The introduction of the term and concept schizophrenia earned its inventor, Swiss psychiatrist Eu... more The introduction of the term and concept schizophrenia earned its inventor, Swiss psychiatrist Eugen Bleuler, worldwide fame. Prompted by the rejection of the main principle of Kraepelinian nosology, namely prognosis, Bleuler's belief in the clinical unity of what Kraepelin had described as dementia praecox required him to search for alternative characterizing features that would allow scientific description and classification. This led him to consider psychological, and to a lesser degree, social factors alongside an assumed underlying neurobiological disease process as constitutive of what he then termed schizophrenia, thus making him an early proponent of a bio-psycho-social understanding of mental illness. Reviewing Bleuler's conception of schizophrenia against the background of his overall clinical and theoretical work, this paper provides a critical overview of Bleuler's key nosological principles and links his work with present-day debates about naturalism, essentialism, and stigma.
... MAURICIO TOHEN and JULES ANGST Lilly Research Laboratories, Indianapolis IN; Department of Ps... more ... MAURICIO TOHEN and JULES ANGST Lilly Research Laboratories, Indianapolis IN; Department of Psychiatry, Harvard Medical School ( ) ( ) ... This study was conducted in one of their settlements in Lancaster County, Pennsylvania, with approximately 11,000 residents. ...
European Archives of Psychiatry and Clinical Neuroscience, 2014
The possible link between work strain and subsequent mental disorders has attracted public attent... more The possible link between work strain and subsequent mental disorders has attracted public attention in many European countries. Burnout has become a favored concept within this context. Most burnout research has concentrated on various professional groups and less so on ordinary community samples. We analyzed the data collected from a 30-year community sample during seven measuring occasions, beginning in 1978. In the last assessment (2008), we included for the first time the Maslach Burnout Inventory (MBI). Making the diagnosis of a lifetime mental disorder a predictor for burnout required us to compile the cumulative prevalence rate over all seven occasions. We also evaluated various psychosocial predictors of burnout over the life cycle of our sample. Concurrent associations of the MBI with subscales from the SCL-90-R were also investigated. The relationship of burnout with several SCL-90-R subscales demonstrated that, in all dimensions, burnout is associated with significant psychopathology. Persons with a lifetime mood disorder, and especially those with a combination of mood and anxiety disorders, had a higher risk for subsequent burnout. Various partnership problems were another predictor for burnout. In conclusion, the role of mental disorder as an occupational illness remains controversial. Various forms of such disorders as well as some psychosocial predictors can predispose to burnout. By contrast, work-related predictors appear to be less important.
European Archives of Psychiatry and Clinical Neuroscience, 1991
Hypomania in a 28- to 30-year-old cohort is described. Data were taken from a prospective longitu... more Hypomania in a 28- to 30-year-old cohort is described. Data were taken from a prospective longitudinal cohort study from the general population of Zurich, Switzerland. An estimated 1-year prevalence rate of hypomania of 4% was found. Over a period of time hypomania was associated with major depression and dysthymia. We found equal proportions of suicide attempts and equal rates of treated family members among hypomanics and depressives. Furthermore, the previous history of treatment of mild bipolars (hypomania with depression) and unipolar depressives was comparable. The sum of life events, several SCL-90R scores and the scores of distress in relationships were already elevated in hypomanics 7 years before diagnosis of hypomania, indicating an increased activity level, a generalized increase in neuroticism, and a relatively unvarying behaviour pattern in social relationships.
... Citation. Database: PsycINFO. [Chapter]. Comorbidity of anxiety and depression in the Zurich ... more ... Citation. Database: PsycINFO. [Chapter]. Comorbidity of anxiety and depression in the Zurich Cohort Study of Young Adults. Comorbidity of mood and anxiety disorders. Angst, Jules; Vollrath, Margarete; Merikangas, Kathleen ...
