Biomedical subjects
Publications and source records attributed to C Perris.
In a series of fifty depressed patients and 258 controls possible differences in the early family situation as concerns parental rearing practices have been investigated by means of the Swedish EMBU inventory. The results show that the depressive experienced their parents as more "rejecting", more "overprotecting" and less "emotionally warm" as compared to their normal counterparts.
The concept of cycloid psychosis or cycloid psychotic disorder has been used in the European psychiatric literature for almost half a century. However, it has now for the first time been comprised into the 10th revision of the World Health Organization's International Classification of Diseases (ICD-10) that is currently in the phase of field trials. In this article evidence is presented that supports the independence of cycloid psychotic disorder from other major psychotic disorders. In particular, evidence is presented in favour of the clinical and predictive validity of the cycloid psychosis construct. Issues related to treatment are discussed and suggestions for future research are given.
Variability of age at onset in affective disorder is a complex event where several variables play a role, resulting in a detectable observed distribution which can be viewed as related to the structural mechanism of the disease. To confirm previous results on factors affecting the distribution of onset in affective disorders, we studied its distribution pattern in two different populations, Italian and Swedish, with an analytic approach that does not require specifications of any a priori hypothesis. The findings in this study, however, tend to confirm the biological nature of the age of onset phenomenon and to exclude cultural determinants. On the other hand, it does not exclude that other factors, not considered in this study, may be operating. This result is very important under the hypothesis of a genetic ethiopathogenesis of affective disorders, and some of its implications are discussed.
The morbidity risk for affective disorders was calculated among the relatives of subgroups of reactive-neurotic depressive patients. The patients were divided into reactive and neurotic depressives. The parents of the neurotic subgroup had a significantly lower morbidity risk of affective disorders in comparison with the parents of the reactive subgroup. The role of genetic and environmental factors in the etiology of reactive-neurotic depression was discussed.
Within the framework of an ongoing cross-national study of hospitalized depressed patients the symptomatology of age, sex and diagnosis matched depressives consecutively admitted to a University Department of Psychiatry in Budapest, Hungary and in Umeå, Sweden has been compared. Only minor differences in symptomatology were detected between the two groups.
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The incidence of parental loss by death before the age of 15 was investigated in a series of 200 depressed patients, sub-divided into unipolars, bipolars and neurotic-reactive depressives, and in their healthy siblings at risk. The age of onset of illness of patients who had lost a parent before 15 was compared with that of depressed controls. No excess of parental loss at any age was found in any of the patient sub-groups, as compared with their healthy siblings, nor did parental loss affect the age of onset of later depression. The results do not support the assumption that the loss of either parent by death in early childhood is significantly associated with depression in adult life, though parental death may be an important variable for individual patients.
Four groups of depressed patients 47 unipolars, 21 bipolars, 34 with neurotic-reactive depression, and 39 with unspecified depressive disorder completed, after recovery, the EMBU, a Swedish instrument aimed at assessing the experience of parental rearing practices. The results for three factors: "rejection", "emotional warmth" and "over-protection" and the global judgement scores of "severity" and "consistency" in rearing attitudes were compared with those obtained from 205 healthy individuals. Depressed patients, particularly in the unipolar unspecified groups rated both parents lower than the controls on emotional warmth. Patients tended also to rate their parents as less consistent in their rearing attitudes. The variables emotional warmth and overprotection allowed 64% of the patients and 72 of the unipolar depressives to be classified correctly. These results, like those of previous studies, support the hypothesis that deprivation of love during childhood represents an important psychological risk factor in the background of depressive disorders.
A psychometric study on Swedish and Dutch samples used the EMBU, a self-report instrument designed to assess memories of parents' rearing behaviour. Of the four primary factors identified previously with Dutch individuals (Rejection, Emotional Warmth, Over-protection, and Favouring Subject), the first three were retrieved in a similar form in the two Swedish groups (depressives and healthy, non-patients). Examination of the metric equivalence of the scales and the strength of the factors for each group indicated that comparisons of patterns and levels between groups from the respective countries on the three factors showing cross-national constancy would be warranted. Scale-level factor analyses of these dimensions produced identical two-factor compositions (CARE and PROTECTION) across national groups which further supported this conclusion.
