Major Affective Illness Research Articles

Psychiatric bed usage under different systems of care. A comparison of South Verona (Italy) and Canberra (Australia)

RiassuntoScopo - Confrontare l'uso dei servizi ospedalieri per le principali malattie psichiatriche in una struttura che offre un «servizio psichiatrico territoriale» (Verona-Sud, Italia) con l'uso di questi servizi in una struttura più «tradizionale», dove l'ospedale è il centro dell'attività (Canberra, Australia). Disegno - Sono stati esaminati i registri dei ricoveri per i malati da psicosi schizofreniche e distimiche negli anni 1986, 1987 e 1988. Sono state comparate le seguenti caratteristiche: la mappa socio-demografica ed i tassi dei ricoveri per i pazienti, la durata del ricovero iniziale ed i tassi di ri-ricovero per questi pazienti nei dodici mesi seguenti. Risultati - Il servizio psichiatrico territoriale (Verona-Sud) ha ricoverato meno pazienti con psicosi schizofreniche e distimiche ma questi risultavano più gravi, restavano degenti più a lungo ed avevano una probabilità maggiore di essere ricoverati nuovamente. Il servizio psichiatrico «tradizionale» (Canberra) ha usato l'ospedale per una gamma più ampia di malattie, incluse le malattie con buona prognosi. La degenza in Canberra è stata più breve ed il ri-ricovero meno frequente. Sembra che il servizio «tradizionale» sia più orientato ad usare l'ospedale per l'inizio o per la stabilizzazione della terapia. Il servizio psichiatrico territoriale non portava ad una degenza più breve o ad un numero minore di ricoveri successivi al primo. Le differenze nella morbilità psichiatrica incontrata nelle popolazioni ha nascosto l'effetto della struttura del servizio sull'uso. Questa differenza nella distribuzione della morbilitù psichiatrica concentrata nel gruppo di più giovane età, rimane senza spiegazione.

Psychopharmacotherapy of suicide

Abstract Approximately 60% of suicides are due to major affective illness; another 20% are due to affective spectrum disorders. Suicidal patients must be evaluated for major and minor psychiatric illness presenting with self-destructive impulses, and diagnosis-specific psychopharmacotherapy, psychotherapy, and sociotherapy should be provided.

Sex differences in the age of onset of affective disorders

Studies of sex differences in first admission age for inpatients in Missouri public psychiatric hospitals were examined for the incidence of major affective illness and dysthymia. Patients diagnosed as schizophrenic were also studied to check for diagnostic comparability. Those males diagnosed as having major affective illness were admitted 3.82 years earlier than females; the differential held up regardless of fifth-digit coding for psychosis. Males diagnosed as dysthymic were admitted 0.98 years earlier than females. Male schizophrenic patients were admitted an average of 7.75 years earlier than females, and the distribution was similar to that reported in a variety of cross-cultural studies.

Secular trends in lifetime onset of MDD stratified by selected sociodemographic risk factors

We used multivariate proportional hazards (Cox) models to investigate the effects of cohort of birth on age of first onset of major depression measured independently at two occassions, about six years apart, in the first degree relatives of probands with major affective illnesses. We estimated the cohort trends in strata defined by sociodemographic and other measures, to see if the cohort trends are the same across strata. Graphical summaries of the trends reveal a generally consistent pattern of increasing rates and earlier age of onset with successive birth cohorts, across all strata examined. The relatives with a divorced parent had a somewhat delayed secular increase, suggesting either a ceiling effect or an interaction of the two risk factors (recent cohort of birth and divorced parents) such that the combined effect is less than the sum of the individual effects. Otherwise, the cohort effect is persistent and ubiquitous in this sample.

