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Biomedical subjects

G L Klerman

Publications and source records attributed to G L Klerman.

At least 19 recordsLinked to original sources
PubMed1979

Differential symptom reduction by drugs and psychotherapy in acute depression.

A randomized, controlled trial compared the combination of amitriptyline hydrochloride and short-term interpersonal psychotherapy, either treatment alone, and a nonscheduled treatment control group in ambulatory acute, nonbipolar, nonpsychotic depressives. Results show the efficacy of both psychotherapy and amitriptyline in overall symptom reduction. Amitriptyline and psychotherapy were about equal, and the effects of both treatments in combination were additive. The additive effect of combined treatment was largely due to the differential effects of the two treatments. Amitriptyline had its effect mainly on the vegetative symptoms of depression such as sleep and appetite disturbance, these occurred early in treatment, often within the first week. Psychotherapy had its effect mainly on mood, suicidal ideation, work, and interests; these effects occurred slightly later, at four to eight weeks.

Adolescent↗
PubMed1979

Neurotic depressions: a systematic analysis of multiple criteria and meanings.

Neurotic depression, the most commonly used psychiatric diagnosis, has multiple meanings that are often used interchangeably in clinical practice. The authors identify six different meanings of neurotic depression and present data from a study of 90 depressed inpatients to determine how many patients met several different criteria; 16 patients met four sets of criteria. The overlap that exists between the different meanings is higher than chance alone but not sufficiently high to allow complete interchangeability. Until new diagnostic classes are developed, the authors recommend that the term "neurotic depression" no longer be used clinically because of its vagueness.

Adjustment Disorders↗
PubMed1979

Personality attributes and affective disorders.

To determine the personality characteristics associated with affective disorders the authors administered a battery of self-report personality inventories to a sample of hospitalized affective patients when their manifest symptoms had abated. Patients were instructed to answer according to their premorbid personalities. The personality characteristics assessed in the 73 depressive and 24 manic patients included neuroticism and extraversion from the Maudsley Personality Inventory, obsessional pattern, hysterical pattern, and oral pattern from the Lazare-Klerman-Armor Personality Inventory, obsessional state and trait from the Leyton Obsessionality Inventory, and solidity, stability, and validity from the Marke-Nyman Temperament Survey. Depressive patients demonstrated more neuroticism, introversion, and obsessionality than manic patients or normal individuals. The manic patients differed from normal persons only on obsessionality.

Adult↗
PubMed1979

National trends in hospitalization.

The past two decades have witnessed several important trends in mental health care: a decline in the resident census in public mental hospitals, an increase in outpatient treatment and facilities, relative stability in the number of hospitalization episodes per 100,000 population, and briefer duration of hospitalization. The combined result of these trends is increased pluraslism, diversity, and deinstitutionalization in mental health care. The changes are primarily the consequences of the success of psychopharmacologic agents, new forms of psychotherapy, changing attitudes of the public and the profession, and increased financial support by the federal government.

Community Mental Health Centers↗
PubMed1979

The efficacy of drugs and psychotherapy in the treatment of acute depressive episodes.

The efficacy of tricyclic antidepressants and various psychotherapies, in comparison with one another or in combination, has not been fully established in randomized clinical trials. The authors present a randomized controlled trial comparing the combination of amitriptyline and short-term interpersonal psychotherapy, either treatment alone, and nonscheduled supportive psychotherapy in ambulatory patients with acute depression. They found that pharmacotherapy and psychotherapy alone were equally efficacious and better than nonscheduled treatment. The combination treatment of psychotherapy and pharmacotherapy was more effective than either treatment alone and delayed the onset of symptomatic failure.

Adolescent↗
PubMed1979

Treatment of depression in the elderly.

Depression is often overlooked, misdiagnosed, or inadequately treated in older patients. Since depressions secondary to drug use or organic diseases are common in the aged, complete physical and laboratory evaluation is essential. Fortunately, depression can be alleviated if you know the therapeutic options. Selection of the best one should be made carefully in elderly patients.

Aged↗
PubMed1978

The borderline patient. A comparative analysis of four sets of diagnostic criteria.

In reviewing the evidence for the validity of the diagnosis borderline, four descriptions in the literature seem to offer comprehensive criteria for the diagnosis. When the four are compared, a total of 104 criteria are enumerated encompassing the mental status, history, interpersonal relationships, defense mechansisms, and other judgments of personality functioning of the borderline patient. Half of these criteria are mentioned in only one of the four diagnostic descriptions. This apparent lack of agreement over diagnostic criteria has three possible interpretations: (1) the borderline concept is an illusion; or (2) the concept is adequately defined by those criteria held in common, the others being nonessential; or (3) apart from the concept defined by the common criteria, there are subtypes emphasized by different authors. Although we favor the third interpretation, it is suggested that further speculation await an adequate test of existing diagnostic criteria.

Diagnosis, Differential↗
PubMed1978

Epidemiology of mental disorders: emerging trends in the United States.

Psychiatric epidemiology in the United States currently is being influenced by developments in genetics, psychopharmacology, neurobiology, and particularly psychopathology after the heavy influences of the social sciences during the post-World War II period. The integration of recent scientific developments in psychiatry, with the methodological precision that characterized the earlier studies of the 50s and 60s promises to provide new knowledge on the epidemiology of mental disorders in the community, which will have important implications both for professional practices in medicine and public health and for public policy in the planning of mental health services, training, and research.

Epidemiologic Methods↗
PubMed1978

Secondary mania: manic syndromes associated with antecedent physical illness or drugs.

While mania usually occurs as a phase of manic-depressive disease, it can occur in association with organic dysfunction--medical and pharmacological--in patients with no history of affective disorder. In reviewing the literature, we have found that mania occurs secondary to drugs, infection, neoplasm, epilepsy, and metabolic disturbances. These cases are best considered secondary manias. They suggest that mania--like, for example, hypertension--is a syndrome with multiple causes and that with further research many manic syndromes currently considered primary will be shifted into the secondary category. Furthermore, the concept of secondary mania casts doubt on any unitary or single-agent hypothesis of the etiology of mania and supports the notion of a continuum of psychopathologic syndromes. Clinicians are alerted to the existence of this syndrome and are urged to screen for it when conditions warrant.

Adrenal Cortex Hormones↗
PubMed1978

The effects of amitriptyline and lithium on a patient with 48-hour recurrent depressions.

A 61-year-old man with a 5-year history of 48-hour mood swing cycles--1 day depressed, 1-day euthymic--was treated with medications in a double blind trial. Placebo had no effect on his cycles, amitriptyline lessened the amplitude of depression on "bad days" but did not effect the 48-hour periodicity, whereas lithium carbonate therapy terminated both affective symptoms and the cycle itself. After several months on lithium, the patient discontinued the drug, but neither symptoms nor cycles returned. Forty-eight-hour affective cycles are unusual, and this patient's response to lithium is particularly striking.

Amitriptyline↗
PubMed1978

Facial electromyography in the assessment of improvement in depression.

Depressed patients who showed decreases in resting corrugator muscle tension levels, as measured electromyographically, also showed improvement in clinical symptoms, as assessed by the Hamilton Psychiatric Rating Scale over a 2-week period. Patients showing good clinical improvement after 2 weeks had resting pretreatment corrugator levels higher than those showing little clinical improvement, suggesting that corrugator activity might also serve as a forecaster of subsequent change. These findings support Darwin's 1872 hypothesis concerning the role of the "grief" muscle in depression. Furthermore, psychophysiological recording of patterns of facial muscle activity may have value in the clinical assessment of depression and treatment effects.

Amitriptyline↗