Biomedical subjects
Publications and source records attributed to C Tennant.
In a study of cases of recent onset of schizophrenia, schizophreniform psychosis and hypomania (DSM-III criteria), threatening life events were significantly related to the onset of schizophreniform psychosis but not schizophrenia. The results also suggest that threatening events may precipitate hypomanic episodes.
The psychosocial adjustment of 126 Vietnam veterans admitted to the psychiatric unit of a Veterans' Affairs hospital was compared with age and diagnosis matched non-veteran controls. Violent behaviour and heavy alcohol use were common in Vietnam veterans. In other domains of personal and social adjustment the veterans and controls did not differ.
Evidence of chronic psychiatric and psychosomatic morbidity was found in a randomly selected sample of Australian prisoners of war (POWs) of the Japanese over the 40-year period following the Second World War. A clinical interview revealed more contemporary depressive and anxiety disorders and more post-war psychiatric illness overall than in a comparison group of randomly selected combatant veterans of the Pacific and South East Asian campaign. The POWs were no more likely to have had psychiatric admissions than non-POWs and fewer of them had had multiple psychiatric admissions. POWs had more duodenal ulcers than controls but otherwise their physical health was similar, as was their age-adjusted mortality in the post-war years. Finally, POWs were more likely to have Totally and Permanently Incapacitated Service Pensions than controls.
The effects of chloroquine and mepacrine were determined on the release of slow reacting substances (leukotrienes) from lung fragments in vitro. These drugs have been shown in a variety of tissues to inhibit phospholipase A2, and thus to reduce the availability of arachidonate, which is a substrate for leukotriene biosynthesis. Leukotriene and histamine release from unsensitized human lung was stimulated by calcium ionophore A23187, and from actively sensitized guinea-pig lung, by ovalbumin. Chloroquine (10 microM and 100 microM) significantly inhibited leukotriene release in lung from both species, and at 100 microM also inhibited histamine release. Mepacrine (10 microM) inhibited leukotriene release in human lung and at 100 microM in guinea-pig lung. The effects of chloroquine (100 microM) on leukotriene release were counteracted by the presence of arachidonic acid (10 microM), which suggests that chloroquine had impaired the availability of arachidonate. It seems probable that chloroquine and mepacrine inhibit leukotriene release by inhibition of phospholipase A2 in lung.
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In a survey of a random sample of the general population recent life events, collected and rated for long-term contextual threat according to the methods of Brown & Harris (1978), were also recorded where possible on an inventory of life event categories (Tennant & Andrews, 1977). Of the 82.5% of all events collected which were covered by the inventory, 12 of the 67 event categories accounted for 77% of life events with an aetiologicaly significant rating of marked or moderate long-term threat. Where practical and economic constraints oblige research workers to choose the inventory method, a brief list of event categories, such as the List of Threatening Experiences, is recommended in preference to much longer lists.
Studies of live events and schizophrenia are few. Most have such methodological limitations that make any causal interpretation of their findings impossible. Of the three studies with appropriate methodology and controls, Brown and Birley (1968) found very recent life events trigger onset, Leff et al. (1983) found events were capable of precipitating relapse, under certain restricted circumstances, while Jacobs and Myers (1976) found independent events appear to have no significant effect. The widely held view that life events can precipitate schizophrenic episodes may be supported by our own clinical impressions; it is as yet not well supported by empirical data. Future research should perhaps focus on other definitions of these psychoses, such as is now embraced by DSM-III. Perhaps then a relation between stressful events and some of the non-depressive functional psychoses might be demonstrated.
The authors reviewed the case records of a random sample of 126 Australian Vietnam veteran inpatients, recorded the diagnostic and background data, and made new DSM-III diagnoses. Neurotic disorders accounted for 49% of the primary or secondary diagnoses. Only 10% of the overall sample had a primary diagnosis of posttraumatic stress disorder but 27% of the veterans who had seen combat had a primary diagnosis of the disorder. Twenty-nine percent of the overall sample were given a primary diagnosis of alcohol abuse or dependence. The early developmental environment of the overall sample frequently included poor parent-child relationships, high rates of parental separation, and family histories dominated by parental alcohol abuse.
Forty-three patients with non-endogenous depressive disorders were assessed shortly after psychiatric referral, and reassessed at six and at 20 weeks. The pattern of improvement appeared to be set shortly after the initial consultation, but could be most clearly predicted by the degree of improvement at the end of the third week. Key baseline factors predicting a more marked improvement at each follow-up were a more severe depression, the break-up of an intimate relationship, and the presence of weight loss. Positive life events occurring after the initial assessment predicted improvement at six and at 20 weeks, while the presence of a neutralising event (which negated an earlier threatening life event) predicted improvement at 20 weeks.
Any notion or concept of stress should fulfil the following requirements. First, the definition should be readily communicable both to professionals and the community at large. Second, the concept should be readily converted into constructs which are suitable for research. In this latter regard it is easier to present and discuss a stress model. This model differentiates a number of factors which, although interdependent, are conceptually distinct. By adequately discriminating between these factors, operational criteria may be defined and a systematic assessment of the effects of stress will be facilitated. A model is thus presented which describes the stress process.
This paper compares the coverage of potential life events by the inventory developed by Tennant & Andrews (1976) and the post hoc designation originated by Brown (1974). It was found that the rubric of the inventory failed to describe 5% of 'marked' events and 21% of 'moderate' events. The relative risk of minor psychiatric disorder in response to events was 3.1 for those defined by the Brown technique and 1.4 for those using the inventory. The results suggests that the post hoc designation is superior. This superiority must be weighed against its undoubted costliness.
A community survey of psychiatric disorder carried out in South London enabled the authors to investigate the 'vulnerability model' proposed by Brown & Harris (1978). In the current study none of the 'vulnerability factors' proposed by Brown & Harris fulfilled the requirements of the model. It was, however, found that working class women with children seemed particularly prone to develop minor psychiatric disorder in response to adversity. A similar result is apparent in the analyses of the earlier authors. A number of studies now published give some support to the vulnerability model using what are broadly measures of social support, but there is little corroboration using the other variables proposed by Brown & Harris.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
The effect of childhood experiences on adult psychiatric morbidity was examined in a community psychiatric survey. The Present State Examination was used to assess psychiatric morbidity. Childhood experiences assessed included childhood demographic factors and 'loss and deprivation' variables. The latter group comprised maternal and paternal deaths and separations and other disruptions in parental care 'Loss and deprivation' in combination accounted for between 4.5 and 5.5% of the variance in adult psychiatric morbidity.
The relation of childhood separation experiences to adult depression, anxiety and 'general psychological morbidity' was assessed in a random population survey. Four causes of separation were examined in each of three age groups: childhood illness, parental illness, parental marital discord and wartime evacuation. Childhood separations occurring up to five years of age bore no relation to depression, anxiety nor to incidence of morbidity generally. From five to ten years of age, separations caused by parental illness and marital discord were related to morbidity, and in the latter instance were more likely to cause depression than anxiety. From 11 to 15 years, only separations due to parental illness were related to morbidity generally.
Studies of prevalence of neurotic disorders show women to be far more vulnerable than men. Biological factors cannot account for this marked sex difference; social factors are clearly implicated. Findings from a community study in London show that social roles, especially those relating to marriage, are implicated. It appeared that lack of employment outside the home was deleterious for both sexes, while a poor marital relationship was deleterious for women alone. Although care of young children was associated with neurosis in women, it did so by virtue of depriving women of employment outside the home.