Showing papers in "British Journal of Psychiatry in 1983"

The prognosis of depression in old age.

Abstract: The paper describes a one year prospective study of 124 elderly depressed patients. Only one third of the group had a good outcome. Poor outcome was associated with severity of initial illness, those with depressive delusions having a particularly poor outcome. Outcome was also influenced by physical health problems and severe life events in the follow-up year. Social class differences in outcome were thought to be due to class differences in the experience of severe life events. There was no evidence that an intimate relationship protected against relapse in the face of continuing life stress.

Cavernosal alpha-blockade: a new technique for investigating and treating erectile impotence.

Abstract: Intravacernosal injection of phenoxybenzamine, in a dose too small to have significant general effects, caused full erection lasting between half an hour and 30 hours in 30 of 4 potent men (2 normal, 2 anorgasmic) and in 6 of 11 impotent men. In the remaining potent man and 3 of the remaining eleven impotent men have had sexual intercourse, for the first time for months or years, while under the drug. The practical implications of this new discovery are discussed.

Social phobia: a comparative clinical study.

Abstract: Eighty-seven people with the symptom of social phobia were compared with 57 people with the symptom of agoraphobia to determine whether these symptoms were part of distinct syndromes. Comparisons were made on demographic, clinical and questionnaire data. Significant differences were found on important variables. The social phobics were younger and more often male, unmarried, and from social classes I and II. The pattern of phobic situations was different in the two groups and so was the pattern of autonomic symptoms experienced in these situations. Symptoms visible to others were more frequent among social phobics. Fainting was more frequent among the agoraphobics.

Sadistic fantasy, sadistic behaviour and offending.

Abstract: This paper explores the genesis of sadistic behaviour in men and its relationship to crime Sixteen male special hospital patients, each with a diagnosis of psychopathic disorder, formed the basis of this descriptive study In only three cases were the crimes explicable in terms of external circumstances and personality traits The offences of the remaining 13 cases became comprehensible only when the offender's internal circumstances were explored: investigation revealed repetitive sadistic masturbatory fantasies which had spilled over into overt behaviour because the patients had felt impelled to seek and create increasingly dangerous in vivo 'try-outs' of their fantasies The paper discusses the crucial link between sadistic fantasy and behaviour

Family history study of anorexia nervosa and bulimia.

Abstract: The 420 first-degree relatives of 14 patients with anorexia nervosa, 55 patients with bulimia, and 20 patients with both disorders were evaluated for the presence of psychiatric illness, using DSM-III criteria, by the family history method. The morbid risk for affective disorder in the families of the eating disorder probands was similar to that found in the families of patients with bipolar disorder; but was significantly greater than that found in the families of patients with schizophrenia or borderline personality disorder. These results add to the growing evidence that anorexia nervosa and bulimia are closely related to affective disorder.

Decreased imipramine binding in the brains of patients with depressive illness.

Abstract: The binding of tritiated imipramine was significantly reduced in the hippocampus and occipital cortex from a series of patients with depressive illness compared with age-matched patients with no psychiatric disorder. In contrast there was no change in imipramine binding in established cases of senile dementia of Alzheimer-type. Scatchard analysis indicated normal binding affinity but a reduction in the number of imipramine binding sites in depression. These observations parallel previous findings of decreased binding sites in platelets from depressed patients and suggest there may be an abnormality in the uptake mechanism for serotonin in depression.

Dexamethasone suppression test in depression and other psychiatric illness.

Abstract: The prevalence of an abnormal response to the dexamethasone suppression test (DST) was examined in 119 in-patients suffering from a major depressive disorder and in 79 normal controls. Only 11 per cent of controls showed an abnormal DST as against 70 per cent of depressed patients. The specificity of the DST was examined by testing patients with other psychiatric disorders. Abnormal responses were found in one-fifth of a sample of schizophrenics, over one-quarter of abstinent alcoholics, two-fifths of neurotics (including neurotic depressives) and almost half of senile dements. Abnormal DST was also found in 33 per cent of patients receiving prophylactic lithium for recurrent affective disorders.

Comparison of research diagnostic systems in an Edinburgh community sample.

Abstract: Four research diagnostic schemes are compared in one community sample. The prevalence of psychiatric disorder ranged from 8.7 per cent (ID-Catego, threshold and definite) through 13.7 per cent (RDC, probable and definite) to 20.3 per cent (Bedford, borderline and definite). The main comparison made is between the PSE/ID/Catego and SADS/RDC systems. Sixty-one per cent of cases are identified as such by both these schemes. There is poor agreement about labelling; only 56 per cent of cases of depression and 16.7 per cent of cases of anxiety are so diagnosed by both systems. A post hoc check list was used to identify Bedford cases; all bar one were found to fulfil RDC and PSE case criteria. The results are compared with those from other centres which have used the same diagnostic criteria in community studies.

