scispace - formally typeset

Showing papers in "Archives of General Psychiatry in 1981"


Journal ArticleDOI
TL;DR: In this article, a new interview schedule allows lay interviewers or clinicians to make psychiatric diagnoses according to DSM-III criteria, Feighner criteria, and Research Diagnostic Criteria.
Abstract: • A new interview schedule allows lay interviewers or clinicians to make psychiatric diagnoses according to DSM-III criteria, Feighner criteria, and Research Diagnostic Criteria. It is being used in a set of epidemiological studies sponsored by the National Institute of Mental Health Center for Epidemiological Studies. Its accuracy has been evaluated in a test-retest design comparing independent administrations by psychiatrists and lay interviewers to 216 subjects (inpatients, outpatients, ex-patients, and nonpatients).

4,830 citations


Journal ArticleDOI
TL;DR: Abnormal DST results were found with similar frequency among outpatients and inpatients with melancholia; but they were not related to age, sex, recent use of psychotropic drugs, or severity of depressive symptoms.
Abstract: • Four hundred thirty-eight subjects underwent an overnight dexamethasone suppression test (DST) to standardize the test for the diagnosis of melancholia (endogenous depression). Abnormal plasma cortisol concentrations within 24 hours after dexamethasone administration occurred almost exclusively in melancholic patients. The best plasma cortisol criterion concentration, above which a DST result may be considered abnormal, was 5 ug/dL. The optimal dose of dexamethasone was 1 rather than 2 mg. Two blood samples obtained at 4 and 11 PM after dexamethasone administration detected 98% of the abnormal test results. This version of the DST identified melancholic patients with a sensitivity of 67% and a specificity of 96%. Baseline nocturnal plasma cortisol concentrations were not useful. Abnormal DST results were found with similar frequency among outpatients and inpatients with melancholia; but they were not related to age, sex, recent use of psychotropic drugs, or severity of depressive symptoms. Extensive evidence validates this practical test for the diagnosis of melancholia.

1,990 citations


Journal ArticleDOI
TL;DR: The inheritance of alcoholism was studied in 862 Swedish men adopted by nonrelatives at an early age and found that both the congenital and postnatal backgrounds of the adoptees modify their risk for alcohol abuse.
Abstract: • The inheritance of alcoholism was studied in 862 Swedish men adopted by nonrelatives at an early age. Both the congenital and postnatal backgrounds of the adoptees modify their risk for alcohol abuse. We distinguish two forms of alcoholism that have distinct genetic and environmental causes and differ in their association with criminality, severity of alcohol abuse, and the frequency of expression in biological mothers. Postnatal milieu determines the frequency and severity of expression of the common type of susceptibility in both men and women. In contrast, the less common type is highly heritable in men but is seldom expressed in mothers of affected men.

1,758 citations


Journal ArticleDOI
TL;DR: Objective evidence is provided that a supportive group intervention for patients with metastatic cancer results in psychological benefit and mechanisms underlying the effectiveness of this group intervention are explored.
Abstract: • The effects of weekly supportive group meetings for women with metastatic carcinoma of the breast were systematically evaluated in a one-year, randomized, prospective outcome study. The groups focused on the problems of terminal illness, including improving relationships with family, friends, and physicians and living as fully as possible in the face of death. We hypothesized that this intervention would lead to improved mood, coping strategies, and self-esteem among those in the treatment group. Eighty-six patients were tested at four-month intervals. The treatment group had significantly lower mooddisturbance scores on the Profile of Mood States scale, had fewer maladaptive coping responses, and were less phobic than the control group. This study provides objective evidence that a supportive group intervention for patients with metastatic cancer results in psychological benefit. Mechanisms underlying the effectiveness of this group intervention are explored.

809 citations


Journal ArticleDOI
TL;DR: A follow-up study revealed a 20% mortality by suicide within a year after lumbar puncture in patients with a CSF-HIAA level below the median, which was lower than normal in suicidal patients who were not diagnosed as depressed at the time of lumbr puncture.
Abstract: • Cerebrospinal fluid concentrations of the monoamine metabolites 5-hydroxyindoleacetic acid (5-HIAA), homovanillic acid (HVA), and 3-methoxy-4-hydroxyphenyl glycol (MHPG) were measured in 30 psychiatric patients who had attempted suicide and 45 healthy volunteers. The suicide attempters had a significantly lower CSF 5-HIAA level than the controls, especially those who had made more violent attempts. After adjustment for differences in body height and age between controls and patients, the difference in 5-HIAA level became even more marked. Concentrations of 5-HIAA also were lower than normal in suicidal patients who were not diagnosed as depressed at the time of lumbar puncture, while HVA levels were lowered only in the depressives. A follow-up study of these and 89 more patients (depressed and/or suicidal) revealed a 20% mortality by suicide within a year after lumbar puncture in patients with a CSF 5-HIAA level below the median.

