Showing papers in "American Journal of Psychiatry in 1979"
TL;DR: Insomnia, nightmares, and hypersomnia were correlated with more frequent general physical and mental health problems and were often chronic and usually started early in life.
Abstract: The authors determined the prevalence of sleep disorders in a general population through a survey of 1,006 representative households in the Los Angeles metropolitan area. They found an overall prevalence of current or previous sleep disorders in adults of 52.1%. Specifically, they found a 42.5% prevalence of insomnia, 11.2% of nightmares, 7.1% of excessive sleep, 5.3% of sleeptalking, and 2.5% of sleepwalking. These conditions were often chronic and usually started early in life. Insomnia was more frequent in older people, particularly older women, and in people of lower educational socioeconomic status. Insomnia, nightmares, and hypersomnia were correlated with more frequent general physical and mental health problems.
836Â citations
677Â citations
TL;DR: A stage theory of adult life seems oversimplified because the timing of life events is becoming less regular, age is losing its customary social meanings, and the trends are toward the fluid life cycle and an age-irrelevant society.
Abstract: Psychologists are increasingly interested in the life cycle as the unit for study and in such questions as whether adult development, like child development, is to be perceived as a succession of stages. A stage theory of adult life seems oversimplified for several reasons. First, the timing of life events is becoming less regular, age is losing its customary social meanings, and the trends are toward the fluid life cycle and an age-irrelevant society. Second, the psychological themes and preoccupations reported by young, middle-aged, and older persons are recurrent ones that appear and reappear in new forms and do not follow in a single fixed order. Third, intrapsychic changes occur slowly with age and not in stepwise fashion. These factors may have implications for the psychiatrist who, in helping the patient make a meaningful life story from a life history, deals always with issues of time, timing, and aging.
625Â citations
TL;DR: A battery of tests indicated that buspirone, a new agent not chemically related to any currently marketed drugs, was as effective an antianxiety agent as diazepam and produced no more and perhaps fewer side effects.
Abstract: In this double-blind study, 56 adult psychoneurotic outpatients with a primary diagnosis of anxiety neurosis were randomly assigned to receive buspirone (N = 18), diazepam (N = 20), or placebo (N = 18) over a four-week period. A battery of tests administered weekly indicated that buspirone, a new agent not chemically related to any currently marketed drugs, was as effective an antianxiety agent as diazepam and produced no more and perhaps fewer side effects. Buspirone showed excellent antidepressant effects as well. If further studies confirm the authors' findings and determine that buspirone does not result in tolerance and addiction, it would be more advantageous than the benzodiazepines in the treatment of anxiety.
372Â citations
TL;DR: The interrater reliability of DSM--III is, in general, higher than that previously achieved and may be due to changes in the classification itself, the separation of axis I from axis II conditions, the systematic description of the various disorders, and the inclusion of diagnostic criteria.
Abstract: The interrater agreement for major diagnostic categories in studies using DSM-I and DSM-II was usually only fair or poor. In phase one of the DSM-III field trials the overall kappa coefficient of agreement for axis I diagnoses of 281 adult patients was .78 for joint interviews and .66 for diagnoses made after separate interviews; for axis II--personality disorders and specific developmental disorders--the coefficients of agreement were .61 and .54. The interrater reliability of DSM--III is, in general, higher than that previously achieved and may be due to changes in the classification itself, the separation of axis I from axis II conditions, the systematic description of the various disorders, and the inclusion of diagnostic criteria.
366Â citations
TL;DR: It was found that pharmacotherapy and psychotherapy alone were equally efficacious and better than nonscheduled treatment and the combination treatment of psychotherapy and pharmacotherapy was more effective than either treatment alone and delayed the onset of symptomatic failure.
Abstract: The efficacy of tricyclic antidepressants and various psychotherapies, in comparison with one another or in combination, has not been fully established in randomized clinical trials. The authors present a randomized controlled trial comparing the combination of amitriptyline and short-term interpersonal psychotherapy, either treatment alone, and nonscheduled supportive psychotherapy in ambulatory patients with acute depression. They found that pharmacotherapy and psychotherapy alone were equally efficacious and better than nonscheduled treatment. The combination treatment of psychotherapy and pharmacotherapy was more effective than either treatment alone and delayed the onset of symptomatic failure.
349Â citations
319Â citations
TL;DR: Follow-up outcomes in the first year after treatment in relation to time spent in treatment in the Drug Abuse Reporting Program showed that longer time in treatment was related to better posttreatment outcome, but clients who spent less than 3 months in treatment were not significantly different from the detoxification- only group or the intake-only group.
