Demographics, family history, premorbid functioning, developmental characteristics, and course of patients with deteriorated affective disorder

OBJECTIVE: This exploratory study examined the characteristics of a group of unusual and previously undescribed patients with major affective disorder who not only had been continuously symptomatic for prolonged periods of time but were also so functionally impaired that they required years of continuous care in psychiatric facilities or by family members. METHOD: Twenty-seven inpatients with major mood disorders and 29 inpatients with schizophrenia were recruited from a large state hospital; 27 outpatients with major mood disorders were recruited from an affiliated outpatient facility. The research battery included the Structured Clinical Interview for DSM-III-R--Patient Version, the Premorbid Adjustment Scale, and a semistructured interview designed to assess demographic, family history, developmental, and course information. RESULTS: Inpatients with deteriorated affective disorder differed from outpatients with nondeteriorated affective disorder along several important dimensions, including family history of mental illness, birth-related problems, physical disorders in infancy, premorbid functioning, presence of mixed episodes and rapid cycling, and medication non-compliance between hospitalizations. Inpatients with deteriorated affective disorder differed from inpatients with schizophrenia on the Premorbid Adjustment Scale. Patients with bipolar affective disorder differed from those with unipolar disorder on many of the variables associated with deterioration of functioning. CONCLUSIONS: Birth-related problems, physical disorders in infancy, and poor premorbid adjustment in childhood and adolescence appear to play an important role in deterioration of functioning among patients with unipolar depression. Disruption in treatment because of medication noncompliance and the appearance of mixed episodes and rapid cycling are associated with functional decline in bipolar affective disorder. Several characteristics previously considered specific to deterioration of functioning in schizophrenia, such as a high rate of birth complications and poor premorbid adjustment, appear to be associated with functional deterioration among patients with major depression as well.     

Reasons for suicide attempts and nonsuicidal self-injury in women with borderline personality disorder.

Self-reported reasons for suicide attempts and nonsuicidal self-injury were examined using the Parasuicide History Interview within a sample of chronically suicidal women meeting criteria for borderline personality disorder (N=75). Overall, reasons given for suicide attempts differed from reasons for nonsuicidal self-injury. Nonsuicidal acts were more often reported as intended to express anger, punish oneself, generate normal feelings, and distract oneself, whereas suicide attempts were more often reported as intended to make others better off. Almost all participants reported that both types of parasuicide were intended to relieve negative emotions. It is likely that suicidal and nonsuicidal parasuicide have multiple intents and functions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Childhood history of anxiety in adults with panic disorder: association with anxiety sensitivity and comorbidity

Converging lines of evidence indicate a nonspecific link between childhood anxiety disorders and adult panic disorder. Anxiety sensitivity, defined as the fear of anxiety symptoms, was hypothesized to be a potential mediating variable in this link. This study examined the association among childhood history of anxiety disorders, current anxiety symptoms, and anxiety sensitivity in a sample of 100 patients with panic disorder undergoing treatment. Fifty-five percent of the patients had histories of one or more childhood anxiety disorders. Despite the heterogeneity of symptoms and treatment interventions among these patients, a childhood history of anxiety was associated with comorbid anxiety conditions, agoraphobic avoidance, and anxiety sensitivity scores. Anxiety sensitivity was itself a significant predictor of current severity of illness, but a childhood history of anxiety was not. These findings are consistent with the hypothesis that having an anxiety disorder during childhood is linked with patterns of anxiety and phobic avoidance in adulthood, including the level of anxiety sensitivity in patients with panic disorder.     

Antisaccade performance in patients with schizophrenia and affective disorder.

The authors examined psychotic patients with schizophrenia, major depression, and bipolar disorder; "normal" participants; and 1st-degree relatives of patients with schizophrenia on an antisaccade task in which participants were instructed to move their eyes in the opposite direction of a target that moved unpredictably and abruptly either to the left or right of central fixation. Patients with schizophrenia were found to make significantly more errors than their relatives, and the latter made more errors than the controls. The poor performance of the relatives could not be attributed to their having a psychiatric disorder. Comparison of the 3 patient groups indicated that antisaccade deficits were more pronounced in schizophrenia and bipolar disorder. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Nonpsychiatric medical comorbidity, health perceptions, and treatment outcome in patients with panic disorder.

