Showing papers in "American Journal of Psychiatry in 1990"
TL;DR: In this paper, a prospective study of 1,958 outpatients found that hopelessness, as measured by the Beck Hopelessness Scale, was significantly related to eventual suicide, and a scale cutoff score of 9 or above identified 16 (94.2%) of the 17 patients who eventually committed suicide.
Abstract: A prospective study of 1,958 outpatients found that hopelessness, as measured by the Beck Hopelessness Scale, was significantly related to eventual suicide. A scale cutoff score of 9 or above identified 16 (94.2%) of the 17 patients who eventually committed suicide, thus replicating a previous study with hospitalized patients. The high-risk group identified by this cutoff score was 11 times more likely to commit suicide than the rest of the outpatients. The Beck Hopelessness Scale thus may be used as a sensitive indicator of suicide potential.
973Â citations
TL;DR: The authors studied 954 psychiatric patients with major affective disorders and found that nine clinical features were associated with suicide, drawing attention to the importance of standardized prospective data for studies of suicide, assessment of short-term suicide risk factors, and anxiety symptoms as modifiable Suicide risk factors within a clinically relevant period.
Abstract: The authors studied 954 psychiatric patients with major affective disorders and found that nine clinical features were associated with suicide. Six of these--panic attacks, severe psychic anxiety, diminished concentration, global insomnia, moderate alcohol abuse, and severe loss of interest or pleasure (anhedonia)--were associated with suicide within 1 year, and three others--severe hopelessness, suicidal ideation, and history of previous suicide attempts--were associated with suicide occurring after 1 year. These findings draw attention to the importance of 1) standardized prospective data for studies of suicide, 2) assessment of short-term suicide risk factors, and 3) anxiety symptoms as modifiable suicide risk factors within a clinically relevant period.
919Â citations
TL;DR: Subjects with a history of childhood abuse reported higher levels of dissociative symptoms than those who did not, and patients with histories of abuse had scores at or above the median score of patients with posttraumatic stress disorder.
Abstract: Studies have reported high rates of childhood abuse in people with psychiatric illness. This study examined whether dissociative symptoms are specific to patients with histories of abuse. Ninety-eight female psychiatric inpatients completed self-report instruments that focused on childhood history of trauma, dissociative symptoms, and psychiatric symptoms in general. Sixty-three percent of the subjects reported physical and/or sexual abuse. Eighty-three percent had dissociative symptom scores above the median score of normal adults, and 24% had scores at or above the median score of patients with posttraumatic stress disorder. Subjects with a history of childhood abuse reported higher levels of dissociative symptoms than those who did not.
798Â citations
TL;DR: The authors' MRI study of young schizophrenic patients demonstrates smaller volume of the superior temporal gyrus and of the left amygdala, which is not accounted for by smaller size of the overall brain or temporal lobe.
Abstract: The authors' magnetic resonance imaging study of young schizophrenic demonstrates smaller volume of the superior temporal gyrus and of the left amygdala
741Â citations
TL;DR: It is suggested that potentially treatable (noncognitive) behavioral and psychiatric symptoms are risk factors for institutionalization, and that treating these symptoms might delay or prevent institutionalization of some patients.
Abstract: Two hundred ten community-dwelling patients with Alzheimer's disease were examined prospectively by psychiatrists as part of a longitudinal study. Twenty-five of these patients who were institutionalized during the next 3 years were then matched to 25 patients who were not institutionalized, and the groups were compared. The patients who had been institutionalized had higher scores on standardized psychiatric rating scales but not on formal neuropsychological tests of cognition. These results suggest that potentially treatable (noncognitive) behavioral and psychiatric symptoms are risk factors for institutionalization, and that treating these symptoms might delay or prevent institutionalization of some patients.
719Â citations
TL;DR: It is concluded that the relationship between alcohol problems and anxiety appears to be variable among the anxiety disorders, and in agoraphobia and social phobia, alcohol problems appear more likely to follow from attempts at self-medication of anxiety symptoms, but panic disorder and generalized anxiety disorder may be more likelyto follow from pathological alcohol consumption.
