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

"Atypical" depression following childbirth

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.

Brain Damage in Relation to Psychiatric Disability After Head Injury

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.

Experimental Analysis of Drinking Patterns of Alcoholics: Concurrent Psychiatric Observations

Abstract: Psychiatric observations of mood, thought content, and social behavior of 12 volunteer subjects prior to, during, and following an experimental drinking situation were carried out. Contrary to commonly-held impressions concerning alcoholics, most of the subjects experienced an increase rather than a decrease in anxiety and depression; no subject reported subjective craving for alcohol following his first drink; the subjects maintained a high degree of social interaction with other patients and disruptive behavior was rare.

Perinatal deaths associated with mepivacaine paracervical-block anesthesia in labor.

Abstract: Fetal bradycardia and depression at birth have previously been reported with varying frequency after paracervical block given for the relief of pain in the first stage of labor. This report concerns the death of two infants occurring after mepivacaine paracervical block. The first experienced prolonged bradycardia and was stillborn. Bradycardia in the second coincided with maternal analgesia. This infant subsequently had convulsions and died. Mepivacaine was found in the urine. Other investigators have detected mepivacaine in depressed infants born after caudal and lumbar epidural anesthesia. Rapid passage of mepivacaine into the fetal circulation, impaired detoxification in the newborn period and increased acidosis in the perinatal period have been noted. Further study of the obstetric use of local anesthetics, and especially their paracervical administration, is imperative.

The Use of Lithium in Affective Disorders: II. Prophylaxis of Depression in Chronic Recurrent Affective Disorder

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.

Depression as a symptom of alcoholism: search for a phenomenon.

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.

Replication Of Symptom Distress Factors In Anxious Neurotic Outpatients.

Abstract: In an attempt to replicate the factor structure of symptom distress re- ported by Mattsson et al. in their study of 404 anxious neurotic outpatients, the same 68-item pretreatment self-report Symptom Check List was administered to an independent but clinically similar sample of 1,116 patients. Using an identical factor-analytic procedure, five useful factors were extracted: Neurotic Feelings, Somatization, Performance Difficulty, Fear-Anxiety, and Depression. Four of these factors were almost identical to those reported by Mattsson e t al. while the fifth factor, Depression, seemed to represent a composite of the two small Depression factors (Anxious and Somatic) found in the earlier study. This minor discrepancy was discussed and the future research potential of these factors was indicated.

Controlled Heart Rate by Atrial Pacing in Angina Pectoris A Determinant of Electrocardiographic S-T Depression

Abstract: This study was undertaken with a consideration of the physiological relationship between myocardial oxygen consumption and heart rate. Atrial pacing was performed in 63 resting subjects, 36 of whom had been referred for evaluation of angina pectoris. Pacing at critical controlled heart rates evoked angina pectoris in six patients of this group with chest pain and, consistently and more frequently, produced significant S-T segmental depression in 28 patients as a manifestation of myocardial ischemia. The functional test employing controlled heart rates has several advantages over other stress tests. The use of the sole stress of controlled atrial tachycardia is a new technique which has provided relatively safe, reproducible results in the objective evaluation and investigation of myocardial ischemia.

The Epidemiology of Depression—A Review

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.

Increase of "Antianxiety" Activity and Tolerance of Behavioral Depression during Chronic Administration of Oxazepam*

Abstract: Summary. Oxazepam has two opposing actions on behavior: a responsedecreasing or depressant action and a response-increasing or disinhibitory action. The course of the two actions in chronic dosing was determined in rats in a test in which punished and unpunished schedules of reinforcement were alternated. The depressant action (measured by a decrease in the rate of unpunished behavior) was observed to undergo tolerance after 3--4 doses, while the disinhibitory action (measured by an increase in the rate of punished behavior) failed to show tolerance and even increased throughout the chronic series. The selective tolerance of the depressant action is probably due to neuronal adaptation, but changes in metabolism also may be involved. The increase in the rate of punished behavior is attributed, at least in part, to a progressive unmasking of the disinhibitory action as tolerance to the depressive action develops.

Depression: the distinction between syndrome and symptom.

Abstract: Few psychiatric controversies have been as persistent as the disagreement surrounding the nosology of depression. The conflict centres on the question of whether depression is a single illness, with its many faces manifestations of individual idiosyncrasy and severity, or whether it constitutes two or more separate conditions. The 1926 debate at the British Medical Association Meetings, with Edward Mapother (11) propounding the case for a single illness and Buzzard and Ross advancing claims for a dichotomy, has in one form or the other continued until today. The issue is complicated by the fact that few terms in psychiatry are used with as many different meanings as depression. Unfortunately the use of the term is seldom clearly defined. As Humpty Dumpty said in Through the Looking-Glass, “it means just what I choose it to mean—neither more nor less”.

Rheumatoid factors in an acute psychiatric population.

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.

Some reflections on the etiologic role of depression in head pain.

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.

Innovar-induced respiratory depression.

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.

The relationship between antigammaglobulin activity and depression.

Abstract: Measurements of rheumatoid factor were done on the sera of 86 patients consecutively admitted to an acute psychiatric service. Sixty-three percent of those with endogenous depressions and 35 percent of those with schizophrenia had positive titers. When the schizophrenic patients were subdivided on the basis of affective state, it was found that 65 percent of those with depressive symptoms, and only 21 percent of those without depressive symptoms, had positive titers. The authors conclude that depression would seem to be associated with a nonspecific effect involving immunological mechanisms.

Circadian rhythm of adrenal cortical activity in depression. II. A comparison of types in 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