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Showing papers in "American Journal of Psychiatry in 1982"


Journal ArticleDOI
TL;DR: The authors describe a Global Deterioration Scale for the assessment of primary degenerative dementia and delineation of its stages and have used it successfully for more than 5 years and validated it against behavioral, neuroanatomic, and neurophysiologic measures in patients with primary degeneratives dementia.
Abstract: Cognitive decline associated with old age and consistent with the diagnosis of primary degenerative dementia is a unique clinical syndrome with characteristic phenomena and progression The authors describe a Global Deterioration Scale for the assessment of primary degenerative dementia and delineation of its stages The authors have used the Global Deterioration Scale successfully for more than 5 years and have validated it against behavioral, neuroanatomic, and neurophysiologic measures in patients with primary degenerative dementia

4,510 citations


Journal ArticleDOI
TL;DR: The life history of aggression and history of suicidal behavior in 12 subjects with borderline personality disorders without major affective disorder were examined, and Histories of aggressive behaviors and of suicide attempts were significantly associated with each other.
Abstract: In an earlier, separate study, the authors found that human aggression and suicide (a specific aggression-related behavior) were associated with lower levels of CSF 5-hydroxyindoleacetic acid (5-HIAA), a serotonin metabolite. That study focused on subjects with personality disorders without affective illness. In the present study they examine the life history of aggression and history of suicidal behavior in 12 subjects with borderline personality disorders without major affective disorder. Histories of aggressive behaviors and of suicide attempts were significantly associated with each other, and each was significantly associated with lower 5-HIAA levels. Altered serotonin metabolism may be a highly significant contributing factor to these behaviors in whatever diagnostic group they occur. Language: en

926 citations


Journal ArticleDOI
TL;DR: Residents were less satisfied than the general population in most life areas, especially finances, unemployment, safety, and family and social relations, and of particular concern was the finding that 34% had been recent victims of crime.
Abstract: Quality of life issues must be addressed more vigorously in the care of chronic mental patients. In a survey of 30 large board-and-care homes in Los Angeles, 278 mentally disabled residents described their life conditions and satisfaction in eight areas: living situation, family relations, social relations, leisure activities, work, finances, safety, and health. Residents were less satisfied than the general population in most life areas, especially finances, unemployment, safety, and family and social relations (p less than .001). Of particular concern was the finding that 34% had been recent victims of crime. The results underscore the need for better social programs for these patients.

464 citations


Journal ArticleDOI
TL;DR: Present data allow some tentative conclusions that the fault usually reflects a defect in central regulation of the pituitary-thyroid axis, and in some patients the fault may be a trait marker, and it may represent a biological bridge between some depressed patients and some patients with other mental disorders.
Abstract: In 1972 it was reported that in some euthyroid depressed patients the serum thyrotropin (TSH) response to thyrotropin-releasing hormone (TRH) was deficient. Since then, 41 reports describing 917 depressed patients have confirmed this finding. Although it is useful to report differences between mean response values of patient populations, it is necessary to identify those individuals in whom the fault occurs so that sensitivity, specificity, state-trait distribution, and clinical correlates can be determined. Present data allow some tentative conclusions: 1) the fault usually reflects a defect in central regulation of the pituitary-thyroid axis, 2) in some patients the fault may be a trait marker, and 3) it may represent a biological bridge between some depressed patients and some patients with other mental disorders.

453 citations


Journal ArticleDOI
TL;DR: It is suggested that combining a measure of brain structure with the clinical picture may provide a useful new approach to the classification of schizophrenia.
Abstract: The authors explored the clinical correlates of ventricular enlargement in schizophrenia by comparing 16 patients with "large" ventricles (ventricles more than I SD above the control mean) with 16 patients with the smallest ventricles from a sample of 52 schizophrenic patients Patients with ventricular enlargement showed some impairment in the sensorium and had a preponderance of "negative" symptoms (eg, alogia, affective flattening, avolition, anhedonia), while those with small ventricles were characterized by "positive" symptoms (eg, delusions, hallucinations, positive formal thought disorder, bizarre behavior) These findings suggest that combining a measure of brain structure with the clinical picture may provide a useful new approach to the classification of schizophrenia