Abstract: The idea that people suffering from anxiety have a proclivity to consume alcohol to relieve their symptoms is supported by reports showing high comorbidity rates of alcohol and anxiety problems. The authors reviewed relevant epidemiologic surveys, family studies, and field studies and conclude that the relationship between alcohol problems and anxiety appears to be variable among the anxiety disorders. In agoraphobia and social phobia, alcohol problems appear more likely to follow from attempts at self-medication of anxiety symptoms, but panic disorder and generalized anxiety disorder may be more likely to follow from pathological alcohol consumption. Simple phobia does not appear to be related to alcohol problems in any meaningful way.
675Â citations
659Â citations
TL;DR: A shift in emphasis is recommended away from studies of the distribution of the disorder toward studies ofThe determinants of the whole spectrum of the disturbance that exists in the community.
Abstract: Research on the epidemiology of bulimia nervosa has focused largely on the prevalence of the disorder. As methods have improved, consensus has increased regarding the prevalence rate among adolescent and young adult women--about 1%. However, the accuracy of this figure and its clinical significance must be questioned. In this synthesis of the epidemiological work to date, the authors review the literature from a clinical and research perspective. They recommend a shift in emphasis away from studies of the distribution of the disorder toward studies of the determinants of the whole spectrum of the disturbance that exists in the community.
625Â citations
TL;DR: The authors suggest that these phenomenological observations concerning relapse with a night of sleep or with naps after successful sleep deprivation would be compatible with the existence of a sleep-associated depressogenic process.
Abstract: Sixty-one papers involving over 1,700 subjects have documented that over half of depressed patients experience an antidepressant response to sleep deprivation. Eighty-three percent of unmedicated depressed patients who had an antidepressant response to sleep deprivation relapsed after one night of sleep. Short naps can also activate severe relapses. The authors suggest that these phenomenological observations concerning relapse with a night of sleep or with naps after successful sleep deprivation would be compatible with the existence of a sleep-associated depressogenic process.
593Â citations
TL;DR: The definition of apathy is discussed, its differential diagnosis is reviewed, a classification for the conditions that may produce it is proposed, and an approach to assessment and treatment is proposed.
Abstract: This paper discusses the definition of apathy, reviews its differential diagnosis, and proposes a classification for the conditions that may produce it. Apathy is defined as diminished motivation not attributable to diminished level of consciousness, cognitive impairment, or emotional distress. In its differential diagnosis, abulia, akinesia and akinetic mutism, depression, dementia, delirium, despair, and demoralization must be ruled out. Classification of apathy is organized in terms of its adaptive and functional consequences, its relationship to personality or to sociocultural or environmental events, and its association with psychiatric, neurological, and medical disorders. An approach to assessment and treatment is proposed.
553Â citations
TL;DR: Six depressed patients free of recent serious suicidal ideation developed intense, violent suicidal preoccupation after 2-7 weeks of fluoxetine treatment, and none of them had ever experienced a similar state during treatment with any other psychotropic drug.
Abstract: Six depressed patients free of recent serious suicidal ideation developed intense, violent suicidal preoccupation after 2-7 weeks of fluoxetine treatment. This state persisted for as little as 3 days to as long as 3 months after discontinuation of fluoxetine. None of these patients had ever experienced a similar state during treatment with any other psychotropic drug.
TL;DR: A stepwise logistic regression revealed that derealization, diagnostic group, and chronic dysphoria were the best predictors of childhood sexual abuse in this group of patients.
Abstract: Experiences of abuse and neglect were assessed in 24 adults diagnosed as having borderline personality disorder according to the Diagnostic Interview for Borderline Patients and in 18 depressed control subjects without borderline disorder. Significantly more of the borderline patients than depressed patients reported childhood sexual abuse, abuse by more than one person, and both sexual and physical abuse. There were no between-group differences for rates of neglect or physical abuse without sexual abuse. A stepwise logistic regression revealed that derealization, diagnostic group, and chronic dysphoria were the best predictors of childhood sexual abuse in this group of patients.
TL;DR: Although the prevalence of any anxiety symptom remained constant, specific types of anxiety varied with age and age differences in nonanxiety behavior were found between subjects with and without anxiety, particularly with regard to interpersonal dysfunction.
Abstract: The authors used an epidemiologic approach to investigate rates, symptoms, and behavioral concomitants of anxiety across the child and adolescent age span. They drew 210 children aged 8, 12, and 17 in equal numbers from a community sample and evaluated them with structured diagnostic assessments. They found anxiety to be the most frequently reported type of psychopathology across all three age groups. Although the prevalence of any anxiety symptom remained constant, specific types of anxiety varied with age. Age differences in nonanxiety behavior were found between subjects with and without anxiety, particularly with regard to interpersonal dysfunction.
