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Showing papers on "Depression (differential diagnoses) published in 1968"


Journal ArticleDOI
TL;DR: Atypical depression is, therefore, a common and important complication of the puerperium, about which more needs to be known.
Abstract: It is well known that women are often depressed after child-birth, but only those ill enough to be admitted to hospital have received much study. A random sample of 305 maternity hospital patients was given a questionnaire designed to measure anxiety and depression associated with childbirth in the seventh month of pregnancy and again 6-8 weeks after delivery. Potential depressives, whose scores had increased, and potential controls, free from depression, with unchanged or diminished scores, were thus obtained, and the diagnosis was confirmed or excluded by clinical interview. Depressives were followed up by questionnaire one year later. Thirty-three (10-8 per cent.) subjects developed puerperal depression. In only one of these was the illness classical; in the rest it was atypical. Twelve depressives (3.9 per cent. of the total population studied) had not improved after one year. There were also 19 subjects (6.2 per cent.) with new or exacerbated psychological symptoms who were classified as doubtfully depressed. Depressives differed most from controls in their M.P.I. scores. Their neuroticism scores were highly significantly greater, and their extraversion scores significantly less. It is unsure whether these scores represented their previous personalities, or simply the fact that they were depressed. At probably significant levels, more depressives had a history of recent dysmenorrohea, more had been married for less than three years, fewer had obstetric complications in pregnancy, and more suffered "Maternity Blues" in the early puerperium. There were no significant differences in respect of previous psychiatric, physical or obstetric disorder, age, endocrine abnormality, complicated labour or obvious psychological or social factors. Atypical depression is, therefore, a common and important complication of the puerperium, about which more needs to be known.

594 citations


Journal ArticleDOI
TL;DR: The extent to which psychiatric disability after head injury depends upon the brain damage which has occurred remains a problem of considerable practical and theoretical interest.
Abstract: The psychiatric disability shown by 670 patients with penetrating head injuries has been evaluated, and explored in relation to two measures of the extent of focal brain damage, representing depth and quantity of brain damage respectively. "Psychiatric disability" has been specially defined to include all aspects of intellectual, emotional, and behavioural disturbance, and graded on a three-point scale for the period 1-5 years after injury. Psychiatric disability has been found to correlate to a statistically significant extent with both measures of brain damage, and this has been found to persist after controlling for the distribution of generalized intellectual impairment in the material. Service rank, age at wounding, and overall physical disability during the follow-up period, do not emerge as significant sources of bias for the results. Evidence is presented which suggests that depth of brain damage and quantity of brain damage may each make relatively independent contributions to psychiatric disability as here defined. The duration of post-traumatic amnesia and the incidence of post-traumatic epilepsy have been explored in 670 patients with penetrating head injury, with special reference to the degree of psychiatric disability shown during the 1-5 years after injury. In both cases significant correlations have been observed. Increasing duration of post-traumatic amnesia is associated with an increased incidence of psychiatric disability. Similarly, the development of epilepsy, especially if within one year of injury, is associated with increased psychiatric disability. These results have been used to qualify and amplify the results reported in the preceding part of the paper. The location of focal brain damage has been explored in 345 patients with penetrating head injury, with special reference to the degree of psychiatric disability shown during the one to five years after injury. Left hemisphere lesions are more closely associated with psychiatric disability than right, and there is evidence to suggest that the relationship between psychiatric disability and extent of brain damage is more close within the left hemisphere than the right. Temporal lobe wounds are more closely associated with psychiatric disability than frontal, parietal or occipital lobe wounds. This association is very largely due to injuries of the left temporal lobe. There is some suggestion that right frontal and left parietal lobe wounds may also show a slightly increased association with psychiatric disability. Lesions which produce sensory motor defects are significantly related to psychiatric disability. This special association persists when attention is restricted to defects associated with shallow cortical wounds. It is due principally to defects originating within the left hemisphere, and especially within the left parietal lobe. Lesions which produce visual field defects are significantly related to psychiatric disability. This is due mainly to defects which originate within the left parietal and left temporal lobes. Lesions which produce dysphasia are significantly related to psychiatric disability. This applies equally to dysphasias of parietal or temporal origin. The special association of left temporal lobe wounds with psychiatric disability persists after discarding cases with each of the above neurological symptoms in turn. The component psychiatric symptoms have been examined in 114 patients with penetrating head injury in which psychiatric disability had been rated "severe" during one to five years after injury. The symptoms have been examined individually and when grouped into four main categories—intellectual disorders, affective disorders, behavioural disorders, and somatic complaints without demonstrable physical basis. In addition, two commonly described clinical syndromes have received special consideration—the "frontal lobe syndrome" and the "post-traumatic syndrome". Intellectual disorders and behavioural disorders are shown to be closely related to indices of organic brain damage, as is also the "frontal lobe syndrome". Amongst intellectual disorders, difficulty in concentration is an exception in this regard. Affective disorders as a group do not show this association, though some component symptoms (apathy and euphoria) appear to be closely related to organic brain damage. Somatic complaints and the "post-traumatic syndrome" show no such association. Intellectual disorders as a group occur more commonly after left hemisphere damage, while affective disorders, behavioural disorders and somatic complaints are more frequent after right hemisphere damage. Intellectual disorders are especially associated with damage to the parietal and temporal lobes of the brain. They are less frequent after damage to the frontal lobes than after damage to other parts of the brain. Affective disorders, behavioural disorders, and somatic complaints are more frequent after frontal lobe damage than after damage elsewhere. All component symptoms among the group of behavioural disorders show this special frontal association, and sexual abnormalities and criminal behaviour are found almost exclusively after frontal wounds. Although the "frontal lobe syndrome" occurs, as expected, principally after wounds which involve the frontal lobes, it is also seen in a number of patients whose wounds have not apparently involved the frontal lobes at all. The interrelationships between the different symptoms and symptom groups have been explored. The various symptoms without demonstrable association with extent of brain damage are seen to be closely associated one with another; they include difficulty in concentration, depression, anxiety, and irritability, the group of somatic complaints, and the "post-traumatic syndrome". The results have been interpreted in relation to previous studies of psychiatric disability after head injury, and in the light of current concepts of regional brain function in relation to psychiatric disorder.

