Showing papers in "Archives of General Psychiatry in 1972"

Diagnostic criteria for use in psychiatric research.

Abstract: Diagnostic criteria for 14 psychiatric illnesses (and for secondary depression) along with the validating evidence for these diagnostic categories comes from workers outside our group as well as from those within; it consists of studies of both outpatients and inpatients, of family studies, and of follow-up studies. These criteria are the most efficient currently available; however, it is expected that the criteria be tested and not be considered a final, closed system. It is expected that the criteria will change as various illnesses are studied by different groups. Such criteria provide a framework for comparison of data gathered in different centers, and serve to promote communication between investigators.

The prediction of outcome in schizophrenia. I. Characteristics of outcome.

Abstract: This is the first of two reports of an investigation of predictors, diagnostic criteria, and outcome characteristics in 111 psychiatric admissions. Most of the patients would be considered schizophrenic by many criteria. Evaluation of outcome characteristics of this cohort indicates that outcome dysfunction is best considered as a continuum. The different areas of outcome dysfunction: work, symptoms, social relations, and duration of nonhospitalization, seem to operate as open systems, all partly interrelated and affected by psychiatric disorder but each area also affected by variables more specific to it alone. Although several diagnostic and classification systems were evaluated, the differences in outcome among different diagnostic groups were less striking than is often expected. These results indicate that outcome is a complex phenomenon, and that the ability of a diagnosis to predict a specific outcome has often been overstated.

Psychiatric Illness in the Families of Hyperactive Children

Abstract: A systematic psychiatric examination of the parents of 50 hyperactive children and 50 matched control children was carried out Increased prevalence rates for alcoholism, sociopathy, and hysteria were found in the parents of the hyperactive children Ten percent of the parents of the hyperactive children were thought to have been hyperactive children themselves, and, of this 10%, all were psychiatrically ill with alcoholism, sociopathy, or hysteria The data support the notion that the hyperactive child syndrome is passed from generation to generation and may be a precursor of certain adult psychiatric illnesses

Catecholamines in the brain as mediators of amphetamine psychosis.

Abstract: Amphetamine psychosis appears to be a fruitful experimental model of paranoid schizophrenia or paranoid state. A variety of animal and human studies suggest that neurochemical mediation of certain behavioral effects of amphetamine in animals may reflect such mechanisms in human amphetamine psychosis. Specifically, locomotor stimulation appears attributable to central norepinephrine and stereotyped behavior to dopamine, while experiments with amphetamine isomers in man suggest a dopamine mediation of human amphetamine psychosis. Pharmacological and stereochemical evidence suggests that clinical efficacy of phenothiazine drugs in the treatment of schizophrenia may be related to blockade of dopamine receptors. Taken together, these findings provoke the speculation that specific and distinct effects of amphetamines on dopamine and norepinephrine neurons may combine to account for major symptoms of amphetamine psychosis.

Catecholamine Metabolism, Depressive Illness, and Drug Response

Abstract: The relationship between therapeutic response and the urinary excretion of norepinephrine and its metabolites by depressed patients before and during treatment with imipramine or desimipramine has been examined. Those patients who excreted the lesser quantities of 3-methoxy-4-hydroxyphenylglycol (MHPG) prior to drug treatment had the best response to medication. Similar relationships were not found for metanephrine, normetanephrine, or vanillymandelic acid (VMA). Those patients who responded best excreted greater quantities of normetanephrine and MHPG during drug treament, relative to the predrug period, and those patients who responded least well had a decrement in the excretion of these two metabolities. There were significant decrements in the quantities of VMA and metanephrine excreted in urine during drug treatment but these changes were unrelated to the therapeutic response. The theoretical and practical implications of these findings are discussed.

Some Features of the Auditory Evoked Response in Schizophrenics

Abstract: Twenty-one schizophrenics and 21 controls were exposed to a tenminute sequence of frequent and infrequent auditory stimuli. The amplitude of the third positive-going component (p 3 ) of the average evoked response to infrequent stimuli was much larger in the control group ( P 3 amplitude of 3.20μv in the first 2.5 minutes as a dividing point, only seven of the 42 subjects were misclassified. This amplitude had a significant correlation of -.48 with patient's age at first hospitalization. Amplitude of the second positive-going component (P 2 ) to frequent stimuli was also much larger in the control group (P

Risk-rescue rating in suicide assessment.

