Showing papers on "Depression (differential diagnoses) published in 1976"
1,410 citations
TL;DR: This paper states the case for an abbreviated version of the primary research instrument used in these studies, the Camberwell Family Interview Schedule, and uses it in a replication and extension of the 1972 study on patterns of emotional response of patients' relatives.
Abstract: In a series of studies of the influence of family life on the course of an established schizophrenic illness, it has been shown that the level of emotion expressed by relatives shortly after a schizophrenic patient is admitted to hospital is strongly associated with symptomatic relapse during the nine months following discharge (Brown et al., 1962, 1972). This paper states the case for an abbreviated version of the primary research instrument used in these studies, the Camberwell Family Interview Schedule. In the 1972 study the single most important measure contributing to the overall expressed emotion index proved to be the number of critical remarks made about the patient by the relative when interviewed alone. An analysis of 15 tape-recorded interviews from this study showed that the majority of critical comments were produced within the first hour and there was virtually no relationship between total number of critical comments and length of interview (r = 0.08). This analysis supported the use of a shortened interview in which the areas most likely to produce any criticism were given priority in the sequence of questioning. This abbreviated version has been used successfully in a replication and extension of the 1972 study. A group of 37 schizophrenic patients is being compared with a group of 31 depressed neurotic patients. Patterns of emotional response of these patients' relatives are discussed.
1,038 citations
955 citations
TL;DR: It is suggested that in patients with hyponatremia, symptoms and morbidity are only grossly correlated with either magnitude or duration of hypon atremia and symptoms appear to correlate best with the interplay between a net increase in brain water versus a loss of brain electrolytes.
546 citations
TL;DR: As hypothesized, suicide intent was significantly more correlated with hopelessness than with depression, and when the effect of hopelessness was removed statistically, there was no relationship between suicide intent and depression.
Abstract: • One hundred fifty-four suicide attempters, threateners, and psychiatric controls were rated on suicide intent scales and given tests to assess hopelessness, depression, and self-rated suicide risk. Ninety-four subjects were retested one month later. Both hopelessness and depression were significantly greater in suicidal subjects. In threateners, hopelessness and depression scores differed significantly between high and low suicide intent subjects. In attempters ranked by suicide intent at time of testing, more and less suicidal subjects differed significantly in hopelessness and depression scores. Both depression and hopelessness were sensitive to changes in suicide risk during the one-month follow-up. In all analyses, hopelessness correlated more highly with suicide intent than did depression. The data were regarded as supporting the hypothesis that hopelessness is more closely related to suicide intent than is depression.
297 citations
TL;DR: A review and reformulation of Postpsychotic depression is presented, finding that therapeutic perseverence purportedly can improve the patient's long-term prognosis, and the phenomenon itself may be favorable prognostic sign.
Abstract: • Several authors have described a severe depression in patients emerging from psychotic states. The clinical picture usually resembles that of a retarded depression with strong neurasthenic and schizoid components. It frequently emerges after a patient has been discharged from the hospital and may often go unnoticed. When manifest, the syndrome is usually stable phenomenologically, is often lengthy, and may be resistant to all modalities of treatment. Postpsychotic depression is a relatively neglected clinical area despite the risk of suicide and prolonged suffering. Therapeutic perseverence purportedly can improve the patient's long-term prognosis, and the phenomenon itself may be a favorable prognostic sign. We present here a review and reformulation of this syndrome.
284 citations
TL;DR: It is interpreted to mean that some schizophrenics may prefer an ego-syntonic grandiose psychosis to a relative drug-induced normality.
Abstract: • The extremes of drug compliance were studied in two groups of schizophrenics: 29 habitual drug-refusers who invariably discontinued medication only to be readmitted several months later, and 30 drug-complier patients who habitually came in for their refills or injections of antipsychotic medication. The drug-refusers experienced the resurgence of an ego-syntonic grandiose psychosis after they discontinued medication. The habitual compliers, in contrast, developed decompensations characterized by such dysphoric affects as depression, anxiety, virtual absence of grandiosity, and some awareness of illness. The refusal of these chronic schizophrenics to take their medication could not be attributed to social isolation, paranoid diagnosis, or secondary gain. A discriminant function analysis showed grandiosity to be the most powerful discriminating variable between the two groups. We interpret these findings to mean that some schizophrenics may prefer an ego-syntonic grandiose psychosis to a relative drug-induced normality.
266 citations
TL;DR: An awareness of his patient's psychiatric illness is necessary for the physician to provide effective treatment, as for depression, and to spare the patient needless medications, hospitalizations, and surgery, as with hysteria.
245 citations
TL;DR: It was concluded that patients with parkinsonism suffer a degree of depression which cannot be solely a reaction to the stress of physical disability and is discussed with reference to the monoamine hypothesis of depressive illness.
