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B Pfohl

Publications and source records attributed to B Pfohl.

At least 37 records · Page 2Linked to original sources
PubMed1987

Prognostic validity of self-report and interview measures of personality disorder in depressed inpatients.

Presence of personality disorders was assessed with the Structured Interview for the DSM-III Personality Disorders (SIDP) in a series of 78 nonpsychotic inpatients with major depression. Measures of severity of depression were administered at admission, at discharge, and 6 months after admission. Outcome for the depression was especially poor in patients meeting criteria for multiple personality disorders from multiple DSM-III clusters. A subgroup of 38 patients received both the SIDP interview and a self-report measure of personality disorder, the Personality Diagnostic Questionnaire. Depressed inpatients who met more than the median number of personality disorder criteria by either measure were approximately half as likely to show improvement at discharge and at 6-month follow-up than were patients with less than the median number of criteria.

Adult↗
PubMed1986

The validity of four definitions of endogenous depression. II. Clinical, demographic, familial, and psychosocial correlates.

Based on a survey of the classic literature and studies examining the correlates of a clinical diagnosis of endogenous or nonendogenous depression, we found 14 variables that should discriminate endogenous and nonendogenous depressives. We applied four definitions of endogenous depression (Feinberg and Carroll, DSM-III, Research Diagnostic Criteria, and Newcastle) to a consecutive series of 152 unipolar major depressive inpatients. We examined the concordance between the definitions and the relationship between each definition and clinical, demographic, family history, and psychosocial factors. The DSM-III and Newcastle definitions were less inclusive than the other two definitions. We found some support for the validity of each of the four definitions. The validity of the Newcastle scale was the most frequently supported, with the endogenous depressives having a lower rate of personality disorder, marital separations and divorces, familial alcoholism, life events, and nonserious suicide attempts.

Adult↗
PubMed1986

The validity of the dexamethasone suppression test as a marker for endogenous depression.

The validity of the dexamethasone suppression test (DST) as an indicator of endogenous depression has been most frequently tested by examining its relationship to operational criteria of endogenous depression. However, these criteria sets themselves have not been empirically validated. We examined the DST in terms of a series of hypotheses and predictions that are consistent with the theoretical construct of endogenous depression. In a consecutively admitted sample of 187 primary unipolar depressed inpatients, the DST nonsuppressors were older, had less premobid personality disorder, better social support, less frequent marital separations or divorces, fewer nonindependent stressful life events during the year prior to admission, made fewer nonserious suicide attempts during the index episode, had fewer dysfunctional attitudes, and had a lower rate of treated alcoholism and antisocial personality in their first-degree relatives. The only clearly negative finding was the lack of association between DST results and family history of depression. Our results strongly support the construct validity of the DST as a marker of endogenous depression.

Adult↗
PubMed1986

Validity of familial subtypes of primary unipolar depression. Clinical, demographic, and psychosocial correlates.

We examined the psychosocial, demographic, and clinical correlates of familial subtypes of primary unipolar depression. Our findings supported the hypothesis that depression spectrum disease is a variant of neurotic depression, whereas familial pure depressive disease overlaps with endogenous depression. Patients with depressive spectrum disease experienced more life events, had more marital separations and divorces, had poorer social support, more frequently made a nonserious suicide attempt, and had a less characteristic endogenous symptom profile than patients with familial pure depressive disease. Consistent with our previous report on the relationship between dexamethasone suppression test results and familial subtyping, the broadness of the criteria used to diagnose the patients' first-degree relatives affected the strength of the association between the familial subtypes and the dependent variables.

Adult↗
PubMed1986

Body weight and reported versus measured weight loss as confounders of the dexamethasone suppression test.

We examined the association between post-dexamethasone suppression test (DST) serum cortisol and body weight, self-report of weight loss during the episode, and measured weight loss during the first week of admission in a series of 245 depressed inpatients. Data on measured weight loss between two successive admissions was available in a group of 57 depressed inpatients. Reported weight loss during the episode and measured weight loss during the first week of admission were not related to DST nonsuppression. In contrast, DST nonsuppression was significantly more frequent in patients with measured weight loss between two successive admissions. This association was particularly strong in patients with below-average body weight and was practically nonexistent in patients with above-average body weight. Multivariate analysis indicates that a significant association between DST results and weight loss may be missed if self-report is substituted for direct measurement of weight loss and if potential confounders, such as total body weight, age, and sex, are ignored.

Adult↗
PubMed1986

Validity of the Hamilton Endogenous Subscale: an independent replication.

