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Showing papers in "Archives of General Psychiatry in 1980"


Journal ArticleDOI
TL;DR: Use of the community program for 14 months greatly reduced the need to hospitalize patients and enhanced the community tenure and adjustment of the experimental patients, and the results suggest that community programming should be comprehensive and ongoing.
Abstract: • A conceptual model for the development of communitybased treatment programs for the chronically disabled psychiatric patient was developed, and the results of a controlled study and follow-up are reported A community-treatment program that was based on the conceptual model was compared with conventional treatment (ie, progressive short-term hospitalization plus aftercare) The results have shown that use of the community program for 14 months greatly reduced the need to hospitalize patients and enhanced the community tenure and adjustment of the experimental patients When the special programming was discontinued, many of the gains that were attained deteriorated, and use of the hospital rose sharply The results suggest that community programming should be comprehensive and ongoing

1,639 citations


Journal ArticleDOI
TL;DR: Questions are raised about the nature of nonspecific distress in relation to Frank's construct of "demoralization," the value of the measured dimensions of psychopathology that contrast with it, and the relation of PERI, which uses a self-report format, to diagnostic interviews developed here and abroad.
Abstract: • This interview study investigated nonspecific psychological distress in the general population. A probability sample of 200 adults was drawn from heterogenous sex, class, and ethnic groups in New York City. Twenty-five scales were developed. Eight reflect a single dimension of nonspecific distress (eg, Poor Self-esteem, Sadness, and Perceived Physical Health) and 17 are distinct from these and from each other (eg, False Beliefs and Perceptions, Manic Characteristics, Insomnia, Antisocial History, and illness-linked Somatic Problems). Both sets of scales have become part of a new interview instrument, the Psychiatric Epidemiology Research Interview (PERI). Questions are raised about the nature of nonspecific distress in relation to Frank's construct of "demoralization," the value of the measured dimensions of psychopathology that contrast with it, and the relation of PERI, which uses a self-report format, to diagnostic interviews developed here and abroad.

874 citations


Journal ArticleDOI
TL;DR: Endogenous anxiety (anxiety hysteria, agoraphobia with panic attacks) is characterized by sudden, spontaneous panic attacks accompanied by multiple autonomic symptoms, overwhelming fear, a flight response, and polyphobic behavior.
Abstract: • Endogenous anxiety (anxiety hysteria, agoraphobia with panic attacks) is characterized by sudden, spontaneous panic attacks accompanied by multiple autonomic symptoms, overwhelming fear, a flight response, and polyphobic behavior. Psychotherapy, behavior therapy, and tranquilizers have been of limited success in treating this syndrome. Fifty-seven patients severely disabled by the syndrome for a mean period of 13 years completed the three-month study. Randomly assigned in a double-blind, placebo-controlled design to imipramine hydrochloride, phenelzine sulfate, or placebo, they were seen in supportive group therapy every two weeks. Patients in the phenelzine and imipramine cells showed significant improvement over patients in the placebo group and over baseline on all outcome measures. The persistent trend for phenelzine to be superior to imipramine achieved significance only on the Work and Social Disability Scale and the Symptom Severity and Phobic Avoidance Scale. The implications for classification and theory are discussed.

634 citations


Journal ArticleDOI
TL;DR: A different group of women are predisposed to have anorexia nervosa develop with bulimia, and the high frequency of obesity in the mothers of bulimic patients was noteworthy.
Abstract: • Bulimia is a poor prognostic sign in anorexia nervosa. This raised the question of whether bulimia represented an "end stage" of chronic anorexia nervosa or whether bulimic patients were a distinct subgroup. All subjects seen by us personally from 1970 to 1978 were included in this study provided they met modified criteria of Feighner et al (1972). Of this group, 68 experienced bulimia and 73 did not (restricters). Bulimic patients had a history of weighing more and were more commonly premorbidly obese. Bulimic patients were those who vomited and misused laxatives. The bulimic group displayed a variety of impulsive behaviors, including use of alcohol and street drugs, stealing, suicide attempts, and self-mutilation. With regard to family history, the high frequency of obesity in the mothers of bulimic patients was noteworthy. The two groups share features common to patients with primary anorexia nervosa. However, these results suggest a different group of women are predisposed to have anorexia nervosa develop with bulimia.