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In a series comprising 166 subjects with affective disorders, the lowest and highest quartiles in the male and female platelet monoamine oxidase (MAO) distribution, respectively, were included. The morbidity risk in the first-degree relatives (parents and siblings) of these low and high platelet MAO subjects was determined. First-degree relatives of low platelet MAO probands were found to have an increased morbidity risk for neurotic-reactive depressions and for alcoholism. The results seem to be in line with the biological high-risk paradigm, indicating that platelet MAO could be a biological marker for increased vulnerability. First-degree relatives of high platelet MAO probands were found to have an increased morbidity risk for bipolar affective disorders.
Two groups of former depressed Italian patients comprising 54 bipolars and 52 unipolars completed the Italian version of the EMBU, a Swedish instrument aimed at assessing the experience of parental rearing behaviour. As in a previous study of Swedish depressives, three factors, "rejection", "emotional warmth", and "over-protection", have been taken into account. The results obtained in the patient group have been compared with those obtained in Italian healthy controls. Depressed patients rated both parents significantly lower than the controls on the factor "emotional warmth". The present results cross-validate those obtained previously in the Swedish depressives and strengthen, together with other findings in the literature, the assumption that the lack of emotional warmth in the parents' rearing practices might be a crucial variable in the pathogenesis of depressive illnesses.
Samples of healthy subjects from Australia, Denmark, Italy, The Netherlands and Sweden completed the EMBU, a Swedish questionnaire aimed at assessing the experience of parental rearing practices. For the purpose of comparison three factors - "emotional warmth", "rejection" and "overprotection" - obtained in a previous factor analytic study, have been used. The most pronounced differences occurred between the Dutch and the Swedish sample on the one hand, and the Italian and Australian sample on the other, with the Danish sample in between. Differences in perceived parental rearing should be considered when comparing personality characteristics and/or psychopathological conditions in subjects from different countries.
A classification of schizoaffective disorders for research purposes is presented. Two main categories are preliminarily singled out: 1) that characterized by the consecutive appearance of an affective and a schizophrenic syndrome (type I), 2) that marked by the concurrent appearance of a full schizophrenic and a full affective syndrome (type II). Within type I, two subtypes are distinguished: 1) that beginning as a typical schizophrenic disorder and shifting later on into a recurrent affective syndrome (affective subtype), 2) that beginning as an affective disorder and showing in its further course a progressive schizophrenic development towards deterioration (schizophrenic subtype). For type II, a multiaxial classification is proposed. Axis 1 should be used to describe the cross-sectional symptomatology, axis 2 to define the course, and axis 3 to note the presence of associated factors. On axis 1, schizoaffective disorder type II can be divided into a manic and a depressive subtype. Operational diagnostic criteria for each are provided. On axis 2, an affective (recurrent) and a schizophrenic (continuous with exacerbations) subtype can be distinguished.
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One of the most patent inconsistencies in the application of the 1978 Psychiatric Reform Act in many areas of Southern Italy has resulted from the irrational choice, by regional governments, of the general hospitals in which Psychiatric Special Units had to be implemented, and from the inappropriate determination of territorial boundaries defining the competence of such Units. Thus, in the city of Naples, it was decided, in June 1978, to set up Psychiatric Special Units only in the two University Psychiatric Departments and in the Psychiatric Emergency Ward at S. Gennaro Hospital. These Units, equipped with an overall number of 39 beds, were put in charge with the whole province of Naples (about three millions inhabitants). Quite arbitrarily, it was established that University Departments had to admit patients coming from the city of Naples and S. Gennaro Hospital those residing in the rest of the province. By an equally arbitrary choice, female patients from the city of Naples were entrusted to the University Department I and male patients to the Psychiatric Department II. In the following years, from 1979 to 1983, some additional Units were set up in general hospitals of the Naples province. Nonetheless, available beds have not exceeded the overall number of 69, and the catchment areas of the three pre-existing Special Units have not been modified. The chaotic situation engendered by this incongruous application of the Reform Act is outlined, by means of an analysis of the requests for compulsory admission addressed to the Special Unit at the Psychiatric Department I of Naples University during the periods June 16, 1978-December 31, 1979 and June 16, 1982-December 31, 1983.