Showing papers in "Archives of General Psychiatry in 1984"
TL;DR: Lifetime rates are presented for 15 DSM-III psychiatric diagnoses evaluated in three large household samples on the basis of lay interviewers' use of the Diagnostic Interview Schedule.
Abstract: • Lifetime rates are presented for 15 DSM-III psychiatric diagnoses evaluated in three large household samples on the basis of lay interviewers' use of the Diagnostic Interview Schedule. The most common diagnoses were alcohol abuse and dependence, phobia, major depressive episode, and drug abuse and dependence. Disorders that most clearly predominated in men were antisocial personality and alcohol abuse and dependence. Disorders that most clearly predominated in women were depressive episodes and phobias. The age group with highest rates for most disorders was found to be young adults (aged 25 to 44 years). Correlates with race, education, and urbanization are presented.
2,459 citations
TL;DR: Preliminary studies in 11 patients suggest that extending the photoperiod with bright artificial light has an antidepressant effect and sleep recordings in nine depressed patients confirmed the presence of hypersomnia and showed increased sleep latency and reduced slow-wave (delta) sleep.
Abstract: Seasonal affective disorder (SAD) is a syndrome characterized by recurrent depressions that occur annually at the same time each year. We describe 29 patients with SAD; most of them had a bipolar affective disorder, especially bipolar II, and their depressions were generally characterized by hypersomnia, overeating, and carbohydrate craving and seemed to respond to changes in climate and latitude. Sleep recordings in nine depressed patients confirmed the presence of hypersomnia and showed increased sleep latency and reduced slow-wave (delta) sleep. Preliminary studies in 11 patients suggest that extending the photoperiod with bright artificial light has an antidepressant effect.
2,186 citations
TL;DR: Six-month prevalence rates for selected DSM-III psychiatric disorders are reported based on community surveys in New Haven, Conn, Baltimore, and St Louis based on data gathered on more than 9,000 adults using the Diagnostic Interview Schedule.
Abstract: • Six-month prevalence rates for selected DSM-III psychiatric disorders are reported based on community surveys in New Haven, Conn, Baltimore, and St Louis. As part of the Epidemiologic Catchment Area program, data were gathered on more than 9,000 adults, employing the Diagnostic Interview Schedule to collect information to make a diagnosis. The most common disorders found were phobias, alcohol abuse and/or dependence, dysthymia, and major depression. The most common diagnoses for women were phobias and major depression, whereas for men, the most predominant disorder was alcohol abuse and/or dependence. Rates of psychiatric disorders dropped sharply after age 45 years.
1,500 citations
TL;DR: The National Institute of Mental Health multisite Epidemiologic Catchment Area (ECA) program is described in the context of four previous psychiatric epidemiologic surveys that included a combined total of 4,000 subjects from Stirling County, the Baltimore Morbidity Study, Midtown Manhattan, and the New Haven third-wave survey.
Abstract: The National Institute of Mental Health multisite Epidemiologic Catchment Area (ECA) program is described in the context of four previous psychiatric epidemiologic surveys that included a combined total of 4,000 subjects from Stirling County, the Baltimore Morbidity Study, Midtown Manhattan, and the New Haven third-wave survey. The ECA program is distinguished by its sample size of at least 3,500 subjects per site (about 20,000 total); the focus on Diagnostic Interview Schedule--defined DSM-III mental disorders; the one-year reinterview-based longitudinal design to obtain incidence and service use data; the linkage of epidemiologic and health service use data; and the replication of design and method in multiple sites. Demographic characteristics of community and sample populations are provided for New Haven, Conn, Baltimore, and St Louis.
1,193 citations
TL;DR: In seeking mental health services, men were more likely to turn to the specialty sector than to the generalist; women used both sectors about equally; the aged infrequently received care from mental health specialists.
Abstract: • Utilization of health and mental health services by noninstitutionalized persons aged 18 years and older is examined based on interviews with probability samples of 3,000 to 3,500 persons In each of three sites of the National Institute of Mental Health Epidemiologic Catchment Area (ECA) program: New Haven, Conn, Baltimore, and St Louis. In all three ECAs, 6% to 7% of the adults made a visit during the prior six months for mental health reasons; proportions were considerably higher among persons with recent DSM-III disorders covered by the Diagnostic Interview Schedule (DIS) or severe cognitive impairment. Between 24% and 38% of all ambulatory visits by persons with DIS disorders were to mental health specialists. In seeking mental health services, men were more likely to turn to the specialty sector than to the generalist; women used both sectors about equally. The aged infrequently received care from mental health specialists. Visits for mental health reasons varied considerably depending on specific types of DIS disorder.
