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Biomedical subjects

I M Goodyer

Publications and source records attributed to I M Goodyer.

At least 19 recordsLinked to original sources
PubMed1998

Family functioning and parent general health in families of adolescents with major depressive disorder.

Family functioning and parent mental health in families of adolescents with major depressive disorder (n = 61) were compared with a community control sample (n = 34) using the McMaster Family Assessment Device (FAD) and the General Health Questionnaire (GHQ). Mean FAD and GHQ scores for clinic families were significantly worse than controls. 56% of clinic and 29% of control families met operational criteria for current dysfunction. In the clinic group family dysfunction was associated with the additive effects of comorbid Oppositional Defiant disorder in the adolescent and mother's current poor mental health, while father's current mental health had no associations with family functioning.

Adolescent↗
PubMed1998

Adrenal steroid secretion and major depression in 8- to 16-year-olds, III. Influence of cortisol/DHEA ratio at presentation on subsequent rates of disappointing life events and persistent major depression.

BACKGROUND: An investigation of the association between diurnal changes in cortisol and DHEA levels, or in the cortisol/DHEA ratio at five different time points at presentation, and the occurrence of undesirable life events (losses, dangers to self and others, disappointments) during follow-up, and the outcome of major depression at 36 weeks were investigated. METHODS: Psychosocial and endocrine assessment of a consecutive cohort (N = 68) of 8- to 16-year-old subjects with first episode major depression reassessed 12 months after presentation using a repeat measures design. RESULTS: Higher cortisol/DHEA ratios at 20.00 or 24.00 h predicted persistent major depression. Basal levels of either hormone alone or cortisol/DHEA ratios at the other three time points (08.00, 12.00 or 16.00 h) did not. High cortisol/DHEA ratios (i.e. values greater than the 60th percentile) at both evening points (20.00 and 24.00 h) also predicted the occurrence of subsequent disappointing life events but no other category of undesirable event. Both high evening cortisol/DHEA ratio at 20.00 h and one or more severely disappointing life events between presentation and follow-up predicted persistent major depression: 86% of subjects with both of these factors were still depressed at 36 weeks whereas 81% with neither factor were not. CONCLUSIONS: The finding that it is depressed subjects with high cortisol/DHEA ratios at presentation who are specifically at risk for subsequent disappointing life events suggests a putative role for these adrenal steroids in abnormal cognitive or emotional processes associated with disturbed interpersonal behaviour.

Adolescent↗
PubMed1998

Post-traumatic stress disorder in children and adolescents following road traffic accidents.

BACKGROUND: Post-traumatic stress disorder (PTSD) can be a persistent and disabling psychiatric disorder. There is little systematic research into the psychiatric consequences of road traffic accidents (RTAs) in children and adolescents. METHOD: A consecutive sample of 8-16-year-olds attending an accident and emergency department following RTAs were screened for PTSD. Potential cases and their parent(s) were interviewed with semi-structured research instruments about six weeks and six months after the accident. RESULTS: Fifty-three (45%) of the 119 subjects fell above PTSD cut-off on the Frederick's Reaction Index. Thirty-three (75%) of the 44 cases met DSM-IV criteria for PTSD. In half of these other psychiatric disorders were present, including major depressive disorder and anxiety disorders. Being female, involvement in car accidents and pre-existing depression and anxiety were associated with developing PTSD. Seventeen per cent of the sample continued to be symptomatic six months after the accident. CONCLUSIONS: PTSD is a common consequence of RTAs. Liaison with accident and emergency departments would enhance the early detection and follow-up of children at risk of developing PTSD.

Accidents, Traffic↗
PubMed1997

Short-term outcome of major depression: I. Comorbidity and severity at presentation as predictors of persistent disorder.