418 citations



Journal ArticleDOI
TL;DR: Although depression must be differentiated from dementia, it is equally important to consider the possibility that the diagnoses coexist, and the authors conclude that the rate of coexisting depression decreased significantly with greater severity of the cognitive impairment.
Abstract: The authors diagnosed depression in 20 (23%) of 88 cognitively impaired geriatric outpatients. Three (20%) of these patients had depression only, and 17 (85%) had depression superimposed on an underlying dementia. The rate of coexisting depression decreased significantly with greater severity of the cognitive impairment: 9 (33%) of 27 mildly impaired patients were depressed, compared with 8 (23%) of 35 moderately impaired and 3 (12%) of 26 severely impaired patients. There was a nonsignificant trend for cognitively impaired women to be more likely to be depressed than for similarly impaired men. The authors conclude that although depression must be differentiated from dementia, it is equally important to consider the possibility that the diagnoses coexist.

346 citations


Journal ArticleDOI
TL;DR: The authors found that patients withsuperimposed depression relapsed at a significantly higher rate immediately after recovery from the acute episode of depression than did patients without superimposed depression.
Abstract: Although ‘ ‘double depression ‘ ‘-major depressive disorder superimposed on an underlying chronic depression-is a f requent phenomenon, the concept has not been well formulated clinically and has rarely been described in the research literature. The authors found that 1) 26% of 101 patients who met the criteria for major depressive disorder had an underlying chronic depressive disorder of at least 2 years’ duration, 2) “recovery” ratesfor patients with superimposed depression differed greatly depending on whether recovery was defined as recovery from the major depressive disorder only or recovery from both disorders, and 3) patients with superimposed depression relapsed at a significantly higher rate immediately after recovery from the acute episode of depression than did patients without superimposed depression.

334 citations


Journal ArticleDOI
TL;DR: The authors trace the evolution of narcissistic personality disorder as a nosological entity in a critical survey of the literature, considering and comparing differing theoretical viewpoints.
Abstract: The authors trace the evolution of narcissistic personality disorder as a nosological entity in a critical survey of the literature, considering and comparing differing theoretical viewpoints regarding the genesis of this disorder. They review its various descriptions, including the one in DSM-III, and develop a composite picture of the syndrome. The disorder consists of characteristic deficits in six broad areas of functioning: 1) self-concept, 2) interpersonal relationships, 3) social adaptation, 4) ethics, standards, and ideals, 5) love and sexuality, and 6) cognitive style. The authors identify guidelines for distinguishing the narcissistic personality from other personality disorders as well as areas needing continued research.

332 citations


Journal ArticleDOI
TL;DR: The reciprocal interaction between psychotherapy and theoretical assumptions is illustrated through observations of anorexia nervosa and traditional psychoanalysis was found to be rather ineffective, whereas an approach evoking active participation on the part of the patient led to better treatment results.
Abstract: The reciprocal interaction between psychotherapy and theoretical assumptions is illustrated through observations of anorexia nervosa Traditional psychoanalysis, with its emphasis on interpretation of unconscious processes, was found to be rather ineffective, whereas an approach evoking active participation on the part of the patient led to better treatment results The experience of being listened to appeared to be of utmost importance The characteristic deficits in self-concept and body awareness could be related to a paucity or an absence of confirming responses in the early mother-child interactions This concept reinforced the focus on encouragement of initiative and autonomy during therapy