Clinical characteristics of akathisia. A systematic investigation of acute psychiatric inpatient admissions.

Abstract: Assessment of drug-induced movement disorders was carried out regularly on 104 psychiatric patients requiring antipsychotic medication on admission to hospital. The data relevant to motor restlessness were subjected to a principal components' analysis. According to their component scores, patients were then classified into two main groups: an akathisia group and an illness-related-movement group, the former group showing the clinical and pharmacological characteristics expected of akathisia. Clinical features which distinguished between the two groups, and between grades of akathisia severity, were identified, so an objective, phenomenological description of the akathisia syndrome was possible. Our observations suggested two distinct types of acute akathisia; one related to severe parkinsonism and one not. The implications of these findings are discussed.

Binge-eating and self-induced vomiting in the community. A preliminary study.

Abstract: This study examined by questionnaire the prevalence of binge-eating and self-induced vomiting among a sample of 369 consecutive attenders at a family planning clinic. 20.9 per cent reported current episodes of uncontrollable and excessive eating ('binges'), 2.9 per cent currently induced vomiting as a means of weight control; and 4.9 per cent reported using laxatives. Binge-eating and self-induced vomiting were strongly associated with disturbed attitudes to food, eating, body weight and shape; and with psychiatric disturbance. Menstrual dysfunction was not associated with either body weight or binge-eating; it was however associated with psychiatric state. Applying conservative rules, 1.9 per cent appeared to fulfil diagnostic criteria for the recently described syndrome bulimia nervosa.

Psychiatric symptoms in dermatology patients.

Abstract: The 30-item General Health Questionnaire (GHQ) (Goldberg, 1972) was administered to 196 consecutive new dermatology out-patients and 40 consecutive admissions to dermatology beds. Thirty per cent of the out-patients and 60 per cent of the in-patients obtained high scores, while half the high scorers in each group scored high on the Wakefield Self-Assessment Depression Scale (Snaith et al, 1971). These findings suggest that dermatology out-patients have a higher prevalence of psychiatric disorder than the general population, and dermatology in-patients a higher prevalence than general medical in-patients. High GHQ scores were associated with (a) diagnoses of acne, eczema, psoriasis or alopecia; with (b) extensive lesions on exposed parts of the body; and with (c) the use of high potency topical steroid. We indicate other areas that might be profitably explored in a full-scale study.

A four-year follow-up of hyperactive boys with and without conduct disorder.

Abstract: A four-year follow-up of clinically selected hyperactive boys with and without associated conduct disorder investigated their outcome during early adolescence and was taken from a structured behavioural interview and standard psychological testing. Boys originally diagnosed as "purely" hyperactive continued to be inattentive and impulsive at follow-up, but showed very few aggressive and antisocial behaviours. Hyperactive boys who had earlier been undersocialized and aggressive continued to have problems with attention and impulsivity, were reported to be aggressive, noncompliant, egocentric, exhibiting antisocial behaviours and using alcohol. These findings suggest that antisocial and delinquent behaviour often reported in follow-up studies of hyperactive boys may be linked to childhood aggression and unsocialized behaviour, rather than the syndrome of hyperactivity.

Controlled comparison of aversive therapy and imaginal desensitization in compulsive gambling.

Abstract: Twenty compulsive gamblers were randomly allocated, half to receive aversion-relief therapy and half to receive imaginal desensitization; both groups were followed-up for one year. Compared with those who received aversion-relief, gamblers who received imaginal desensitization reported a significantly greater reduction of gambling urge and behaviour; they also showed a significant reduction in trait anxiety at one year and in state anxiety at one month and one year following treatment. A high level of state anxiety at one month following treatment predicted failure to respond to treatment at one year in the subjects who received imaginal desensitization, but not in those who received aversion-relief. The relationship between reduction in anxiety and in gambling urge in response to imaginal desensitization was predicted from the theory that compulsive gambling is driven by aversive tension.

Psychiatric disorder in women from an Edinburgh community: associations with demographic factors.

Abstract: The prevalence of psychiatric disorder was determined according to alternative diagnostic criteria in a random sample of 576 women from an Edinburgh community. Whichever diagnostic system was applied, significantly higher rates of disorder were found among the working class, the unemployed and women who were divorced, widowed, separated or cohabiting; in the subgroup of women who met all these conditions, up to half were found to satisfy the diagnostic criteria. The observed prevalence estimates can be explained as the effects of each demographic factor acting independently, no interaction effects being needed. Our results are discussed in relation to the findings of others, and in terms of the statistical issues involved.