Abstract: The author examined follow-up outcomes in the first year after treatment in relation to time spent in treatment in the Drug Abuse Reporting Program. Follow-up interviews were completed with more than 3,000 people admitted to drug abuse treatment during 1969--1972, including clients treated with methadone maintenance, therapeutic communities, outpatient drug-free programs, and outpatient detoxification, as well as a group who completed intake procedures but did not return for treatment. Longer time in treatment was related to better posttreatment outcome, but clients who spent less than 3 months in treatment were not significantly different from the detoxification-only group or the intake-only group.
291Â citations
TL;DR: In a pilot study of 150 manic or depressive patients, preliminary analysis of symptom pictures of the index episode of different diagnostic groups, joint diagnostic classification of the different subtypes of major depressive disorder, and differential outcome by diagnostic groups suggest schizophrenic symptoms in affective disorders do have diagnostic and prognostic significance.
Abstract: In a pilot study of 150 manic or depressive patients, the authors used the Research Diagnostic Criteria (RDC) and the Schedule for Affective Disorders and schizophrenia (SADS) to perform preliminary analysis of symptom pictures of the index episode of different diagnostic groups, joint diagnostic classification of the different subtypes of major depressive disorder, and differential outcome by diagnostic groups The results suggest that schizophrenic symptoms in affective disorders do have diagnostic and prognostic significance, that the term "psychotic depression" should be limited to impaired reality testing without reference to degree of incapacitation, that situational-nonsituational and endogenous-nonendogenous classifications are separate depressive subtypes, and that it may not be true that patients with endogenous major depressive disorder have a better prognosis than patients with nonendogenous depression
234Â citations
TL;DR: There was no difference between depressed patients who did and did not show escape from suppression in type of previous episodes, family history, symptoms, or medication, however, those who showed escape tended to respond better to treatment and to be rated as having a more severe depression.
Abstract: Of 54 male psychiatric patients undergoing dexamethasone suppression tests in a clinical setting, 40% of those with a major depressive disorder showed escape from suppression over the 24 hours after dexamethasone administration, while all of the patients with schizophrenia, neurosis, alcoholism,and drug abuse showed normal pituitary-adrenal suppression. Only 10% of the depressed patients showed resistance to suppression 8 hours after dexamethasone administration. There was no difference between depressed patients who did and did not show escape from suppression in type of previous episodes, family history, symptoms, or medication. However, those who showed escape tended to respond better to treatment and to be rated as having a more severe depression. The theoretical and clinical implications of these findings are not yet clear.
233Â citations
TL;DR: The authors suggest that the high incidence of seizures at puberty observed in this study may be specific to children with total autistic symptomatology and may represent a distinct pathological process associated with autism.
Abstract: The authors examined 183 children with autistic symptoms and found that the age-specific incidence rates of seizures in this sample were between 3 and 28 times the rates for children in the general population. The subjects classified as totally autistic were at high risk of developing seizure from early childhood well into adolescence, but especially so at puberty. The partially autistic children had an increased risk of seizures only up to age 10. The authors suggest that the high incidence of seizures at puberty observed in this study may be specific to children with total autistic symptomatology and may represent a distinct pathological process associated with autism.
TL;DR: The authors report on 40 families who broke this family pattern and found mechanisms for change used in these families included reliance on a broad network of resources, a degree of self-differentiation, an attitude of realistic optimism, and the ability to marshall extra resources to meet crisis situations.
Abstract: The tendency for the cycle of abusive and neglectful parenting to be transmitted across generations has been well documented. The authors report on 40 families who broke this family pattern. The mechanisms for change used in these families included reliance on a broad network of resources, a degree of self-differentiation, an attitude of realistic optimism, and the ability to marshall extra resources to meet crisis situations. The authors recommend further study of such exceptions and a more hopeful approach to the problem of abusive families.
TL;DR: The author notes that pre- and post-interview meetings of clinicians and interpreters have been found useful in minimizing distortions in clinically relevant interpreter-related distortions.
Abstract: Non-English-speaking patients in need of psychiatric services are usually evaluated with the help of an interpreter. Discussions with psychiatrists and lay hospital interpreters who had experience in these interviews and content analysis of eight audiotaped interpreter-mediated psychiatric interviews suggested that clinically relevant interpreter-related distortions could lead to misevaluation of the patient's mental status. The author notes that pre- and post-interview meetings of clinicians and interpreters have been found useful in minimizing these distortions.