Background: No systematic data exists on the phenomenology and psychometric aspects of hypomania.... more Background: No systematic data exists on the phenomenology and psychometric aspects of hypomania. In this report we focus on the factor structure of hypomania and its relationships with cyclothymic temperament in unipolar (UP) and bipolar II (BP-II) spectrum (soft bipolar) patients. Method: The combined sample of UP and BP-II spectrum patients (n=427) derives from the French National multi-center study (EPIDEP). The study involved training 48 psychiatrists at 15 sites in France in a protocol based on DSM-IV phenomenological criteria for major depressive disorder, hypomania, and BP-II, as well as a broadened definition of soft bipolarity. Psychometric measures included Angst’s Hypomania Checklist (HCA) and Akiskal’s Cyclothymic Temperament (CT) Questionnaires. Results: In the combined sample of the UP and BP-II spectrum, the factor pattern based on the HCA was characterized by the presence of one hypomanic component. In the soft bipolar group (n=191), two components were identified before and after varimax rotation. The first factor (F-1) identified hypomania with positive (driven-euphoric) features, and the second factor (F-2) hypomania with greater irritability and risk-taking. In exploratory analyses, both factors of hypomania tentatively distinguished most soft BP subtypes from UP. However, F-1 was generic across the soft spectrum, whereas F-2 was rather specific for II-1/2 (i.e., BP-II arising from CT). CT, which was found to conform to a single factor among the soft bipolar patients, was significantly correlated only with irritable risk-taking hypomania (F-2). Limitation: In a study conducted in a clinical setting, psychiatrists cannot be kept blind of the data revealed in the various clinical evaluations and instruments. However, the systematic collection of all data tended to minimize biases. Conclusion: EPIDEP data revealed a dual structure of hypomania with ‘classic’ driven-euphoric contrasted with irritable risk-taking expressions distributed differentially across the soft bipolar spectrum. Only the latter correlated significantly with cyclothymic temperament, suggesting the hypothesis that repeated brief swings into hypomania tend to destabilize soft bipolar conditions.
The article reviews research and presents our results on the natural history of 2 forms of anxiet... more The article reviews research and presents our results on the natural history of 2 forms of anxiety disorder, panic disorder and generalized anxiety disorder. Data from our epidemiological cohort study give evidence of premorbid anxiousness and overadaptation already in childhood. Distressing conditions in the family are more prevalent among subjects with anxiety disorders or major depression than among controls. Anxiety disorders frequently begin between age 20–30 and can be triggered by life events. The course is often characterized by a certain chronicity that manifests itself in residual symptoms and mild impairment in social roles even after many years and is frequently complicated with depression. The best predictors are severity and duration of symptoms, as well as comorbidity with depression. Future studies of the natural history should take into account these factors in multivariate approaches.
The 1-year prevalence rates and sex ratio of dysphoric mood, brief (BDE, less than 2 weeks) and e... more The 1-year prevalence rates and sex ratio of dysphoric mood, brief (BDE, less than 2 weeks) and extensive (EDE, greater than or equal to 2 weeks) depressive episodes and major depression (RDC, DSM-III) from an epidemiologic study are presented. Factors influencing the sex ratio are analyzed: subjective suffering from EDE, social and work impairment were found to an equal degree in both genders. Factors favoring female preponderance: women report more symptoms, men most probably forget symptoms, frequency and length of less recent depressions more readily, women see a physician or proceed to self-medication much more often. Consequently, the identical minimum symptom number for both genders is questioned and occupational impairment suggested as an alternative case-defining criterion.
A representative sample of 908 hospital records covering admissions between 1920 and 1982 for dep... more A representative sample of 908 hospital records covering admissions between 1920 and 1982 for depression was analyzed in order to assess the switch rate to hypomania/mania. The results are the following: (1) Over the decades of this century there has been a substantial increase in hospital admissions in Zurich for both depression and mania, but the ratio remained constant. (2)
Onset, course, and outcome of affective disorders were studied prospectively--at 5-year intervals... more Onset, course, and outcome of affective disorders were studied prospectively--at 5-year intervals, until 1980--in 406 patients admitted to the Psychiatric University Hospital, Zurich, between 1959 and 1963. A few results are summarized. Bipolar I and bipolar II disorders take a very similar course. The distinction between unipolar depression and bipolar affective disorder, and the separation by presence or absence of psychotic features (delusions and hallucinations), and then again by mood congruence, are of high prognostic value.
... The real progress from the views of Aretaeus of Cappadocia, of Richard Mead, Vincenzo Chiarug... more ... The real progress from the views of Aretaeus of Cappadocia, of Richard Mead, Vincenzo Chiarugi or Esquirol was Jean-Pierre Falret's concept of ... interest in so-called mixed states or mixed bipolar disorders, especially in the USA (ie Akiskal 1992, 1997, 1999, McElroy et al. ...