569 citations


Journal ArticleDOI
TL;DR: The association of bulimia with certain personality features and a distinct psychiatric symptomatology suggests that patients with bulimic patients form a subgroup among patients with anorexia nervosa.
Abstract: • Among the various eating patterns encountered in anorexia nervosa, the occurrence of bulimia (rapid consumption of large amounts of food in a short period of time) is a perplexing phenomenon, because its presence contradicts the common belief that patients with anorexia nervosa are always firm in their abstinence from food. We studied the eating habits of 105 hospitalized female patients within the context of a prospective treatment study on anorexia nervosa: 53% had achieved weight loss by consistently fasting, whereas 47% periodically resorted to bulimia. The two groups were contrasted with regard to their developmental and psychosocial history, clinical characteristics, and psychiatric symptomatology. Fasting patients were more introverted, more often denied hunger, and displayed little overt psychic distress. In contrast, bulimic patients were more extroverted, admitted more frequently to a strong appetite and tended to be older. Vomiting was frequent, and kleptomania almost exclusively present in bulimic patients, who manifested greater anxiety, depression, guilt, interpersonal sensitivity, and had more somatic complaints. This association of bulimia with certain personality features and a distinct psychiatric symptomatology suggests that patients with bulimia form a subgroup among patients with anorexia nervosa.

485 citations


Journal ArticleDOI
TL;DR: Clomipramine, but not nortriptyline, was superior to placebo in interview-based ratings of severity of OCD, and the effect was not clear-cut until after five weeks of treatment.
Abstract: The effect of clomipramine hydrochloride in severe obsessive-compulsive disorder (OCD) was compared with that of nortriptyline hydrochloride and placebo in a five-week randomized, double-blind trial. Clomipramine, but not nortriptyline, was superior to placebo in interview-based ratings of severity of OCD. The effect was not clear-cut until after five weeks of treatment. When clomipramine was given openly to 22 patients after the end of the controlled trial, half of the patients responded to the drug. The response could not be predicted from severity or duration of illness, sex or age of the patient, or presence or absence of secondary depressive symptoms. The amelioration with clomipramine was not sustained if the drug was withdrawn.

471 citations


Journal ArticleDOI
TL;DR: The BDI was shown to be a sensitive screening test; its use is advocated to improve recognition of depression by primary physicians.
Abstract: • Previous studies of medical outpatients have documented a high prevalence of depression that is often unrecognized by primary physicians. However, the subjective methodologies of most of these studies limit their quantitative and comparative usefulness. By contrast, in the present study, 526 medical outpatients completed a self-report questionnaire, the Beck Depression Inventory (BDI). Questionnaire results were calibrated by psychiatric interviews of a subsample of 41 patients. The prevalence of depression was 12.2% when at least mild depression was used as a criterion; the rate for moderate depression was 5.5%, and the rate for severe, probably "psychotic," depression was 0.6%. A review of medical charts showed that primary physicians failed to diagnose about 50% of both depressed and otherwise impaired patients. The BDI was shown to be a sensitive screening test; its use is advocated to improve recognition of depression by primary physicians.

411 citations


Journal ArticleDOI
TL;DR: It is suggested that the depressive abnormalities represent a "damaged," weakened sleep cycle "oscillator" and its correlate, a circadian rhythm disturbance, and that REM sleep deprivation improved depression to the extent that it stimulated the oscillator and corrected one manifestation of the circadian rhythm disturbances.
Abstract: We compared sleep variables in 14 drug-free endogenous depressives and in 14 age- and insomnia-matched, nondepressed controls before and after brief rapid eye movement (REM) sleep deprivation by awakenings. Before REM sleep deprivation, compared with controls, depressives had lower REM latency, higher REM frequency, and--a new finding--an abnormal temporal distribution of REM sleep. Depression improvement by REM sleep deprivation correlated with the ameliorative effect of brief REM sleep deprivation on on indicator of the abnormal temporal distribution of REM sleep. Several findings suggest that the depressive abnormalities represent a "damaged," weakened sleep cycle "oscillator" and its correlate, a circadian rhythm disturbance, and that REM sleep deprivation improved depression to the extent that it stimulated the oscillator and corrected one manifestation of the circadian rhythm disturbance.

