Showing papers in "American Journal of Psychiatry in 1983"
TL;DR: A 6-item Orientation-Memory-Concentration Test has been validated as a measure of cognitive impairment and has been shown to discriminate among mild, moderate, and severe cognitive deficits.
Abstract: A 6-item Orientation-Memory-Concentration Test has been validated as a measure of cognitive impairment. This test predicted the scores on a validated 26-item mental status questionnaire of two patient groups in a skilled nursing home, patients in a health-related facility, and in a senior citizens' center. There was a positive correlation between scores on the 6-item test and plaque counts obtained from the cerebral cortex of 38 subjects at autopsy. This test, which is easily administered by a nonphysician, has been shown to discriminate among mild, moderate, and severe cognitive deficits.
1,915 citations
TL;DR: The authors conclude that the CES-D Scale may be useful as an initial or first-stage screening test for depression and corroborated earlier findings of a modest relationship between self-reported symptoms of depression and the diagnosis of depression.
Abstract: The authors gave the Center for Epidemiologic Studies Depression (CES-D) Scale, a self-report depression symptom scale, to 528 subjects drawn from a larger longitudinal community survey. Interviewers also assessed respondents using the Schedule for Affective Disorders and Schizophrenia (SADS), a structured clinical interview; on the basis of the SADS the subjects were then given diagnoses according to the Research Diagnostic Criteria. The results corroborated earlier findings of a modest relationship between self-reported symptoms of depression and the diagnosis of depression. The authors conclude that the CES-D Scale may be useful as an initial or first-stage screening test.
793 citations
TL;DR: A 4-year follow-up study of 25 school-bus kidnapping victims and one child who narrowly missed the experience revealed that every child exhibited posttraumatic effects, including pessimism about the future, belief in omens and prediction, memories of incorrect perceptions, thought suppression, shame, fear of reexperiencing traumatic anxiety, trauma-specific and mundane fears, posttraumatic play, behavioral reenactment, repetitions of psychophysiological disturbances that began with the kidnapping, repeated nightmares, and dreams of personal death as mentioned in this paper.
Abstract: A 4-year follow-up study of 25 school-bus kidnapping victims and one child who narrowly missed the experience revealed that every child exhibited posttraumatic effects. Symptom severity was related to the child's prior vulnerabilities, family pathology, and community bonding. Important new findings included pessimism about the future, belief in omens and prediction, memories of incorrect perceptions, thought suppression, shame, fear of reexperiencing traumatic anxiety, trauma-specific and mundane fears, posttraumatic play, behavioral reenactment, repetitions of psychophysiological disturbances that began with the kidnapping, repeated nightmares, and dreams of personal death. Brief treatment 5-13 months after the kidnapping did not prevent symptoms and signs 4 years later.
574 citations
TL;DR: The authors propose the general concept of somatic style--in particular, an amplifying style--which could be used to investigate symptom formation, bodily perception, and medical illness as a psychological and social event.
Abstract: Hypochondriasis can be conceptualized in four ways: 1) as a psychiatric syndrome composed of "functional" somatic symptoms, fear of disease, bodily preoccupation, and the persistent pursuit of medical care, 2) psychodynamically, as a derivative of aggressive or oral drives or as a defense against guilt or low self-esteem, 3) as a perceptual amplification of bodily sensations and their cognitive misinterpretation, and 4) as socially learned illness behavior eliciting interpersonal rewards. There is evidence supporting each of these views, but much more investigation is needed. The authors propose the general concept of somatic style--in particular, an amplifying style--which could be used to investigate symptom formation, bodily perception, and medical illness as a psychological and social event.
564 citations
TL;DR: Analysis of 56 published case reports of self-harm revealed a typical pattern of onset in late adolescence, multiple recurrent episodes, low lethality, harm deliberately inflicted upon the body, and extension of the behavior over many years.
Abstract: Recent research has differentiated several distinct classes of self-destructive behavior. This paper describes the clinical characteristics of one class, the deliberate self-harm syndrome. Analysis of 56 published case reports of self-harm revealed a typical pattern of onset in late adolescence, multiple recurrent episodes, low lethality, harm deliberately inflicted upon the body, and extension of the behavior over many years. Since the clinical characteristics of the deliberate self-harm syndrome differ substantially from those of other classes of self-destructive behavior, the authors propose that DSM-IV classify deliberate self-harm as a separate diagnostic syndrome.
530 citations
TL;DR: The authors examined two groups from the National Institute of Mental Health-Clinical Research Branch Collaborative Program on the Psychobiology of Depression: Clinical Studies--patients whose symptoms had completely remitted and those who had not recovered.