The introduction of the term and concept schizophrenia earned its inventor, Swiss psychiatrist Eu... more The introduction of the term and concept schizophrenia earned its inventor, Swiss psychiatrist Eugen Bleuler, worldwide fame. Prompted by the rejection of the main principle of Kraepelinian nosology, namely prognosis, Bleuler's belief in the clinical unity of what Kraepelin had described as dementia praecox required him to search for alternative characterizing features that would allow scientific description and classification. This led him to consider psychological, and to a lesser degree, social factors alongside an assumed underlying neurobiological disease process as constitutive of what he then termed schizophrenia, thus making him an early proponent of a bio-psycho-social understanding of mental illness. Reviewing Bleuler's conception of schizophrenia against the background of his overall clinical and theoretical work, this paper provides a critical overview of Bleuler's key nosological principles and links his work with present-day debates about naturalism, essentialism, and stigma.
... MAURICIO TOHEN and JULES ANGST Lilly Research Laboratories, Indianapolis IN; Department of Ps... more ... MAURICIO TOHEN and JULES ANGST Lilly Research Laboratories, Indianapolis IN; Department of Psychiatry, Harvard Medical School ( ) ( ) ... This study was conducted in one of their settlements in Lancaster County, Pennsylvania, with approximately 11,000 residents. ...
European Archives of Psychiatry and Clinical Neuroscience, 2014
The possible link between work strain and subsequent mental disorders has attracted public attent... more The possible link between work strain and subsequent mental disorders has attracted public attention in many European countries. Burnout has become a favored concept within this context. Most burnout research has concentrated on various professional groups and less so on ordinary community samples. We analyzed the data collected from a 30-year community sample during seven measuring occasions, beginning in 1978. In the last assessment (2008), we included for the first time the Maslach Burnout Inventory (MBI). Making the diagnosis of a lifetime mental disorder a predictor for burnout required us to compile the cumulative prevalence rate over all seven occasions. We also evaluated various psychosocial predictors of burnout over the life cycle of our sample. Concurrent associations of the MBI with subscales from the SCL-90-R were also investigated. The relationship of burnout with several SCL-90-R subscales demonstrated that, in all dimensions, burnout is associated with significant psychopathology. Persons with a lifetime mood disorder, and especially those with a combination of mood and anxiety disorders, had a higher risk for subsequent burnout. Various partnership problems were another predictor for burnout. In conclusion, the role of mental disorder as an occupational illness remains controversial. Various forms of such disorders as well as some psychosocial predictors can predispose to burnout. By contrast, work-related predictors appear to be less important.
European Archives of Psychiatry and Clinical Neuroscience, 1991
Hypomania in a 28- to 30-year-old cohort is described. Data were taken from a prospective longitu... more Hypomania in a 28- to 30-year-old cohort is described. Data were taken from a prospective longitudinal cohort study from the general population of Zurich, Switzerland. An estimated 1-year prevalence rate of hypomania of 4% was found. Over a period of time hypomania was associated with major depression and dysthymia. We found equal proportions of suicide attempts and equal rates of treated family members among hypomanics and depressives. Furthermore, the previous history of treatment of mild bipolars (hypomania with depression) and unipolar depressives was comparable. The sum of life events, several SCL-90R scores and the scores of distress in relationships were already elevated in hypomanics 7 years before diagnosis of hypomania, indicating an increased activity level, a generalized increase in neuroticism, and a relatively unvarying behaviour pattern in social relationships.
... Citation. Database: PsycINFO. [Chapter]. Comorbidity of anxiety and depression in the Zurich ... more ... Citation. Database: PsycINFO. [Chapter]. Comorbidity of anxiety and depression in the Zurich Cohort Study of Young Adults. Comorbidity of mood and anxiety disorders. Angst, Jules; Vollrath, Margarete; Merikangas, Kathleen ...