291 citations


Journal ArticleDOI
TL;DR: High plasma and urinary corticosteroid levels, a disturbed diurnal rhythm, and adrenocortical resistance to dexamethasone suppression were seen in three patients with severe depression, but these abnormalities of pituitary-adrenal function disappeared with successful treatment of the depression.

136 citations


Book
01 Jan 1968

109 citations




Journal ArticleDOI
TL;DR: In a longitudinal outpatient study, the authors found that lithium produced a mild decrease in depth of depression scores among patients who had been on the drug for more than seven months, as compared with patients whoHad been receiving lithium less thanSeven months.
Abstract: In a longitudinal outpatient study, the authors found that lithium produced a mild decrease in depth of depression scores among patients who had been on the drug for more than seven months, as compared with patients who had been receiving lithium less than seven months. They assess the factors contributing to reported positive clinical results of maintenance lithium treatment in recurrent affective disorder.

65 citations


Journal Article

65 citations


Journal ArticleDOI
TL;DR: It was indicated that depression as a symptom decreases over time and the rate of decrease is not affected by the type of drug regimen employed and amount of change is proportional to the initial level of depression.
Abstract: A review of the existing literature relative to the symptom of depression in alcoholism indicated that this symptom apparently had not come under direct investigation. Accordingly, 73 consecutively admitted alcoholics were given the Zung scale, a 20-item self-report depression scale, at the beginning and end of a 21-day treatment period. A descriptive analysis of the data indicated that 70% of all the alcoholic patients exhibited mild to deep depression. An ANCOVA indicated that depression as a symptom decreases over time and the rate of decrease is not affected by the type of drug regimen employed. A further analysis of depression by levels (low, mild, high) indicated that amount of change is proportional to the initial level of depression. These findings were discussed in regards to traditional treatment and research strategies.