Panic disorder is frequently complicated by high rates of co-occurring nonpsychiatric medical conditions. The present study examined the relationship between medical morbidity, perceived physical health, and treatment outcome in panic disorder Patients meeting the American Psychiatric Association's Diagnostic and Statistical Manual of mental disorders (1994) criteria for panic disorder (N?=?71) completed 12 sessions of cognitive-behavioral treatment and were assessed at posttreatment and 6-month follow-up. Medical comorbidity and perceived health were both found to be related to end-state functioning. Medical comorbidity did not uniquely predict outcome beyond its shared variance with perceived health. At posttreatment, 71% of patients who perceived their physical health as good met recovery criteria compared with only 35% of those who perceived their health as poor. At follow-up, 67% of those who perceived their physical health as good met composite recovery criteria compared with only 33% of those with perceived poor health. These findings offer preliminary support for the impact of physical health, both actual and perceived, on treatment outcome of patients with panic disorder. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Longitudinal assessment of symptoms of depression, agitation, and psychosis in 181 patients with Alzheimer's disease

OBJECTIVE: The goal of this study was to define the recurrence or continuation of neuropsychiatric symptoms in patients with Alzheimer's disease who were observed serially for a 1-year period. METHOD: One hundred eighty-one patients with probable Alzheimer's disease were assessed five times at 3-month intervals with a standardized neuropsychiatric rating instrument. RESULTS: Recurrence rates of neuropsychiatric symptoms during the 1-year period were 85% for depression, 93% for agitation, and 95% for psychosis. Symptom frequency at any point in time underestimated the cumulative 1-year frequency. Recurrence rates were significantly greater among patients who had multiple symptoms. Women exhibited more symptoms than men. Patients in the oldest age group (76-87 years) had more psychosis, less depression and agitation, and slower cognitive decline. Psychosis was associated with more rapid cognitive decline, and agitation was associated with more rapid functional deterioration. CONCLUSIONS: These results indicate that once psychiatric symptoms are present in patients with Alzheimer's disease, they frequently recur. These symptoms vary with age, sex, and rate of illness progression.     

Familism, mother-daughter mutuality, and suicide attempts of adolescent Latinas.

National surveys in the U.S. reveal that Latina adolescents have higher rates of suicide attempts than females of other ethnic and racial groups. Past reports indicate that the suicide attempts among Latinas are lodged within family contexts in which sociocultural and individual experiences influence parental and adolescent behaviors. To better understand the parent-adolescent relations that explain the Latina suicidal phenomenon, we examined how the high value on family unity and support, as reflected by familism, and its effects on mother-daughter mutuality (i.e., reciprocal empathy and engagement) were evident in a group of adolescent Latinas with suicide attempts and a group of adolescent Latinas without suicide attempts. Drawing from data on 169 mother-daughter dyads recruited from Latino communities in a Northeastern metropolis and who self-identified as being of Latino origin or heritage, we considered how differences in familism between mothers and daughters influenced their sense of mutuality, the adolescents' internalizing and externalizing behaviors, and suicide attempts. Results show that gaps in familism (mothers scoring higher than their daughters on the scale) predicted less mother-daughter mutuality and more externalizing behaviors in the adolescents. Also, mother-daughter mutuality was negatively related to internalizing and externalizing behaviors which, in turn, predicted suicide attempts. Findings point to further research on family interactions that raise the risk for suicidality in Latino youth, particularly to including fathers and siblings in study designs. Clinical implications point to enhancing family and dyadic communication skills focusing mutuality while observing the cultural value of familism. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Distress, depressive symptoms, and depressive disorder among caregivers of patients with brain injury