663 citations


Journal ArticleDOI
TL;DR: The effects of long-term antidepressant treatment on biogenic amine metabolism and on various indexes of presynaptic and postsynaptic receptor function are evaluated to provide support for hypotheses of amine receptor abnormalities in depression and indicate the need for expanded studies ofAmine receptor function in patients.
Abstract: • Considerable evidence suggests that the acute effects of antidepressant treatments on brain norepinephrine (NE) and serotonin (5-HT) systems cannot account fully for their delayed therapeutic action. This review evaluates the effects of long-term antidepressant treatment on biogenic amine metabolism and on various indexes of presynaptic and postsynaptic receptor function. In contrast to variable effects on NE and 5-HT turnover and on presynaptic receptor sensitivity, almost all long-term antidepressant treatments produce consistent alterations in a number of measures of postsynaptic amine receptor sensitivity. Longterm treatment has been found to reduce β-adrenergic sensitivity while enhancing responses to serotonergic and α-adrenergic stimulation, suggesting that modulation of receptor sensitivity may be a mechanism of action common to tricyclic antidepressants, "atypical" antidepressants, monoamine oxidase inhibitors, and electroconvulsive therapy. These findings provide support for hypotheses of amine receptor abnormalities in depression and indicate the need for expanded studies of amine receptor function in patients.

638 citations


Journal ArticleDOI
TL;DR: During depressive episodes, patients show both qualitative and quantitative changes in how information is processed, and disruptions in arousal-activation in depression can account for these cognitive impairments.
Abstract: During depressive episodes, patients show both qualitative and quantitative changes in how information is processed. Depressed patients appear to use weak or incomplete encoding strategies to organize and transform events to be remembered. This makes these events less memorable. If the depressed patient is provided organization and structure, then learning-memory deficits are not apparent. Disruptions in arousal-activation in depression can account for these cognitive impairments.

573 citations


Journal ArticleDOI
TL;DR: A new syndrome called "delayed sleep phase insomnia" is described, which is proposed to be a disorder of the circadian sleep-wake rhythm in which the "advance" portion of the phase response curve is small.
Abstract: We describe a new syndrome called "delayed sleep phase insomnia." Thirty of 450 patients seen for a primary insomniac complaint had the following characteristics: (1) chronic inability to fall asleep at a desired clock time; (2) when not on a strict schedule, the patients have a normal sleep pattern and after a sleep of normal length awaken spontaneously and feel refreshed; and (3) a long history of unsuccessful attempts to treat the problem. These patients were younger than the general insomniac population and as a group did not have a specific psychiatric disorder. Six patients' histories are described in detail, including the successful nonpharmacological chronotherapy regimen (resetting the patients' biological clock by progressive phase delay). Delayed sleep phase insomnia is proposed to be a disorder of the circadian sleep-wake rhythm in which the "advance" portion of the phase response curve is small.

450 citations


Journal ArticleDOI
TL;DR: There was a threefold excess of alcohol abusers among the adopted daughters of alcoholic biological mothers compared with other daughters, confirming the heterogeneity among alcoholics noted in earlier work with adopted sons, which found that the latter type of criminal alcoholics also had no excess of alcoholic mothers.
Abstract: The inheritance of alcohol abuse was studied in 913 Swedish women adopted by nonrelatives at an early age. There was a threefold excess of alcohol abusers among the adopted daughters of alcoholic biological mothers compared with other daughters. In addition, there was an excess of alcohol abuse among the daughters of biological fathers with alcohol abuse that was mild and not associated with criminality. However, fathers with extensive treatment for both alcoholism and criminality had no excess of alcoholic daughters. This confirms the heterogeneity among alcoholics noted in earlier work with adopted sons, which found that the latter type of criminal alcoholics also had no excess of alcoholic mothers. Imitation of alcohol abuse by adoptive parents did not increase later alcohol abuse by adopted women. The importance of nonfamilial environments and maternal effects is demonstrated for alcohol abuse in women.