Relationship of object loss during development to hypothalamic-pituitary-adrenal axis function during major affective illness later in life

Although many studies have attempted to determine whether early object loss influences the risk of developing major affective illness in adulthood, there are few empirical data relating early loss to subsequent hypothalamic-pituitary-adrenal (HPA) axis dysfunction in adulthood. Forty-five psychiatric inpatients admitted for an active major affective illness, all of whom had a previous history of a significant permanent object loss (by death only), were studied retrospectively in this preliminary investigation to examine whether the type and timing of object loss experienced earlier in life would discriminate affectively ill patients who exhibit HPA dysfunction. Several loss variables were found to be statistically significant predictors of cortisol responses following glucocorticoid challenge. A median split of the distribution was used to classify patients into early loss (⩽ 19 years) and late loss (⩾ 20 years) groups. Analyses for all subjects, early and late loss combined, showed that late loss was associated with higher 11 p.m. cortisol levels. Within the early loss group, however, age of first loss was the most significant predictor of 4 p.m. cortisol levels after dexamethasone challenge. Consistent with the hypothesis that childhood object loss may be associated with long-term alterations in HPA axis function, younger age of loss correlated significantly with higher 4 p.m. cortisol responses. These preliminary data suggest that future prospective investigation of the neurobiological as well as psychosocial consequences of various types of early loss warrant further study.

National Institute of Mental Health longitudinal study of chronic schizophrenia. Prognosis and predictors of outcome.

We performed a longitudinal study of chronic schizophrenic patients who were hospitalized for research purposes at the National Institute of Mental Health (NIMH) Intramural Program in the 1970s and early 1980s. We assessed present course, outcome and predictor data from the initial cohort of 58 young chronic schizophrenic patients who were followed up for 2 to 12 years following their NIMH index hospitalization. At follow-up, the sample showed substantial functional impairment and levels of symptoms with only about 20% of the sample demonstrating a good outcome. In addition, strong intercorrelation was noted among the symptom and functioning indexes at follow-up. Moreover, neuropsychologic tests of frontal cortical functioning were significantly correlated with outcome levels of negative symptoms and social functioning but not with levels of positive symptoms. During the period from the index hospitalization to the follow-up assessment, 78% of the sample suffered a relapse, 38% attempted suicide and 24% had episodes of major affective illness. Furthermore, levels of positive and negative symptoms ascertained when patients received optimal neuroleptic treatment during the index hospitalization significantly predicted outcome levels of symptoms and functioning and time spent hospitalized during the follow-up period. In contrast, levels of index positive and negative symptoms ascertained during the drug-free state did not predict outcome symptoms or functioning. These data suggest that treatment response is a critical predictor variable. We examined the implication of these data for the course of illness in schizophrenics.

Psychiatric Consultation in a Teaching Nursing Home

The first 60 psychiatric consultations provided to a university-affiliated teaching nursing home are reviewed. All patients seen had a diagnosable mental disorder, and over 40% suffered from major affective illness. Consultation resulted in a critical change in diagnosis and management in more than one-third of patients. The authors discuss the benefits and drawbacks of psychiatric consultation for nursing home patients, staff physicians, and the psychiatrists themselves.

Case Study Atypical Outcome in Attention Deficit Hyperactivity Disorder

<h2>ABSTRACT</h2> This report describes the course of psychiatric illness in two boys. Both presented with attention deficit hyperactivity disorder (ADHD) in midchildhood; after puberty, one boy developed a schizophrenic illness while the other boy developed a major affective illness. Although the major ADHD outcome studies have found no link between the childhood occurrence of ADHD and psychosis in adulthood, occasionally such a link may exist. The theoretical and practical implications of this finding are discussed. It should be noted, however, that such outcome is highly atypical and very rare.

Loss history and glucocorticoid challenge in major affective illness : John M. Petitto, M.D., Cort A. Pedersen, M.D., Arch A. Hicks, M.A., Dwight L. Evans, M.D. Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC 27599

Loss history and glucocorticoid challenge in major affective illness : John M. Petitto, M.D., Cort A. Pedersen, M.D., Arch A. Hicks, M.A., Dwight L. Evans, M.D. Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC 27599

Suicide in subtypes of primary major depression

Among 100 consecutive suicide victims with primary major depression at the time of their suicide, 46% were found to have had bipolar II depression, 1% bipolar I disorder and 53% non-bipolar major depression. Since the lifetime prevalence rates of bipolar II and bipolar I depressions are relatively low compared to primary major non-bipolar depression, the present findings suggest that bipolar II disorder gives a particularly high risk of suicide among the different subtypes of primary major affective illness. Fifty-nine percent of the patients had medical contact during the depressive episode, but the depression was frequently undiagnosed, untreated or undertreated. The implications of these findings for suicide prevention are discussed briefly.