OBJECTIVE: To examine the prevalence and correlates of major depression in caregivers of individuals with moderate to severe traumatic brain injuries. DESIGN: Repeated-measures design involving structured diagnostic interview and self-report of psychological distress administered on two occasions separated by 6 months. SETTING: Three acute care rehabilitation hospitals. SUBJECTS: Fifty-nine caregivers (39 mothers and 20 spouses) of individuals with moderate to severe brain injuries recruited from previous inpatient rosters. All caregivers were currently residing with the person with traumatic brain injury. MAIN OUTCOME MEASURE: The Diagnostic Interview Schedule-Revised [DIS-R] was utilized to assess depression. The Symptom Checklist 90-Revised (SCL 90-R) measured general psychological distress. RESULTS: Forty-seven percent of caregivers initially met diagnostic criteria for depression, and 43% met criteria 6 months later. Nearly two thirds of those who were initially depressed continued to be depressed 6 months later, and 17% of those who were not depressed initially subsequently met criteria for depression. The best predictor of depression was a previous (pre-brain injury) depressive episode. Neither time since injury nor injury severity predicted diagnostic status, and spouses were no more likely to be depressed than were mothers. The SCL 90-R, including its depression scale, showed high specificity but low sensitivity in predicting diagnostic status. CONCLUSIONS: The prevalence of major depression is high in caregivers of individuals with brain injuries. Because depression may interfere with the capacity to provide care and contribute to the rehabilitation process, it is important for clinicians to carefully assess both the current and preaccident affective status of primary caregivers.     

The contribution of environmental events and social support to serious suicide attempts in primary depressive disorder.

Interviewed patients (18–65 yrs old) about the events that occurred to them or their spouse in the 12 mo previous to the suicide attempt. Only primary depressive attempters (14 Ss) were selected, and for purposes of comparison, a primary depressive control group (14 Ss) was selected. Ss were administered the Hamilton Rating Scale for Depression. Moreover, seriousness of suicide attempts was quantified and assessed in each patient, and only moderately or severely serious attempters were chosen. Results show that the occurrence of serious suicide attempts is strongly associated with an increased rate of independent events (events not influenced by the patient's behavior, decisions, or disorder) in the year preceding the attempt, and that a particularly high density of such events between episodic onset and the attempt may serve as the direct initiator of an attempt. Data also suggest that exit events, where an important social support is lost to the patient, may play a significant role in initiating an attempt. Implications for the highest risk period of suicide are discussed. (40 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prenatal and perinatal risk factors for schizophrenia, affective psychosis, and reactive psychosis of early onset: case-control study

OBJECTIVE: To examine prenatal and perinatal risk factors for subsequent development of schizophrenia and affective and reactive psychosis. DESIGN: Three population based, case-control studies conducted within a Sweden-wide cohort of all children born during 1973-9. This was done by linking individual data from the Swedish birth register, which represents 99% of all births in Sweden, to the Swedish inpatient register. SUBJECTS: Patients listed in inpatient register as having been first admitted to hospital aged 15-21 years with a main diagnosis of schizophrenia (n=167), affective psychosis (n=198), or reactive psychosis (n=292). For each case, five controls were selected. MAIN OUTCOME MEASURES: Risks of schizophrenia and affective and reactive psychosis in relation to pregnancy and perinatal characteristics. RESULTS: Schizophrenia was positively associated with multiparity (odds ratio 2.0), maternal bleeding during pregnancy (odds ratio 3.5), and birth in late winter (odds ratio 1.4). Affective psychosis was associated with uterine atony (odds ratio 2.2) and late winter birth (odds ratio 1.5). Reactive psychosis was related to multiparity (odds ratio 2.1). An increased risk for schizophrenia was found in boys who were small for their gestational age at birth (odds ratio 3.2), who were number four or more in birth order (odds ratio 3.6), and whose mothers had had bleeding during late pregnancy (odds ratio 4.0). CONCLUSIONS: A few specific pregnancy and perinatal factors were associated with the subsequent development of psychotic disorder, particularly schizophrenia, in early adult life. The association of small size for gestational age and bleeding during pregnancy with increased risk of early onset schizophrenia among males could reflect placental insufficiency.     