The role of perceived parental rearing practices in the aetiology of phobic disorders: A controlled study

Abstract: The perceived parental rearing practices and attitudes of social phobics, agoraphobics, height phobics and non-patient normal controls were investigated, employing the EMBU, an inventory for assessing memories of upbringing. Findings revealed that, as compared with the controls, social phobics and height phobics scored both parents not only as lacking in emotional warmth, but also as having been rejective and overprotective. Agoraphobics reported both parents as having lacked emotional warmth, but only their mothers as being rejecting. Interestingly, the perception of negative rearing practices of parents appeared to be stronger in height phobics than in either social phobics or agoraphobics.

Relationship between neurosis and personality disorder.

Abstract: 316 psychiatric patients--predominantly out-patients--with a clinical diagnosis of neurosis (International Classification of Disease), were given an interview schedule for assessing personality disorders. Nearly two fifths were rated as having personality disorder, the anankastic type being the most common and sociopathic personality disorder the least. Patients with anxiety, phobic and obsessional neurosis were all significantly more likely to show personality disorder than those with depressive neurosis. Broadly, passive-dependent personalities were linked to anxiety neurosis, anankastic personality disorder to obsessional neurosis, and both anankastic and passive-dependent personalities to phobic neurosis. In a clinical trial of the efficacy of two dosage regimes of phenelzine in 60 patients the presence of personality disorder significantly impaired clinical outcome. The results suggest strongly that the assessment of personality in neurotic disorders is necessary to make an adequate diagnosis and predict the outcome of treatment.

Prognostic implications of the sex of schizophrenic patients.

Abstract: In two follow-up studies of a total of 175 patients, carried out approximately eight years after first hospitalization, men were under hospital care more often and for more prolonged periods than women, but used outpatient services less. At the end there were only small differences in clinical condition between the sexes, but social condition, as depicted by social adjustment, psychosexual situation and work adjustment, was clearly poorer in men than in women. This was perhaps a reflection of the men's poorer premorbid psychosocial development and social role. The differences between the sexes in the prognosis for schizophrenia are considered.

The development of sex differences in infantile autism.

Abstract: Seventy-five autistic children, 52 males and 23 females, were admitted to the Iowa Autism Programme over a 3-year period. An overall male-female ratio of 2.26:1 was found, but in the patients with IQs less than 50, the ratio was 1.31:1. When IQ and receptive language functioning were considered together, significantly more females than males showed a more deviant form of autism. Autistic females were more seriously affected than autistic males; and more autistic females than males had IQs of less than 50 and evidence of cerebral dysfunction. However, when autistic males and females were closely matched in chronological age and receptive language functioning, the males and females were equally impaired in cognitive and perceptual-motor abilities. The findings suggest that the overall greater degree of morbidity in autistic females was accounted for by a significantly greater proportion of autistic males affected with a mild form of autism, whereas a significantly greater proportion of autistic females were affected with a more deviant form of autism. The findings were linked to the hypothesis of differential genetic loading in males and females.

Corpus callosum thickness in chronic schizophrenia.

Abstract: In an effort at replication of the original report (Rosenthal and Bigelow, 1972) of increased callosal thickness in schizophrenic brains, the corpus callosum was measured in a blind study of 64 brains autopsied between the years 1972 and 1976. Diagnosis was established by independent chart review. The mean corpus callosum mid sections of 21 early onset chronic schizophrenic brains were found to have a significantly greater thickness when compared with 8 subjects with late onset schizophrenia, 13 patients with neurological diagnoses, or 14 patients with other psychiatric diagnoses. These studies, if independently confirmed, should provide an impetus for testing the hypothesis that some chronic schizophrenic patients have an illness associated with a pathological process in the corpus callosum.

Dexamethasone Suppression Test and Serum Prolactin in Dementia Disorders

Abstract: The dexamethasone suppression test (DST) was performed on 21 patients with dementia of the Alzheimer type (DAT), 11 patients with multi-infarct dementia (MI) and 14 healthy controls. Twelve of the DAT patients and eight of the MI patients showed abnormal lack of suppression, compared with just one member of the control group. Abnormal DST was related to dementia as such and not to age or depression, or to levels of CSF monoamine metabolites. Basal serum prolactin concentrations were not increased.

Suggestibility, intelligence, memory recall and personality: an experimental study.

Abstract: A new suggestibility test, potentially useful in the context of police interrogation, was administered to 45 subjects who also completed the Wechsler Adult Intelligence Scale and the Eysenck Personality Questionnaire. Suggestibility was significantly related to low intelligence, poor memory recall, neuroticism and social desirability.

Electroconvulsive therapy and complaints of memory dysfunction: a prospective three-year follow-up study.