Abstract: The Risk-Rescue Rating is a descriptive and quantitative method of assessing the lethality ofsuicide attempts. Its underlying hypothesis is that the lethality of implementation, defined as the probability of inflicting irreversible damage, may be expressed as a ratio of factors influencing risk and rescue. Five risk and five rescue factors have been operationally defined, weighted, and scored. Illustrations of typical high risk/high rescue, high risk/low rescue, low risk/high rescue, and low risk/low rescue are presented, together with scoring instructions and tables of values. Risk-rescue ratings correlate well with the level of treatment recommended (none, emergency ward only, hospital admission, and intensive care), with the subject's sex, and whether the subjects lived or died. There is less decisive correlation with age and little correlation with marital status and multiple attempts. Taken by itself, the risk-rescue rating is not a predictive instrument. However, when considered along with other kinds of lethality, such as that of intentionality and psychosocial involvement, the lethality of implementation can add to the basis of individualized suicide prognosis.

Abnormalities of Indoleamines in Affective Disorders

Abstract: The end product of serotonin metabolism, 5-hydroxyindoleacetic acid (5-HIAA), is reduced in the cerebrospinal fluid of both manic and depressed patients. The decrement in this substance, however, does not correlate with severity of illness in either condition. The decrement persists after clinical recovery in depressed patients. These findings must be integrated with current concepts about the role of brain biogenic amines in affective disorders.

Suppression of plasma testosterone levels and psychological stress. A longitudinal study of young men in Officer Candidate School.

Abstract: Plasma testosterone levels were determined in 18 young men in Officer Candidate School. Plasma testosterone levels were significantly lower during the early, stressful part of the course as contrasted with levels during the senior phase. This finding represents the first evidence in humans supporting the hypothesis that psychological stress suppresses levels of circulating plasma testosterone.

Dextroamphetamine: Evaluation of Psychomimetic Properties in Man

Abstract: Nine informed volunteers having previous experience with self-administered drugs were given small, frequent orally administered doses of dextroamphetamine sulfate. Within five days following supervised administration, eight subjects experienced a paranoid psychosis which rapidly abated with drug discontinuance. Factors such as sleep deprivation, predrug personality, or drug idiosyncrasy which have been thought crucial in the origin of amphetamine paranoia proved to be insufficient as explanations for the psychosis. Surprisingly, it was found that large long-term doses of dextroamphetamine caused the subjects to feel depressed rather than elated. This suggests that while the short-term effects of dextroamphetamine might be explained as a potentiation of catecholamines, the long-term effects of the drug, including paranoid symptoms, may result from depletion of the central nervous system's stores of catecholamine by dextroamphetamine or one of its metabolites, or both.

Comparison of lithium carbonate and chlorpromazine in the treatment of mania. Report of the Veterans Administration and National Institute of Mental Health Collaborative Study Group.

Abstract: In an 18-hospital collaborative study, 255 newly admitted manic patients were randomly assigned to lithium carbonate or chlorpromazine for a three-week period. Patients were classified as highly active or mildly active on the basis of degree of motor activity shown at admission. Treatments were compared in terms of early terminations, symptom change, and toxicity. The following results were obtained: (1) Chlorpromazine was clearly superior to lithium carbonate in treating the highly active patient. Chlorpromazine acted more quickly, produced significantly fewer dropouts, and had a lower incidence of severe side effects. (2) The difference between lithium carbonate and chlorpromazine was less pronounced among mildly active patients. Lithium carbonate, however, appeared to be the better treatment. Both drugs effectively reduced manic symptomatology but lithium carbonate left the patient feeling less sluggish and fatigued. Lithium carbonate also produced fewer severe side effects than chlorpromazine.

The comparative antidepressant value of L-tryptophan and imipramine with and without attempted potentiation by liothyronine.

Abstract: In a trial lasting four weeks patients responded equally well to imipramine (150 mg daily) or to L-tryptophan (9 gm daily). Patients who received a small dose of L-triiodothyronine (T 3 , liothyronine sodium (25μg daily for the first two weeks of treatment) in addition to imipramine showed a significantly better therapeutic response than patients who received either imipramine or tryptophan alone. Liothyronine did not enhance the therapeutic response to L-tryptophan. None of the treatments tested seemed to benefit any particular symptom of depression differenntially. In particular, L-tryptophan had no specific effect on the sleep deficit of the syndrome. Liothyronine appeared to diminish the side effects of both imipramine and L-tryptophan in both men and women.