Background: No systematic data exists on the phenomenology and psychometric aspects of hypomania.... more Background: No systematic data exists on the phenomenology and psychometric aspects of hypomania. In this report we focus on the factor structure of hypomania and its relationships with cyclothymic temperament in unipolar (UP) and bipolar II (BP-II) spectrum (soft bipolar) patients. Method: The combined sample of UP and BP-II spectrum patients (n=427) derives from the French National multi-center study (EPIDEP). The study involved training 48 psychiatrists at 15 sites in France in a protocol based on DSM-IV phenomenological criteria for major depressive disorder, hypomania, and BP-II, as well as a broadened definition of soft bipolarity. Psychometric measures included Angst’s Hypomania Checklist (HCA) and Akiskal’s Cyclothymic Temperament (CT) Questionnaires. Results: In the combined sample of the UP and BP-II spectrum, the factor pattern based on the HCA was characterized by the presence of one hypomanic component. In the soft bipolar group (n=191), two components were identified before and after varimax rotation. The first factor (F-1) identified hypomania with positive (driven-euphoric) features, and the second factor (F-2) hypomania with greater irritability and risk-taking. In exploratory analyses, both factors of hypomania tentatively distinguished most soft BP subtypes from UP. However, F-1 was generic across the soft spectrum, whereas F-2 was rather specific for II-1/2 (i.e., BP-II arising from CT). CT, which was found to conform to a single factor among the soft bipolar patients, was significantly correlated only with irritable risk-taking hypomania (F-2). Limitation: In a study conducted in a clinical setting, psychiatrists cannot be kept blind of the data revealed in the various clinical evaluations and instruments. However, the systematic collection of all data tended to minimize biases. Conclusion: EPIDEP data revealed a dual structure of hypomania with ‘classic’ driven-euphoric contrasted with irritable risk-taking expressions distributed differentially across the soft bipolar spectrum. Only the latter correlated significantly with cyclothymic temperament, suggesting the hypothesis that repeated brief swings into hypomania tend to destabilize soft bipolar conditions.
The article reviews research and presents our results on the natural history of 2 forms of anxiet... more The article reviews research and presents our results on the natural history of 2 forms of anxiety disorder, panic disorder and generalized anxiety disorder. Data from our epidemiological cohort study give evidence of premorbid anxiousness and overadaptation already in childhood. Distressing conditions in the family are more prevalent among subjects with anxiety disorders or major depression than among controls. Anxiety disorders frequently begin between age 20–30 and can be triggered by life events. The course is often characterized by a certain chronicity that manifests itself in residual symptoms and mild impairment in social roles even after many years and is frequently complicated with depression. The best predictors are severity and duration of symptoms, as well as comorbidity with depression. Future studies of the natural history should take into account these factors in multivariate approaches.
The 1-year prevalence rates and sex ratio of dysphoric mood, brief (BDE, less than 2 weeks) and e... more The 1-year prevalence rates and sex ratio of dysphoric mood, brief (BDE, less than 2 weeks) and extensive (EDE, greater than or equal to 2 weeks) depressive episodes and major depression (RDC, DSM-III) from an epidemiologic study are presented. Factors influencing the sex ratio are analyzed: subjective suffering from EDE, social and work impairment were found to an equal degree in both genders. Factors favoring female preponderance: women report more symptoms, men most probably forget symptoms, frequency and length of less recent depressions more readily, women see a physician or proceed to self-medication much more often. Consequently, the identical minimum symptom number for both genders is questioned and occupational impairment suggested as an alternative case-defining criterion.
A representative sample of 908 hospital records covering admissions between 1920 and 1982 for dep... more A representative sample of 908 hospital records covering admissions between 1920 and 1982 for depression was analyzed in order to assess the switch rate to hypomania/mania. The results are the following: (1) Over the decades of this century there has been a substantial increase in hospital admissions in Zurich for both depression and mania, but the ratio remained constant. (2)
Onset, course, and outcome of affective disorders were studied prospectively--at 5-year intervals... more Onset, course, and outcome of affective disorders were studied prospectively--at 5-year intervals, until 1980--in 406 patients admitted to the Psychiatric University Hospital, Zurich, between 1959 and 1963. A few results are summarized. Bipolar I and bipolar II disorders take a very similar course. The distinction between unipolar depression and bipolar affective disorder, and the separation by presence or absence of psychotic features (delusions and hallucinations), and then again by mood congruence, are of high prognostic value.
... The real progress from the views of Aretaeus of Cappadocia, of Richard Mead, Vincenzo Chiarug... more ... The real progress from the views of Aretaeus of Cappadocia, of Richard Mead, Vincenzo Chiarugi or Esquirol was Jean-Pierre Falret's concept of ... interest in so-called mixed states or mixed bipolar disorders, especially in the USA (ie Akiskal 1992, 1997, 1999, McElroy et al. ...
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