Diagnosis Of Major Affective Disorder Research Articles

Differential associations of affective temperaments and diagnosis of major affective disorders with suicidal behavior

BackgroundAffective temperaments are associated with suicidal risk, but their predictive value relative to diagnosis of major affective disorder is uncertain. MethodsWe compared diagnoses, affective-temperament ratings (TEMPS-A), and other potential risk factors in 956 psychiatric inpatients, using bivariate analyses and multivariable logistic regression modeling for associations with suicidal status. ResultsLifetime suicide-attempt rates were high (43.9% overall), ranking by diagnosis: bipolar-II (58.4%), major depressive (50.0%), bipolar-I (44.6%), other (38.0%), and psychotic (33.9%) disorders. TEMPS-A scores for depressive (dep), cyclothymic (cyc), irritable (irr), and anxious (anx) temperaments and their sum were strongly associated with suicidal risk; hyperthymic (hyp) temperament scores were inversely associated; and a composite measure (dep+cyc+irr+anx – hyp), even more strongly associated. The composite score was highly, independently associated with suicidal behavior (p<0.0001), as was female sex (p=0.0002), but older age and diagnosis of major affective disorder, much less (both p=0.02). ConclusionsMeasures of affective temperament-types were independently and more strongly associated with lifetime suicide attempt than was diagnosis of a major affective disorder. However, in this hospitalized cohort, suicide rates were high across diagnoses, possibly limiting the predictive value of diagnosis.

Periventricular white matter hyperintensities as predictors of suicide attempts in bipolar disorders and unipolar depression

The aim of this study was to evaluate whether deep white matter hyperintensities (DWMH) and periventricular white matter hyperintensities (PVH) are associated with suicidal behavior in patients with major affective disorders. Subjects were 99 consecutively admitted inpatients (42 men; 57 women; mean age: 46.5 years [SD = 15.2; Min./Max. = 19/79]) with a diagnosis of major affective disorder (bipolar disorder type I, bipolar disorder type-II and unipolar major depressive disorder). 44.4% of the participants had made at least one previous suicide attempt. T2-weighted brain magnetic resonance images were rated for the presence and extension of WMH using the modified Fazekas scale. Patients were interviewed for clinical data on average 5 days after admission. Bivariate analyses, corrected for multiple-testing, and logistic regression analysis were used to test the association between suicide attempts and clinical variables. Attempters and nonattempters differed only in the presence of PVH—the former were more likely to have PVH. The logistic regression indicated that the presence of PVH was robustly associated with suicidal behaviors after controlling for age (OR: 8.08). In conclusion, neuroimaging measures may be markers of risk for suicidal attempts in patients with major affective disorders.

Mental health service utilization among long-term cancer survivors

Although generally well-adjusted, a subset of cancer survivors have been observed to experience ongoing psychological distress. There has been little study of mental health care utilization among cancer survivors, however. We identified a cohort of cancer survivors continuously enrolled in a managed care organization who were alive at least 5 years after a diagnosis of cancer and without evidence of recurrence. We matched them each to four controls without a history of cancer based on age, sex, and clinic location. We then obtained their health care claims and evaluated their health care utilization along with explanatory variables such as cancer type, non-cancer comorbid conditions, and types of health care providers seen. One thousand one hundred eleven survivors were matched to 4,444 controls. Cancer survivors were more likely than controls to have a mental health diagnosis (33.5 vs. 30.3%, p < 0.05), accounted for mostly by anxiety and sleep disorders. Other predictors of receiving any mental health diagnosis on multivariable analysis were age: Odds Ratio (OR) 0.99 (95% Confidence Interval (CI) 0.99-0.99) for each year; male sex: OR 0.87 (95% CI 0.77-0.99), and comorbidity: OR 0.56 (95% CI 0.49-0.64) for each point on the Charlson scale. The largest subgroup was breast cancer survivors, who were more likely to have a diagnosis of major affective disorder than were female survivors of other cancers. Survivors had more outpatient medical visits in general (mean 27.4 versus 21.9, p < 0.001) and specifically more mental health visits (2.5 versus 1.7 on average, p < 0.001) than did controls. Long-term cancer survivors have increased rates of mental health care utilization. Given the size and growth of the survivor population, this represents a significant amount of ongoing distress with important health resource allocation implications for policy makers.