A study of "atypical schizophrenia". Comparison with schizophrenia and affective disorder by sex, age of admission, precipitant, outcome, and family history

Eighty-five cases of atypical schizophrenia were compared with 200 of schizophrenia, 100 of bipolar (mania), and 225 of unipolar (depression) affective disorder. Comparisons were made on the basis of sex, age at admission, precipitating factors, outcome, and a family history of schizophrenia or of affective disorder. The atypical schizophrenia differed remarkably from the schizophrenia and most closely resembled the bipolar affective disorder when allowance was made for a younger age at onset and a higher frequency of precipitants. An analysis of symptoms verified the predominance of schizophrenic features in the atypical schizophrenia, but also showed a high percentage (80%) of patients who had one or more manic symptoms at index admission. It is concluded that great care should be taken in diagnosing schizophrenia in a patient who also has manic symptoms.     

Panic disorder in emergency department chest pain patients: prevalence, comorbidity, suicidal ideation, and physician recognition

Rush immunotherapy (RIT) with house dust extract was given to 15 patients with mild extrinsic or mixed asthma. Every patient was strongly positive for IgE on the radioimmunosorbent test and sensitive to house dust extract on the scratch skin test. Nine patients were positive on the bronchial provocation test to house dust extract and 6 could not be examined. All patients did not drop out and got to house dust extract solution 10(-1) within 1 week. The symptom-medication scores decreased significantly after RIT. During RIT 1 patient developed a mild asthmatic attack and 3 patients developed generalized skin reaction. Eight weeks later, the threshold for house dust-provoked bronchoconstriction increased in 9 patients, but did not in 3 patients. The blood eosinophil count and blood histamine level significantly decreased. We conclude that RIT is able to raise antigen concentrations for a short periods and effective but not risky for mild asthma.     

Clinical correlates of anhedonia and perceptual aberration in first-episode patients with schizophrenia and affective disorder.

Examined the association between scales measuring physical anhedonia, social anhedonia, and perceptual aberration and premorbid functioning, clinical state, and current level of adjustment in 91 psychotic Ss. The patients were examined at the onset of their 1st psychotic episode and again 18 mo later. For patients with schizophrenia, anhedonia was significantly related to premorbid functioning. No association was found between the scales and clinical state or level of adjustment at intake or follow-up. In affective disorder patients, no correlation was found between premorbid functioning (a stable characteristic) and scale scores, but moderately large correlations emerged between the scales and clinical state and level of adjustment at both assessment times. These results suggest that schizophrenic and affective disorder patients endorse items on these scales for different reasons. The authors hypothesize that for patients with schizophrenia the scales assess enduring personality characteristics, whereas for the affective disordered patients they assess clinical condition at the time of testing. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Negative mood, depressive symptoms, and major depression after smoking cessation treatment in smokers with a history of major depressive disorder.

Negative mood, depressive symptoms, and major depressive episodes (MDEs) were examined in 179 smokers with a history of major depression in a trial comparing standard smoking cessation treatment to treatment incorporating cognitive-behavioral therapy for depression (CBT-D). Early lapses were associated with relatively large increases in negative mood on quit date. Mood improved in the 2 weeks after quit date among those returning to regular smoking but not among those smoking moderately. Continuous abstinence was associated with short- and long-term reductions in depressive symptoms. MDE incidence during follow-up was 15.3% and was not associated with abstinence. Unexpected was that CBT-D was associated with greater negative mood and depressive symptoms and increased MDE risk. Results suggest complex bidirectional associations between affect and smoking outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Circadian profiles of cortisol, prolactin, and thyrotropin in seasonal affective disorder

To determine whether circadian profiles of various plasma hormones are abnormal in patients with winter seasonal affective disorder (SAD), we obtained 24-hour profiles of plasma cortisol, prolactin, and thyrotropin in subsets of a sample of 22 depressed patients with SAD on and off light therapy and in subsets of a sample of 24 normal controls. Cortisol levels did not differ between patients and controls, and levels in patients were not affected by light therapy. Prolactin levels were lower in patients than in controls throughout the day (p < 0.03) but were unaffected by light therapy. Independent of patient vs. control status, prolactin levels were higher in women than in men throughout the day (p < 0.003). Thyrotropin levels were no different in patients and controls, but levels in patients were lower following light therapy (p < 0.05).     