408 citations


Journal ArticleDOI
TL;DR: It is suggested that stressful events can bring about depressive episodes, but most of the evidence that supports this conclusion emanates from retrospective studies, and corroborating prospective studies are definitely needed.
Abstract: • I reviewed studies examining the hypothesis that life events may precipitate a depressive disorder. Although some contradictory results exist, the majority of studies demonstrate that depressed patients experience more stressful events in the months that precede the onset of their disorder than do normal controls or schizophrenics. In calculating relative risk figures, it seems that depressive risk is increased by a factor of about 5 or 6 for the six months after an event. Certain events, such as undesirable, loss, or severely threatening events, are particularly likely to precede a depression. These results suggest that stressful events can bring about depressive episodes, but most of the evidence that supports this conclusion emanates from retrospective studies, and corroborating prospective studies are definitely needed. Furthermore, not all depressives report precipitating events, so other causal factors are also operative.

398 citations


Journal ArticleDOI
TL;DR: Stimulants appear to act similarly on normal and hyperactive prepubertal boys and adults and adults.
Abstract: The effects of a single oral dose of dextroamphetamine sulfate on motor activity, vigilance, learning, and mood were compared for normal and hyperactive prepubertal boys and normal college-aged men using a double-blind crossover design. Both groups of boys and men showed decreased motor activity increased vigilance, and improvement on a learning task after taking the stimulant drug. The men reported euphoria, while the boys reported only feeling "tired# or "different# after taking the stimulant. It is not clear whether this difference in effect on mood between adults and children is due to differing experience with drugs, ability to report affect, or a true pharmacologic age-related effect. While there were some quantitative differences in drug effects on motor activity and vigilance between these different groups, stimulants appear to act similarly on normal and hyperactive children and adults.

389 citations


Journal ArticleDOI
TL;DR: Considering all the forms of benefits and costs that the authors were able to derive in monetary terms, the experimental program provided both additional benefits and additional costs as compared with the conventional treatment.
Abstract: • A cost-benefit analysis should be seen not as a mechanism for deciding mechanically on the allocation of funds and resources among programs but as a structure for weighing advantages and disadvantages (that is, for organizing knowledge). Considering all the forms of benefits and costs that we were able to derive in monetary terms, the experimental program provided both additional benefits and additional costs as compared with the conventional treatment. However, the added benefits, some $1,200 per patient per year, are nearly $400 more per patient per year than the added costs. A number of the forms of benefits and costs that we have measured in quantitative but nonmonetary terms show additional advantages of the community-based experimental program. The generalizability of a single experiment is limited, but the methodologies developed may be useful if their proper role is appreciated.

Journal ArticleDOI
TL;DR: The data suggest that the depressive syndrome is composed of separate illnesses, each of which has a distinctive pattern of hypothalamic-pituitary-adrenal axis activity during the depressed state as well as a specific clinical and familial psychiatric history.
Abstract: • Serum cortisol response to the 1-mg overnight dexamethasone suppression test was studied in 221 depressed patients and 109 nondepressed psychiatric controls. Nonsuppression distinguished patients with primary unipolar depression (65/ 146) from patients with secondary unipolar depression (0/42) and nondepressed controls (0/109). Furthermore, nonsuppression distinguished the three familial subtypes of primary unipolar depressive illness: familial pure depressive disease (FPDD; 38/50 patients), sporadic depressive disease (SDD; 24/55 patients), and depression spectrum disease (3/41 patients). Moderate elevations in baseline serum cortisol levels were found in FPDD, SDD, and bipolar depression. Medication did not affect the results. The data suggest that the depressive syndrome is composed of separate illnesses, each of which has a distinctive pattern of hypothalamic-pituitary-adrenal axis activity during the depressed state as well as a specific clinical and familial psychiatric history.