63 citations



Journal ArticleDOI
TL;DR: In community surveys reviewed in this article, prevalence rates for depression are under one per 1,000 population for depressive psychoses and two or three times that for depressive neuroses.
Abstract: In community surveys reviewed in this article, prevalence rates for depression are under one per 1,000 population for depressive psychoses and two or three times that for depressive neuroses. Depressives are regarded in clinical practice as a high-risk group with respect to suicide: in epidemiologic terms there also seems to be a strong association between depression and suicide, leading one to the hypothesis that suicide is the mortality of depressive illness.



Journal ArticleDOI
TL;DR: It is now clear that rheumatoid factor is not specific for r heumatoid arthritis, but occurs in individuals with a wide variety of other diseases characterized by inflamma-tion, infection, and/or granulomatous formation.
Abstract: The existence of agglutinating substances reactive with autologous and isologous human gamma globulin (yG) has been recognized for some time. These substances were first found in patients with rheumatoid arthritis and were consequently termed \"rheumatoid factor\" (RF). It is now clear that rheumatoid factor is not specific for rheumatoid arthritis, but occurs in individuals with a wide variety of other diseases characterized by inflammation, infection, and/or granulomatous formation. Hepatitis, primary biliary cirrhosis, leprosy, syphilis, and subacute bacterial endocarditis are but a few of the other diseases unrelated to rheumatoid arthritis in which some degree ofRF activity has been observed. RF has been detected in a high proportion of aged individuals, and is known to occur occasionally in healthy younger persons. Experimentally, rheumatoid-like factor has been induced in rabbits after repeated immunization with various antigens. Since rheumatoid factors derived from various human sources share the ability to react with some form of yG immunoglobulin, they have been sometimes referred to as \"anti-yG factors\". As part of a survey of the presence of rheumatoid factor in various populations, it was decided to examine patients newly admitted to an acute psychiatric voluntary hospital who were free of coexisting physical illness, known to be associated with RF, and who had not been subjected to long periods of institutional confinement just before testing. This study was originally prompted by the casual observation of transient RF activity in a patient during a period of severe depressive psychosis.





Journal ArticleDOI
01 Apr 1968-Headache
TL;DR: Though headache is common, it is relatively rare to find a single specific illness producing it, even though both the physician and the patient may have convinced themselves that they have, in fact, discovered the etiology in a particular case.
Abstract: THE PHYSICIAN confronted by the patient who complains of chronic face pain or headache not infrequently finds himself in a diagnostic and therapeutic morass. Headache is considered the commonest complaint for which a patient seeks medical aid; though, in truth, the manner in which that oft-quoted statement was obtained has so far eluded this writer. Suffice it to say that headache is an extremely common affliction, and that all physicians who deal with patients are familiar with it. Yet the genesis of an individual's head pain may be most elusive. The reasons for this are multiple. The brain is encased in the cranium and, therefore, relatively impervious to study except by the most indirect and gross methods. Sensation cannot be measured, and many patients describe their complaints poorly. Though headache is common, it is relatively rare to find a single specific illness producing it, even though both the physician and the patient may have convinced themselves that they have, in fact, discovered the etiology in a particular case. Furthermore, headache may be the most benign of symptoms or it may be the only expression of the most malignant of diseases. Some clinical categories of headache are precise and well-defined, but others are not. The patient with a brain tumor may describe his head pain in desultory terms. Patients with migraine may experience agonizing discomfort, yet migraine is usually (but not always) a benign disease.


Journal ArticleDOI
TL;DR: The purpose of the present study was to clinically document the degree of respiratory depression produced by Innovar in surgical patients whose ventilation was not artificially supported.
Abstract: NNOVAR@ is a parenteral solution containI ing a major tranquilizer, droperidol (2.5 mg./ml.), and a narcotic, fentanyl (0.05 mg./ml.) . Human studies have shown droperidol to have little effect on respiration, while fentanyl is a potent respiratory depressant.',, The majority of clinical investigators who have employed Innovar and nitrous oxide for neuroleptanesthesia have utilized technics of assisted or controlled ventilation2-4 to avoid this complication. The purpose of the present study was to clinically document the degree of respiratory depression produced by Innovar in surgical patients whose ventilation was not artificially supported.

