Biomedical subjects
Publications and source records attributed to G I Keitner.
The dexamethasone suppression test (DST) was done in 53 psychiatric patients during at least two separate hospital admissions. The agreement between DST results on both admissions exceeded chance expectations: 69.8% of all patients and 72.3% of those with major depression had consistent DST results.
Emotional and physical relationships among copatients on a short-term psychiatric unit were assessed in a two-year prospective study. Sixty-four relationships involving 102 patients were reported; the incidence rate was estimated at 10.7 percent. Thirty-three percent of the relationships were characterized as emotional, 9 percent as physical, and 58 percent as both. Patients involved in the relationships tended to be young and unmarried and to have a diagnosis of eating disorder, personality disorder, or bipolar disorder. Although most of the relationships were reciprocal, half were judged to be destructive and to create management problems. Staff discussed the relationship with the patients when it was considered destructive or exploitative but ignored relationships felt to be positive and healthy. The authors urge further studies of such relationships to help clarify patient management issues.
In this study we examined the relationship of psychopathology and personality dysfunction to neuroendocrine functioning. MMPI profiles were examined for 30 psychiatric inpatients with major depression who were suppressors (60%) and nonsuppressors (40%) on the dexamethasone suppression test. There were no differences between suppressors and nonsuppressors on any of the MMPI scales or on DSM-III Axis-II diagnosis. When subdivided according to T-score elevations above 70 on MMPI scales 4 and 6, or 4 and 9, 30% of the sample, however, met criteria for personality dysfunction. Furthermore, a significantly higher proportion of suppressors (50%) evidenced personality dysfunction than did the nonsuppressors (8%). This suggests that certain MMPI scales are able to identify a subgroup of depressed patients with personality disturbances who also have a hypothalamic-pituitary-adrenal dysfunction.
There is uncertainty about the clinical usefulness of the dexamethasone suppression test (DST). It is also unclear whether there are advantages to a 1-mg or 2-mg DST. Eighty-three consecutive psychiatric inpatients were randomly given a 1-mg or 2-mg DST within the first week of admission. Sensitivity, specificity, and diagnostic confidence are reported for this group, and also in combination with those for 119 semi-consecutive psychiatric admissions. Although rates of nonsuppression were consistently higher in patients with affective disorders than in patients with other diagnoses, the diagnostic confidence of the DST for major depression in a diverse and unselected patient population was not greater than the prevalence of the disorder. The DST does not appear to be useful for clinical diagnostic decision-making. Nonetheless, the DST may still be an important biological marker in neuroendocrine psychiatric research.
Rates of nonsuppression on the dexamethasone suppression test were compared in 32 psychiatric inpatients with reported weight loss and 32 psychiatric inpatients without weight loss who were matched for age, sex, and diagnosis. There was no significant difference in rate of nonsuppression.
A case is presented exemplifying continuing concern over lithium-haloperidol interactions even at low to moderate doses. Emphasis is placed on distinguishing between worsening psychosis and neurotoxicity. The role of electroencephalographic diagnosing and monitoring of such reactions is discussed. Possible mechanisms of action and interaction with different neuroleptics are reviewed.
A 19-year-old man developed a schizophrenia-like psychosis after ingesting isosafrole. His use of amphetamines and LSD failed to produce a similar syndrome. Isosafrole may provide another biochemical model for schizophrenia.
This study compared the performance of male and female medical students on a psychiatric clerkship rotation. The women performed at a higher level than the men, although the difference was not significant. In general, the men scored significantly higher on national standardized medical examinations. Correlations between psychiatric clerkship evaluations and national examinations were low, suggesting that the two measures are independent. These findings for psychiatric clerkship are consistent with those for clerkships in medicine, surgery and obstetrics, implying that female clinical clerks are just as capable as male clinical clerks in providing high quality medical care.
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Sensitivity and specificity rates for 1 and 2 mg dexamethasone suppression tests (DSTs) are compared in 119 psychiatric inpatients diagnosed by DSM-III criteria. No differences are apparent between 1 and 2 mg groups. Moreover, combining a variety of affective disorders does not change the rates from those obtained using major depression alone. These data do not support a previous study which suggested that, compared to a 2 mg DST, a 1 mg test increases sensitivity without diminishing specificity. Nonsuppression appears to identify a subgroup of patients that cuts across several DSM-III categories.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Thirty-seven inpatients with pure major depression were compared with 41 inpatients with compounded depression (major depression with coexistent axis I, II, and/or III disorders) to assess the impact of the patients' illness on their families. Families of patients with compounded depression had worse family functioning (especially in their ability to solve problems and in maintaining acceptable standards of behavior), both during the acute depressive episode and at 6-month follow-up. A significantly smaller percentage of patients with compounded depression had recovered by 6 months (28%) than those with pure depression (51%).
A sample of depressed inpatients was subdivided according to their initial levels of cognitive dysfunction. These high cognitive dysfunction (HCD) patients and low cognitive dysfunction (LCD) patients received either pharmacotherapy or combined pharmacotherapy plus cognitive-behavioral psychotherapy. Treatments began in the hospital and continued for 20 weeks on an outpatient basis. Results indicated that HCD patients had significantly better treatment response to the combined treatment than pharmacotherapy alone, while LCD patients responded equally to pharmacotherapy alone and combined treatment.
The objective of the current study was to better understand the nature of prodromal and residual symptoms of mania and depression, as reported by patients with bipolar I disorder and their family members. Prodromal and residual symptoms of mania and depression were elicited from 74 patients with bipolar I disorder. In 45 cases, an adult family member provided similar information. Three clinicians classified the symptoms into six broad categories: behavioral, cognitive, mood, neurovegetative, social, and other. The clinicians also categorized symptoms as typical or idiosyncratic. Seventy-eight percent of the patients reported prodromal depressive symptoms and 87% reported prodromal manic symptoms; greater than half of the patients disclosed residual symptoms of depression (54%) and mania (68%). Within each of these four illness categories, cognitive symptoms were consistently the most common symptoms reported by patients. A substantial number of symptoms were idiosyncratic, particularly those reported for residual depression. Agreement between patient and family members on reported symptoms was strong for the prodromal phase of both polarities, but less so for the residual phases. These preliminary results suggest that patients with bipolar I disorder and their family members can identify prodromal and residual symptoms, that these symptoms are quite common, and that prodromal symptoms may be more prevalent or easier to identify than residual symptoms. Cognitive symptoms were consistently the most common symptoms reported by patients.
This study examined the association between suicidality, family factors, and clinical and diagnostic variables in depressed adult inpatients. The subjects were 121 depressed adult inpatients living with a family member or significant other. Demographic, clinical, and diagnostic information about the patient, and subjective and observer ratings of family functioning were obtained. Trained interviewers rated families of suicidal depressed patients as more dysfunctional than families of patients with no history of attempted suicide. In a logistic regression model, earlier age of depression onset, number of psychiatric hospitalizations, and objectively rated poorer family communication were associated with a history of a prior suicide attempt. Also, modest evidence suggested that patients with a prior suicide attempt perceived their families as more dysfunctional than did their respective family members. Variations in family functioning are associated with different degrees of suicidality. However, prospective longitudinal designs would elucidate the causal relation between family dysfunction and suicidal behavior.