448 citations


Journal ArticleDOI
TL;DR: Relatives of 125 probands, who had dementia of the Alzheimer type as proved by autopsy, were subjects of a genetic investigation and exhibited an excess of dementing illness consistent with genetic transmission.
Abstract: • Relatives of 125 probands, who had dementia of the Alzheimer type as proved by autopsy, were subjects of a genetic investigation. The relatives exhibited an excess of dementing illness consistent with genetic transmission. Risk to relatives decreased sharply as severity of the proband's illness decreased. Also, when compared with a control group and the general population, the relatives had excesses of Down's syndrome, lymphoma, and immune diatheses. These associated conditions also were more likely to be present when the proband had severe illness. Mortality at all ages was increased among the relatives.

435 citations


Journal ArticleDOI
TL;DR: The problems of research design and execution in studies of diagnostic reliability are reviewed, and statistical problems are examined, and solutions to many of these problems are suggested, including recommendations of appropriate reliability coefficients and data analyses.
Abstract: • The existing literature on the reliability of psychiatric diagnosis falls into two periods, the earlier reporting low reliability and the latter reporting much higher figures. The reasons for this trend are examined in the context of a discussion of the design of diagnostic reliability studies. The problems of research design and execution in studies of diagnostic reliability are reviewed, and statistical problems are examined. Solutions to many of these problems are suggested, including recommendations of appropriate reliability coefficients and data analyses.

Journal ArticleDOI
TL;DR: Favorableness of one-year posttreatment outcomes with respect to illicit drug use, criminality, and employment and other productive activities was found to increase linearly with the length of time patients stayed in methadone maintenance, a therapeutic community, or outpatient drug-free treatment.
Abstract: • A sample of 1,496 persons admitted to 26 community treatment agencies participating in the Drug Abuse Reporting Program (DARP) during 1972 and 1973 were located and interviewed in 1978 and 1979. Favorableness of one-year posttreatment outcomes with respect to illicit drug use, criminality, and employment and other productive activities was found to increase linearly with the length of time patients stayed in methadone maintenance, a therapeutic community, or outpatient drug-free treatment. In addition, follow-up outcome for persons who spent less than three months in treatment was least favorable, and was not significantly different from that of persons in outpatient detoxification programs or who were admitted but not treated (intake-only). Persons who completed treatment generally stayed in treatment longer, as expected; they also had a more favorable outcome after DARP treatment than did others.

Journal ArticleDOI
TL;DR: The comparative reliability and the validity of the extracted HDRS score as a substitute for a realHDRS score was established and the correlation between the extracted and real HDRS scores was positive and large.
Abstract: • Investigators who wish to use new procedures usually wish to relate their results to those already in the literature. This often results in the use of both old and new measures. The Schedule for Affective Disorders and Schizophrenia Regular and Change Versions (SADS and SADS-C) have advantages over the widely used Hamilton Depression Rating Scale (HDRS). A procedure was developed to extract the HDRS score from the SADS and SADS-C. The comparative reliability and the validity of the extracted HDRS score as a substitute for a real HDRS score was established. The SADS-C and the HDRS were completed by the raters for 48 subjects. The correlation between the extracted and real HDRS scores was positive and large.

Journal ArticleDOI
TL;DR: Using this classification, there is less variation in epidemiologic rates (point prevalence, incidence, and lifetime risk) than has been noted in previous reviews.
Abstract: Epidemiologic studies of depression have been difficult to interpret because of differing case definitions and variation in diagnostic procedures between studies. We review data from recent epidemiologic studies in which the new research diagnostic techniques were used. We have divided the data into studies of depressive symptoms, bipolar disorder, and nonbipolar depression. An effort is made to integrate the findings of older studies in light of this new classification. Using this classification, there is less variation in epidemiologic rates (point prevalence, incidence, and lifetime risk) than has been noted in previous reviews. Future directions of research are also discussed.