Phobic anxiety syndrome complicated by drug dependence and addiction. A treatable form of drug abuse.

Abstract: The evidence of the efficacy of antidepressants in the treatment of the "phobic anxiety syndrome" is reviewed. This syndrome, characterized by panic attacks, subsequent development of anticipatory dread and consequent emergence of phobias, is seen most often in the patient with evidence of having been a fearful dependent child with a great deal of separation anxiety and the patient with some type of endocrine imbalance. A malignant complication of this synarome is the abuse of sedatives and alcohol. We view this form of drug abuse as an incorrect attempt at self-medication whereas proper psychopharmacologic treatment with imipramine is enormously helpful. The clinical courses of two groups of patients followed from six months to three years are compared. The patients on imipramine did well and did not return to drug or alcohol abuse, but those not maintained on imipramine tended to return to drug abuse, were rehospitalized, and responded poorly to ECT and phenothiazines.

Concordance Between Clinical Assessments and Patients' Self-Report in Depression

Abstract: In a survey of 200 depressed patients, clinical symptoms of depression were assessed by both semistructured clinical interview and self-report. Both instruments were given during the acute episode and at follow-up, ten months later, when a majority of patients had recovered. Results indicate concordance between clinical assessment and self-report is low during the acute episode but generally improved at follow-up. Ratings of individual symptoms show a fair degree of specificity. The overall assessment of severity during the acute episode is particularly discordant. These findings demonstrate that self-reports are useful in measuring the presence or absence of symptoms and therefore valuable in assessing recovery. However, self-report ratings from acutely depressed patients are not a reliable estimate of the severity of their symptoms.

The depressive personality. A critical review

Abstract: Enduring personality patterns influence clinical depressions by coloring and altering depressive symptoms and, possibly, by predisposing certain individuals to episodes of depressive illness. The existence and characteristics of such putative predisposing personality patterns has been the subject of considerable discussion in psychiatric and psychoanalytic literature, the reliability of which, when subjected to critical review, is compromised seriously by method ological and other inadequacies. For instance, the association of obsessive personality and involutional depression rests on tenuous grounds. There is enough evidence for depressogenic potential of the socalled oral or dependent personality as described by psychoanalysts, especially in the case of major (manic-depressive) illnesses, to warrant further investigation.

Current and Past Psychopathology Scales (CAPPS): Rationale, Reliability, and Validity

Abstract: Many research questions in psychiatry can be adequately studied by cross-sectional evaluations of psychopathology at one or more points in time, such as before and after evaluation of various treatment modalities. Other important questions relevant to issues such as diagnosis and prognosis can only be answered satisfactorily by including historical information. There are, however, practically no standardized procedures for obtaining and recording historical information. This paper describes a new instrument, the Current and Past Psychopathology Scales (CAPPS), which can be used for evaluating both current and past psychopathology and social functioning in patients and nonpatients. The coverage includes dimensions of importance in the evaluation of severity of illness, prognosis, and diagnosis. Individuals from a variety of disciplines and with various levels of education have been trained to use it with a degree of reliability and validity satisfactory for research purposes.

Psychiatric effects of hashish

Abstract: An American Army population of 36,000 in which hashish was commonly smoked was studied over a three-year period. Direct medical and psychiatric observations of 720 hashish smokers revealed that the casual smoking of less than 10 to 12 gm of hashish monthly resulted in no ostensible adverse effects other than minor respiratory ailments. Panic reactions, toxic psychosis, and schizophrenic reactions were infrequent occurrences except when hashish was simultaneously consumed with alcohol or other psychoactive drugs. Highdose hashish abuse of over 50 gm per month in 110 patients was associated with a chronic intoxicated state characterized by apathy, dullness, and lethargy with mild-to-severe impairment of judgment, concentration, and memory. Severe hashish abuse and its simultaneous use with alcohol or other psychoactive drugs by large numbers of young American men is alarming.

New therapies for the eating disorders. Behavior modification of obesity and anorexia nervosa.