Journal ArticleDOI
TL;DR: The notion that ventricular enlargement is clinically relevant in patients with chronic schizophrenia and that patients with this abnormality may have a biologically different illness than similar patients without it is supported.
Abstract: • Response to neuroleptic drug treatment in ten chronic schizophrenic patients with enlarged cerebral ventricles was compared with ten similar patients with normal ventricles. The groups were closely matched for age, age at onset of illness, years of illness and hospitalization, drug dosage, and plasma neuroleptic concentration as measured by radioreceptor assay. Response was significantly worse in the patients with enlarged ventricles. This finding supports the notion that ventricular enlargement is clinically relevant in patients with chronic schizophrenia and that patients with this abnormality may have a biologically different illness than similar patients without it.

Journal ArticleDOI
TL;DR: The amelioration of obsessive-compulsive symptoms was positively correlated to the reduction of CSF concentrations of 5-HIAA during clomipramine treatment but negatively correlated to plasma concentrations of clomIPramine.
Abstract: Concentrations of the serotonin metabolite 5-hydroxyindoleacetic acid (5-HIAA), the dopamine metabolite homovanillic acid, and the noradrenaline metabolite 4-hydroxy-3-methoxyphenyl glycol were measured in CSF before and after three weeks' treatment of severe obsessive-compulsive disorder with clomipramine hydrochloride. Patients who responded to clomipramine treatment had significantly higher CSF levels of 5-HIAA before treatment. The amelioration of obsessive-compulsive symptoms was positively correlated to the reduction of CSF concentrations of 5-HIAA during clomipramine treatment but negatively correlated to plasma concentrations of clomipramine. Reduction of CSF concentrations of 5-HIAA, which probably reflects drug action on central serotonin neurons, was maximal at a plasma clomipramine concentration of about 300 nmole/L. At higher levels, the reduction of CSF levels of 5-HIAA was smaller. The antiobsessive effect of clomipramine may be connected to its capacity to inhibit serotonin uptake.

Journal ArticleDOI
TL;DR: Early-onset characterological depressions are distinguished from late-ONSet chronic depressions that complicate the long-term course of unipolar and nonaffective illnesses.
Abstract: • Early-onset characterological depressions are distinguished from late-onset chronic depressions that complicate the longterm course of unipolar and nonaffective illnesses. In turn, characterological depressions are divisible into at least two subtypes: (1) "Subaffective dysthymias" have even sex distribution, are often complicated by superimposed depressive episodes, rapid eye movement latency is shortened, and they tend to respond to tricyclics or lithium carbonate. In brief, they share many features of primary affective illness. (2) "Character spectrum disorders," by contrast, represent a heterogeneous mixture of personality disorders with inconstant depressive features, are more common in women, are often complicated by alcohol and drug abuse, and outcome tends to be unfavorable.

Journal ArticleDOI
TL;DR: Quantitative data from the study of a population with post-traumatic stress disorder confirms clinical impressions of the importance and wide prevalence of episodes of intrusive ideas and feelings in states of distress precipitated by serious life events.
Abstract: The new diagnostic nomenclature of the American Psychiatric Association (DSM-III) provides well-described categories of stress response syndromes that were not included in the previous nosology. The signs and symptoms of these syndromes used in the descriptive statements have been understood largely in terms of field studies of nonpatient populations and clinical descriptive and impressionistic studies of patient populations. We report quantitative data from the study of a population with post-traumatic stress disorder. The results confirm clinical impressions of the importance and wide prevalence of episodes of intrusive ideas and feelings in states of distress precipitated by serious life events.

Journal ArticleDOI
TL;DR: A comparison of these patients with agoraphobic women previously treated with imipramine and imaginal desensitization showed a superiority of exposure in vivo midway in treatment, but no significant difference between the two groups at the completion of therapy.
Abstract: Seventy-six white agoraphobic women, 21 to 45 years old, were treated with combined group exposure in vivo and imipramine or placebo in a randomized double-blind study. A majority of the patients in both the placebo and imipramine groups showed moderate to marked improvement. However, imipramine therapy was significantly superior to placebo therapy on three of the four reported measures of improvement: primary phobia, spontaneous panic, and global improvement. There was a negative correlation between depression and outcome; ie, the more depressed patients fared worse on several outcome measures than those who were less depressed. A comparison of these patients with agoraphobic women previously treated with imipramine and imaginal desensitization showed a superiority of exposure in vivo midway in treatment, but no significant difference between the two groups at the completion of therapy.