751 citations
TL;DR: The characteristics and diagnostic validity of major depressive disorder, dysthymic disorder, and adjustment disorder with depressed mood were examined in a school-aged cohort and early age at onset predicted a more protracted illness.
Abstract: • In the context of a prospective, longitudinal, and controlled nosologic study, the characteristics and diagnostic validity of major depressive disorder, dysthymic disorder, and adjustment disorder with depressed mood were examined in a school-aged cohort. The entities were distinguishable on several dimensions such as age at onset and pattern of recovery. Time to recovery from onset was most favorable for the adjustment disorders (90% remission rate during nine months) and least so for the dysthymias (89% remission rate during six years). Major depression and dysthymia were similar with respect to the prevalence of concurrent nonaffective disorders. For both, early age at onset predicted a more protracted illness. Treatment contacts, none of which were under the control of the investigators, had no clear impact on recovery from the depressions.
697 citations
TL;DR: There were significant correlations between the yohimbine-induced rise in plasma MHPG level and patient-rated anxiety and nervousness and the frequency of reported panic attacks and it is suggested that impaired presynaptic noradrenergic neuronal regulation may exist in patients with frequent panic attacks.
Abstract: • Yohimbine, an α2-adrenergic receptor antagonist that increases noradrenergic function, was administered to 20 healthy subjects and 39 drug-free patients with agoraphobia and panic attacks. Following drug administration, changes in plasma levels of the norepinephrine metabolite 3-methoxy-4-hydroxyphenylglycol (MHPG), BP, pulse rate, and subjective ratings of feelings and somatic symptoms were examined during a four-hour period. Yohimbine produced significantly greater increases in patient-rated anxiety, nervousness, palpitations, hot and cold flashes, restlessness, tremors, piloerection, and sitting systolic BP in the total patient group compared with healthy subjects. There were significant correlations between the yohimbine-induced rise in plasma MHPG level and patient-rated anxiety and nervousness and the frequency of reported panic attacks. Patients experiencing frequent panic attacks (>2.5 per week) had a significantly greater plasma MHPG response to yohimbine than the healthy subjects and patients having less frequent panic attacks. These observations support a hypothesis of increased sensitivity to augmented noradrenergic function in anxiety states associated with panic, and they suggest that impaired presynaptic noradrenergic neuronal regulation may exist in patients with frequent panic attacks.
584 citations
TL;DR: There are several diseases, including schizophrenia, alcoholism, and opiate addiction, for which the long-term prognosis is subject to disagreement between clinicians and researchers and also among researchers, and sampling bias in clinical and research samples is illustrated.
Abstract: There are several diseases, including schizophrenia, alcoholism, and opiate addiction, for which the long-term prognosis is subject to disagreement between clinicians and researchers and also among researchers. Part of this disagreement may be attributable to a difference in the populations they sample. The clinician samples the population currently suffering from the disease (a "prevalence" or census sample), while research samples tend to more nearly represent the population ever contracting the disease (an "incidence" sample). The clinician's sample is biased toward cases of long duration, since the probability that a case will appear in a prevalence sample is proportional to its duration, hence "the clinician's illusion." The statistical mechanism of this bias is illustrated and its consequences detailed. Other sources of sampling bias in clinical and research samples are briefly described and partial remedies are suggested.
558 citations
TL;DR: Treatment outcome, which was evaluated primarily in terms of the occurrence of major depression or manic episodes, was significantly related to characteristics of the index episode, ie, the episode that brought the patient into the study.