We calculated scores on the Hamilton Endogenous Subscale (HES) (Thase et al., 1983) for 252 depressed inpatients. The HES scores were bimodally distributed, and HES classification was significantly associated with endogenous (Research Diagnostic Criteria) and melancholic (DSM-III) subtyping. Based on a cutoff score of 8, HES classification was not associated with either family history of specific psychiatric illness or abnormal dexamethasone suppression test (DST) results. When the cutoff was raised to 10, DST nonsuppression was more frequent in HES endogenous depressives, although we again failed to find an association with a family history of psychiatric disorders.

Adult↗
PubMed1986

Life events assessment of depressed patients: a comparison of self-report and interview formats.

Both self-report questionnaires and semi-structured interviews have been employed in past research on the association between life events and psychiatric disorder. We examined the comparability of these two approaches by giving both a self-report life events scale and semi-structured life events interview to 38 depressed patients. About 40% of the items noted on the interview were missed when using the questionnaire. Approximately 15% of the items noted on the questionnaire were errors since the events did not meet the definition or time criteria specified in the questionnaire. Twenty percent of the items noted on the questionnaire were not noted on the interview and may represent underinclusiveness on the part of the interview. The implications of these differences were examined by comparing the association between a variety of demographic and clinical variables and life events under each methodology. There were no significant differences between the two methods except when examining the association between life events and other subjective self-report measures.

Depressive Disorder↗
PubMed1986

Outcome at discharge and six months in major depression. The significance of psychotic features.

Inpatients with nonbipolar psychotic major depression (N = 46) had significantly lower Hamilton Rating Scale scores at discharge and a significantly greater number of weeks back to their "normal selves" during a 6-month follow-up than did patients with nonpsychotic major depression (N = 159). While both baseline severity and the receipt of electroconvulsive therapy distinguished these groups, neither accounted for the outcome differences noted. Severity ratings at discharge were clearly more predictive of follow-up course in psychotic patients than they were in nonpsychotic patients. Moreover, patients with psychotic depression had clearer outcomes in that their average follow-up weeks were more likely to involve either full syndromes or a complete absence of depressive symptoms. This finding, if replicated, may account in part for the lack of consensus on the prognostic significance of psychotic depression.

Delusions↗
PubMed1986

An American validation study of the Newcastle scale. III. Course during index hospitalization and six-month prospective follow-up.

One hundred and fifty-two depressed inpatients were classified endogenous or neurotic according to the Newcastle Diagnostic Scale. Endogenous depressives were significantly more likely than neurotic depressives to be treated with electroconvulsive therapy (ECT). Newcastle subtyping was not associated with response to ECT; however, neurotic depressives not treated with ECT were more symptomatic at hospital discharge than endogenous depressives not treated with ECT. A prospective 6 month follow-up interview was completed with 85% of the patients. There was no association between Newcastle subtyping and follow-up outcome.

Depressive Disorder↗
PubMed1986

A comparison of adrenal cortical function in patients with depressive illness and Cushing's disease.

We measured total and free plasma cortisol, 24-hour urinary cortisol excretion, and corticosteroid-binding globulin in 21 normal subjects, 25 patients with depressive illness, and 6 patients with Cushing's disease. Patients with depression had mean 24-hour plasma (8.3 +/- 2.7 micrograms/dl) and urinary (36 +/- 33.55 micrograms/g creatinine) cortisol levels that did not differ from those of normal subjects (6.6 +/- 1.7 microgram/dl; 24.6 +/- 15.4 micrograms/g creatinine), but were significantly lower than those of patients with Cushing's disease (14.4 +/- 2.4 micrograms/dl; 215 +/- 101 micrograms/g creatinine). Not all patients with depression had hypercortisolemia, and the 1-mg dexamethasone suppression test identified some of those with adrenal hyperfunction. 17 of 25 patients had normal 8 a.m. and/or 4 p.m. plasma cortisol after dexamethasone (suppressors), while 8 patients had values greater than 5 micrograms/dl (nonsuppressor). Suppressors had normal total 24-hour plasma and urinary cortisol, while nonsuppressors had levels that were in the range seen in Cushing's disease. Patients with depression showed the expected circadian variation in total and free cortisol, but nonsuppressors had elevated levels in evening and early a.m. hours when levels in normal subjects were low. Patients with Cushing's disease had elevated levels throughout the day. The mean binding capacity of corticosteroid-binding globulin was not different in normal and depressed subjects (23.9 +/- 3.2 vs. 22.2 +/- 3.4 micrograms/dl), but was significantly decreased in patients with Cushing's disease (15.7 +/- 3.5 micrograms/dl). Although total cortisol levels were similar, nonsuppressors had significantly lower mean 24-hour plasma free cortisol (1.01 +/- 0.27 microgram/dl) than patients with Cushing's disease (2.4 +/- 0.54 microgram/dl).(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenal Cortex Function Tests↗
PubMed1986

Melancholic subtyping: a qualitative or quantitative distinction?