Abstract: The influence of the clinically depressed state on personality assessment was evaluated by comparing self-report personality inventories of patients while clinically depressed and at follow-up 1 year later. The authors examined two groups from the National Institute of Mental Health (NIMH)-Clinical Research Branch Collaborative Program on the Psychobiology of Depression: Clinical Studies--patients whose symptoms had completely remitted and those who had not recovered. The clinically depressed state strongly influenced assessment of emotional strength, interpersonal dependency, and extraversion. Assessment of rigidity, level of activity, and dominance did not change after symptomatic recovery.
500 citations
TL;DR: The authors review published studies of the children of parents with major affective disorder and report the rates of diagnosable disorder in the children, their clinical symptoms and other behavioral disturbances, and the differing impact of parental illness at different ages and stages of development.
Abstract: The authors review published studies of the children of parents with major affective disorder and report the rates of diagnosable disorder in the children, their clinical symptoms and other behavioral disturbances, and the differing impact of parental illness at different ages and stages of development. There is significant risk to children in having parents with major affective disorder, and considerable impairment is evident in these children. The authors discuss the methodological issues in the studies and offer suggestions for future investigations.
492 citations
442 citations
TL;DR: The author develops a nosologic framework for understanding the psychopathology of low-grade chronic depressions and proposes operational criteria to identify a thymoleptic-responsive subaffective dysthymic group.
Abstract: The author develops a nosologic framework for understanding the psychopathology of low-grade chronic depressions: 1) late-onset primary depressions with residual chronicity, 2) chronic secondary dysphorias, having a variable onset age and considered part of the symptomatic picture of nonaffective "neurotic" disorders or reactions to longstanding incapacitating medical diseases, and 3) early-onset characterologic depressions, which include a) character-spectrum disorders developing in the setting of tempestuous early object relationships and b) subaffective dysthymic disorders, conceptualized as genetically attenuated forms of primary affective illnesses. Differences in family history, REM latency, and pharmacologic responsiveness are presented in support of these distinctions. The author also proposes operational criteria to identify a thymoleptic-responsive subaffective dysthymic group.
429 citations
TL;DR: The author discusses clinical features, etiology, pathogenesis, diagnosis, and treatment of delirium and related transient disorders of cognition in the elderly.
Abstract: Cognitive disorders are on the rise. Their growing importance as a medical and psychiatric problem reflects the continued increase in the number of the elderly worldwide.1,2 In the United States, there are 25.5 million persons aged 65 years and older. Dementia and delirium, the main cognitive disorders, are most common among the elderly. Recent medical editorials speak of dementia as a “quiet epidemic” and “one of the greatest problems facing modern society.”3 4 The elderly, and especially the demented, are uniquely prone to transient cognitive disorders, usually referred to in the literature as delirium or acute confusional states.5 As the prevalence of dementia is expected to rise in the coming years because of the aging of the populaion, so the incidence of delirium is likely to follow suit. While dementia has attracted growing attention.6, 7 delirium in the elderly continues to be neglected.8, 9 A recent report of the Royal College of Physicians emphasizes that insufficient attention has been paid to this common and important mental disorder, one whose onset in an elderly patient usually heralds physical illness and hence calls for immediate medical evaluation.8 Furthermore, delirium is still often mistaken for an irreversible dementia. The present overview may help prevent such grave diagnostic errors in the future and stimulate sorely needed research on transient cognitive disorders.
351 citations
TL;DR: In most patients, delirium was caused by multiple factors, and the authors outline strategies for management of terminal cancer patients withDelirium.
Abstract: Nineteen patients believed to be in the terminal stages of cancer were evaluated for signs of delirium. Six patients improved; 13 who died during hospitalization were studied until their death. Patients were interviewed three times a week using a delirium scale; medical records also were used to gather data. Eleven (85%) of the 13 patients developed delirium. In most patients, delirium was caused by multiple factors. The authors outline strategies for management of terminal cancer patients with delirium.
TL;DR: Twin studies of schizophrenia probably provide a valid measure of the major etiologic role genetic factors play in schizophrenia, and are likely to be substantially biased by the greater similarity in social environment of identical versus fraternal twins.