PII: S0022-3999(05)00155-8

The aim of this study was to evaluate whether deep white matter hyperintensities (DWMH) and periventricular white matter hyperintensities (PVH) are associated with suicidal behavior in patients with major affective disorders. Subjects were 99 consecutively admitted inpatients (42 men; 57 women; mean age: 46.5 years [SD = 15.2; Min./Max. = 19/79]) with a diagnosis of major affective disorder (bipolar disorder type I, bipolar disorder type-II and unipolar major depressive disorder). 44.4% of the participants had made at least one previous suicide attempt. T2-weighted brain magnetic resonance images were rated for the presence and extension of WMH using the modified Fazekas scale. Patients were interviewed for clinical data on average 5 days after admission. Bivariate analyses, corrected for multiple-testing, and logistic regression analysis were used to test the association between suicide attempts and clinical variables. Attempters and nonattempters differed only in the presence of PVH—the former were more likely to have PVH. The logistic regression indicated that the presence of PVH was robustly associated with suicidal behaviors after controlling for age (OR: 8.08). In conclusion, neuroimaging measures may be markers of risk for suicidal attempts in patients with major affective disorders.

Suicide risk assessment: a review of risk factors for suicide in 100 patients who made severe suicide attempts. Evaluation of suicide risk in a time of managed care.

A study of 100 patients who made a severe suicide attempt suggested that the managed care criteria often applied for approving admission to hospitals for potentially suicidal patients were not, in fact, predictive of features seen in patients who actually made such attempts. Severe anxiety, panic attacks, a depressed mood, a diagnosis of major affective disorder, recent loss of an interpersonal relationship, recent abuse of alcohol or illicit substances coupled with feelings of hopelessness, helplessness, worthlessness, global or partial insomnia, anhedonia, inability to maintain a job, and the recent onset of impulsive behavior were excellent predictors of suicidal behavior. The presence of a specific suicide plan or suicide note were not. Patients with managed care were overrepresented by 245% in the study.

Suicidality in hospitalized patients with a primary diagnosis of personality disorder.

In this investigation the frequency and clinical importance of suicidal behavior in patients with a primary diagnosis of personality disorder was studied. The sample was drawn from a group of over 8000 psychiatric inpatients admitted to a university psychiatric hospital. Only patients with a primary diagnosis of personality disorder were included. In the subgroup of 226 patients with this diagnosis, it was found that the rate of suicidality was almost as great as that of patients with a primary diagnosis of major affective disorder (39% as opposed to 41%), despite the absence in all but 3% of these patients of an additional diagnosis of affective disorder. Further, this figure was considerably higher than that for all psychiatric inpatients (24%). Suicidal patients had more suicide attempts in their history and had a more serious depressive syndrome, despite the fact that only 3% fulfilled the criteria for major affective disorder. The conclusion which can be drawn is that a high degree of suicidality should not be regarded as exclusively linked to a primary diagnosis of major affective disorder.

Effectiveness in psychiatric care. III: Psychoeducation and outcome for patients with major affective disorder and their families.

This hypothesis-generating study had the objective of dissecting the process of psychiatric care in an attempt to understand outcomes for patients and their families. In all, 24 patients who carried a DSM-III diagnosis of major affective disorder were identified 12-18 months after hospital admission. The patients, their families, and their doctors were interviewed using instruments measuring delivery of treatment and achievement of treatment goals; findings were then correlated with resolution of the index episode and patient global outcome. Delivery of patient and family psychoeducation was associated with better resolution of the index episode and better global outcome.