Abstract: New approaches to psychotherapy, which appear more effective than traditional ones in modifying several kinds of disturbed behavior, have recently been applied to the eating disorders. Patients with both anorexia nervosa and obesity have responded to behavior modification, and experience with obesity has already been sufficient to permit the development and description of relatively specific behavioral programs. These programs have been used to compare behavior modification in a systematic manner with a variety of alternate treatment methods. Every one of eight such studies has reported results favoring behavior modification, an unusual example of unanimity in this heterogeneous and complex disorder. Furthermore, some new experimental designs developed in these studies are making a significant contribution to the study of psychotherapy and the elucidation of its effective components.

Potentiation of Amitriptyline by Thyroid Hormone

Abstract: A double-blind comparison was made between amitriptyline alone and amitriptyline with added L-triiodothyronine (T3, liothyronine sodium at two dose levels, in cases of depression seen in general practice. Assessments were made initially, and at 3, 7, 10, 14, and 21 days, using Hamilton's Depression Scales and the NIMH Self-Rating Scales. Significant differences in favor of the two regimes with added liothyronine were obtained at 14 days on both scales (P

The "switch process" in manic-depressive illness. I. A systematic study of sequential behavioral changes.

Abstract: This paper presents the first of a three-part report on behavioral and biological aspects of the "switch process" in a group of manicdepressive patients. It documents a regular temporal pattern of change in thought and mood observed during ten spontaneous episodes of switches from depression into mania and seven episodes of switches out of mania into depression. Patients were described in detail and their behavior rated every eight hours on a longitudinal basis throughout these periods of change. The depressive period prior to the switch into mania was characterized by moderate depression, seclusiveness, nonverbalization, and dozing. Each of the ten episodes of mania was preceded by a normal or transitional period which was manifested by sudden appearance of spontaneous speech and motor activity and normalization of mood. Total sleep time was markedly reduced on the day prior to the switch into mania and remained low during the manic period.

Environmental stress in primary depressive illness.

Abstract: The occurrence of life-change events (as defined by the social readjustment rating questionnaire) prior to disease onset was measured in a group of 74 patients suffering from primary depressive disorders. The resultant frequency distribution histogram was unimodal. Patients with a positive family history for depression did not differ significantly, in these measurements, from those with a negative family history nor did patients with "endogenous" depression differ significantly from those with "reactive" depression. We were, therefore, unable to distinguish two populations within the depressed group using this parameter. We conclude that the terms "endogenous" and "reactive" are misleading for the majority of patients with depressive illness.

Depression and MHPG excretion. Response to dextroamphetamine and tricyclic antidepressants.

Abstract: A study of 12 depressed inpatients shows a significant correlation of improvement with both double-blind administration of dextroamphetamine sulfate and tricyclic antidepressant drug treatment and the l ow mean baseline excretion of 3-methoxy-4-hydroxyphenylglycol (MHPG). The mean MHPG excretion for six patients with a good response to dextroamphetamine was found to be significantly lower than the mean MHPG level for six nonresponders. Five of six responders showed a slight increase in MHPG excretion with dextroamphetamine while five of six nonresponders showed a modest decrease in MHPG excretion. A correlation coefficient between low mean baseline MHPG excretion and improvement in depression ratings reached .58 ( P P

The Objective Study of a Multiple Personality: Or, Are Four Heads Better Than One?

Abstract: This report pertains to the systematic, "controlled" study of a 27year-old patient with four distinct personalities—the "square," the "mediator," the "lover," and the "warrior." The aim of this study has been to clarify the mechanisms of action underlying the emergence of these alter personalities and the relative degrees of amnesia existing among all personalities, as well as to elucidate the areas of independence and overlap among them. To accomplish this aim, clinical-psychological, psychophysiological, and neurophysiological procedures were employed. All the data obtained fall into a consistent pattern and suggest that traditional skeptical explanations of pretense or role-playing are insufficient to account for the phenomena observed. A new theoretical construct for interpreting the phenomena of multiple personality and other related dissociative states is presented.

The Structured and Scaled Interview to Assess Maladjustment (SSIAM): I. Description, Rationale, and Development

Abstract: The Structured and Scaled Interview to Assess Maladjustment (SSIAM) is described, together with its rationale and development. The SSIAM contains questions by which a trained interviewer gathers evidence of maladjustment, and corresponding scales on which to rate this evidence. The interview, which takes about half an hour, has 45 items to assess deviant behavior, friction with others, and subjective distress, within five fields of maladjustment: work, social, family, marriage, and sex. A further 15 items cover the degree of environmental stress, prognostic issues, and aspects of positive mental health.