Abstract: The author reviews the results of twin studies of schizophrenia from the perspective of recent advances in our understanding of the twin method and of the transmission of schizophrenia. The evidence suggests that twin studies of schizophrenia are not likely to be substantially biased by the greater similarity in social environment of identical versus fraternal twins. Raw concordance figures from twin studies of schizophrenia are quite variable. When models to estimate the etiologic importance of genetic factors are applied to these figures, the results from all studies are similar. According to these models, genetic factors are as etiologically important in schizophrenia as in such medical conditions as diabetes and hypertension. Twin studies of schizophrenia probably provide a valid measure of the major etiologic role genetic factors play in schizophrenia.
TL;DR: Imipramine was associated with a significantly reduced frequency of binge eating and with improvement on several other measures of eating behavior, which augments the growing evidence that bulimia may be related to affective disorder.
Abstract: Bulimia, the syndrome of compulsive binge eating, is a common and often severe disorder frequently resistant to known therapies. Recent evidence suggesting a link between bulimia and affective disorder prompted the authors to perform a double-blind study of imipramine versus placebo with 22 chronically bulimic women. Imipramine was associated with a significantly reduced frequency of binge eating and with improvement on several other measures of eating behavior. On 1- to 8-month follow-up, 18 of the 20 treated subjects (90%) had responded to imipramine or a subsequent antidepressant. This finding augments the growing evidence that bulimia may be related to affective disorder.
TL;DR: The authors review the goals, methods, sample, and selected epidemiologic findings from a collaborative study of affective disorders among the Amish, finding this culturally and genetically homogeneous population constitutes an excellent research setting for psychiatric Epidemiologic and genetic study.
Abstract: The authors review the goals, methods, sample, and selected epidemiologic findings from a collaborative study of affective disorders among the Amish. This culturally and genetically homogeneous population (N = 12,500) constitutes an excellent research setting for psychiatric epidemiologic and genetic study. Alcoholism, drug abuse, and sociopathy did not complicate the study because they are culturally prohibited. During 1976-1980, 112 active cases of mental illness were identified; 71% received diagnoses of major affective disorder. Equal numbers of men and women received diagnoses of unipolar illness, and slightly more men than women were diagnosed as having bipolar illness.
TL;DR: Consideration of the array of behavioral disturbances encountered in this pathogenetically unified disorder suggests that a dimensional approach to symptom classification might prove more useful heuristically than present typological methods.
Abstract: Thirty patients with Huntington's disease, a genetically transmitted neuropsychiatric disorder that can be diagnosed reliably, were evaluated systematically for psychopathology, followed for extended periods, and treated with psychopharmacological medications when necessary. DSM-III criteria were used for establishing syndromic diagnoses. Twenty-four individuals demonstrated substantial behavioral abnormalities, including affective and schizophrenic syndromes, changes of personality, and disorders that could not be classified adequately. Pharmacotherapy was modestly beneficial in some cases. Consideration of the array of behavioral disturbances encountered in this pathogenetically unified disorder suggests that a dimensional approach to symptom classification might prove more useful heuristically than present typological methods.
TL;DR: The longer the patient continued to suffer from a chronic minor depression after recovering from the major depression, the greater the probability that relapse into another major depression would preempt recovery from the chronic depression.
Abstract: Of 316 patients with a major depressive disorder who were followed for between 6 months and 2 years, 80 (25%) had a preexisting chronic minor depression of at least 2 years' duration. The chronic minor depression reduced the apparent effect of the known predictors of recovery and relapse from the major depressive disorder and predicted a very pernicious course for the chronic depression. Furthermore, the longer the patient continued to suffer from a chronic minor depression after recovering from the major depression, the greater the probability that relapse into another major depression would preempt recovery from the chronic depression.
TL;DR: It appears that black and Hispanic (Puerto Rican) bipolar patients may be at a higher risk than whites for misdiagnosis as schizophrenic, particularly if they are young and experience auditory hallucinations during affective episodes.
Abstract: The records of 76 bipolar (DSM-III) patients were reviewed for a history of previous misdiagnosis of schizophrenia. Multivariate analyses identified three variables significantly associated with previous misdiagnosis--auditory hallucinations, early age at onset, and ethnicity. Ethnicity remained significantly associated with misdiagnosis of bipolar patients as schizophrenic even after all other significant variables were partialled out of the equation. It appears from these data that black and Hispanic (Puerto Rican) bipolar patients may be at a higher risk than whites for misdiagnosis as schizophrenic, particularly if they are young and experience auditory hallucinations during affective episodes.
TL;DR: Findings suggest that neuroendocrine abnormalities identified previously in anorexia nervosa are not solely an artifact of low weight and, further, that eating disorders and affective disorders may share neurochemical similarities.