Abstract: Forty-five patients with parkinsonism were carefully matched for age and sex with 45 chronically disabled control patients with a significantly more severe grade of physical handicap. Depression was measured by the Hamilton Rating Scale, and it was found that the parkinsonian group was very significantly more depressed than the control group (p less than 0-0001). Depression scores in both groups were unaffected by the patients's sex or by the severity of the disability. Analysis of the individual ratings of the Hamilton Scale showed that parkinsonian patients had significantly higher scores on items relating to suicide, work and interests, retardation, psychic anxiety, general somatic symptoms, and loss of insight. It was concluded that patients with parkinsonism suffer a degree of depression which cannot be solely a reaction to the stress of physical disability. This finding is discussed with reference to the monoamine hypothesis of depressive illness.
185 citations
TL;DR: A behavioural test of 5-HT action in animals has been used to clarify the mechanism of its action and the effects of various drugs used clinically in affective disorders.
Abstract: 5-Hydroxytryptamine (5-HT), seems to be involved in depression and perhaps schizophrenia A behavioural test of 5-HT action in animals has been used to clarify the mechanism of its action and the effects of various drugs used clinically in affective disorders
176 citations
TL;DR: Evaluation of the total material after 6 weeks of NT treatment demonstrated a strong correlation of high plasma level to poor antidepressive effect of NT, and a randomized reduction of the plasma level among the patients at the high level resulted in a significant correlation to remission.
Abstract: Below the toxic plasma level of nortriptyline (NT) an upper therapeutic limit has been postulated in patients with endogenous depression. If so the clinical significance is obvious and a double-blind, randomized study was performed in order to solve this problem. Two groups of patients were controlled at different plasma levels ( 180 ng/ml). The degree of depression was rated weekly. Only about one third (n=24) of the patients originally included, were carried through the full protocol, the most prominent reason for drop out beeing spontaneous remission during an initial placebo period. After 4 weeks of NT treatment the majority in the high level group was still depressed, but the difference barely significant (P=5.5%). However, a randomized reduction of the plasma level among the patients at the high level resulted in a significant correlation to remission. Evaluation of the total material after 6 weeks of NT treatment demonstrated a strong correlation of high plasma level to poor antidepressive effect of NT. No correlation could be obtained between side-effects, which were few, and plasma level. The non-proteinbound fraction in plasma was found to 7% (SD 1.83) by simultaneous determinations of NT in plasma and CSF in 13 patients. The variation in the proteinbinding was not likely to invalidate the over all results based on total NT determination. A therapeutic plasma range of 50–150 ng/ml is recommended.
TL;DR: Two groups of patients at opposite ends of the rehabilitation spectrum were identified and Severity of infarct, as measured by the Peel Index, did not differentiate between the two groups.
TL;DR: In a study of 106 predominantly young, lower-social-class men participating in a methadone maintenance program, the authors found that about one-third were moderately to severely depressed as assessed on standard rating scales of depression.
Abstract: In a study of 106 predominantly young, lower-social-class men participating in a methadone maintenance program, the authors found that about one-third were moderately to severely depressed as assessed on standard rating scales of depression. The depressive symptoms were associated with a decrease in social functioning, increase in stress in the past 6 months, and a history of alcohol abuse. Because the combination of depression and drug addiction creates a high risk for suicide, depressive symptoms require early detection and treatment. The authors point to the need for more research on treatment approaches, particularly the use of psychotropic drugs. Language: en
TL;DR: The findings indicate that postpsychotic depression occurs commonly, especially in patients medicated during hospitalization; it is difficult to predict on the basis of the presenting clinical picture; it represents an already existing symptom comlex that remits more slowly than the acute psychosis; and it fails to predict a more favorable outcome for schizophrenia at one year.
Abstract: Postpsychotic depression is an important clinical phenomenon about which little is known. Using data from a cohort of 30 schizophrenic patients, the authors examine the frequency of the syndrome, predictive variables, and its prognostic implications. Their findings indicate that postpsychotic depression occurs commonly, especially in patients medicated during hospitalization; it is difficult to predict on the basis of the presenting clinical picture; it represents an already existing symptom comlex that remits more slowly than the acute psychosis; and it fails to predict a more favorable outcome for schizophrenia at one year.
TL;DR: Treatment with lithium carbonate resulted in a reduction in the frequency of depressive attacks, and there was a suggestion that the depressive attacks that occurred during treatment with lithium Carbonate might be less severe than with placebo treatment.