Effectiveness in Psychiatric Care II. Outcome for the Family After Hospital Treatment for Major Affective Disorder

AbstractRecent research suggests that despite the development of effective psychiatric treatment, optimal results are not achieved. This hypothesis-generating study had the objective of dissecting the process of care in an attempt to understand outcomes for patients and, this paper's focus, their families.Twenty-four patients who carried a DSM-III diagnosis of Major Affective Disorder were identified 12-18 months after hospital admission in three countries (Italy, Japan, and the United States). The patients, their families, and their doctors were interviewed separately, and then together, using instruments measuring delivery of treatment (using an ideal treatment criteria set) and achievement of treatment goals, which were then (using nonparametric statistical techniques) correlated with resolution of the index episode for the family.The data demonstrated that only four families of the 24 had achieved a relatively successful resolution. Physicians delivered only 37% and subsequently, achieved only 44% of ...

Effectiveness in Psychiatric Care: A Cross-National Study of the Process of Treatment and Outcomes of Major Depressive Disorder

Recent research suggests that, despite the development of effective psychiatric treatment, there is marked underuse of care. This pilot study had the objective of dissecting the process of care in an attempt to understand outcomes for patients with major affective disorder and for their families. Twenty-four patients with a DSM-III diagnosis of major affective disorder were identified 12 to 18 months after hospital admission in three countries (Italy, Japan, and the United States). The patients, their families, and their doctors were interviewed separately and then together, using instruments measuring delivery of treatment (using an ideal treatment criteria set) and percentage of achievement of treatment goals. These measures were then (using parametric and nonparametric statistics) correlated with resolution of the index episode and the patient's global outcome (using the Global Assessment Scale). The data demonstrated that physicians delivered about half (52%) and, subsequently, achieved about half (54%) of what would be considered ideal care to patients and other family members. The mean resolution of the index episode at follow-up was only 3.0 (on a 0- to 5-point scale). There was a significant positive association between the most important outcome measure, i.e., the resolution of the episode, and the achievement of treatment goals for both the patient (p less than .07) and the family (p less than .005). Patients and families with the best resolutions received significantly more good treatment than those with the worst resolutions (p less than .02), most notably with regard to medication (p less than .002).

Patterns of course in patients with a cross-sectional diagnosis of schizoaffective disorder

The authors conducted a longitudinal study on two samples of patients, fulfilling Research Diagnostic Criteria for schizoaffective disorder and for major affective disorder, respectively. The long-term course in patients defined cross-sectionally as schizoaffective was very heterogeneous. Ten different patterns of course were identified. In schizoaffectives showing a bipolar course with the occurrence of pure affective episodes, the outcome was not different from that in patients with a cross-sectional diagnosis of major affective disorder, whereas in schizoaffectives whose course was characterized by the occurrence of schizodepressive episodes only, or of schizodepressive and schizophrenic episodes, the outcome was significantly poorer than in patients diagnosed as affective.

The Concept of Personality Organization: A Long-Term Comparative Follow-Up Study With Special Reference to Borderline Personality Organization

In a 5-year long-term follow-up study, index and end-point diagnoses were made on 44 psychiatric inpatients according to DSM-III, the Diagnostic Interview for Borderlines according to Gunderson, and the Structural Interview for assessment of personality organization according to Kernberg. Working capacity and psychiatric hospitalization during follow-up were registered. Analyses were made in a comparative design between the three diagnostic categories defined by Otto Kernberg: neurotic, borderline, and psychotic personality organization (NPO, BPO, and PPO). BPO turned out to be a wide concept including patients with a variety of Axis I and Axis II DSM-III disorders: 21% received a diagnosis of major affective disorder, 13% a diagnosis of schizophrenic disorder (residual type), and 46% fulfilled criteria for an Axis II diagnosis of borderline personality disorder. Long-term prognosis was severe. Patients with BPO were hospitalized, on average, during 23% of the follow-up period and only 8% managed without ...

The Prevalence and Diagnostic Significance of Schneiderian First-Rank Symptoms in a Random Sample of Acute Psychiatric In-patients

Ninety-nine acute in-patients were interviewed within four days of admission to hospital. The interview included items concerning all 11 first-rank symptoms. Two definitions (wide and narrow) of each first-rank symptom were employed. Three definitions of schizophrenia and a research diagnosis of major affective disorder were used to determine their relationship with first-rank symptoms. Of subjects with schizophrenia, 73% had first-rank symptoms, as had five (14%) of 34 subjects with affective disorder. The results do not support the hypothesis that first-rank symptoms are specific to schizophrenia, although the specificity of first-rank symptoms for schizophrenia increased if a narrow rather than a wide definition of symptoms was employed.