Abstract: The authors examined the relationship of clinical variables, family history, and neuroendocrine function in 18 bulimic patients. Twelve of 18 patients (67%) showed abnormalities of cortisol suppression, and 8 of 10 (80%) showed blunted thyrotropin-releasing hormone (TRH) tests. These findings suggest that neuroendocrine abnormalities identified previously in anorexia nervosa are not solely an artifact of low weight and, further, that eating disorders and affective disorders may share neurochemical similarities.
TL;DR: The author describes psychiatric symptoms that appeared in 14 inmates exposed to periods of increased social isolation and sensory restriction in solitary confinement and asserts that these symptoms form a major, clinically distinguishable psychiatric syndrome.
Abstract: Psychopathological reactions to solitary confinement were extensively described by nineteenth-century German clinicians. In the United States there have been several legal challenges to the use of solitary confinement, based on allegations that it may have serious psychiatric consequences. The recent medical literature on this subject has been scarce. The author describes psychiatric symptoms that appeared in 14 inmates exposed to periods of increased social isolation and sensory restriction in solitary confinement and asserts that these symptoms form a major, clinically distinguishable psychiatric syndrome.
TL;DR: Findings suggest that a surprisingly simple set of cellular and molecular mechanisms in various combinations may underlie a wide range of both adaptive and maladaptive behavioral modifications.
Abstract: Through the use of animal models, specific forms of mentation can now be explored on the cellular and molecular levels. Chronic anxiety and anticipatory anxiety in humans are closely paralleled by two forms of learned fear in the sea snail Aplysia: sensitization and aversive classical conditioning. In Aplysia's simple nervous system it is possible to delineate how the two forms are acquired and maintained. Both rely on the mechanisms of presynaptic facilitation. An augmented form of presynaptic facilitation accounts for the associative component of conditioning. These findings suggest that a surprisingly simple set of cellular and molecular mechanisms in various combinations may underlie a wide range of both adaptive and maladaptive behavioral modifications.
TL;DR: The authors caution that neither the stress disorder nor the coexisting syndrome should be considered the primary condition; clinicians should screen patients with stress disorders for other conditions and treat them when possible.
Abstract: Twenty-five combat veterans hospitalized for treatment of posttraumatic stress disorder were evaluated for the presence of other disorders. Fourteen patients (56%) met operationally defined criteria for one additional diagnosis, five (20%) for two additional diagnoses, and two (8%) for three additional diagnoses. The coexisting syndromes included alcoholism, drug dependence, antisocial personality disorder, somatization disorder, endogenous depression, and organic mental syndrome. The authors caution that neither the stress disorder nor the coexisting syndrome should be considered the primary condition; clinicians should screen patients with stress disorders for other conditions and treat them when possible.
TL;DR: It is suggested that delusions are a multidimensional phenomenon; the results have implications for the measurement of delusions in clinical research and for the understanding of the structure of psychotic experience.
Abstract: The authors describe a scale designed to measure five dimensions of delusional experience: conviction, extension, bizarreness, disorganization, and pressure. Reliability was adequate to excellent on four of the dimensions, but only fair on the dimension of bizarreness. In 52 delusional patients, no two dimensions correlated highly with each other, indicating that the dimensions were not redundant. Factor analysis identified two factors from the five dimensions--delusional involvement and delusional construct. On the basis of these results the authors suggest that delusions are a multidimensional phenomenon; the results have implications for the measurement of delusions in clinical research and for the understanding of the structure of psychotic experience.
TL;DR: The findings of this study support the hypothesis of previous investigators that ventricular enlargement is present early in the course of schizophrenia.
Abstract: Recent research has demonstrated statistically significant differences between the ventricular-brain ratios (VBRs) of schizophrenic patients and control subjects. In this study the VBRs of teenage schizophrenic/schizophreniform patients (N = 15) and borderline patients (N = 8) were measured and compared with those of controls of similar ages (N = 18). The schizophrenic group had significantly larger ventricles than the other two groups (p less than .0001). These findings support the hypothesis of previous investigators that ventricular enlargement is present early in the course of schizophrenia.
TL;DR: Virtually all of the subjects had psychiatric symptoms; only slight differences were found among those who were victims, observers, or rescuers.
Abstract: The author provides data regarding psychiatric symptoms reported by 102 persons who had experienced the collapse of two skywalks in the lobby of the Hyatt Regency Hotel in Kansas City, Mo. Those interviewed were injured victims, guests of the hotel who were not injured, and rescue workers. They were interviewed within 5 months of the disaster. Virtually all of the subjects had psychiatric symptoms; only slight differences were found among those who were victims, observers, or rescuers.