TL;DR: The best predictor of Time 2 depressive symptom scores was Time 1 symptom scores; losses and resources were also statistically significant factors and demonstrate the complex interrelatedness of life events, coping resources, and depressive symptomatology.
Abstract: The author presents data on the relationships between life events, coping resources, and depressive symptomatology. A probability sample (N = 517) was interviewed three years apart. Respondents with high life-event scores had significantly more depressive symptomatology than those with low scores. Those with personal, familial, and interpersonal resources had significantly less depressive symptomatology than those without such resources in both the low- and high-life-event groups. The best predictor of Time 2 depressive symptom scores was Time 1 symptom scores; losses and resources were also statistically significant factors. These findings demonstrate the complex interrelatedness of life events, coping resources, and depressive symptomatology.
TL;DR: The authors conducted a follow-up study of 81 rape victims to analyze the effect of adaptive or maladaptive response to rape on recovery over a 4-6 year period, and found that victims recovering fastest used more adaptive strategies.
Abstract: Being raped generates an enormous amount of anxiety in the victim. This anxiety is the basis for an acute traumatic reaction called the rape trauma syndrome 1 The nucleus of the anxiety is the impact of the life-threatening or highly stressful experience on the individual.
TL;DR: Depressive patients demonstrated more neuroticism, introversion, and obsessionality than manic patients or normal individuals, and the manic patients differed from normal persons only on obsessionality.
Abstract: To determine the personality characteristics associated with affective disorders the authors administered a battery of self-report personality inventories to a sample of hospitalized affective patients when their manifest symptoms had abated Patients were instructed to answer according to their premorbid personalities The personality characteristics assessed in the 73 depressive and 24 manic patients included neuroticism and extraversion from the Maudsley Personality Inventory, obsessional pattern, hysterical pattern, and oral pattern from the Lazare-Klerman-Armor Personality Inventory, obsessional state and trait from the Leyton Obsessionality Inventory, and solidity, stability, and validity from the Marke-Nyman Temperament Survey Depressive patients demonstrated more neuroticism, introversion, and obsessionality than manic patients or normal individuals The manic patients differed from normal persons only on obsessionality
TL;DR: The authors identify a new syndrome of family violence--parent battering, which they conclude, on the basis of their clinical work with these families, is distinct from child and spouse abuse.
Abstract: The authors identify a new syndrome of family violence--parent battering. Relevant dynamics include individual characteristics of the parent batterer, distortions in the generational authority hierarchy, the role of secrets and denial, and cultural influences. The authors conclude, on the basis of their clinical work with these families, that this subtype of family violence is distinct from child and spouse abuse.
TL;DR: The authors reevaluate a large prospective Italian study that compared high-dose imipramine with ECT treatment in the treatment of depression and find that the superiority of ECT was evident among patients with endogenous depression and especially evident among those with delusional depression.
Abstract: The authors reevaluate a large prospective Italian study (437 patients) that compared high-dose imipramine with ECT treatment in the treatment of depression. The superiority of ECT was evident among patients with endogenous depression, and especially evident among those with delusional depression (83% improved with ECT versus 40% with imipramine) and depressions defined as severe (83% versus 35%).
TL;DR: Despite the strong association of decreasedMAO activity and chronic schizophrenia, the etiological relationship of low platelet MAO activity to schizophrenia has not been demonstrated and further metabolic investigations with such patients are needed to determine the physiological significance of this phenomenon.
Abstract: The authors review studies of platelet and white cell monoamine oxidase (MAO) activity in schizophrenic patients. The data on acute schizophrenic patients remain inconclusive. Review of 26 reports of chronic schizophrenic patients leaves little doubt, however, that there is a subgroup in which the enzyme activity is decreased. Despite the strong association of decreased MAO activity and chronic schizophrenia, the etiological relationship of low platelet MAO activity to schizophrenia has not been demonstrated. More complete diagnostic descriptions will shed light on precisely which patients have lowered MAO activity. Further metabolic investigations with such patients are needed to determine the physiological significance of this phenomenon.
TL;DR: Serum prolactin levels were moderately increased between 90 minutes and 4 hours after administration of very high doses of oral clozapine in 4 patients but were smaller than those produced by chlorpromazine in other subjects but the authors suggest that clozAPine may achieve its antipsychotic effect differently than do classical neuroleptics and that sustained Prolactin increases are not essential for antipsychotics action.