Lithium Carbonate in Emotionally Unstable Character Disorder

Abstract: Emotionally unstable character disorder (EUCD) is the diagnosis applied to those patients with chronic maladaptive behavior patterns, such as poor acceptance of reasonable authority, truancy, poor work history, manipulativeness, but with a core psychopathological disturbance of depressive and hypomanic mood swings that last hours to days. Their lability is not usually reactive to environmental or interpersonal events. We examined 21 such patients in a six-week, double-blind random assignment cross-over study comparing lithium carbonate to placebo. Using a global measure of mood swings, lithium carbonate was statistically significantly superior to placebo. This was also true for a week's rating of the mean of the daily range of mood swings. We interpret these findings to mean that EUCD is closely related to affective illness and that lithium carbonate joins chlorpromazine as a valuable, and perhaps a superior, therapy for EUCD.

The relationship between depression and anxiety.

Abstract: Six self-rating mood scales were administered to a group of psychiatric inpatients. Two main factors emerged from this study, factors similar to the two broad dimensions of psychiatric disturbance derived by Welsh from the Minnesota Multiphasic Personality inventory. These factors did not correspond to the clinical dimensions of anxiety and depression; most of these scales related closely to each other as part of the first factor. Further, the intercorrelation between the scores obtained on the individual scales were, in the main, all high. This inability to demonstrate that these scales could separate patients into two groups (anxious and depressed) raises important questions about their use and the relationship between depression and anxiety.

Hypersomnia with "sleep drunkenness".

Abstract: Sleep drunkenness (SD) consists of difficulty in coming to complete wakefulness accompanied by confusion, disorientation, poor motor coordination, slowness, and repeated returns to sleep. Patients report that these symptoms occur at almost every awakening; nearly all report abnormally ``deep'' and prolonged sleep as well. Approximately one third of all hypersomniacs seen suffered from sleep drunkenness. Of 58 cases of hypersomnia with sleep drunkenness examined, 52 were apparently idiopathic; six cases were possibly symptomatic of organic brain disturbance. A familial history of the disorder was found in 36% of the idiopathic cases. Electroencephalographic abnormalities were not remarkably prevalent or distinctive. Except for relatively high heart and respiratory in nocturnal polygraphic records, and except for extended sleep, no anomalies of sleep patterns were observed.

A Controlled Study of the Antidepressant Effects of Lithium Carbonate

Abstract: In a double-blind crossover study comparing lithium carbonate with desimipramine in the treatment of selected depressed patients, there was considerable improvement in both groups of patients, with no statistically significant difference between the effectiveness of the two drugs. This finding, together with other reports, raises the question of whether lithium carbonate might be effective in the treatment of selected depressed patients. Consideration is also given to the implications of our observations and findings for the bipolar concept of mania and depression. Evidence is considered for an alternative model which highlights some of the similarities between these two clinical states.

Treatment of tardive dyskinesia. I. Clinical efficacy of a dopamine-depleting agent, tetrabenazine.

Abstract: Tardive dyskinesia is becoming detectable in increasing numbers of chronic psychiatric patients. More than 24 such patients were identified among approximately 400 ambulatory long-term patients at Boston State Hospital. This study demonstrates that tetrabenazine (Nitoman [Great Britain]), a dopamine-depleting agent, significantly reduces the frequency of abnormal mouth, jaw, and tongue movements at dosages up to 150 mg/day. The intensity of these movements and of associated abnormal movements of the extremities and trunk were also reduced. Reversible extrapyramidal symptoms were not increased at the dosage used. The antidyskinetic effect was marked in two thirds of the patients. The results of the study are consistent with the hypothesis that the abnormal movements of tardive dyskinesia might result from overactivity of dopaminergic neurones in the basal ganglia.

Behavioral Measurement of Severe Depression

Abstract: Three different methods of measuring depression were studied in ten severely depressed patients Serial assessments were made using the Beck Depressive Inventory (self-rating scale), the Hamilton Rating Scale (physician-rated scale), and objective behavioral measures The hypothesis was that these three methods would show a significant correlation; the study confirms this The behavioral measures are an inexpensive method of assessing the depth of depression and seem to predict the posttreatment adaptation better than the Beck Depressive Inventory or the Hamilton Rating Scale Behavioral measures should be useful in future research to assess the results of drug or somatic therapies