Journal ArticleDOI
TL;DR: A one-year naturalistic follow-up of the 35 subjects who completed the protocol revealed that although many of the patients had a variable clinical course, both original treatment groups remained generally well and none of the between-group differences were significant.
Abstract: Using a controlled, clinical-trial format, 44 nonpsychotic, nonbipolar, depressed outpatients were treated with cognitive therapy or imipramine hydrochloride over a 12-week period. Although both interventions were associated with significant reductions in levels of depression, the cognitive-therapy patients showed greater symptomatic improvement and a higher treatment-completion rate. A one-year naturalistic follow-up of the 35 subjects who completed the protocol revealed that although many of the patients had a variable clinical course, both original treatment groups remained generally well. Self-rated depressive symptomatology was significantly lower for those who, one year earlier, had completed cognitive therapy than for those who had been in the clinical trial's pharmacotherapy cell. While there were several other interesting trends in favor of the cognitive-therapy patients, none of the between-group differences were significant. The pragmatic and clinical implications of the followup results are discussed.

Journal ArticleDOI
TL;DR: While dosage may be correlated to the risk of developing mental disturbances, neither dosage nor duration of treatment seems to affect the time of onset, duration, severity, or type of mental disturbances.
Abstract: • We reviewed the literature to determine the characteristics of corticosteroid-induced mental disturbances. We conclude that (1) while dosage may be correlated to the risk of developing mental disturbances, neither dosage nor duration of treatment seems to affect the time of onset, duration, severity, or type of mental disturbances; (2) euphoria, depression, and psychotic reactions are the common manifestations of corticosteroidinduced mental disturbances; (3) females seem to be more prone to these disturbances than males; (4) patients with past mental illness are not necessarily predisposed to such disturbances; and (5) corticosteroid-induced mental disturbances are usually reversible on dose reduction or discontinuation of the drug. At present there are no simple models to explain the psychotic reactions, anxiety, or agitation seen in corticosteroidinduced mental disturbances.

Journal ArticleDOI
TL;DR: These results, coupled with previous studies showing a significant decrease in the maximal uptake of serotonin in platelets from depressed patients, suggest that an inherited or acquired deficiency of the serotonin transport protein or proteins may be involved in the pathogenesis of depression.
Abstract: The high-affinity tritiated (3H) imipramine binding sites are functionally (and perhaps structurally) associated with the presynaptic neuronal and platelet uptake sites for serotonin. Since there is an excellent correlation between the relative potencies of a series of antidepressants in displacing 3H-imipramine from binding sites in human brain and platelet, we have examined the binding of 3H-imipramine to platelets from 14 depressed patients and 28 age- and sex-matched controls. A highly significant decrease in the number of 3H-imipramine binding sites, with no significant change in the apparent affinity constants, was observed in platelets from the depressed patients compared with the controls. These results, coupled with previous studies showing a significant decrease in the maximal uptake of serotonin in platelets from depressed patients, suggest that an inherited or acquired deficiency of the serotonin transport protein or proteins may be involved in the pathogenesis of depression.

Journal ArticleDOI
TL;DR: Pemoline was demonstrably more effective than placebo in a random-assignment, parallel, double-blind trial of placebo and pemoline, a noneuphorigenic psychostimulant drug effective in children with ADD.
Abstract: This study replicated an earlier one dealing with the diagnosis and treatment of attention deficit disorder (ADD, or minimal brain dysfunction) in adults. Subjects who met provisional operational criteria for adult ADD were entered in a random-assignment, parallel, double-blind trial of placebo and pemoline, a noneuphorigenic psychostimulant drug effective in children with ADD. There was improvement in both the pemoline group and the placebo group, but the difference in improvement was not statistically significant. When the analyses were confined to that subgroup of patients whose parents had described them in the 95th percentile of childhood "hyperactivity" or when the hyperactivity score was partialled out statistically, pemoline was demonstrably more effective than placebo. Revised operational criteria for adult ADD are proposed.

Journal ArticleDOI
TL;DR: Evidence suggests that the modulation by thyroid hormones of the beta-adrenergic receptor response to catecholamines may contribute to these effects of depression and mania.
Abstract: • Recent prospective studies suggest that thyroid state plays a role in affective disorders. A lack of thyroid hormones can lower the threshold for depression; an excess can contribute to a state of tense dysphoria. Thyroid function in some persons also appears to influence the course of affective disorders. Adequate mobilization of thyroid hormones favors recovery from depression; excess mobilization increases the risk of mania in vulnerable individuals. Although other mechanisms may be involved, evidence suggests that the modulation by thyroid hormones of the β-adrenergic receptor response to catecholamines may contribute to these effects. Norepinephrine stimulates such receptors; thyroid hormones increase their ability to receive stimulation. The plausibility of such interactions between catecholamines and thyroid hormones occurring in the CNS is strengthened by their common origin in the amino acid tyrosine and by their synergism in many metabolic processes.