Abstract: • In a double-blind, long-term follow-up study, 117 bipolar patients received lithium carbonate, imipramine hydrochloride, or both and 150 unipolar patients received lithium carbonate, imipramine, both lithium carbonate and imipramine, or placebo. With bipolar patients, lithium carbonate and the combination treatment were superior to imipramine in preventing manic recurrences and were as effective as imipramine in preventing manic recurrences and were as effective as imipramine in preventing depressive episodes. The combination treatment provided no advantage over lithium carbonate alone. With unipolar patients, imipramine and the combination treatment were more effective than lithium carbonate and placebo in preventing depressive recurrences. The combination treatment provided no advantage over imipramine alone. The lithium carbonate-treated group had fewer manic episodes than the other groups. Treatment outcome, which was evaluated primarily in terms of the occurrence of major depression or manic episodes, was significantly related to characteristics of the index episode, ie, the episode that brought the patient into the study.
546 citations
TL;DR: There was a general tendency toward co-occurrence, so that the presence of any disorder increased the odds of having almost any other disorder, even if DSM-III does not list it as a related disorder.
Abstract: • The diagnostic criteria of the third edition of the DSM-III often state that one diagnosis cannot be made If It is "due to" another disorder. Using data from the National Institute of Mental Health Diagnostic Interview Schedule, with a sample of 11,519 subjects from a community population, we found that if two disorders were related to each other according to the DSM-III exclusion criteria, then the presence of a dominant disorder greatly increased the odds of having the excluded disorder. We also found that disorders, which DSM-III says are related to each other, were more strongly associated than disorders, which DSM-III says are unrelated. However, we also found there was a general tendency toward co-occurrence, so that the presence of any disorder increased the odds of having almost any other disorder, even if DSM-III does not list it as a related disorder. We concluded that empirical studies are needed to study the assumptions underlying the use of a diagnostic hierarchy.
507 citations
TL;DR: In this article, a longitudinal study of major depressive disorder, dysthymic disorder (DD), and adjustment disorder with depressed mood (ADDM) in a school-aged cohort, the predictive validity of each diagnosis was examined.
Abstract: • As part of a longitudinal nosologic study of major depressive disorder, dysthymic disorder (DD), and adjustment disorder with depressed mood (ADDM) in a school-aged cohort, the predictive validity of each diagnosis was examined. Using all available data on the course of the disorders, the criterion was the first subsequent major depressive episode. Major depressive disorder and DD signaled a similarly high risk of a new bout of depressive illness. For the children who recovered from their first episode of major depression and then had their second one (40%), the free interval did not exceed two years; an underlying dysthymia increased the risk of recurrence. Major depression and dysthymia were distinct from ADDM and a set of control disorders; the latter two diagnostic groups were associated with a minimal risk for major depression.
TL;DR: There was a similarity in rates of affective disorders in the relatives of ambulatory and of hospitalized depressed probands (suggesting that ambulatory depressed patients may be as suitable as hospitalized ones for biological studies) and a comparability of rates of illness in relatives between centers for most disorders when comparable diagnostic criteria and procedures were used.
Abstract: A family study of psychiatric disorders in 2,003 first-degree relatives of 335 probands found increased rates of bipolar I disorder and major depression (MD) in the relatives of probands with bipolar disorder and increased rates of MD in the relatives of probands with MD. There was a similarity in rates of affective disorders in the relatives of ambulatory and of hospitalized depressed probands (suggesting that ambulatory depressed patients may be as suitable as hospitalized ones for biological studies) and a comparability of rates of illness in relatives between centers for most disorders when comparable diagnostic criteria and procedures were used.
TL;DR: The findings suggest a relationship between depression and some of the anxiety disorders, and between adult panic disorder and agoraphobia and transmission of anxiety disorders to children.
Abstract: The children (aged 6 to 17 years) of probands with primary major depression, with and without various anxiety disorders, were compared with the children of a matched normal control group. The results from the study of these young children parallel our previous findings among the adult first-degree relatives of these probands. Depression in the proband increased the risk of depression in the children. Depression plus panic disorder or agoraphobia in the proband conferred an additional risk of depression and of an anxiety disorder in the children. Panic disorder in the parents conferred more than a threefold increased risk of separation anxiety in the children. Other factors that increased the risk to children were degree of familial loading for psychiatric illness, parental assortative mating, and parental recurrent depression. The findings suggest a relationship between depression and some of the anxiety disorders, and between adult panic disorder and agoraphobia and transmission of anxiety disorders to children.