Abstract: • The efficacy of lithium carbonate as a prophylactic drug against depression in bipolar manic depressive patients was assessed through a double-blind, placebo-controlled study of patients who had histories of recurrent depressions and hypomanias ("bipolar II") The results revealed that treatment with lithium carbonate resulted in a reduction in the frequency of hypomanic episodes However, no reduction in the frequency of depressive attacks was observed with lithium carbonate treatment during the study (mean length of study, approximately 16 months), although there was a suggestion that the depressive attacks that occurred during treatment with lithium carbonate might be less severe than with placebo treatment
TL;DR: There was a high incidence of the personality traits of hypochondriasis, depression, hysteria, and manifest anxiety in the 70 complete denture patients of this study, and the technical quality of complete dentures and the degree of patient satisfaction with the same dentures was low.
Abstract: 1. There was a high incidence of the personality traits of hypochondriasis, depression, hysteria, and manifest anxiety in the 70 complete denture patients of this study. 2. Most patients in this study were satisfied with the complete dentures received. 3. There was no significant relationship between the personality traits of hypochondriasis, depression, hysteria, and manifest anxiety and the degree of patient satisfaction with dentures. 4. There was no significant relationship between the personality traits of hypochondriasis, depression, hysteria, and manifest anxiety and the techinical quality of dentures. 5. There was no significant relationship between the technical quality of complete dentures and the degree of patient satisfaction with the same dentures.
TL;DR: A consecutive three-month study of alcohol-intoxicated patients admitted to the casualty ward showed 24 patients with an initial serum alcohol concentration above 110 millimols/liter showed surprisingly slight depression of the central nervous system (CNS).
Abstract: A consecutive three-month study of alcohol-intoxicated patients admitted to the casualty ward showed 24 patients with an initial serum alcohol concentration above 110 millimols/liter. Eight patients were excluded because of insufficient data. Eight of the remaining 16 patients showed surprisingly slight depression of the central nervous system (CNS). (JAMA236:1600-1602, 1976)
Journal Article•
TL;DR: Psychiatric consultation-liaison services offer the most direct form of collaboration between psychiatry and medicine in the interests of comprehensive patient care and greater emphasis on teaching psychiatric syndromes is called for.
Abstract: 1,000 medical and surgical inpatients referred for psychiatric conSULTATION SHOWED CONCURRENT PHYSICAL AND PSYCHIATRIC DISORDER IN 68.2% of cases. This is in accordance with epidemiological findings that these two types of morbidity have a positive association and coexist in 20-50% of patients. Depression was the commonest psychiatric disorder in all classes of organic disease and accounted for 53% of all psychiatric diagnoses. Organic brain syndromes, acute and chronic constituted 18% of referrals. Almost twice as many women as men were referred despite their nearly equal distribution in hospital population. One-third of the females had no positive medical diagnosis compared to one-fifth of the men. Alcoholism was a major problem in 8.9% of referrals. 7.8% of patients were referred following suicidal attempt. Of the 50 patients with cancer. 66% had depression. Too few medical patients with psychiatric complications are referred and adequately treated. Greater emphasis on teaching psychiatric syndromes is called for. Psychiatric consultation-liaison services offer the most direct form of collaboration between psychiatry and medicine in the interests of comprehensive patient care.
TL;DR: Electroencephalographic sleep patterns suggest that quantification of REM density may be used clinically to distinguish between medical-depressive syndromes and primary affective disorders.
Abstract: • The electroencephalographic sleep patterns of 12 patients with a final diagnosis of primary depression and those of 12 patients admitted to the Clinical Research Unit with this diagnosis, but subsequently also found to be suffering from severe medical disease, were compared. Patients with depression concurrent with severe medical disease have significantly less phasic conjugate rapid eye movement (REM) activity during REM sleep than subjects with the diagnosis of a primary depression. These findings suggest that quantification of REM density may be used clinically to distinguish between medical-depressive syndromes and primary affective disorders.
TL;DR: Life events, particularly exit events and events regarded as undesirable, tend to cluster prior to onset of depression and suicide attempts, and interactions with predisposing and biological causes are probably of great importance.
Abstract: This paper summarizes a series of controlled studies into the relationship of life events to depression and to suicide attempts. Life events, particularly exit events and events regarded as undesirable, tend to cluster prior to onset of depression. These findings are supported by comparisons with general population controls, depressives after recovery, other patient groups, and by studies of relapse. Interactions with predisposing and biological causes are probably of great importance. Suicide attempters are a rather different patient group and they experience a particularly striking accumulation of threatening events. There is a marked peaking of events in the month before the attempt, suggesting a crisis response and the potential relevance of crisis intervention techniques.
TL;DR: It is indicated that ST-segment depression occurs more commonly in the absence than in the presence of chest pain and that ambulatory electrocardiographic monitoring is a useful method of determining the frequency of myocardial ischemia during normal daily activity.
TL;DR: It is found that in chronic painful conditions, needle puncture may be very effective in producing at least transient analgesia, and it also can produce permanent relief of acute (self‐limited) pains.