Abstract: Self-reports of memory problems have been evaluated prospectively in depressed patients receiving bilateral ECT or unilateral ECT, and in depressed patients receiving treatments other than ECT. Depressed patients did not complain of poor memory at seven months after hospitalization. Compared to bilateral ECT, right unilateral ECT was associated with only mild memory complaints. At three years after treatment approximately one-half of the persons who had received bilateral ECT reported poor memory. These reports seemed to be influenced by three factors: (1) recurrence or persistence of conditions that were present before ECT; (2) the experience of amnesia initially associated with ECT and a subsequent tendency to question if memory had ever recovered; and (3) impaired memory for events that had occurred up to six months before treatment and up to about two months afterwards.

Was insanity on the increase? The fifty-sixth Maudsley Lecture.

Abstract: At the autumn meeting of the Medico-psychological Association in 1871, Maudsley—that time President of the Association—reada paper entitled 'In Issanity on the Increase?. The question was then one of profound concern both to the British public and to psychiatrists. Not only had there been for years a constant need to build new asylums—a cause ‘of terrible discouragement and complaint with the ratepayers’ (Arlidge, 1859)—but also, as was clearly apparent in the publications of the Poor Law Office and the Annual Reports of the Commissioners in Lunacy, the number of the registered insane was increasing every year, far out of proportion to the increase in the population (see Fig 1). This circum stance, it was said, ‘miwghetll give rise to alarming apprehension of a mental degeneracy’ in the country (Arlidge, 1862).

Dreaming: The functional state-shift hypothesis. A neuropsychophysiological model.

Abstract: The different brain functional states during sleep and wakefulness are associated with differences in processing strategies, memory stores, and EEG patterns. Shifts of functional state occur spontaneously or as orienting reactions to processed information, and cause the formal characteristics of dreams. Forgetting of dreams is a function of the magnitude of the difference between states during storage and recall. Based on EEG similarities between sleep stages and developmental stages, brain states during sleep in adults are proposed to correspond functionally with waking states during childhood. Repeated functional regressions occur during sleep, with access to earlier memory material and cognitive strategies unavailable during waking life, so that earlier experiences can be used for current problems. This dream work constitutes the biological significance of sleep.

Life events precipitating mania.

Abstract: A study of 20 manic patients, with patient and matched control comparisons, showed a two fold increase in life events during the 4 month period before admission to hospital. Life events, independent of affective illness and having significant objective negative impact (i.e. traumatic) were significantly more common. These findings are considered in relation to social relationships, family history of affective illness and the use of psychotropic medication.

Depression in chronic schizophrenia.

Abstract: Eighteen depressed chronic schizophrenic out-patients were matched with non-depressed schizophrenic out-patients. The depressed schizophrenics had had significantly more psychiatric admissions, past depression, past treatment for depression, significantly more had attempted suicide, lived alone, had low self-esteem, had early parental loss and had had more life events in the six months before the onset of depression. Depressive disorder in schizophrenic out-patients well controlled by neuroleptics may occur in those who are at risk for depression and experience an excess of life events.

Distress or illness? A study of psychological symptoms after myocardial infarction.

Abstract: Three groups of patients were identified during a study of men who had recently suffered an acute myocardial infarction: those with psychiatric morbidity antedating the infarction and those with no significant psychopathology. Compared to the other two groups, patients with psychiatric morbidity before the infarction were more likely to be unmarried, unemployed and to have received previous psychiatric treatment. They also obtained higher scores for neuroticism and psychoticism on personality assessment. Patients whose symptoms have been precipitated by the infarction resembled the psychologically healthy group with regard to their demographic characteristics and personality. Their symptoms tended to be transient, improving without special psychiatric treatment.

Mood change following bilateral hemisphere brain injury

Abstract: Fifteen patients with bilateral hemisphere brain injury secondary to thromboembolic stroke or trauma were evaluated for depression, cognitive impairment, and functional physical impairment. Analysis of CT scans and standardized mood scales revealed that patients with left anterior brain injury were significantly more depressed than patients without such injury. Depression severity was directly and significantly correlated with left lesion proximity to the frontal pole. Left lesion age, lesion temporal sequence, right lesion location, cognitive impairment, and functional physical impairment did not significantly correlate with depression. Depressive symptomatology previously shown to be associated with single left frontal lobe lesions appeared to dominate post-brain injury psychopathology regardless of location or temporal sequence of other brain lesions.

Cushing's syndrome and depression--a prospective study of 26 patients.

Abstract: Of 26 patients with active Cushing's syndrome assessed before and at three and 12 months after treatment, 21 had pituitary-dependent disease. Median urinary free cortisol values (per 24 hours) were 680, 180 and 200 nmol at zero, three and 12 months (normal less than 270 nmol), with significant improvement (P less than 0.001) at three and 12 months. Depression on the Hamilton rating scale was significantly less at three months (P less than 0.01) and at 12 months (P less than 0.001). We have already demonstrated that some patients with Cushing's syndrome have PSE diagnoses of depression and are more depressed than patients with other pituitary tumours. This is the firmest evidence to date that when Cushing's syndrome occurs it commonly causes depressive illness.