Abstract: The authors determined serum prolactin levels in 13 patients receiving clozapine, an antipsychotic drug that does not produce extrapyramidal side effects. Morning serum prolactin levels, 11 hours after the last dose, were not elevated during chronic treatment with clozapine in any subject despite its therapeutic effects. Serum prolactin levels were moderately increased between 90 minutes and 4 hours after administration of very high doses of oral clozapine in 4 patients but were smaller than those produced by chlorpromazine in other subjects. The authors suggest that clozapine in other subjects. The authors suggest that clozapine may achieve its antipsychotic effect differently than do classical neuroleptics and that sustained prolactin increases are not essential for antipsychotic action.
TL;DR: Twelve patients with abnormal involuntary movement disorders were treated with clozapine in a double-blind, placebo-controlled trial and two patients with Huntington's disease showed a marked decrease in movements.
Abstract: Twelve patients with abnormal involuntary movement disorders were treated with clozapine in a double-blind, placebo-controlled trial. The cohort consisted of individuals with Gilles de la Tourette's syndrome, Huntington's disease, and atypical persistent dyskinesia that was drug induced. Two subjects were dropped from the protocol due to complications. Two patients with Huntington's disease showed a marked decrease in movements; other individuals obtained no significant therapeutic benefits. Seven of the 10 patients completing the trial experienced moderate or marked side effects.
TL;DR: The author traces the historical background of brief psychotherapy, focusing on the contributions of Freud, Ferenczi, Rank, and Alexander and French, and then presents a synthesis of contemporary views.
Abstract: Short-term dynamic psychotherapy is rooted in psychoanalytic theory. The author traces the historical background of brief psychotherapy, focusing on the contributions of Freud, Ferenczi, Rank, and Alexander and French, and then presents a synthesis of contemporary views. Selection criteria for patients who can benefit from short-term therapy, and the techniques used, are discussed. Similarities to and differences from crisis intervention techniques are pointed out. The trend of the future can be expected to be toward shorter-term therapies, but given the present state of psychiatric knowledge, long-term therapy will still be necessary for many patients.
TL;DR: The authors found that juvenile sexual assaulters suffered from neuropsychiatric problems similar to those of other violent juveniles, had committed violent acts other than sexual assault, and had had seriously aberrant behavior since early childhood.
Abstract: This study compares the psychiatric, neurological, and psychoeducational status of sexually assaultive male juveniles and other violent juveniles. The authors found that juvenile sexual assaulters suffered from neuropsychiatric problems similar to those of other violent juveniles, had committed violent acts other than sexual assault, and had had seriously aberrant behavior since early childhood. The findings contradict prevailing assumptions that sexual assaults by juveniles are rare occurrences and that juvenile sex offenders have low rates of recidivism. Theoretical and treatment implications are discussed.
TL;DR: The IMPETUS for the NIMH-Clinical Research Branch Collaborative Program on the Psychobiology of Depression stemmed from the growing concern with depression as a U.S. public health problem and the growing awareness that there had been some striking changes over the past 20 years in the authors' conception of the nature and etiology of the affective disorders.
Abstract: THE IMPETUS for the NIMH-Clinical Research Branch Collaborative Program on the Psychobiology of Depression stemmed from the growing concern with depression as a U.S. public health problem and the growing awareness that there had been some striking changes over the past 20 years in our conception of the nature and etiology of the affective disorders. New findings in the area of genetics and biochemistry inspired hypotheses implicating the chemistry of the endocrine and central nervous systems in ways quite different than had been thought in the past. There was reason to believe that we were on the verge of linking physiology, psychosocial factors, and behavior in these disorders, which would eventually make possible the development of a coherent and valid psychobiologic theory ofdepression. However, serious methodologic problems and the practical difficulties intrinsic to clinical research had seriously retarded progress toward this objective. Because of these developments and the perceived
TL;DR: Results suggest that beta-adrenergic receptor sensitivity is reduced in depressive illness.
Abstract: In a study of beta-adrenergic receptor sensitivity, the authors determined the response of cyclic AMP synthesis to in vitro addition of norepinephrine (NE) and isoproterenol (IP) in leukocytes of patients with affective illness and schizophrenia and of normal controls. IP-stimulated increase in 3H-cyclic AMP synthesis in depressed patients was significantly lower than in normal subjects and schizophrenic patients. These results suggest that beta-adrenergic receptor sensitivity is reduced in depressive illness.