TL;DR: Cross-cultural results concerning the prophylactic effects of medication suggest that clinicians should look to the emotional atmosphere in the home for explanations of medication failures.
Abstract: • Our study of the emotional atmosphere of the homes of schizophrenic patients in southern California has replicated British findings concerning the influence of the family environment on the course of schizophrenia. As in the British studies, criticism and overinvolvement expressed by a key relative about the patient at the time of the key admission proved to be the best single predictor of symptomatic relapse in the nine months after discharge from the hospital. Replicating the British results, the association between relatives' expressed emotion and relapse was independent of all other variables investigated. Cross-cultural results concerning the prophylactic effects of medication suggest that clinicians should look to the emotional atmosphere in the home for explanations of medication failures.
TL;DR: In this paper, the authors reported that either cognitive therapy or antidepressant drug treatment can be effective in treating outpatients with primary, nonbipolar depression of moderate or greater severity.
Abstract: • Eighty-seven moderately to severely depressed psychiatric outpatients were randomly assigned to 12 weeks of cognitive therapy (CT) (n = 24), pharmacotherapy (n = 24), CT plus pharmacotherapy (n = 22), or CT plus active placebo (n =17) Seventy patients completed the treatment protocol Seventeen dropped out before the end of the treatment period Patients who completed treatment showed significant improvement in mean scores on two common measures of severity of depression (the Beck Depression Inventory and the Hamilton Rating Scale for Depression) between evaluation and termination Improvement did not differ as a function of the different treatment modalities Inclusion of dropout patients' end-point scores did not alter these results Treatment gains in all groups were maintained at one-month follow-up assessment A portion of this study replicated an earlier study While the results were not identical, they indicated that either CT or antidepressant drug treatment can be effective in treating outpatients with primary, nonbipolar depression of moderate or greater severity Combining treatments did not lead either to additive effects or negative interactions
TL;DR: The FHP subjects (at elevated risk for the development of alcoholism) reported less intense feelings of subjective intoxication after drinking, especially during the two hours following the peak blood alcohol concentration (BAC).
Abstract: • We matched 23 nonalcoholic male drinkers who were aged 21 to 25 years and had alcoholic close relatives (FHP) with 23 control subjects with negative family histories (FHN) for demographic characteristics and drinking and smoking histories. The subjective feelings of intoxication for the 46 men were studied on three occasions using placebo, 0.75 mL/kg of ethanol, and 1.1 mL/kg of ethanol. The FHP subjects (at elevated risk for the development of alcoholism) reported less intense feelings of subjective intoxication after drinking, especially during the two hours following the peak blood alcohol concentration (BAC). Group differences were most marked with the 0.75-mL/kg dose. The two groups did not differ significantly on their BACs nor on the expectation of how they would feel under the influence of alcohol.
TL;DR: A deficit in inhibitory gating of auditory evoked responses was examined in 15 schizophrenic patients, their first-degree relatives, and normal subjects, using a conditioning-testing paradigm with the P50 wave of the auditory evokes response, finding a result that replicates the previous finding of a deficit in inhibition in schizophrenia.
Abstract: A deficit in inhibitory gating of auditory evoked responses was examined in 15 schizophrenic patients, their first-degree relatives, and normal subjects, using a conditioning-testing paradigm with the P50 wave of the auditory evoked response. This paradigm demonstrates inhibition by presenting paired stimuli to the subject; the P50 wave evoked by the second stimulus is reduced because of inhibitory mechanisms activated during the response to the first stimulus. In normal subjects, the mean amplitude of the second P50 response was reduced to less than 20%. In the schizophrenics, the mean amplitude of the second response was more than 85% of the first, a result that replicates our previous finding of a deficit in inhibition in schizophrenia. Approximately half the first-degree relatives, generally including at least one parent, had a similar deficit. Presence of this deficit in the parents was associated with a family history of schizophrenia. Family members with this deficit also had significantly higher scores on several scales of the Minnesota Multiphasic Personality Inventory than did family members without the deficit. Despite the deficit in inhibition, other characteristics of the P50 wave were normal in the relatives, in contrast to unmedicated schizophrenics, who showed additional abnormalities in wave latency and amplitude.