Melancholic depressed subjects scored significantly higher than did nonmelancholic subjects both on the depressive symptoms used and those not used for melancholic subtyping. The results suggest that DSM-III's melancholic criteria do not identify a qualitatively distinct subgroup, but instead reflect illness severity.

Adolescent↗
PubMed1986

ECT response in depressed patients with and without a DSM-III personality disorder.

Twenty-five inpatients with DSM-III major depressive disorder received ECT and were interviewed with the Structured Interview for DSM-III Personality Disorders. Patients with and patients without a personality disorder had similar short-term responses to ECT. The results of a 6-month prospective follow-up showed that depressed patients with a personality disorder were significantly more symptomatic and eight times more likely to be rehospitalized.

Adult↗
PubMed1986

An American validation study of the Newcastle diagnostic scale. I. Relationship with the dexamethasone suppression test.

The Newcastle diagnostic index was completed on 159 depressed in-patients, who received the dexamethasone suppression test during their first week in hospital. Patients suffering from endogenous depression had a significantly higher rate of DST non-suppression, were older, were more frequently psychotic, and more frequently lost weight; even after controlling for these variables, DST non-suppression was significantly more frequent in the endogenous group. The relationship between Newcastle scores and the frequency of DST non-suppression was non-linear.

Adult↗
PubMed1986

Assessment of DSM-III personality disorders: the importance of interviewing an informant.

The Structured Interview for DSM-III Personality Disorders was used to interview 82 patients. In addition, a close relative or friend of the patient was interviewed regarding each patient's normal personality. After the informant interview, the diagnosis of the presence or absence of any personality disorder was changed in almost 20% of the sample. In general, the information given by the informants revealed additional pathology in the patients and was less frequently used to retract a diagnosis. Despite conflicting information from the patients and informants, the reliability of personality disorder assessment remained high.

Adult↗
PubMed1985

A structured interview for the DSM-III personality disorders. A preliminary report.

With few exceptions, published studies fail to indicate that the DSM-III personality disorders can be distinguished from each other with respect to etiology, prognosis, treatment response, or family history. The Structured Interview for the DSM-III Personality Disorders (SIDP) was developed to improve axis II diagnostic reliability, and hence allow validity testing of axis II. Sixty-three subjects were independently rated by two interviewers using the SIDP. The kappa coefficients for interrater agreement reached .70 or higher for histrionic, borderline, and dependent personalities. While it is impossible to separate the validity testing of the SIDP from validity testing of the DSM-III personality criteria themselves, preliminary results from 102 inpatient SIDP interviews suggest some criterion-based validity with respect to standard personality rating scales and some construct validity with respect to the dexamethasone suppression test.

Adolescent↗
PubMed1985

Pituitary-adrenal axis rhythm disturbances in psychiatric depression.

We studied disturbances in the circadian pattern of plasma corticotropin and cortisol concentrations in 25 depressed patients (eight dexamethasone suppression test [DST] nonsuppressors and 17 suppressors) and 21 normal control subjects. Blood samples were drawn every 20 minutes for 24 hours before the administration of dexamethasone, and for a second 24 hours after the administration of 1 mg of dexamethasone. The corticotropin and cortisol level rhythms were examined using three different statistical methods. Nonsuppressors averaged greater elevations in plasma cortisol and corticotropin levels than did subjects in the other two groups, both before and after administration of the dexamethasone. The cortisol levels of the suppressors were virtually identical to those of the control subjects. However, the suppressors had significant elevations of corticotropin levels compared with normal control subjects, especially on the day before taking dexamethasone. Before taking dexamethasone, the depressed patients reached a daily nadir of cortisol concentration approximately two hours earlier than did the normal control subjects. The DST nonsuppressors also exhibited a blunting in the expected circadian rhythm of the corticotropin level.

Adrenocorticotropic Hormone↗
PubMed1985

Differences in plasma ACTH and cortisol between depressed patients and normal controls.

Although studies have repeatedly demonstrated that depressed patients average higher baseline and postdexamethasone serum cortisol than normal controls, studies examining similar trends in adrenocorticotrophic hormone (ACTH) have produced conflicting results. The current study uniquely employs 48 hr of every 20-min serum sampling: the first 24 hr prior to dexamethasone administration and the second 24 hr subsequent. The depressed patients showed higher baseline cortisol levels than normal controls, with the greatest differences between 2 AM and 6 AM. After an 11 PM dose of dexamethasone, the difference was greatest between the hours of 8 AM and 4 PM. Among the depressed patients, those who reported recent weight loss had significantly higher plasma ACTH and cortisol levels than those without weight loss. Depressed patients without weight loss had higher baseline plasma ACTH than normal controls, and the differences reached significance during some time periods.

Adrenocorticotropic Hormone↗