OBJECTIVE: To determine whether there is a pattern of clinical characteristics at presentation that specifically predicts persistent major depression at 36 weeks follow-up. METHOD: Sixty-eight consecutive cases with a first episode DSM-III-R diagnosis of major depression were interviewed with the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present Episode version and completed the mood and feelings self-report depression questionnaire (MFQ) at presentation and again at 36 weeks. RESULTS: At presentation, 63 (93%) had one or more comorbid psychiatric disorders (median = 3). At 36 weeks, 17 (25%) cases were recovered; 17 (25%) continued to meet criteria for one or more psychiatric disorder but not major depression; 34 (50%) still met criteria for DSM-III-R major depression, of whom 25 (73%) had been persistently depressed and 9 (27%) had recovered and subsequently relapsed. Major depression at follow-up was specifically predicted by the additive effect of three features at presentation, comorbid obsessive-compulsive disorder, higher MFQ score, and being older. Comorbid oppositional defiant disorder at presentation was a significant predictor of persistent psychiatric disorder. Individuals with persistent depression (n = 25) were more likely to have a longer duration of illness before presentation. CONCLUSION: Systematic assessment of comorbid psychiatric conditions at initial interview, together with the use, in older subjects, of a self-report questionnaire to determine subjective severity, will provide valid clinical information concerning the potential short-term outcome of major depression.

Adolescent↗
PubMed1997

Short-term outcome of major depression: II. Life events, family dysfunction, and friendship difficulties as predictors of persistent disorder.

OBJECTIVE: To determine whether there is a pattern of social characteristics that specifically predicts persistent major depression at 36 weeks follow-up. METHOD: Sixty-eight consecutive cases with a first-episode DSM-III-R diagnosis of major depression completed a life events and friendship difficulties interview at presentation and again at 36 weeks. RESULTS: Four factors were associated with persistent psychiatric disorder in general: lack of a maternal confiding relationship with current partner, family dysfunction and poor friendships at presentation, and severely disappointing events between presentation and follow-up. There was no association between these adverse experiences. No combination of long-term or recent life events or difficulties was, however, specifically associated with persistent depression. CONCLUSION: Nonsocial factors may need to be taken into account to specifically explain the phenotypic persistence of major depressive disorder in first-episode nonrecovered cases within a year of presentation. Psychosocial interventions with first-degree relatives and current close friendships should be considered as a part of the treatment strategy for first-episode major depression.

Adolescent↗
PubMed1996

Recent undesirable life events: their influence on subsequent psychopathology.

Life events appear to exert a range of effects on subsequent behaviour through their impact on affective-cognitive processes. Their effects on those physiological processes pertinent to psychopathology have yet to be investigated. Single events do not exert much risk for subsequent disorder. It is the pattern of adverse life experiences, of which recent life events is frequently a component, that determines the degree of risk and the mechanisms and processes that may lead to subsequent psychopathology. Recall of events that occurred in the recent past may be influenced independently by the age of the individual and a previous episode of psychiatric disorder. Longitudinal studies determining the impact of life events on subsequent behaviour will need to take these features into account. There remains no specificity between particular types of recent undesirable life events and anxious or depressive disorders. Future longitudinal research should employ modern methods of life event data collection and measurement. The goal of future longitudinal research should be to determine the relative contribution of undesirable and desirable recent life events in the presence and absence of other putative casual factors from different domains. This should necessarily include social (e.g. long-term difficulties), psychological (e.g, temperament (18) or self esteem) and physiological (e.g. hypercortisolaemia in adolescent major depression (14, 11) elements. It is only through this combination of longitudinal design, together with sensitive and concurrent multiple repeat measurements that a greater understanding of the mechanisms and processes that determine psychopathology over the course of development will occur.

Adaptation, Psychological↗
PubMed1996

Adrenal secretion during major depression in 8- to 16-year-olds, I. Altered diurnal rhythms in salivary cortisol and dehydroepiandrosterone (DHEA) at presentation.