Abstract: The present study was undertaken in order to investigate the analgesic effect of needle puncture in a small self-selected group of patients with chronic or acute pain, and to examine the factors which determine success or failure of this treatment modality. We have found that in chronic painful conditions, needle puncture may be very effective in producing at least transient analgesia. It also can produce permanent relief of acute (self-limited) pains. Needle puncture was not helpful in the management of pain resulting from nerve damage. High score on psychometric indicators of anxiety and depression is a significant predictor of successful needle puncture analgesia in patients with chronic pain. Comparison of our results to studies of counterirritation indicate that the analgesia produced by needle puncture involves a mechanism similar to that of counterirritation-induced analgesia.
Journal Article•
TL;DR: Data presented by Coppen indicate that women with affective disorder are more likely to report the premenstrual symptom of depression than women with other psychiatric disorders.
Abstract: The relationship between premenstrual affective syndrome and psychiatric disorder was investigated, using 81 women presenting to a Neurology Clinic with functional headache. Premenstrual affective syndrome was significantly associated with a history of depressive syndrome in the population studied. Patients judged to have a non-affective psychiatric disorder reported no greater frequency of definite or probable premenstrual affective syndrome than patients considered psychiatrically normal. The premenstrual occurrence or exacerbation of affective symptoms has been noted. This symptom exacerbation maybe sufficient to require hospitalization. Data presented by Coppen indicate that women with affective disorder are more likely to report the premenstrual symptom of depression than women with other psychiatric disorders. These findings suggest that there may be some relationship between depressive disorder and premenstrual affective symptoms. As part of a larger study on the personality and psychiatric correlates of functional headache, data on the relationship between depressive syndrome and premenstrual affective symptoms were obtained.
TL;DR: The authors present follow-up results based on 150 women 1 year after maintenance treatment for depression, finding approximately 30% of the patients remained in complete remission, 60% experienced recurrence of symptoms, and 12% remained mildly but chronically symptomatic.
Abstract: The authors present follow-up results based on 150 women 1 year after maintenance treatment for depression. Maintenance treatment consisted of 8 months of amitriptyline, psychotherapy, or a combination of the two, administered by random assignment following recovery from an acute depressive episode. Approximately 30% of the patients remained in complete remission, 60% experienced recurrence of symptoms, and 12% remained mildly but chronically symptomatic. The implications of these findings for planning care for the ambulatory depressed patient on both an individual and a public health basis are discussed.
TL;DR: In this paper, the concentration of whole-blood 5-HT was significantly lower during depression, but returned to normal after clinical recovery, in thirty-five depressive patients not on antidepressants and in comparable control subjects.
Abstract: Whole-blood 5-HT was examined in thirty-five depressive patients not on antidepressants, and in comparable control subjects. The concentration of whole-blood 5-HT was significantly lower during depression, but returned to normal after clinical recovery.
TL;DR: This study suggests that safe and effective stress testing may be accomplished not only in persons with normal resting ECGs but also in selected patients who have abnormal ST segments at rest.
Abstract: Near maximal graded exercise tests and coronary angiograms were compared in 37 patients with a history of chest pain and with ST segment depression at rest, who were free of obvious nonischemic causes of ST depression. Additional ST depression of 0.1 mV or more occurred with exercise in 26 patients and 23 of these had obstruction of one or more coronary arteries (sensitivity = 0.92). Eleven patients showed no additional ST-segment depression with exercise, and nine of these had normal coronary angiograms (specificity = 0.75). Patients with no increase in ST depression on exercise developed the highest heart rates; those with asymptomatic additional ST depression achieved intermediate rates; and those with anginal attacks during testing demonstrated the least heart rate acceleration. Those with less coronary obstruction exercised longer on the treadmill than those with more obstruction. Those showing added ST depression were predominantly men (18 of 26) and were older (mean 54 years) than those who did not (mean 44 years). No test complications were encountered. This study suggests that safe and effective stress testing may be accomplished not only in persons with normal resting ECGs but also in selected patients who have abnormal ST segments at rest.
TL;DR: Group A members were older, living with a spouse less often, and had low incomes, while Group I members showed much more cerebrovascular disease, incontinence, recent loss of independence in the activities of daily living, dementia, recent hospitalization, loneliness, and depression.
Abstract: As part of a study of long-term institutional care of the elderly, this report presents a comparison of the characteristics, health problems, and state of mind of 193 elderly applicants for such care (Group A) with those of 141 elderly persons living independently in the community (Group I). Group A members were older, living with a spouse less often, and had low incomes. They showed much more cerebrovascular disease, incontinence, recent loss of independence in the activities of daily living, dementia, recent hospitalization, loneliness, and depression. They had had much less recent involvement in social and recreational activities, although most had not been socially isolated. They had received more extensive help from relatives and friends, and it seemed unlikely that additional help from these sources would keep many more of these elderly persons out of institutions. Community agencies and services had been used by a relatively low proportion of Group A, and hardly at all by Group I.