The Social Functioning of Depressed Patients: A Longitudinal Assessment

The present study was designed to examine the social functioning of depressed patients. Depressed and nondepressed psychiatric outpatients and nondepressed nonpsychiatric community control subjects completed measures of social functioning at two points in time: the first while the depressed patients met criteria for a diagnosis of major affective disorder, and the second 7 to 10 months later. The results of this study indicated that depressed patients reported more impaired social functioning than did either the nondepressed patients or the community controls. This pattern of results suggests that social dysfunction is specific to depression, rather than characteristic of general psychiatric disorder. Furthermore, despite a significant reduction in depressive symptomatology in the second session, the social functioning of the depressed patients did not improve over the course of the follow-up period. The possible role of social dysfunction as a risk factor for depression is discussed, and directions for f...

Improving the validity of FH-RDC diagnosis of major affective disorder in uninterviewed relatives in family studies: A model based approach

Analysis of family history and family study diagnoses of major affective disorder in 4806 relatives of affectively ill probands from the NIMH Collaborative Study of the Psychobiology of Depression (Clinical) suggests that rates of disorder in uninterviewed relatives are greatly underestimated by family history. The implications of these underestimates for family and genetics analyses using the family history method are discussed, and other estimates are developed that have better statistical properties. Using the Model Based Direct Adjustment method, the rate of major affective disorder in all relatives (interviewed and uninterviewed) is estimated to be 32%, compared to 25% by the consensus (standard) method, which uses the Family History-RDC interview with one or more family members to make diagnoses on all uninterviewed relatives. This difference (over ten standard errors) is due to the much higher rate of illness estimated for the uninterviewed relatives (28% compared to 14%). Analysis of the sources of insensitivity of the FH-RDC is used to explain the difference between observed and imputed diagnosis rates.

Borderline personality in serious delinquents

Seventy-one seriously delinquent adolescents (40 male, 31 female) were evaluated by two of the authors (an interviewer and an observer) using the Social Adaptation and Interpersonal Relations sections of the DIB (Diagnostic Interview for Borderlines) in combination with the SADS (Schedule for Affective Disorders and Schizophrenia). DIB scores and DSM-III diagnoses were assigned to each subject by the consensus of the two evaluators. Twenty-six subjects received a primary DSM-III diagnosis of borderline personality disorder. Nineteen (73%) of these subjects were also identified as borderline by the DIB. The DIB was generally successful in differentiating the DSM-III borderlines from subjects with other DSM-III diagnoses on DIB total, subscale and statement scores. Subjects with a DSM-III diagnosis of major affective disorder were frequently inappropriately categorized as borderline by the DIB, however, reasons for the difficulty of the DIB in distinguishing delinquent adolescents with borderline personalities from those with major affective disorder are discussed, comparisons with adult studies using the DIB are made and directions for future research are indicated.

HLA and major affective disorder.

Fifteen unrelated multiplex families, each containing two or more offspring with a diagnosis of major affective disorder, were HLA typed to provide additional data bearing on the proposed linkage of affective disorder susceptibility genes with the major histocompatibility complex on chromosome 6. Altogether 19 parents, 38 affected children, and 13 unaffected children were typed. The distribution of shared HLA haplotypes among pairs of affected siblings, pairs of affected-unaffected siblings, and various diagnostic subsets of these families fails to lend any support for the HLA linkage hypothesis.

Suicide rates among public mental health patients.

Age-specific suicide rates are presented, based on 207 white patients of the Missouri Department of Mental Health who were identified as having committed suicide during 1972-74. Results, divided by age, sex, diagnosis and patient status, are compared with other studies. Male inpatients are about five times more likely to commit suicide compared to the general population, while female inpatients are about 10 times more likely to do so. In both sexes, the rate is greatest for the diagnosis of major affective disorder. A history of psychiatric treatment increases the suicide risk more for women than for men, although male patients are still about twice as likely to commit suicide than are female patients. A quantitative model is presented which describes the relative influence of age, sex and diagnosis on suicide rates.