Improving the aggregate performance of psychiatric diagnostic methods when not all subjects receive the standard test.

Family studies of disease incidence often include some subjects who receive a diagnostic evaluation less accurate than that obtained with a standard method. This is particularly true of family studies of mental illness, where the standard is a consensus diagnosis based on both direct interview and corroborating family history from an informant in the family. Family members who are not interviewed have diagnoses based on history alone. Interviewed and uninterviewed relatives differ in several factors that influence the probability of disease, so that interview is not independent of disease. Thus, one cannot use the interview data to estimate the overall rate of illness. Family history-based illness rates may substantially underestimate true rates, so the observed rate in uninterviewed subjects is also a biased estimate. We discuss several models to reduce the bias in estimation of incidence rates. We propose explicit modelling and imputation as alternatives to the implicit assumptions that constitute the basis of the methods in current use. A clinical example involving 4806 relatives of probands with major affective illness illustrates the statistical issues.

In Reply to Drinka and Drinka

To the Editor: — In their letter, Dr Drinka and Ms Drinka question the generalizability of research findings using a sample of normal elderly volunteers from a senior citizens’ center, suggesting that these subjects are atypical of the geriatric population at large. The authors imply that elderly volunteers are a self-selected group characterized by positive attitudes which they feel are not “normal.” We agree that this psychiatrically healthy group tended to consist of likeable, gregarious, and well-adjusted individuals who regarded research projects without suspicion. Are these attitudes normal? Actually, little is known about what constitutes mental health in the elderly, and there is no reason to assume that adaptive personality traits are infrequently found. We have certainly encountered an excessively positive, seemingly unrealistic “have a nice day” attitude, especially in senior citizens’ centers and other nonhospital settings. Such behavior may be characteristic of a group of elderly individuals who have not had major affective illness earlier in life. By process of selection this group may also be unusually free of personality dysfunction, consistent with the hypothesis that personality disorders predispose to affective illness or represent subclinical affective symptomatology. Alternatively, the strongly positive attitudes observed in elderly volunteers might reflect a particular constellation of personality traits unique to healthy old age. This is an important area for future developmental studies in geriatric psychiatry. Dr Drinka and Ms Drinka also suggest that the patient group in our study was not representative of geriatric depression. Because patients recovered from less severe depression (ie, outpatients) may not have had the same disorder as those requiring admission, we limited this study to a comparison of hospitalized major depressives and normal controls. Further investigations of personality traits in depressed geriatric outpatients would be of considerable interest.

Clinical psychiatric illness in prisoners of war of the Japanese: forty years after release.

Clinical psychiatric and medical assessments were carried out on a randomly selected sample of Australian prisoners of war captured by the Japanese in 1942 and a sample of combatants from Pacific theatres of war who were not captured. Prisoners of war had significantly more anxiety and depressive 'neuroses' and more major affective illness, although the latter finding was not statistically significant. The two groups did not differ in the risk of alcohol abuse and dependence.

Uses of lithium in patients without major affective illness.

Back to table of contents Previous article Next article ArticleNo AccessUses of Lithium in Patients Without Major Affective IllnessBessel A. van der KolkBessel A. van der KolkSearch for more papers by this authorPublished Online:1 Apr 2006https://doi.org/10.1176/ps.37.7.675AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail "Uses of Lithium in Patients Without Major Affective Illness." Psychiatric Services, 37(7), pp. 675–684 Access content To read the fulltext, please use one of the options below to sign in or purchase access. Personal login Institutional Login Sign in via OpenAthens Purchase Save for later Item saved, go to cart PPV Articles - Psychiatric Services $35.00 Add to cart PPV Articles - Psychiatric Services Checkout Please login/register if you wish to pair your device and check access availability. Not a subscriber? Subscribe Now / Learn More PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development. Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.). FiguresReferencesCited byDetailsCited ByNone Volume 37Issue 7 July 1986Pages 675-684 Metrics PDF download History Published online 1 April 2006 Published in print 1 July 1986

Platelet [3H]imipramine binding in affective disorders: trait versus state characteristics.

