rates in affective disorders due to unnatural and natural causes with respect to illness subtype and social–demographic features. Methods : Mortality data were determined from a prospective study of 354 outpatients with affective disorders during a follow-up period of 5 years. Death from natural and unnatural causes was compared to sex- and age-specific expectations in the general population. Standardized mortality rates (SMR) in diagnostic subgroups and the influence of social–demographic features were investigated. Results : The observed 30 deaths represented nearly three times (SMR, 2.9) the number expected on the basis of age- and sex-s…

A replication study for the prediction of doxepine-response in depressed outpatients.

Untersuchungen zum Validierungsparameter „familiäre Belastung“

Untersuchungsziel ist die vergleichende Validierung unterschiedlicher Subtypisierungen depressiver Syndrome am Kriterium der familiaren Belastung (bezogen auf Angehorige 1. Grades) mit „major depression“, wiederkehrender „major depression“, beliebigen Formen affektiver Erkrankungen und Alkoholismus. In der Literatur werden 2 dieser 4 Kriterien eine besondere Prioritat zugewiesen: der familiaren Belastung mit „major depression“ und der familiaren Belastung mit Alkoholismus (Weissman et al., 1986, Winokur, 1986). Die beiden anderen Angehorigendiagnosen, die sich auf affektive Erkrankungen beziehen (wiederkehrende „major depression“, jegliche Form affektiver Erkrankungen) werden verwendet, um …

The association between psychopathological aspects and CT measurements in affective disorders.

Response to treatment in minor and major depression: results of a double-blind comparative study with paroxetine and maprotiline.

Several concepts of minor depression in the sense of acute but less severe symptomatology than major depression have been proposed in the literature, but currently none of them is generally accepted. For the treatment of these conditions, only few recommendations based on empirical data are available. We conducted a randomized double-blind multicentre study in depressed outpatients comparing paroxetine and maprotiline in both patients with minor (n = 245) and major depression (n = 298). For the diagnosis, Research Diagnostic Criteria were used in a modified version. Two response criteria were applied: a reduction of 50% or more in total HAMD-17 scores from baseline (criterion 1), and a redu…

A German Validation Study of the Inventory to Diagnose Depression

The Inventory to Diagnose Depression (IDD), a self-rating scale designed to identify major depressive episodes (MDE) according to DSM-III, was validated in a sample of 83 inpatients. Depending whether the time criterion of MDE was included or omitted, 63 or 77 patients obtained a syndrome diagnosis of MDE established by means of a structured clinical interview (Polydiagnostic Interview) which served as yardstick. Sensitivity (84.1% with time criterion, 89.6% without time criterion), specificity (60%, 50%), predictive value (67.8%, 64.2%) and kappa (0.43, 0.29) were calculated and found to necessitate improvement for a reasonable application of the IDD in epidemiological and clinical setting…

Reliability and Validity of the Assessment of Antidepressant Effects

Psychopathological predictors of suicide in patients with major depression during a 5-year follow-up.

SummaryObjective. It is widely known that the risk of suicide is higher in cases of major depressive disorders in comparison to the general population. The purpose of this study was to examine which psychopathologic symptoms during the index episode are predictors for an increased risk of suicide in the further course of major depression.Method. Mortality data were determined from a prospective study of 280 patients with major depression (DSM-III-R, single episode or recurrent) during a follow-up period of 5 years. The predictive power of different depressive symptoms including psychotic symptoms for suicide risk was investigated.Results.Patients who committed suicide(N = 16)during the foll…

A comparison study of moclobemide and doxepin in major depression with special reference to effects on sexual dysfunction

A double-blind parallel-group comparison study of moclobemide versus doxepin in 237 patients with major depression confirmed that moclobemide was equal in efficacy and better tolerated than doxepin. It was less sedating and caused fewer anticholinergic adverse events as measured by the UKU side-effect rating scale. Unexpectedly, moclobemide therapy more often than doxepin resulted in increased sexual desire. An exploratory analysis of UKU-measured symptoms of impaired sexual function prior to commencement of the study revealed that moclobemide more often than doxepin led to an improvement of reduced libido and impaired erection, ejaculation and orgasm. This finding is compatible with the as…

Dimensional Classification as an Instrument for Biological Research in Endogenous Depression

Biological psychiatry needs highly reliable classifications capable of supplying research with homogeneous groups of patients. Operational diagnoses (OPD abbreviated) have been introduced to serve this aim. At present, research in endogenous depression can choose among more than ten different operational diagnoses, all purporting to be valid for diagnosing endogenous depression. Eight of these operational diagnoses are listed in Table 1.

The concept of major depression. I. Descriptive comparison of six competing operational definitions including ICD-10 and DSM-III-R.

All operationalized diagnostic systems contain a diagnostic category, which corresponds to the concept of major depression. Yet, these corresponding definitions are not identical. Up to now, no comprehensive comparisons of the competing diagnoses have been published. We will therefore present a series of studies, describing six different operational definitions of major depression according to their content and construction and empirically comparing them in large inpatient and outpatient samples. This first paper presents a descriptive comparison of the definitions given in the Feighner Diagnostic Criteria, the Research Diagnostic Criteria, the Diagnostic and Statistical Manual of Mental Di…

Prediction of Course in Major Depression. Does Psychopathology Predict Future Drug Intake or Relapse?

Pharmacotherapy of panic attacks.

The influence of medication on the course of major depression: a 3-year-follow-up with polydiagnostic measures.

Development of a rating scale for quantitative measurement of the alcohol withdrawal syndrome

The alcohol withdrawal syndrome consists of autonomic, neurological and mental symptoms. For its assessment, these symptoms have to be rated in a quantitative and valid manner. We developed a new rating scale for mild and moderate alcohol withdrawal states. Difficulty, discrimination coefficient, internal consistency, and the principal component analysis were assessed. External validation was tested on a separate sample of inpatients. Eight of 12 original items fulfilled test-the-oretical criteria. From these a psychosensory and an autonomic factor have been extracted. This instrument can be used repeatedly for clinical assessment as well as for evaluation of the alcohol withdrawal syndrome…

Differentiation between major and minor depression

Though the concept of Major Depression was generated by clinicians using depressed inpatients as models, a polydiagnostic study in 600 psychiatric inpatients with heterogenous psychological disturbances revealed that all six competing operational definitions of Major Depression (including DSM-III-R and ICD-10) were too restrictive to serve as a general concept of depression. Another polydiagnostic study in 500 primary care outpatients showed that more than two-thirds of all non-chronic depressed cases were below the severity threshold of Major Depression: these patients are classified as Depression Not Otherwise Specified (NOS) by DSM-III-R. Loosening of the over-restrictive time criteria w…

A double-blind study comparing paroxetine and maprotiline in depressed outpatients.

A double-blind multicenter randomized parallel group study comparing paroxetine and maprotiline was carried out in a total of 544 outpatients. Included were patients with varying degrees of severity of depressive symptoms who fulfilled modified RDC criteria for either Minor or Major Depression and showed a HAMD-17 score of > or = 13. No concomitant benzodiazepine treatment was allowed. Duration of treatment was 6 weeks, after an initial wash-out period. Doses were fixed during the first 3 weeks of treatment, patients receiving either 20 mg paroxetine or 100 mg maprotiline daily. An option for dose escalation was provided for insufficient responders after 3 weeks. The weekly assessments comp…