TL;DR: Lymphocyte stimulation by phytohemagglutinin, concanavalin A, and pokeweed mitogen was significantly lower in a group of hospitalized depressed patients than in matched controls, which may be related to the altered neuroendocrine function found in patients with depressive disorders.
Abstract: Lymphocyte stimulation by phytohemagglutinin, concanavalin A, and pokeweed mitogen was significantly lower in a group of hospitalized depressed patients than in matched controls. The absolute number of T and B cells was lower in the depressed group, but the percentage of these cell types did not differ between the groups. These findings may be related to the altered neuroendocrine function found in patients with depressive disorders.
TL;DR: Local cerebral uptake of deoxyglucose labeled with fluorine 18 was measured by positron emission tomography in patients with schizophrenia and patients with affective disorder, sharing a lack of diagnostic specificity with many biologic measures.
Abstract: • Local cerebral uptake of deoxyglucose labeled with fluorine 18 was measured by positron emission tomography in 16 patients with schizophrenia and 11 patients with affective disorder. Patients received no medication a minimum of 14 days and an average of 39.8 days. The subjects were administered the deoxyglucose 18F just before receiving a 34-minute 1/s series of unpleasant electrical stimuli to the right forearm while resting with eyes closed in a darkened, acoustically attenuated psychophysiologic testing chamber. Following monitored stimulation in the controlled environment, subjects were scanned and images converted to values of glucose use in micromoles per 100 g per minute according to Sokoloff's model. Data were analyzed with a four-way analysis of variance (ANOVA) with independent groups (normals, schizophrenics, and affectives) and repeated measures for slice level (supraventricular, midventricular, and infraventricular), hemisphere (right, left), and anteroposterior position (four sectors). Both normal subjects and patients showed a significant anteroposterior gradient in glucose use with highest values in the frontmost sector. Patients both with schizophrenia and with affective illness showed less of an anteroposterior gradient especially at superior levels, which was statistically confirmed by ANOVA. Absolute glucose levels in patients, which were actually higher in posterior regions rather than lower in frontal regions, were the largest contributors to the effect. Neither group differences in whole brain glucose use nor left-right asymmetries reached statistical significance. These results are consistent with our earlier reports of a relative hypofrontal function in schizophrenia compared with controls. This report extends this finding to affective illness, sharing a lack of diagnostic specificity with many biologic measures.
TL;DR: It is suggested that lactate acts, by as yet unidentified mechanisms, to trigger the same panic attacks as occur spontaneously in vulnerable persons.
Abstract: • To assess the pharmacologic and phenomenologic comparability of lactate-induced and naturally occurring panic attacks, patients meeting DSM-III criteria for panic disorder or agoraphobia with panic attacks were infused with 0.5M racemic sodium lactate before and after successful drug treatment. Lactate-induced and naturally occurring panic attacks were symptomatically similar. Following treatment, the patients' response to lactate did not differ from that of normal controls, whereas the pretreatment panic rate was much higher. These data suggest that lactate acts, by as yet unidentified mechanisms, to trigger the same panic attacks as occur spontaneously in vulnerable persons.
TL;DR: The age at onset of schizophrenia was determined in 100 male and 100 female patients who unequivocally met DSM-III criteria for the illness and the sex difference is not readily apparent, but it could be a valuable clue to some of the causes of schizophrenia.
Abstract: • The age at onset of schizophrenia was determined in 100 male and 100 female patients who unequivocally met DSM-III criteria for the illness. Three different indexes of onset were used: first treatment, first hospitalization, and the immediate family's first awareness of psychotic symptoms and signs. The mean age at onset of the male patients was approximately five years earlier than that of the female patients according to all three criteria. About nine of ten male patients, compared with only two of three female patients, became schizophrenic before the age of 30 years. The onset of psychosis after the age of 35 years occurred in 17% of women and in only 2% of men. About 10% of women gave no evidence of psychosis until after the age of 40 years. The reason for the sex difference is not readily apparent, but it could be a valuable clue to some of the causes of schizophrenia.
TL;DR: Pretreatment measures of hypothalamic-pituitary-adrenocortical (HYPAC) function in depressed, manic, and healthy normal subjects showed that nonsuppression on the dexamethasone suppression test (DST) had less positive predictive value for major diagnostic category and was more frequent in normals than recently reported, although it was yet more Frequent in depressed patients.