Journal ArticleDOI
TL;DR: While most patients were functioning reasonably well, there were some main effects of IPT on social functioning at the one-year follow-up and patients who received IPT with or without pharmacotherapy were doing significantly better on some measures of social functioning.
Abstract: • A one-year follow-up was conducted on ambulatory nonbipolar, nonpsychotic, acutely depressed patients who received amitriptyline hydrochloride and/or interpersonal psychotherapy (IPT), each alone and in combination, as part of a four-month clinical trial. There were no differential long-term effects of the initially randomized treatment on clinical symptoms one year later since most of the patients were asymptomatic. While most patients were functioning reasonably well, there were some main effects of IPT on social functioning at the one-year follow-up. Patients who received IPT with or without pharmacotherapy were doing significantly better on some measures of social functioning.

Journal ArticleDOI
TL;DR: In this paper, three experiments were conducted using tachistoscopically presented stimuli in order to evaluate these two stages of information processing (iconic storage and speed of processing) in schizophrenic and control subjects and found that, independent of iconic storage and sensory registration, slow information processing is a relatively stable deficit of schizophrenic patients with a poor prognosis.
Abstract: • In recent years, the idea that schizophrenia involves a primary disturbance of the higher cognitive (ie, cortical) thinking processes has been challenged by investigators who have shown that there may be a primary disturbance in schizophrenia in the early stages of information processing that occurs during the first few hundred milliseconds after the stimulus reaches the sense organs. Among the hypothesized early information processing deficits are deficiencies in iconic storage (a brief peripheral memory store) and slowness of processing from iconic storage to a more permanent memory system. Three experiments were conducted using tachistoscopically presented stimuli in order to evaluate these two stages of information processing (iconic storage and speed of processing) in schizophrenic and control subjects. Results converged in supporting the hypothesis that, independent of iconic storage and sensory registration, slow information processing is a relatively stable deficit of schizophrenic patients with a poor prognosis. The schizophrenic patients with a good prognosis had a similar deficit, which was reversible. Results are discussed as they relate to the early information processing deficit theories of schizophrenia.

Journal ArticleDOI
TL;DR: For instance, this paper found that depressed mood is characterized by asymmetrical EEG activation over the frontal lobes, with relatively greater activity in the right frontal region than the left frontal region.
Abstract: • Evidence from psychiatric patients has suggested that depressive affect may coincide with a decrement in the functioning of the right cerebral hemisphere. We have observed that college students who reported greater depression also reported less vivid imagery. Students undergoing experimental induction of depressive and euphoric moods in the laboratory showed an auditory attentional bias and impaired imagery during the depression condition, while their arithmetic task performance was unchanged. A second mood-induction experiment indicated a depressed mood to be characterized by asymmetrical EEG activation over the frontal lobes, with relatively greater activity in the right frontal region. These observations suggest that anterior regions of the brain may modulate the differential effects of emotional arousal on the information-processing capacities of the cerebral hemispheres.