TL;DR: Both the DSM-III diagnoses and the authors' global diagnoses found a highly significant concentration of chronic, latent, and uncertain schizophrenia or schizotypal personality disorder in the biological relatives of adoptees who developed chronic schizophrenia.
Abstract: Previous studies by the author and his collaborators, Rosenthal, Wender, Schulsinger, and Jacobsen, of the biological and adoptive relatives of schizophrenic adoptees are reviewed in conjunction with more recent studies by Spitzer and Endicott and by Kendler, Gruenberg, and Strauss, who independently made operational diagnoses using the Research Diagnostic Criteria or DSM-III specifications, both of which showed good agreement with the authors' global diagnoses based on the descriptions in DSM-II Both the DSM-III diagnoses and the authors' global diagnoses found a highly significant concentration of chronic, latent, and uncertain schizophrenia or schizotypal personality disorder in the biological relatives of adoptees who developed chronic schizophrenia A response is made to recent criticisms published in this journal by Lidz and Blatt and by Abrams and Taylor
TL;DR: A retrospective analysis of all the suicides at the New York State Psychiatric Institute over a 25-year period found there was a significant association between delusions and suicide: a delusionally depressed patient was five times more likely to commit suicide than a nondelusional one.
Abstract: A retrospective analysis of all the suicides at the New York State Psychiatric Institute over a 25-year period was carried out. The authors retrospectively assigned diagnoses according to Research Diagnostic Criteria and DSM-III and found that among the patients who committed suicide there were 14 with unipolar endogenous depression. Of those 14 patients, 10 were considered delusional or probably delusional. In comparison, a control group of similarly diagnosed depressed patients taken from the same institution over the same time period included far fewer delusional depressions. Thus, there was a significant association between delusions and suicide: A delusionally depressed patient was five times more likely to commit suicide than a nondelusional one.
TL;DR: Depression and psychopathology were assessed in 110 adult patients classified as borderline, mildly, moderately, or severely mentally retarded and the measures correlated significantly with each other and were consistently related to the diagnosis of depression.
Abstract: Depression and psychopathology were assessed in 110 adult patients (ages 18-71 years) classified as borderline, mildly, moderately, or severely mentally retarded. Patients completed modified versions of the Beck Depression Inventory, the Zung Self-Rating Depression Scale, the MMPI depression scale, the Thematic Apperception Test, and the Psychopathology Instrument for Mentally Retarded Adults. Clinicians and ward personnel rated the patients on the Hamilton Rating Scale for Depression and an informant version of the Psychopathology Instrument for Mentally Retarded Adults. The measures correlated significantly with each other and were consistently related to the diagnosis of depression.
TL;DR: This study of alcoholic patients with and without secondary depression showed that the two groups were almost identical in demographic characteristics, early-life antisocial problems, quantity and frequency of drinking, and family history of affective disorder.
Abstract: This study of alcoholic patients with and without secondary depression showed that the two groups were almost identical in demographic characteristics, early-life antisocial problems, quantity and frequency of drinking, and family history of affective disorder. The depressed patients reported slightly more alcoholism in their first-degree male relatives and tended to have more alcohol-related life problems. The only significant difference between the two groups was that the depressed patients were heavier users of drugs other than alcohol. Thus severe depression in alcoholics may be related to a greater intake of drugs in addition to alcohol.
TL;DR: Cosyntropin (ACTH alpha 1-24) infusion caused significantly higher cortisol concentrations, with earlier peak responses, in patients with endogenous depression than in normal subjects, and there was no relationship between the cortisol levels after administration of dexamethasone and cosyntropins.
Abstract: Cosyntropin (ACTH alpha 1-24) infusion caused significantly higher cortisol concentrations, with earlier peak responses, in patients with endogenous depression than in normal subjects. There was no relationship between the cortisol levels after administration of dexamethasone and cosyntropin.
TL;DR: Good agreement is found between the diagnosis of antisocial personality disorder and assessments of psychopathy, although DSM-III did not readily identify individuals who fit the classic picture of psychopathic but avoided early contact with the judicial system.
Abstract: The author presents data on the incidence and reliability of the DSM-III diagnosis of antisocial personality disorder in 246 male inmates of two prisons, comparing this diagnosis with assessment procedures that have proven useful in the study of psychopathy. He found good agreement between the diagnosis of antisocial personality disorder and assessments of psychopathy, although DSM-III did not readily identify individuals who fit the classic picture of psychopathy but avoided early contact with the judicial system. Nevertheless, DSM-III may be useful for differential diagnosis in criminal populations.