The association between basal cortisol, dehydroepiandrosterone (DHEA), its sulphate (DHEAS) and major depression was investigated in 8- to 16-year-olds. Eighty-two subjects with major depression, 25 non-depressed psychiatric cases and 40 community controls were systematically assessed for current mental state and hormone levels at 08.00, 12.00 and 20.00 h, assayed from salivary samples collected over a 48 h period. The average mean of the two time points was compared between the three groups. Evening cortisol hypersecretion and morning DHEA hyposecretion were significantly, and independently, associated with major depression. High evening cortisol (> 0.594 ng/mL) and low morning DHEA (< 0.200 ng/mL) identified subgroups of depressives with different types of adrenal hormone dysregulation. The association between high evening cortisol or low morning DHEA and MDD was not affected by either age or gender.

Adolescent↗
PubMed1996

Adrenal secretion and major depression in 8- to 16-year-olds, II. Influence of co-morbidity at presentation.

The association between high evening cortisol and low morning DHEA and the pattern of co-morbid diagnoses in 82 cases of major depressive disorder in 8- to 16-year-olds has been analysed. There was a significant association between the presence of high evening cortisol and co-morbid dysthymia. This was independent of age or sex. No positive association was found between the presence of low morning DHEA and any co-morbid diagnosis. However, co-morbid panic or phobic disorder was significantly associated with the absence of this endocrine abnormality. These findings suggest that specific endocrine disturbances may be associated with different patterns of co-morbidity during an episode of major depression in this age group.

Adolescent↗
PubMed1996

Temperament and psychopathology amongst siblings of probands with depressive and anxiety disorders.

Thirteen (42%) of 31 siblings of 29 probands with depression (n = 21) or anxiety disorders (n = 8) attending a clinic met DSM-IIIR criteria for psychiatric disorder, a rate nearly three times greater than reported from community studies. The diagnoses were heterogeneous. Compared with probands, sibling cases had half the level of comorbidity and significantly lower levels of psychosocial impairment. Comparisons of temperamental characteristics showed that higher levels of emotionality, but no other aspect of temperament, was associated with an increased likelihood of a sibling being a case. Higher emotionally in all cases (sibs and probands) was associated with greater comorbidity in general and the diagnoses of dysthymia and separation anxiety in particular.

Adolescent↗
PubMed1996

Cortisol, dehydroepiandrosterone (DHEA), and DHEA sulfate in the cerebrospinal fluid of man: relation to blood levels and the effects of age.

The relation between blood and cerebrospinal fluid (CSF) concentrations of cortisol, dehydroepiandrosterone (DHEA), and its sulfate (DHEAS) was measured in 62 subjects aged 3-85 yr old, fitted with ventriculo-peritoneal or lumbar-peritoneal shunts for a variety of diagnoses. There were 36 males and 36 females. Forty-eight subjects were not taking exogenous corticosteroids; the other 14 were receiving either systemic or local steroids. A single sample of blood and CSF was taken from each subject within 10 min for measurement of cortisol, DHEA, and DHEAS. The proportional levels of cortisol (5.8%) and DHEA (5.4%) in the CSF compared with those in the blood were similar in subjects not taking steroids. However, CSF DHEAS levels were only 0.15% of those in the blood. Because DHEAS blood levels were so much greater than DHEA, DHEAS in the CSF was still higher than DHEA despite the reduced penetration of the sulfated steroid. The blood/CSF ratios were similar in subjects taking steroids. There were significant correlations in steroid-free subjects between blood and CSF levels for DHEA (r = 0.65) and DHEAS (r = 0.88) but not for cortisol (r = 0.26). Steroid treatment significantly lowered blood cortisol, DHEA and DHEAS, and CSF DHEA, but not CSF cortisol or DHEAS compared with an age- and sex-matched sample of steroid-free subjects. In steroid-free adults (18 yr and over; n = 37), blood cortisol showed no age-related change. However, CSF cortisol was markedly raised in a proportion of steroid-free subjects over the age of 60 yr. Levels of corticoid-binding globulin in plasma did not alter with age. As expected, there were significant age-related decrements in both blood DHEA and DHEAS. CSF DHEA (r = 0.42) and CSF DHEAS (r = 0.39) were significantly negatively correlated with age. In steroid-free juveniles (n = 11) there were no age-related changes in either blood or CSF cortisol, but significant increases with age in DHEA and DHEAS in both blood and CSF. Calculation of the cortisol/DHEA and cortisol/ DHEAS molar ratios in the CSF showed both to be raised in the very young (3-8 yr) and the elderly (60 yr and over) by a factor of 4-5 compared with young adults aged 18-39. There were no sex differences in any of the parameters measured. These findings show that the relation between levels in the blood and CSF differ for each of these three neuroactive steroids. The brain is exposed to relatively high levels of DHEA and DHEAS during later childhood and early adulthood but to relatively or absolutely high levels of cortisol during infancy and older age. In view of the known antiglucocorticoid action of DHEA and DHEAS, and the direct action of these steroids on membrane-bound transmitter events (such as gamma-aminobutyric acidA receptors), these changes may have important implications for age-related alterations in brain function.