Abstract: • Pretreatment measures of hypothalmic-pituitary-adrenocortical (HYPAC) function in depressed, manic, and healthy normal subjects showed that nonsuppression on the dexamethasone suppression test (DST) had less positive predictive value for major diagnostic category and was more frequent in normals (8/77) than recently reported, although it was yet more frequent in depressed patients (35/111). Nonsuppression was common in manics (8/16), was similar in unipolar and bipolar depressed patients (35% and 27%, respectively), and did not segregate with melancholic, endogenous, or psychotic depression subtypes. Patterns of post-DST plasma cortisol concentration other than simple escape or nonescape from suppression were common. Nonsuppression of 9amplasma cortisol levels on the DST had as good or better diagnostic specificity as nonsuppression of any of three post-DST samples. Nonsuppression was not completely synonymous with HYPAC hypersecretion. Means of pre-DST HYPAC measures (morning plasma cortisol, urine free cortisol, and CSF cortisol levels) were elevated in depressed patients compared with normals. There were significant differences in HYPAC measures of depressed patients studied at different centers. Age correlated positively and body weight negatively with plasma cortisol level.
TL;DR: More studies will be needed to sort out secular changes in the rates of the occurrence of major depression among young persons (cohort effect) from the high familial loading ofmajor depression that has its onset in childhood and adolescence, and to determine whether the specificity of transmission of early-onset depression is the result of a single homogeneous disorder.
Abstract: • In a family study of 133 probands with major depression and 82 normal control subjects, and 1,518 of their first-degree relatives, we found a substantial inverse relationship between the age of onset of major depression in the probands and the risk of major depression in their relatives. The relatives of probands whose onset of major depression occurred when they were younger than 20 years of age had the highest risk of major depression, compared with the relatives of probands who had later ages of onset or with the relatives of normal subjects. Probands with an age of onset of 40 years or more had familial loading that was only slightly higher than the families of normal control subjects. Our statistical methods enabled us to examine the relationship of the ages of onset in the probands and their relatives while accounting for possible confounding factors. More studies will be needed to sort out secular changes in the rates of the occurrence of major depression among young persons (cohort effect) from the high familial loading of major depression that has its onset in childhood and adolescence, and to determine whether the specificity of transmission of early-onset depression is the result of a single homogeneous disorder.
TL;DR: Both haloperidol and lithium carbonate were found to be significantly superior to placebo in decreasing behavioral symptoms and although both medications were clinically effective, haloperodol was associated more often with untoward effects than was lithium Carbonate.
Abstract: The efficacy and safety of haloperidol, lithium carbonate, and placebo were critically assessed in 61 treatment-resistant, hospitalized children aged 5.2 to 12.9 years with diagnoses of conduct disorder, aggressive type. In this double-blind and well-controlled study, the optimal dosages of haloperidol ranged from 1.0 to 6.0 mg/day and those of lithium carbonate from 500 to 2,000 mg/day. For the assessment of behavioral changes and untoward effects, various rating scales were used in different settings. Both haloperidol and lithium carbonate were found to be significantly superior to placebo in decreasing behavioral symptoms. Although both medications were clinically effective, haloperidol was associated more often with untoward effects than was lithium carbonate.
TL;DR: The view that in a subgroup of patients, episodes of depression and panic anxiety disorder may be manifestations of a common underlying pathogenic process is supported.
Abstract: • A review of the life-time occurrence of major depression, the temporal relationship of major depression to episodes of panic and agoraphobic disorders, and the severity of anxiety and depressive symptoms were determined In 60 patients with agoraphobia or panic disorder. Forty-one (68%) of the patients had a past or current episode of major depression, and 35 (85%) of these patients had endogenous-type major depression. Twenty patients (33%) had an episode of primary major depression, and an average of three years separated the end of primary major depression and the first panic attack. Secondary major depression occurred in 28 patients. Patients with a history of major depression had a more severe anxiety disorder. These data support the view that In a subgroup of patients, episodes of depression and panic anxiety disorder may be manifestations of a common underlying pathogenic process.
TL;DR: Subjects who were treated with desipramine hydrochloride showed marked decreases in a measure of cocaine craving after two to three weeks of treatment and became abstinent regardless of whether an affective disorder was also present.