Platelet [3H]imipramine binding (Bmax) was determined in 67 patients with major affective illness (33 euthymic bipolar, 34 depressed unipolar) and 58 normal control subjects. Bipolar patients had significantly lower Bmax values than did control subjects. The mean Bmax in the unipolar patients was lower than in the control subjects, but the difference was not statistically significant. Dissociation constant (Kd) values did not distinguish patients in either category from control subjects. The significantly lower Bmax in euthymic bipolar patients and the apparent state independence of Bmax in some but not all unipolar patients suggest that platelet imipramine binding may be a trait marker in a subset of affective disorders.

Effect of carbamazepine on mean urinary free cortisol excretion in patients with major affective illness.

Carbamazepine, a tricyclic anticonvulsant effective in the treatment of major affective disorder, has been observed to induce cortisol non-suppression following dexamethasone administration. The mechanism of this effect has not been clearly established. In this study, the authors report carbamazepine-induced elevations of mean urinary free cortisol in patients with affective illness. The theoretical and practical implications of these findings are discussed.

Treatment of Mental Disorders in Pregnancy: A Review of Neuroleptics, Antidepressants, and Lithium Carbonate

Pregnancy is frequently complicated by the development or recurrence of a serious mental disorder; neurotic, major affective, and psychotic illnesses have all been observed (1-4). When a major mental disorder arises in a pregnant woman and threatens the health or life of the patient and/or fetus, it should be treated early and aggressively to minimize complications and forestall the advance of the disease. Nonbiologic methods like individual psychotherapy, couples or family therapy, social casework, and hospitalization in a supportive, structured milieu should form the first line of treatment. Electroconvulsive therapy (ECT) may be the treatment of choice for some patients, e.g., a first trimester mother with a life-threatening episode of bipolar illness. If the illness persists in spite of nonbiological interventions, and if the risks of the inadequately treated disease outweigh the risks associated with a potentially useful medication, then a trial of that medication is clearly indicated.

The relationship between syndrome and personality disorder in DSM-III: experience with 2,462 patients.

The authors studied the relationship between DSM-III axis I and axis II diagnoses in 2,462 medical center patients. Personality disorders were most commonly associated with substance use disorders and with the anxiety and somatoform disorders traditionally classified as neuroses. There was a particularly strong connection between antisocial personality disorder and substance abuse. The psychotic and major affective illnesses were significantly less often associated with personality disorders. The results of this study suggest a need for refining the criteria for several DSM-III categories. Overall, the separate personality disorder axis in the DSM-III system provides information not contained with the syndromal classification alone.

Neuroendocrine responses to apomorphine in depressed patients and healthy control subjects

Increasing evidence implicates altered dopamine function in major affective illness. In the present study, growth hormone responses to the dopamine agonist apomorphine were not different for 14 male depressed patients and 16 healthy male volunteers. Baseline and post-apomorphine prolactin levels were lower for the depressed patients than the control subjects, but the percent decrease following apomorphine was not different for the two groups. Neuroendocrine responses were not significantly altered during chronic treatment with the dopamine agonist piribedil. These neuroendocrine results suggest that decreased baseline prolactin levels in depressed patients do not reflect altered postsynaptic receptor sensitivity in the tuberoinfundibular dopamine system.

Psychosis in bipolar and unipolar affective illness with special reference to schizo-affective disorder.

Bipolar and unipolar patients respectively were separated into psychotic and non-psychotic sub-types. The bipolar psychotic patients were more likely to have certain severe symptoms, such as hallucinations and motor abnormalities, than were the unipolar patients, but the family histories of the four sub-groups were identical. The psychotic sub-groups had a different course of illness, in that they were less likely to have had a history of multiple episodes on admission and were more likely to show chronicity for a period of time on discharge. The data are interpreted as being opposed to the concept of a continuum of vulnerability in the affective disorders, and as not favouring either psychotic unipolar or psychotic bipolar illnesses or schizo-affective disorder being considered autonomous. One possible interpretation of the findings is that a trait or propensity to psychosis is transmitted totally independently of the major affective illness, and that this propensity is silent or not observed when the patient is in remission.