Journal ArticleDOI
TL;DR: Adolescents whose parents had both a pathologic affective style of communication and a high level of communication deviance had schizophrenia-like disorders develop in young adulthood, and adolescents of parents who had both lower levels of communicationDeviance and a benign affectivestyle had offspring with healthier outcomes.
Abstract: \s=b\In an attempt to assess the contributory role of family factors to the development of schizophrenia-like disorders, measures of parental communication deviance and affective styles of communication were obtained for a sample of families of disturbed but nonpsychotic adolescents. Outcome was assessed five years later. Absence of a pathologic affective style was associated with a benign outcome, but neither parental variable alone allowed precise identification of the schizophrenia-spectrum cases. However, an index using a combination of both variables was statistically predictive of subsequent psychiatric status at follow-up. Thus, adolescents whose parents had both a pathologic affective style of communication and a high level of communication deviance had schizophrenia-like disorders develop in young adulthood. Adolescents of parents who had both lower levels of communication deviance and a benign affective style had offspring with healthier outcomes. (Arch Gen Psychiatry 1981;38:679-685) Disordered family relationships may be an important factor in the development of schizophrenia, but meaningful empirical evidence of the process is difficult to obtain. Most of the evidence comes from cross-sectional studies in which families with a diagnosed schizophrenic offspring are contrasted with families with psychiatrically disturbed or normal offspring. Such designs, of course, cannot separate antecedent family patterns from accom¬ modations to the presence of a psychotic offspring. We report a prospective longitudinal study of family relation¬ ships to examine whether specific disordered patterns of intrafamilial relationships antedate the actual onset of schizophrenic and schizophrenia-like symptoms in the offspring. There are several recent reviews of the cross-sectional studies.'-' Those measuring communication disorder have shown the most consistent results. In particular, the Singer and Wynne index of parental communication deviance (CD) has identified parents of schizophrenics and border¬ line schizophrenics in diverse measurement contexts.410 This index reflects an inability of the parent or parents to establish and maintain a shared focus of attention during transactions with another person. The theory maintains that the extent to which parents fail to communicate effectively reflects the extent to which the child will become confused, lost, distressed, and more vulnerable to subsequent breakdown.1 Such findings have been repli¬ cated in several cross-sectional studies, although in one study" the parental-group separation was less sharp than in the Singer-Wynne studies. The implication of these cross-sectional studies is that communication deviance (CD) may play a contributory role in the development of schizophrenia. However, before any etiological role is considered, it is necessary to demonstrate that this parental attribute is present substantially before the onset of prodromal or actual clinical features of a schizophrenic disorder. A basic goal of the present study is to determine whether parental CD does indeed antedate the onset of schizophrenia and related disorders. The subjects in our study were first studied in midadolescence, at a time when all were disturbed but when none showed any prodromal or clinical signs of schizophrenic disor¬ ders. While most of the cross-sectional studies have focused on issues of the family's potential role in the etiology of schizophrenia, Vaughn and Leff,'- building on the work of Brown et al,'3 reported that the course of the disorder may be affected by the affective tone or expressed emotion (EE) of the family environment to which the patient returns after hospitalization. Expressed emotion is a con¬ struct that includes negative attitudes directed toward the target patient, including criticism, hostility, and overinvolvement; the likelihood of relapse is greater when patients return to high-EE environments.

Journal ArticleDOI
TL;DR: The results are interpreted as supporting a link between puerperal psychosis and manic-depressive disease.
Abstract: Fifty-eight psychoses beginning within two weeks of childbirth are compared with 52 episodes of nonpuerperal psychotic illness occurring in young women. A clinical approach based on the use of multiple information sources and integrated assessment was used. Statistically significant differences between the two groups of patients were found in 52 of 214 psychopathological variables. Postpartum patients had more manic symptoms and "confusion," while nonpuerperal patients had more schizophrenic symptoms. The Research Diagnostic Criteria (RDC) showed an excess of schizoaffective (manic) puerperal patients and schizoaffective (depressed) or schizophrenic nonpuerperal patients. Only five of 58 puerperal episodes met RDC for schizophrenia. The relative lack of schizophrenic symptoms in the puerperal group was confirmed by self-ratings. The results are interpreted as supporting a link between puerperal psychosis and manic-depressive disease.

Journal ArticleDOI
TL;DR: Based on five case studies, several clinical guidelines for recognizing and diagnosing depression in brain-damaged patients are offered and initial hypotheses about the neuroanatomical basis of the depressive syndrome are generated.
Abstract: • Recognizing depression in brain-damaged patients poses considerable problems. The standard dignostic criteria often are not applicable since the neurological lesion may distort or even obliterate salient features of depression. Patients actually may deny being depressed or dysphoric, not have a depressive affect, or be totally unaware of abnormal vegetative behaviors. Furthermore, brain lesions themselves may produce striking behavioral alterations that can be mistakenly attributed to depression, or striking behavioral changes due to depression may be mistakenly attributed to the brain lesion. Based on five case studies, several clinical guidelines for recognizing and diagnosing depression in brain-damaged patients are offered. These cases also provide a data base to generate initial hypotheses about the neuroanatomical basis of the depressive syndrome. By observing how focal brain lesions modify the signs and symptoms of depression, inferences are made about brain areas crucial for modulating the various features of the depressive syndrome.