305 citations


Journal ArticleDOI
TL;DR: Rates of single and multiple serious offenses and of institutionalization for delinquency were significantly higher in the ADD subjects, suggesting a strong relationship between childhood ADD and later arrests for delinquent behavior.
Abstract: The authors studied official arrests from childhood through adolescence in two groups of boys; one group (N = 110) was diagnosed in childhood as suffering from attention deficit disorder (ADD), and the second group (N = 88) consisted of normal control adolescents. Rates of single and multiple serious offenses and of institutionalization for delinquency were significantly higher in the ADD subjects. These findings suggest a strong relationship between childhood ADD and later arrests for delinquent behavior. (Abstract Adapted from Source: American Journal of Psychiatry, 1982. Copyright © 1982 by American Psychiatric Publishing) Longitudinal Studies Juvenile Crime Juvenile Delinquency Juvenile Offender Juvenile Behavior Delinquency Causes Behavior Effects Child Behavior Child Male Juvenile Male Male Behavior Male Crime Male Delinquency Male Offender Attention Deficit Disorder Arrest and Apprehension 12-01


Journal ArticleDOI
TL;DR: In a review of pediatric hospital emergency room admissions over 7 years, the authors found 505 children and adolescents who had attempted suicide; there were three times as many girls as boys, and the boys were significantly younger.
Abstract: In a review of pediatric hospital emergency room admissions over 7 years, the authors found 505 children and adolescents who had attempted suicide. There were three times as many girls as boys, and the boys were significantly younger. Features that distinguished them from matched controls were religion, living situation, substance abuse, current psychiatric illness, prior psychotherapy, and current medical illness. Their families had more psychiatric illness (primarily drug or alcohol abuse), suicide, paternal unemployment, and paternal and maternal absence than the controls' families. The suicide attempts usually occurred in the winter, after school or in the evening, at home with someone nearby, and by drug overdose.

Journal ArticleDOI
TL;DR: The results indicate that the acute augmentation of cholinergic activity in some patients with Alzheimer's disease can partially reverse the memory deficit of that disorder and may provide an approach to the eventual therapy of this condition.
Abstract: Physostigmine (.125 mg, .25 mg, or .50 mg) or placebo was administered intravenously to 10 neuroleptic-free patients with Alzheimer's disease over a 30-minute period. All patients performed better on a recognition memory task while receiving physostigmine. When placebo or the dose of physostigmine previously associated with an improvement in memory was readministered, physostigmine again enhanced performance on a recognition memory task. These results indicate that the acute augmentation of cholinergic activity in some patients with Alzheimer's disease can partially reverse the memory deficit of that disorder and may provide an approach to the eventual therapy of this condition.

Journal ArticleDOI
TL;DR: Advances in recognition of developmental issues and medical management support the trend toward decreased institutionalization and the concurrent increased normalization of the retarded individual.
Abstract: Because of their high incidence of CNS impairment and low overall interpersonal coping abilities, retarded persons have a greater than average risk for developing associated psychiatric disorders. The authors describe the types of disorders and their incidence and review allied treatment challenges. Advances in recognition of developmental issues and medical management support the trend toward decreased institutionalization and the concurrent increased normalization of the retarded individual.

Journal ArticleDOI
TL;DR: Clinical data showing parallels between REM sleep and depressive phenomena are summarized, and the author discusses evidence for his hypothesis that the following commonalities in neurobiological control systems generate these parallels.
Abstract: The author summarizes clinical data showing parallels between REM sleep and depressive phenomena; e.g., patients with endogenous depression show a first REM period that has a shorter than normal latency and a higher density of eye movement. The author discusses evidence for his hypothesis that the following commonalities in neurobiological control systems generate these parallels: 1) brainstem norepinephrine and serotonin systems suppress both REM sleep and depressive phenomena, 2) acetylcholine systems promote both REM and depressive phenomena, and 3) in control of depressive phenomena, as acetylcholine neuronal systems interact and the balance of activity between these two systems, rather than absolute activity levels in either, is the critical factor.