Journal ArticleDOI
TL;DR: Strong linear correlations between ages and both the prevalences and severity of TD are found, which support caution in the prolonged use of neuroleptics in patients older than age 50 years but encourage optimism for eventual spontaneous remission of TD in young adults.
Abstract: • Advancing age is one of the few factors suggested to predict increased risk of tardive dyskinesias (TDs). By pooling and reanalyzing available epidemiological data, we found strong linear correlations between ages ( prevalences and severity of TD, while neither increased significantly after age 70 years. There was also a strong inverse correlation between rates of spontaneous remission of TD and age ( 80 years); TD in those younger than 60 years improved over three times as often as in older patients. These correlations are not readily explained by the duration of previous exposure to neuroleptic drugs and may reflect increased sensitivity of the aging brain to them. These observations support caution in the prolonged use of neuroleptics in patients older than age 50 years but encourage optimism for eventual spontaneous remission of TD in young adults.

Journal ArticleDOI
TL;DR: The social costs of an experimental in-community program were compared with those of a traditional approach using short-term hospitalization plus aftercare and showed that the total in- community program resulted in no more burden on the family or community than the traditional approach.
Abstract: • Much concern has been expressed over the possible burden placed on family and community members by programs that emphasize community treatment of severely disturbed patients. In this study, the social costs of an experimental in-community program were compared with those of a traditional approach using short-term hospitalization plus aftercare. Six objective and one subjective measures of the burden placed on the family members of patients in both groups were obtained. Community burden was assessed through police records of frequency of patient arrests, number of suicidal gestures that required medical attention, and frequency of emergency room use. All measures showed that the total in-community program resulted in no more burden on the family or community than the traditional approach. The large amount of support provided to patients, families, and community members in the experimental approach is emphasized in explaining these results.

Journal ArticleDOI
TL;DR: A patient with a 62-year history of Gilles de la Tourette syndrome describes 35 years of self-observation of the subjective events that precede, accompany, and follow the occurrence of symptomatic movements and sounds.
Abstract: • A patient with a 62-year history of Gilles de la Tourette syndrome describes 35 years of self-observation of the subjective events that precede, accompany, and follow the occurrence of symptomatic movements and sounds. Bodily sites become sensitized, and the movements (however bizarre) are intentional acts aimed at satisfying and eliminating unfulfilled sensations and urges. Sensory impressions may be projected onto other persons, objects, or imagined objects; these phantom sensations also demand discharge through actions. With vigilance and self-observation, barely emergent sensations can be recognized and controlled temporarily through substitution or extinction. The need to cope with rampant sensations and their consequences on one hand and current affairs on the other creates a dual citizenship within the person.

Journal ArticleDOI
TL;DR: Clonidine hydrochloride, a centrally active alpha-adrenergic agonist, was observed to ameliorate the disorder in the majority of 25 patients who could not tolerate or did not benefit from treatment with haloperidol.
Abstract: • Gilles de la Tourette syndrome (TS) is a severe, familial neuropsychiatric disorder of childhood onset that is characterized by multiform motor, phonic, behavioral, and psychological symptoms. Clonidine hydrochloride, a centrally active α-adrenergic agonist, was observed to ameliorate the disorder in the majority of 25 patients who could not tolerate or did not benefit from treatment with haloperidol. Clonidine had a gradual onset of action. Compulsive behavior, frustration intolerance, speech difficulties, behavioral blocking, attentional problems, and tics were responsive to treatment. The noradrenergic system may be involved, primarily or secondarily, in the expression of the genetic predisposition to TS. These observations will require testing by suitably controlled efficacy studies.