Adolescent↗
PubMed1993

Depression in 11-16-year-old girls: the role of past parental psychopathology and exposure to recent life events.

Interviews with parents of a non-referred sample of 11-16-year-old girls (n = 82) revealed that a significantly greater proportion of mothers with a lifetime history of any psychiatric disorder also reported one or more recent undesirable life events focused on the adolescent compared with mothers with no such history. Lifetime episodes of maternal depression and recent undesirable life events exerted significant additive effects on the likelihood of depression occurring in the previous 12 months in adolescent girls. Some families may be "life event prone" as a consequence of lifetime episodes of parental psychopathology.

Adolescent↗
PubMed1993

Temperament and major depression in 11 to 16 year olds.

Temperament (EAS teacher and parent questionnaire) and mental state (modified DISC-C interview with adolescent) was systematically assessed in 193 11 to 16 year olds (112 girls, 81 boys) screened for major depression in the community. Sex differences in the structure of temperament were noted from both parent and teacher reports. High (negative) emotionality alone was associated with major depression, particularly (but not exclusively) in girls.

Adolescent↗
PubMed1991

Lifetime exit events and recent social and family adversities in anxious and depressed school-age children and adolescents--I.

The number of lifetime exit events occurring over the lives of 7-16-year-old children was compared between cases with new onset episodes of anxiety and depression (n = 100) and community controls (n = 100). The reporting of events by adult responders appears reliable and not subject to distortions of recall. Overall the likelihood of experiencing exit events increases with age. A significant association was found between current disorder and two or more previous lifetime exit events. There is, however, a non-significant trend for those cases who experience multiple lifetime exits to be younger than the controls and to be female rather than male. These findings are uninfluenced by pubertal stage at time of onset of disorder or by diagnosis.

Adolescent↗
PubMed1991

Lifetime exit events and recent social and family adversities in anxious and depressed school-age children and adolescents--II.

The relative contribution made by three sets of social adversities preceding the onset of anxiety and depression in 8-16-year-olds is reported. These three sets of adversities are (i) lifetime exit events over the whole of the subject's life excluding those in the 12 months before onset of disorder in cases or day of interview for controls; (ii) recent family adversities; (iii) recent friendship difficulties and an absence of social achievements. Three cases compared with 35 controls experienced none of these sets of adverse social variables. Lifetime exit events exert significant independent effects on the likelihood of being a case in the presence or absence of the other two sets of factors. This suggests that the impact of multiple lifetime exits is not explained by the presence of recent adversities measured in this study. Twenty controls however experienced two or more of these sets of adversities with four experiencing all three. This suggests that some children appear protected from the pathological effects of these social adversities. The findings are not influenced by the sex or pubertal stage of the subjects and appear with equal likelihood in both anxious and depressive cases.

Achievement↗