Journal ArticleDOI
TL;DR: Evidence is presented further substantiating the hypothesis that changes in the level and timing of adrenal cortical activity in depression represented a response of the pituitary adrenal axis of the depressed patient to the discomfort associated with the depression.
Abstract: IN a previous article,1this research group presented evidence which suggested an alteration in the circadian rhythm of adrenal cortical activity in depression. The data showed that there was not only an increase in the level of serum and urinary 17-hydroxycorticosteroids (17-OHCS) in depressed patients but that the timing of this increase was different in the depressed patients compared to controls. It was pointed out in this article that the alteration in the circadian rhythm of adrenal cortical activity paralleled the changes in mood commonly described in depression. It was suggested that these changes in the level and timing of adrenal cortical activity in depression represented a response of the pituitary adrenal axis of the depressed patient to the discomfort associated with the depression. This article will present evidence further substantiating that hypothesis by showing that the level of adrenal cortical



Journal ArticleDOI
13 Jul 1968-BMJ
TL;DR: Familial investigations are of particular interest in chondrocalcinosis, but are difficult because the disease does not seem to become manifest before the age of 20 years, and because in long-standing cases arthritic alterations predominate and are accompanied by a gradual loss of calcified cartilage, which makes a roentgenological diagnosis difficult.
Abstract: the most reliable and best technique is to determine the presence of C.P.P.D. by x-ray diffraction. This method can be used even when only microscopic specimens of the material are available. Calcification of the meniscus in the knee is very common in chondrocalcinosis. In the roentgenological examination of such cases various projections should be tried in order to visualize also calcifications of the joint cartilage, which are of greater significance in the diagnosis of chondrocalcinosis. The synovial fluid (joint effusion) has been described as milky and was of such appearance in one of our cases at Ljungby. In their series of 33 cases D. Zitfian and S. SitAj' found five pedigrees with 24 cases, and they regard chondrocalcinosis as hereditary, as it affects a greater number of members of one family, passing from generation to generation. It is true that of 80 cases McCarty found only two crystallographically proved examples of familial disease, but three other \" definite \" cases had asymptomatic siblings with typical calcifications on roentgenograms and many others gave histories suggestive of the disease in close relatives. Several other authors have found a familial occurrence of the disease. Perhaps about 60 familial cases are described in the literature. At the department of internal medicine, Lasarettet, Ljungby, we found the disease (with x-ray diffraction) in 4 of 12 siblings. Familial investigations are of particular interest in chondrocalcinosis, but are difficult because the disease does not seem to become manifest before the age of 20 years, and because in long-standing cases arthritic alterations predominate and are accompanied by a gradual loss of calcified cartilage, which makes a roentgenological diagnosis difficult. In the investigation of the mode of inheritance it is also important to find out how many members of a family or of a sibship are not affected or not carriers of the gene for the disease.-I am, etc., CURT W. EKELUND. Department of Medicine, Lasarettet, Ljungby, Sweden.


Journal ArticleDOI
TL;DR: A sample of 344 women, who had Anovlar prescribed in 1964, was investigated by a mailed questionnaire in March, 1966, and no significant relations were found between psychiatric symptoms on the one hand and parity, age, and social group on the other.
Abstract: Questionaires covering personality psychiatric and gynecologic symptoms were administered to 344 women in March 1966. 281 of the patients who had received Anovlar from a Lund clinic in 1964 responded. To determine whether oral contraceptives evoke neurotic symptoms the data were analysed with respect to social parameters duration of use of the pill reasons for discontinuing previous psychiatric symptoms. Age parity marital state and social class had no effect on incidence of psychiatric side effects. Premenstrual tension was improved in 70.9%. Sexual adaptation was increased in 45.3% usually because of security but decreased in 26.0% concomitant with a loss of libido. 69.4% of women discontinuing the pill claimed they experienced psychiatric symptoms or weight gain. The most frequent psychiatric symptoms noted by 48.6% marked in 17% were tiredness irritability sensitivity and depression. Increased psychiatric symptoms were correlated highly with overweight emotional problems during early pregnancy prior use of psychoactive drugs prior psychiatric symptoms and duration of use of oral contraceptives. The authors suggest that these women by given oral contraceptives with caution.