Journal ArticleDOI
TL;DR: Although some of the data is consistent with the view that SDD is a "mild" form of schizophrenia, the bulk of the evidence suggests thatSDD and schizophrenia are distinct syndromes.
Abstract: The diagnostic status of paranoia (renamed simple delusional disorder [SDD]) has been debated since the time of Kraepelin Three main views have emerged that consider paranoia (1) a subtype of schizophrenia, (2) a subtype of affective illness, or (3) a distinct nosologic entity The literature pertinent to the diagnostic validity of a SDD is examined Although the methodology of a number of the studies reviewed would not be considered rigorous by today's standards, certain tentative conclusions can nonetheless be reached The available data do not suggest that SDD is a subtype of affective illness The evidence reviewed also does not strongly support the hypothesis that SDD is a subtype of schizophrenia Although some of the data is consistent with the view that SDD is a "mild" form of schizophrenia, the bulk of the evidence suggests that SDD and schizophrenia are distinct syndromes

Journal ArticleDOI
TL;DR: The findings suggest the importance of a genetic factor in alcoholism and are in accord with previous work that failed to show an independent effect of an alcoholic environment in development of adoptee alcoholism.
Abstract: • Male adoptees raised apart from alcoholic biologic parents were followed up and compared with adoptees of nonalcoholic biologic parents. Significant associations were found between adoptee alcoholism and an alcoholic biologic background and between childhood conduct disorder and the development of alcoholism as an adult. None of the environmental factors—psychiatric or alcohol problems in adoptive family, socioeconomic status of the adoptive family, or exposure to discontinuous mothering as an infant—predicted adoptee alcoholism. These findings suggest the importance of a genetic factor in alcoholism and are in accord with previous work that failed to show an independent effect of an alcoholic environment in development of adoptee alcoholism.

Journal ArticleDOI
TL;DR: An overview of research on the outcome of anorexia nervosa in the last 25 years is presented and findings in the areas of mortality, nutritional status, eating difficulties, menstrual function, psychiatric status, psychosexual and psychosocial adjustment, and treatment effects are discussed.
Abstract: • An overview of research on the outcome of anorexia nervosa in the last 25 years is presented. Findings in the areas of mortality, nutritional status, eating difficulties, menstrual function, psychiatric status, psychosexual and psychosocial adjustment, and treatment effects are discussed.

Journal ArticleDOI
TL;DR: Data suggest that pituitary adrenal disinhibition as assessed by the DST is selectively associated with primary depression, which may be a marker of a depressive subtype with a specific pathophysiology or pathogenesis.
Abstract: • This study examines the utility of the dexamethasone suppression test (DST) in identifying a clinically meaningful subtype of depression. Forty-nine inpatients who met research diagnostic criteria for major depressive disorder underwent DSTs and standard clinical assessments and ratings. Half of those with primary depression showed escape from dexamethasone suppression and are referred to as nonsuppressors, while few of those with secondary depression had this response. Most of the nonsuppressors were rated as having a good response to treatment, while only one third of the suppressors were rated as having a good response to treatment. These data suggest that pituitary adrenal disinhibition as assessed by the DST is selectively associated with primary depression. The DST may be a marker of a depressive subtype with a specific pathophysiology or pathogenesis.

Journal ArticleDOI
TL;DR: Investigation of the relationship between size of cerebral ventricles in chronic schizophrenics and performance on a comprehensive neuropsychological battery found a multiple correlation between the ventricular brain ratio and Luria scores.
Abstract: The relationship between size of cerebral ventricles in chronic schizophrenics and performance on a comprehensive neuropsychological battery, the Standardized Luria-Nebraska Neuropsychological Battery, was investigated. Ventricular size was determined by using a planimeter to measure the size of the lateral ventricles and the ventricular body, if present, on the computerized tomographic (CT) scan image that showed the largest lateral ventricles. This number was divided by the size of the brain as a whole on the same image of the CT scan to yield a ventricular brain ratio. This ratio was then correlated with the scores on the Luria-Nebraska Neuropsychological Battery. Eight of the 14 scales of the Luria-Nebraska Neuropsychological Battery correlated significantly at the .05 level with the ventricular brain ratio in a sample of 42 chronic schizophrenics with an average age of 32.3 years. Overall, there was a multiple correlation of .72 between the ventricular brain ratio and Luria scores. The overall ventricular brain ratio for the schizophrenics was significantly above that found in normal populations. Changes in the size of the ventricles in schizophrenics appear to have significant correlates with measures of neuropsychological performance.