TL;DR: The resting-state cerebral metabolic rates for glucose of severely depressed patients were compared, before and after treatment with tricyclic antidepressants, to those of 10 control subjects of similar age by means of positron emission tomography and the fluorodeoxyglucose method.
Abstract: The resting-state cerebral metabolic rates for glucose of 10 severely depressed patients (seven bipolar and three unipolar) were compared, before and after treatment with tricyclic antidepressants, to those of 10 control subjects of similar age by means of positron emission tomography and the fluorodeoxyglucose method. Significant left-right prefrontal asymmetry was present in the patients before but not after successful treatment, suggesting that medication can reduce this asymmetry. Also, significant hypofrontality and whole-cortex hypometabolism were found in the patients in the depressed state and persisted in the treated state, despite clinical improvement, suggesting that these abnormalities are not state dependent.
TL;DR: Level of exposure to that event remained the primary predictor of ongoing posttraumatic stress reactions in 100 schoolchildren who were followed up and guilt feelings and knowing the child who was killed were associated with a greater number of symptoms.
Abstract: Fourteen months after a sniper attack at an elementary school, level of exposure to that event remained the primary predictor of ongoing posttraumatic stress reactions in 100 schoolchildren who were followed up. Guilt feelings and knowing the child who was killed were associated with a greater number of symptoms. Grief reactions occurred independent of degree of exposure to the event. The authors discuss the public health implications of these longitudinal findings.
TL;DR: Findings raise the possibility of specific corticosteroid-related cognitive impairments in depressed patients,healthy volunteers given a single 1-mg dose of dexamethasone, and healthy volunteers given 80 mg/day of prednisone for 5 days.
Abstract: In three independent studies with different designs and groups of subjects, the authors found that 1) depressed patients who did not suppress cortisol when given dexamethasone (compared to suppressors and normal control subjects), 2) healthy volunteers given a single 1-mg dose of dexamethasone (compared to those given placebo), and 3) healthy volunteers given 80 mg/day of prednisone for 5 days (compared to those given placebo) all made significantly more errors of commission in verbal memory tasks, with no significant change in their rates of errors of omission. These findings raise the possibility of specific corticosteroid-related cognitive impairments.
TL;DR: Patients with personality disorders had a significantly worse outcome in social functioning and were significantly more likely to have residual symptoms of depression and there were no significant differences in work functioning or in mean depression scores at treatment termination.
Abstract: The authors investigated the relationship between personality disorders and treatment outcome in the National Institute of Mental Health Treatment of Depression Collaborative Research Program, which involved 239 outpatients with major depressive disorder randomly assigned to one of four 16-week treatment conditions. Patients with personality disorders (74% of the sample) had a significantly worse outcome in social functioning than patients without personality disorders and were significantly more likely to have residual symptoms of depression. There were no significant differences in work functioning or in mean depression scores at treatment termination. Outcome was similar for patients in the different clusters of personality disorders.
TL;DR: Results showed that scale scores did not differ between men and women and were not influenced by income, employment status, education, place of birth, religious affiliation, or number of persons in the respondent's household.
Abstract: The Dissociative Experiences Scale was administered to a random sample of 1,055 adults in the city of Winnipeg. Results showed that scale scores did not differ between men and women and were not influenced by income, employment status, education, place of birth, religious affiliation, or number of persons in the respondent's household. Dissociative experiences are common in the general population and decline with age. The findings suggest that dissociative disorders may also be common in the general population.
TL;DR: The authors gave the self-report Personality Diagnostic Questionnaire--Revised to 87 applicants for inpatient treatment of severe personality psychopathology and, blind to these results, diagnosed personality disorders in the applicants by using the Personality Disorder Examination and the Structured Clinical Interview for DSM-III-R Personality Disorders.
Abstract: The authors gave the self-report Personality Diagnostic Questionnaire--Revised (PDQ-R) to 87 applicants for inpatient treatment of severe personality psychopathology and, blind to these results, diagnosed personality disorders in the applicants by using the Personality Disorder Examination and the Structured Clinical Interview for DSM-III-R Personality Disorders. The PDQ-R was not a substitute for a structured interview assessment of axis II disorders because many of its diagnoses were false positives. Its high sensitivity and moderate specificity for most of the axis II disorders suggest, however, that it is an efficient instrument for screening patients with DSM-III-R personality disorders.