Journal ArticleDOI
TL;DR: The results replicate the findings of Kety and co-workers on borderline schizophrenia and support the validity of the diagnosis of SPD.
Abstract: To assess the relationship between schizophrenia and schizotypal personality disorder (SPD) as defined in DSM-III, the interviews of relatives from the Danish Adoption Study of Schizophrenia were independently and blindly reevaluated. The prevalence of SPD was significantly higher in the biologic relatives of the schizophrenic adoptees than in the biologic relatives of matched controls and was low and equal in the two groups of adoptive relatives. Compared with "borderline" and uncertain borderline schizophrenia as defined by Kety and co-workers, the criteria for SPD were more specific but less sensitive in identifying biologic relatives of schizophrenics. In this sample, SPD has a strong genetic, but no familial-environmental, relationship to schizophrenia. These results replicate the findings of Kety and co-workers on borderline schizophrenia and support the validity of the diagnosis of SPD.

Journal ArticleDOI
TL;DR: Overdose of tricyclic antidepressants (TCAs) leave no doubt that TCA drugs at high concentrations have serious cardiac effects, but recent prospective, plasma-level-controlled studies have improved understanding of these drugs and proved assumptions to be inaccurate.
Abstract: • Overdoses of tricyclic antidepressants (TCAs) leave no doubt that TCA drugs at high concentrations have serious cardiac effects. It has been assumed that, to a lesser extent, these effects would occur at usual therapeutic concentration. Recent prospective, plasma-level-controlled studies have improved our understanding of these drugs and proved these assumptions to be inaccurate. The most common serious cardiovascular complication of most tricyclic drugs is orthostatic hypotension. Tricyclic antidepressants are essentially free of any other serious adverse effects in depressed patients without cardiovascular disease. In patients with preexisting bundlebranch disease, there is a risk of heart block. On the other hand, patients with ventricular arrhythmias are likely to have their arrhythmias improve with TCA therapy. Finally, therapeutic doses of TCA have little adverse effect on left ventricular performance. As a result, TCA drugs can often be used to benefit depressed patients with overt heart disease.

Journal ArticleDOI
TL;DR: Platelet serotonin (5-HT) uptake was determined in 72 newly admitted, unmedicated psychiatric patients and there was a trend for the increase in Km in the nortriptyline-treated patients to correlate with clinical improvement.
Abstract: • Platelet serotonin (5-HT) uptake was determined in 72 newly admitted, unmedicated psychiatric patients. Decreased maximum velocity (V max ) of 5-HT uptake was present in unipolar and bipolar depressed patients as well as schizoaffective depressed patients. The apparent Michaelis constant (k m ) of 5-HT uptake was normal in these groups, as was V max and K m in manicdepressive and chronic schizophrenic patients. Treatment of depressed patients with notriptyline hydrochloride or imipramine hydrochloride increased K m significantly. There was a trend for the increase in K m in the nortriptyline-treated patients to correlate with clinical improvement. Decreased 5-HT uptake in platelets provides additional evidence for the role of 5-HT in the pathophysiologic process of some forms of depression.

Journal ArticleDOI
TL;DR: Data for schizophrenic patients in prospective studies and a comparison group of depressives show that depressive symptoms are more prevalent during the acute phase of the illness and they decrease (rather than increase) in severity with effective neuroleptic treatment.
Abstract: • Symptoms of depression are common in patients who have been treated for schizophrenia. Various concepts have been proposed to explain the relationship between depression and schizophrenia. Data for schizophrenic patients in prospective studies and a comparison group of depressives show that depressive symptoms are more prevalent during the acute phase of the illness and that they decrease (rather than increase) in severity with effective neuroleptic treatment.

Journal ArticleDOI
TL;DR: It is recommended that patients with a history of dysphoric response be given a very low dose initially, and some dysphoric responders did have a good outcome when treated with very low doses.
Abstract: Sixty-three newly admitted schizophrenic patients were given a test dose of thiothixene and their subjective response was recorded by a technician blind to clinical ratings. All patients were then treated wih thiothixene in an active milieu setting. Patients varied widely in their subjective responses. An initial dysphoric response was a powerful predictor of both immediate and eventual drug refusal. Before treatment, dysphoric responders tended to be less symptomatic and did significantly better on the Continuous Performance Test. Dysphoric responders experienced significantly more extrapyramidal symptoms following the test dose. Some dysphoric responders did have a good outcome when treated with very low doses. We recommend that patients with a history of dysphoric response be given a very low dose initially.