Journal ArticleDOI
TL;DR: The Diagnostic Interview for Borderlines is an hour-long, semistructured interview that evaluates five areas of borderline pathologic features--social adaptation, impulse/action patterns, affects, psychotic symptoms, and interpersonal relations.
Abstract: • As a part of an ongoing effort to provide operational criteria for a diagnosis of borderline personality disorder, the Diagnostic Interview for Borderlines (DIB) has been developed. The DIB is an hour-long, semistructured interview that evaluates five areas of borderline pathologic features—social adaptation, impulse/ action patterns, affects, psychotic symptoms, and interpersonal relations. The DIBs were administered to 70 hospitalized patients and compared with clinical diagnoses made at the time of discharge. The DIB discriminates borderline patients from others, especially from schizophrenic and neurotic depressives. It reflects clinical diagnosis, yielding higher scores for patients on whom there is more agreement on the diagnosis of borderline. The instrument can be used flexibly to identify populations of borderline patients for research purposes.

Journal ArticleDOI
TL;DR: The characteristics of 9,365 patients admitted to public hospitals in a one-year period were analyzed in relation to the presence of assaultive or suicidal problems prior to admission to demonstrate the usefulness of a large, routinely collected data base in the study of specific psychiatric problems.
Abstract: • The characteristics of 9,365 patients admitted to public hospitals in a one-year period were analyzed in relation to the presence of assaultive or suicidal problems prior to admission. There were definite differences in the occurrence of assaultive or suicidal problems in relation to sex, age, primary diagnosis, education, race, marital status, prior private care, and source of referral to the hospital. There were no significant differences in regard to the history of previous psychiatric admissions, veteran status, or history of seizures. These findings demonstrate the usefulness of a large, routinely collected data base in the study of specific psychiatric problems and offer directions for intervention and future research in the field of life-threatening behavior.

Journal ArticleDOI
TL;DR: Heroin can be seen as maintaining the status quo, with the majority continuing to inject heroin regularly and to supplement their maintenance prescription from other sources; it was associated with a continuing intermediate level of involvement with the drug subculture and criminal activity.
Abstract: • Ninety-six confirmed heroin addicts requesting a heroin maintenance prescription were randomly allocated to treatment with injectable heroin or oral methadone. Progress was monitored throughout the next 12 months by research workers operating independently of the clinic. Heroin can be seen as maintaining the status quo, with the majority continuing to inject heroin regularly and to supplement their maintenance prescription from other sources; it was associated with a continuing intermediate level of involvement with the drug subculture and criminal activity. Refusal to prescribe heroin while offering oral methadone constituted a more confrontational response and resulted in a higher abstinence rate, but also a greater dependence on illegal sources of drugs for those who continued to inject. Those offered oral methadone tended to polarize toward high or low categories of illegal drug use and involvement with the drug subculture, and were more likely to be arrested during the 12-month follow-up. There was no difference between the two groups in terms of employment, health, or consumption of nonopiate drugs. Refusal to prescribe heroin resulted in a significantly greater drop out from regular treatment.

Journal ArticleDOI
TL;DR: No pattern of antisocial or "acting-out" behavior differentiated the depressed group, although the depression group did relate more of their problems to drug and alcohol abuse, and a depressed or alcoholic family member significantly predicted for depression.
Abstract: One hundred and twenty adolescents aged 13, 14, and 15 were given a structured psychiatric interview within 48 hours of their admission to a correctional facility. The interview assessed demography, social and delinquent history, family history, and drug and alcohol use and related problems. The interview issued diagnoses based on the Research Diagnostic Criteria. The adolescents were followed up with self-rated and observer-rated instruments. Twenty-three percent of the population met criteria for a major affective disorder. Observer blind ratings significantly identified the depressed group at 15 days. Self-ratings of depression did not separate the two groups. No pattern of antisocial or "acting-out" behavior differentiated the depressed group, although the depressed group did relate more of their problems to drug and alcohol abuse. A depressed or alcoholic family member significantly predicted for depression. Some possible unique cognitive aspects of depression in younger adolescents are explored, and implications for further research with delinquents are discussed.