Journal ArticleDOI
TL;DR: The author suggests that child mental health professionals should improve their skills for identifying sexually abused children and help parents to be supportive of such children.
Abstract: Of 28 sexually abused children (22 girls and 6 boys) aged 21/2 to 151/2 years, those suffering moderate to extreme emotional disturbance were female, unsupported by a close adult, molested by their father and by more than one male relative, genitally molested, and molested from an early age and over a long period. Twelve children were referred for psychiatric evaluation due to sexual abuse without apparent symptoms, and 5 solely due to symptoms, with sexual abuse unknown. The author suggests that child mental health professionals should improve their skills for identifying sexually abused children and help parents to be supportive of such children. Language: en

Journal ArticleDOI
TL;DR: The authors found that patients with major affective disorder had higher levels of plasma norepinephrine and higher pulse rates (tachycardia) than healthy control subjects, but their blood pressures were normal, suggesting sympathetic hyperactivity in the major affectives disorders.
Abstract: The authors found that patients with major affective disorder had higher levels of plasma norepinephrine and higher pulse rates (tachycardia) than healthy control subjects, but their blood pressures were normal These measurements were similar in all three subgroups of patients with affective disorder--manic, bipolar depressed, and unipolar Because norepinephrine is the primary neurotransmitter of the sympathetic nervous system, these data suggest sympathetic hyperactivity in the major affective disorders This conclusion is compatible with recent speculation based on the effect of antidepressants on noradrenergic receptors and a failure of alpha-receptors to downregulate normally in patients with major affective disorder

Journal ArticleDOI
TL;DR: The authors believe that increased cholinergic sensitivity and REM density may be biological markers of increased vulnerability to bipolar affective illness.
Abstract: To test the hypothesis that depression and REM sleep share common cholinergic mechanisms the authors administered arecoline 25 min after completion of the first REM period to 14 patients with remitted bipolar affective disorder, 15 normal controls, and 5 subjects with a personal or family history of affective disorder. The second REM period occurred significantly sooner in the remitted patients than in the normal controls. The patients also had a significantly higher density of eye movements during the first REM period and a higher percentage of REM sleep. The authors believe that increased cholinergic sensitivity and REM density may be biological markers of increased vulnerability to bipolar affective illness.

Journal ArticleDOI
TL;DR: The authors studied cortisol circadian rhythm and the overnight DST in 15 nondepressed patients with advanced primary degenerative dementia and 15 normal control subjects, finding that DST-positive dementia patients had a blunted predexamethasone circadian cortisol rhythm.
Abstract: Before the dexamethasone suppression test (DST) can be accepted as a valid diagnostic tool for differentiating depression from dementia, it must be demonstrated that dementing illnesses per se are not associated with a positive DST. The authors studied cortisol circadian rhythm and the overnight DST in 15 nondepressed patients with advanced primary degenerative dementia and 15 normal control subjects. Seven dementia patients and no control patients were DST positive. The DST-positive dementia patients had a blunted predexamethasone circadian cortisol rhythm. These results cast doubt on the utility of the DST in diagnosing depression that complicates advanced primary degenerative dementia.

Journal ArticleDOI
TL;DR: Six women and 6 men who were treated in double-blind fashion major depressive illness did not respond to imipramine or amitriptyline, 150-300 mg/day, but after the addition of L-triiodothyronine (T3), 9 patients showed statistically significant improvement in depression scores.
Abstract: Six women and 6 men who were treated in double-blind fashion major depressive illness did not respond to imipramine or amitriptyline, 150-300 mg/day, during periods of 26-112 days. After the addition of 25 micrograms/day (10 patients) or 50 micrograms/day (2 patients) of L-triiodothyronine (T3), 9 patients showed statistically significant improvement in depression scores; in 8 patients the response was marked. Improvement generally began within 1-3 days and was noted in all aspects of the depressive syndrome; side effects were minimal. T3 did not change plasma levels of imipramine or desipramine or their ratio but did suppress serum thyroxine.

Journal ArticleDOI
TL;DR: The authors report on ventricular enlargement in a rigorously defined but representative sample of schizophrenic patients intermittently hospitalized but living in the community, providing additional evidence that ventricular enlargeement does occur in schizophrenia, although not at rates as high as those previously reported.
Abstract: Ventricular enlargement in schizophrenia as measured by ventricular-brain ratio (VBR) has been described by three different research groups. Because of the possibility that the samples might not be representative of the broad population of schizophrenic patients, questions have been raised about generalizability. The authors report on ventricular enlargement in a rigorously defined but representative sample of schizophrenic patients intermittently hospitalized but living in the community. They provide additional evidence that ventricular enlargement does occur in schizophrenic patients, although not at rates as high as those previously reported. Issues related to the definition of ventricular enlargement, as well as the effects of sampling and choice of a control group, are discussed.