TL;DR: Subcortical hyperintensity on T2-weighted brain magnetic resonance imaging was significantly more common and more severe in elderly depressed patients referred for ECT than in a matched control group of normal elderly subjects.
Abstract: Subcortical hyperintensity on T 2 -weighted brain magnetic resonance imaging was significantly more common and more severe in elderly depressed patients referred for ECT than in a matched control group of normal elderly subjects. The potential clinical and research implications of these findings are discussed
TL;DR: Of the patients with PTSD who were enrolled in the clinic before March 1988, 46% were given a diagnosis of PTSD only after the reinterview, and the Mein had the highest rate of PTSD and the Vietnamese the lowest.
Abstract: All 322 patients at a psychiatric clinic for Indochinese refugees were surveyed to determine the presence of posttraumatic stress disorder (PTSD). If PTSD was not diagnosed at the time of initial evaluation, a structured reinterview was performed. Seventy percent of the patients (N = 226) met the criteria for a current diagnosis of PTSD, and an additional 5% (N = 15) met the criteria for a past diagnosis. The Mein had the highest rate of PTSD (93%) and the Vietnamese the lowest (54%). Of the patients with PTSD who were enrolled in the clinic before March 1988, 46% (N = 87) were given a diagnosis of PTSD only after the reinterview. PTSD is a common disorder among Indochinese refugees, but the diagnosis is often difficult to make.
TL;DR: In this article, the effects of chronic cocaine intoxication on dopamine receptors in human subjects were evaluated using positron emission tomography (PET) in 10 cocaine abusers and 10 normal control subjects, and the authors concluded that postsynaptic dopamine receptor availability decreases with chronic cocaine abuse but may recover after a drug-free interval.
Abstract: To assess the effects of chronic cocaine intoxication on dopamine receptors in human subjects, the authors evaluated [18F]N-methylspiroperidol binding using positron emission tomography in 10 cocaine abusers and 10 normal control subjects. Cocaine abusers who had been detoxified for 1 week or less showed significantly lower values for uptake of [18F]N-methylspiroperidol in striatum than the normal subjects, whereas the cocaine abusers who had been detoxified for 1 month showed values comparable to those obtained from normal subjects. The authors conclude that postsynaptic dopamine receptor availability decreases with chronic cocaine abuse but may recover after a drug-free interval.
TL;DR: After treatment and at 2-month follow-up, both treatment groups had improved significantly more than control subjects in their scores on the Beck Depression Inventory, SCL-90-R depression and global scales, Hamilton Rating Scale for Depression, and Automatic Thoughts Questionnaire.
Abstract: The authors evaluated a six-session interactive computer cognitive-behavioral treatment program given to volunteer patients who met Research Diagnostic Criteria (RDC) for major or minor depressive disorder. Patients were randomly assigned to computer-administered cognitive-behavioral treatment, to therapist-administered cognitive-behavioral treatment, or to a waiting-list control condition. After treatment and at 2-month follow-up, both treatment groups had improved significantly more than control subjects in their scores on the Beck Depression Inventory, SCL-90-R depression and global scales, Hamilton Rating Scale for Depression, and Automatic Thoughts Questionnaire. The treatment groups did not differ from each other at either time.
TL;DR: It is suggested that anxiety disorders should be considered in the medical evaluation and treatment of parkinsonian patients and that further attention should be paid to the role of the dopaminergic system in anxiety and phobic disorders.
Abstract: To study the prevalence and importance of anxiety disorders in patients with idiopathic Parkinson's disease, the authors systematically evaluated 24 parkinsonian patients for the presence of DSM-III-R axis I syndromes. Nine subjects (38%) had a clinically significant current anxiety disorder. Severity of anxiety was not correlated with severity of parkinsonian symptoms, cumulative duration of L-dopa exposure, or current dose of L-dopa. These findings suggest that anxiety disorders should be considered in the medical evaluation and treatment of parkinsonian patients and that further attention should be paid to the role of the dopaminergic system in anxiety and phobic disorders.
TL;DR: The study supported the notion that PTSD is specifically linked to intense stressors and mechanisms for interactions among risk factors are discussed.