Psychophysiological, somatic, and affective changes across the menstrual cycle in women with panic disorder.

This study explored menstrual symptoms, somatic focus, negative affect, and psychophysiological responding across the menstrual cycle in women with panic disorder and controls. Women with and without panic disorder completed a psychophysiological task and self-report measures of menstrual symptoms, somatic focus, and negative affect on 4 occasions across 2 menstrual cycles (twice during intermenstrual and premenstrual phases). Women in the panic disorder group exhibited greater skin conductance magnitude and more frequent skin conductance responses to anxiety-provoking stimuli during the premenstrual phase than did controls. Compared to controls, women with panic disorder endorsed more severe menstrual symptoms relating to bodily sensations, anxiety sensitivity, state and trait anxiety, fear of body sensations, and illness-related concerns. The applicability of anxiety sensitivity to understanding the relation of menstrual reactivity and panic disorder is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Compensation seeking, comorbidity, and apparent exaggeration of PTSD symptoms among Vietnam combat veterans.

Evaluated whether veterans who apparently exaggerate their symptoms are more likely to be (a) seeking disability compensation or (b) suffering from more comorbid pathology than nonexaggerating veterans. 54 of 145 (37%) veterans with posttraumatic stress disorder who completed the Minnesota Multiphasic Personality Inventory—2 (J. N. Butcher, W. G. Dalhstrom, J. R. Graham, A. Telegen, & B. Kaemmer, 1989) were identified as apparent exaggerators, with F (Frequency)– K (Correction) >13. These participants scored higher than nonexaggerators on self-report measures of various psychological symptoms but were no more likely to be seeking compensation or to have comorbid substance use or other anxiety disorders. Affective disorder was overrepresented among apparent exaggerators, however. Findings support the hypothesis of increased comorbidity among symptom exaggerators as measured by the F–K index but not the commonly held belief that symptom exaggerators are more likely to seek compensation. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Chronic fatigue syndrome in psychiatric patients: lifetime and premorbid personal history of physical health

OBJECTIVE: This preliminary report compares a group of chronic fatigue syndrome (CFS) patients and controls on several variables of potential significance in the etiology of CFS. METHOD: The lifetime prevalence of reported physical disorders was compared among 46 CFS psychiatric patients, 92 relatively physically healthy psychiatric patients (C-I), and 46 psychiatric patients selected without regard to physical health (C-II). All patients were matched on age, sex, and psychiatric diagnosis and were drawn from the same psychiatric practice. The same groups were compared on a 7-point scale of lifetime physical health by three raters independently evaluating physical health narratives of the CFS patients up to the time of onset of CFS and that of the controls up to the corresponding age. RESULTS: The CFS patients had a significantly higher reported lifetime prevalence of irritable bowel syndrome (IBS), infectious mononucleosis-like syndromes (IM), infectious mononucleosis-like syndromes two or more times (IM x 2), and herpes (other than genital or perioral herpes) than one or both control groups. The CFS group also had a higher incidence of allergic rhinitis or asthma, IBS, IM, and IM x 2 than the combined controls. On the independent ratings, the CFS patients had significantly more impaired physical health up to the time of onset of the CFS than C-I at a comparable age. CONCLUSIONS: The findings suggest that a general health factor may be involved in the pathogenesis of some cases of CFS.     

The treatment history of patients with borderline personality disorder in the Republic of Germany

The present study was undertaken to explore the treatment history of women with borderline personality disorder and to provide an estimation of the treatment costs. Using a semi-structured interview, forty-five carefully diagnosed patients were interrogated about their lifetime treatment history with respect to every inpatient and outpatient treatment received for any psychical symptoms, including physical treatment after self-injurious behaviour. Results demonstrate an extensive and protracted use of psychiatric, psychotherapeutic and physical help, and a chaotic course of treatment with discontinuance of treatments as a characteristic feature. Treatment costs were estimated at a minimum of 24,000 DM per year and patient; 22,000 DM due to hospitalisations. The unsatisfactory treatment situation for these patients in the public health system and the socioeconomic advantages of a specified treatment programme are discussed.