Journal ArticleDOI
TL;DR: The authors recommend more explicit instructions in the administration of the scale, the use of a standardized interview, and more training for raters as ways of increasing reliability of axis V of DSM-III.
Abstract: The authors studied the reliability of axis V of DSM-III by analyzing ratings of 97 psychiatric inpatients made by a multidisciplinary team of clinicians. The intraclass correlation coefficient for ratings of the overall sample was .49, lower than the figure found during the DSM-III field trials. The psychiatric diagnosis, age, ethnicity, marital status, and sex of the patient did not significantly influence reliability. The authors recommend more explicit instructions in the administration of the scale, the use of a standardized interview, and more training for raters as ways of increasing reliability.

Journal ArticleDOI
TL;DR: A depression scale in the Vietnamese language that contains culturally consistent items describing the thoughts, feelings, and behaviors of depressed individuals and items describing common clinical characteristics of depressed Vietnamese patients is developed.
Abstract: The authors developed a depression scale in the Vietnamese language that contains culturally consistent items describing the thoughts, feelings, and behaviors of depressed individuals and items describing common clinical characteristics of depressed Vietnamese patients After pretesting, the preliminary 43-item scale was given to 21 depressed Vietnamese patients and a matched community sample of 44 Fifteen items accounted for 96% of the variance between the two groups and were used as the final form of the Vietnamese Depression Scale A cutoff of 13 points (of a possible 34) identified 91% of the patients and 96% of the community sample

Journal ArticleDOI
TL;DR: Although the acute dysphoria peaked between 1 and 2 years, several grief-related feelings, symptoms, and behaviors continued indefinitely, and some had persistent identification phenomena.
Abstract: As part of an effort to develop an instrument to measure grief, a 58-item questionnaire was completed by 211 subjects who had lost a loved one because of death. The results demonstrated wide individual variations in specific symptoms and in their intensity and duration. Long after the immediate grief period, most bereaved individuals continued to feel upset, empty, or tearful; many experienced anniversary reactions and/or physical symptoms; and some had persistent identification phenomena. Although the acute dysphoria peaked between 1 and 2 years, several grief-related feelings, symptoms, and behaviors continued indefinitely. The relevance of present work and directions for future studies are discussed.



Journal ArticleDOI
TL;DR: The authors interviewed 162 widows 1, 6, 12, and 24 months after bereavement to determine which sociodemographic, prebereavement, and response variables and circumstances of the husband's death were related to distress level.
Abstract: The authors interviewed 162 widows 1, 6, 12, and 24 months after bereavement to determine which sociodemographic, prebereavement, and response variables and circumstances of the husband's death were related to distress level, as measured by the General Health Questionnaire (GHQ). The most important variable associated with high distress at 1 month was the woman's perception that she was seeing old friends less than before her husband's death. At 2 years it was possible to predict distress levels with 86% accuracy by means of a multiple regression analysis using 10 variables, including 1-month GHQ score, short final illness of the husband, and satisfaction with available help.


Journal ArticleDOI
TL;DR: The author considers two main concepts of minimalbrain dysfunction: 1) a continuum notion, in which minimal brain dysfunction is viewed as a lesser variant of gross traumatic brain damage, and 2) a syndrome notion, which constitutes a genetically determined disorder rather than a response to any form of injury.
Abstract: The author considers two main concepts of minimal brain dysfunction: 1) a continuum notion, in which minimal brain dysfunction is viewed as a lesser variant of gross traumatic brain damage, and 2) a syndrome notion, in which minimal brain dysfunction constitutes a genetically determined disorder rather than a response to any form of injury. The evidence on the former indicates that subclinical damage to the brain may occur and may involve psychological sequelae-but the damage probably has to be rather severe, and the result is not a homogeneous syndrome. The second alternative remains a possibility, but the claims far outrun the empirical findings that could justify them.