Abstract: • We conducted an open clinical trial of desipramine hydrochloride or lithium carbonate as adjuncts to psychotherapy in cocaine abusers. Subjects who were treated with desipramine hydrochloride showed marked decreases in a measure of cocaine craving after two to three weeks of treatment and became abstinent regardless of whether an affective disorder was also present. Lithium carbonate was effective only in cyclothymic subjects. Other subjects treated with lithium carbonate, as well as nonpharmacologically treated subjects, continued their cocaine use.
TL;DR: It is suggested that cognitive change may be more accurately seen as a part of improvement rather than the primary cause of improvement, and a more complex conceptualization of the role of cognitions in the change secured by cognitive therapy is suggested.
Abstract: • Twenty-eight moderately depressed outpatients were randomly assigned to 12 weeks of cognitive therapy (N =14) or pharmacotherapy (N =14). Significant changes in mood, cognitive processes, and content were similar to those found in previous studies demonstrating effectiveness of cognitive therapy. Patients treated with medication, however, demonstrated nearly identical change on all measures, including cognitive measures, despite the absence of direct focus on cognitive activity. Further analyses disclosed that cognitive change may be an important feature of overall clinical improvement, as patients whose conditions did not improve (regardless of treatment modality) showed significantly less change on cognitive measures. These findings suggest that cognitive change may be more accurately seen as a part of improvement rather than the primary cause of improvement. This suggests a more complex conceptualization of the role of cognitions in the change secured by cognitive therapy.
TL;DR: There was a marked blunting of the maximal prolactin response to the tryptophan in both the male and female patients, providing strong support for a possible serotonergic abnormality in depression.
Abstract: • There is considerable evidence that serotonergic function may be reduced in the brains of depressed patients. Serotonin is an effective stimulant of prolactin release, and intravenous (IV) tryptophan (the amino acid precursor of serotonin), when administered to healthy subjects, produces a reliable and robust increase in serum prolactin level. To evaluate serotonergic function in depressed patients, we gave 25 patients and 19 age- and sex-matched controls tryptophan, 7 g IV. There was a marked blunting of the maximal prolactin response to the tryptophan in both the male and female patients. The patient control differences could not be accounted for on the basis of age, sex, or time without medications. The data provide strong support for a possible serotonergic abnormality in depression.
TL;DR: Outcome varied little as a function of follow-up interval (time) across all diagnostic categories, except in the realm of symptomatic diathesis, between these major axis I disorders consonant with Kraepelin's original observations.
Abstract: • This report details the long-term course for systematically rediagnosed (and largely chronically ill) patients with schizophrenia (n =163) and with bipolar (n =19) and unipolar (n = 44) affective disorders from the Chestnut Lodge, Rockville, Md, follow-up study. Their conditions were assessed and they are described rigorously from multiple outcome perspectives. Except in the realm of symptomatic diathesis, striking differences emerged between these major axis I disorders consonant with Kraepelin's original observations. Roughly two thirds of the schizophrenic patients were functioning marginally or worse at follow-up, compared with one third of the unipolar cohort. The reverse held for better outcomes. Outcome varied little as a function of follow-up interval (time) across all diagnostic categories. Representative case examples serve to place the ratings in meaningful clinical contexts.
TL;DR: Six sets of operational criteria for diagnosing schizophrenia were applied to a systematically ascertained twin series by raters who were blind to zygosity and to the psychiatric status of the co-twin, resulting in significant monozygotic twin correlations.
Abstract: Six sets of operational criteria for diagnosing schizophrenia were applied to a systematically ascertained twin series by raters who were blind to zygosity and to the psychiatric status of the co-twin. Assuming a multifactorial/threshold model of transmission, twin correlations in liability and, where possible, approximate broad heritabilities were calculated for each criterion. All definitions resulted in significant monozygotic twin correlations. The highest heritabilities (of approximately 0.8) were given by the Research Diagnostic Criteria and by the categories "probable" plus "definite" schizophrenia according to the criteria of Feighner et al. In contrast, Schneider's first-rank symptoms defined a form of schizophrenia with a heritability of 0 and, together with the criteria of Carpenter et al and Taylor et al, proved to be excessively restrictive, identifying fewer than half of the probands as schizophrenic.