Biomedical subjects
Publications and source records attributed to B A Prusoff.
This paper describes a method for measuring the interventions employed by psychotherapists in the short-term interpersonal treatment of depressive disorders. The psychotherapy techniques are described, and the methodology for measuring these techniques is presented. These are illustrated with the findings of the collaborative Boston-New Haven project.
In a follow-up study of 150 women who had undergone treatment on an outpatient basis for acute depression, it was found that the most important predictor of their long-term clinical outcome (8, 20, and 48 months after the acute episode) was personality as measured by the Neuroticism Scale of the Maudsley Personality Inventory (MPI-N). Age, race, social class, marital status, religion, number of previous depressions or suicide attempts, diagnosis, history of early deaths of or separations from significant others, history of neurotic traits as a child, amount and type of stress in the 6 months before onset, and severity and pattern of pretreatment symptoms were not predictive of outcome.
Data from five psychiatric populations and a community sample are presented on the CES-D, 20-item self-report depression symptom scale developed by the Center for Epidemiologic Studies. Results show that the scale is a sensitive tool for detecting depressive symptoms and change in symptoms over time in psychiatric populations, and that it agrees quite well with more lengthy self-report scales used in clinical studies and with clinician interview ratings. Although a symptom scale cannot differentiate between diagnositc groups, the CES-D has demonstrated its validity as a screening tool for detecting depressive symptoms in psychiatric populations.
This paper reports a replication study of prediction of outcome by a cluster-analysis derived four-group typoloy of depression. 143 acutely depressed women were treated with amitriptyline for 4 weeks. In replication of the earlier findings, anxious depressives showed the worst response, hostile depressives and young depressive with personality disorder the best, with psychotic depressive intermediate. The findings provide further validating evidence for the typology, and for the view that nonpsychotic depressives are heterogenous.
This paper summarises findings from a study of maintenance treatment in predominantly neurotic depressive responding to initial treatment with amitriptyline. Patients were continued on amitriptyline for eight months, withdrawn double-blind to placebo after two months, or withdrawn overtly to no medication, with and without individual psychotherapy from social workers in the factorial design. Continuation significantly reduced early relapse and symptom return, compared with either condition of early withdrawal. Psychotherapy improved social adjustment after eight months in patients who did not relapse, without any significant interactions. Side effects were minimal, except for carbohydrate craving. These findings suggest that tricyclic antidepressants should be routinely continued for several months after drug-induced remission.
Temporal stability of symptom patterns was examined in 33 depressives studied initially at the height of illness and again some months later in a relapse following earlier recovery. Relapse symptoms were significantly less severe at the time of rating, and initial and relapse severity were not significantly related. Neverthless there were significant correlations between initial and relapse scores on two factors orthogonal to severity. One of these reflected symptom patterns important to the endogenous-neurotic distinction, the other a contrast between depression and anxiety. These findings indicate some consistency in symptom patterns in successive episodes of depression, and thereby support the value of clinical classifications depending on symptom patterns.
This paper reports relationships between symptoms and premorbid personality in a varied sample of depressed patients. Symptoms were rated by a psychiatrist at clinical interview; personality was rated by patients on a self-report after clinical improvement, using the Maudsley Personality Inventory and an inventory of obsessive, hysterical and oral personality. Additional ratings on the latter were obtained at interview with a relative. The most prominent finding was that patients with premorbid neuroticism also showed a neurotic rather than an endogenous symptom pattern. Additional relationships were relatively weak but consistent with previous studies. Depressives with neurotic rather than endogenous symptom pattern showed more evidence of oral dependent personality and less obsessionality. Patients with hysterical personalities tended to be less severely ill and to show a pattern characterized by mixed depression and hostility with less evidence of anxiety.
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Life events experienced in the six months before a suicide attempt were compared with events for two matched control groups. Suicide attempters reported four times as many events as were reported by subjects from the general population and 11/2 times as many as were reported by depressed patients prior to depressive onset. A substantial peaking of events occurred in the month before the attempt. The excess over general population controls spanned most types of event. That over depressive onset was more selective, and it involved events with threatening implications, including undesirable events, those rated as stressful, and those outside the respondent's control. Unlike depression, suicide attempts were preceded equally by entrances and exits in the social field. Overall, the findings indicate a strong and immediate relationship between suicide attempts and life events.
Depressives responding to initial treatment were maintained on amitriptyline for eight months, withdrawn double-blind to placebo after two months, or withdrawn overtly onto no medication. In each group half the patients received weekly psychotherapy and half were seen once monthly. Effects on symptom ratings were examined. Maintenance amitriptyline gave a significant advantage over early withdrawal in preventing symptom recrudescence. There were no differences between double-blind or overt withdrawal. There were no interactions between drug withdrawal and psychotherapy. Psychotherapy produced no significant advantages over low contact on symptoms, although it did improve social adjustment ratings reported elsewhere.
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Explore the source record for details and available documents.