Abstract: This study examined the contribution of premilitary, military, and postmilitary risk factors to posttraumatic stress disorder (PTSD) and other postwar diagnoses in a sample of Vietnam veterans. PTSD was explained primarily by war stressors, including threat to life and exposure to grotesque death, but premilitary and postmilitary factors also contributed to the likelihood of a current diagnosis of PTSD. Panic disorder was also highly predicted by war experiences, whereas prewar functioning played a stronger role in several non-PTSD diagnoses. The study supported the notion that PTSD is specifically linked to intense stressors. Mechanisms for interactions among risk factors are discussed.
TL;DR: There is evidence to support family and marital interventions, particularly in the treatment of depressed women, and unresolved issues regarding the authors' understanding of the factors mediating the interaction between major depression and family functioning are explored.
Abstract: The authors review the evidence supporting the idea that the family plays a major role in the development and course of major depression. They find that the family pathology evident during an acute depressive episode continues after the patient's remission; that the course of depressive illness, relapse rates, and suicidal behavior are all affected by family functioning; and that children of depressed parents are at high risk for psychopathology. The authors explore unresolved issues regarding our understanding of the factors mediating the interaction between major depression and family functioning, concluding that there is evidence to support family and marital interventions, particularly in the treatment of depressed women.
TL;DR: This represents the first demonstration that preschizophrenic subjects can be distinguished from sibling control subjects within the first 8 years of life by observing their behavior.
Abstract: In a preliminary study of developmental precursors of schizophrenia, home movies of adult-onset schizophrenic patients and their healthy siblings filmed during their childhood were viewed by judges who were blind to the psychiatric outcome of the subjects. The films began with the infancy of all subjects and extended through at least the first 5 years of their lives. Although none of the subjects had any psychiatric disorder in childhood, the preschizophrenic children were reliably identified by the viewers. This represents the first demonstration that preschizophrenic subjects can be distinguished from sibling control subjects within the first 8 years of life by observing their behavior.
TL;DR: Data suggest that valproate has marked antimanic and mixed state efficacy, but minimal to moderate antidepressant properties, similar to other anticonvulsant literature.
Abstract: In order to explore valproate's spectrum of efficacy in rapid-cycling bipolar disorder, 55 patients underwent a prospective, open, 7.8-month trial designed to assess the drug's acute and prophylactic properties. Twenty patients received monotherapy, and 35 received combination therapy. Moderate to marked acute antidepressant responses were seen in 47% of the patients, prophylactic antidepressant responses in 76%, acute antimanic responses in 91%, prophylactic antimanic responses in 94%, acute responses in mixed states in 85%, and prophylactic responses in mixed states in 93%. Consistent with other anticonvulsant literature, these data suggest that valproate has marked antimanic and mixed state efficacy, but minimal to moderate antidepressant properties.
TL;DR: Surviving analyses indicated a significant association between life events and relapse or recurrence of the disorder and could not be explained by differences in levels of medication or compliance.
Abstract: The authors examined the impact of life stress on the course of bipolar disorder over a 2-year period in a group of 61 outpatients. The patients were followed prospectively with ongoing assessments of stressful life events, symptoms, levels of maintenance medication, and compliance with treatment regimens. As predicted, survival analyses indicated a significant association between life events and relapse or recurrence of the disorder. These effects could not be explained by differences in levels of medication or compliance. Further research is recommended to examine which specific subgroups of bipolar patients are most susceptible to stress.
TL;DR: A treatment-response model based on four classes of antidepressants identified eight disorders that may share a pathophysiologic abnormality: major depression, bulimia, panic disorder, obsessive-compulsive disorder, attention deficit disorder with hyperactivity, cataplexy, migraine, and irritable bowel syndrome.
Abstract: Response to pharmacologic treatments may identify groups of disorders with a common pathophysiology. The authors applied a treatment-response model, based on four classes of antidepressants (tricyclic types, monoamine oxidase inhibitors, serotonin uptake inhibitors, and atypical agents), to the medical literature. The model identified eight disorders that may share a pathophysiologic abnormality: major depression, bulimia, panic disorder, obsessive-compulsive disorder, attention deficit disorder with hyperactivity, cataplexy, migraine, and irritable bowel syndrome. Phenomenologic and family studies support this grouping. If the model is validated, this family of disorders, which the authors term "affective spectrum disorder," would represent one of the most prevalent diseases in the population.