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Forty-two epileptics were given a psychiatric interview and completed five questionnaires. Current affective symptoms were significantly associated with a past history of neurotic disorder but not with temporal lobe epilepsy.
In a recent article in the Schizophrenia Bulletin, Goplerud and Depue (1978) discuss our writings on postpsychotic depression (McGlashan and Carpenter (1976a and 1976b). They argue that postpsychotic depression is the depressed phase of bipolar affective illness and thus join many workers who now challenge the diagnosis of schizophrenia in patients in whom affective disturbance is a significant part of the manifest psychopathology. In our response, we place special emphasis on the fallacy of using nondiscriminating similarities between groups (e.g., suicidal ideation) as a basis for positing disease homogeneity. Contrariwise, we argue the value of emphasizing nosologically discriminating features of individual patients in reaching diagnostic decisions. Concern is expressed with the current trend of defining diagnostic criteria such that acute and episodic psychoses are increasingly classified as affective disorders. We present arguments in favor of maintaining such cases within an ambiguous or uncertain category and reassert the time-honored (but recently forgotten) observation that schizophrenic patients can be affectively disturubed and still be schizophrenic.
McGlashan and Carpenter (1979) have critiqued our article (Goplerud and Depue 1978), in which we suggested that postpsychotic depression and bipolar depressive disorder may well be related. Their critique has many problems and, most importantly, raises new ambiguities concerning the definition of postpsychotic depression. Therefore, we have attempted to clarify the issues their discussion raises.
This is a hypothesis-seeking case study. It is the product of naturalistic research on one asthmatic patient seen 212 times in individual psychotherapy over a period of 32 months. Both retrospective and prospective data were gathered, the prospective phase beginning about halfway into the therapy. Clinical vignettes are cited from which the following hypothesis was developed: there was a reciprocal relationship between the manifestation of physical symptoms and of affective reactions in this patient. In support of the possibility of testing this hypothesis, the therapist's observations and patient's report of physical and affective reactions each independently indicated a much greater incidence of one reaction or the other occurring separately than of both together. The occasional occurrence of both together indicates that the physical and the affective reactions are not mutually exclusive; therefore, the null hypothesis is also possible. A critique and synthesis of diverse literature ranging from psychoanalytic, group, and behavioral oriented clinical reports to human and animal physiological studies precede the presentation of the case study. The conclusion reached in reviewing the literature is that confirmation of the reciprocal hypothesis awaits further studies, but there is indication in the literature of support for such further study.
Several authors have noted that patients with an abnormally patent Eustachian tube (APET) seem to be psychologically disturbed. We investigated the psychological status of these patients before and after treatment with polytef paste (Teflon) injections. Twelve women were evaluated by a series of tests designed to catalog the nature and intensity of the symptoms, the degree to which symptoms affected the patient, psychopathological trends, and an assessment by the patients of improvement. Results prior to treatment indicated that the patients' symptoms were quite disturbing and were moderately disabling; such symptoms affected concentration, and a marked decrease in the enjoyment of life was noted. After treatment, a notable decrease in APET symptoms was reported, with a parallel decline in emotional disturbances. Patients felt less depressed, anxious, and angry, and they reported that the quality of life was much improved. These findings indicate that physical symptoms can have profound effects on emotional status. In such cases, the most effective psychological treatment is control of physical symptoms rather than psychiatric referral.
The Moos Menstrual Distress Questionnaire (MDQ) Form T, was analyzed for split-half and test-retest reliability. Also, an Experimental Group (N = 47)received neutral instructions to determine if knowledge of the purpose of the questionnaire would affect symptom ratings. Results indicated that the MDQ is internally consistent and does have high test-retest reliability. Also, altered instructions did not significantly affect symptom ratings. However, the MDQ, Form T, was not able to differentiate between Ss who were in different menstrual cycle phases when completing the questionnaire. It is suggested that Form T be used instead as originally intended to compare the ratings of different Ss in different cycle phases.
The relationship between premenstrual affective syndrome and psychiatric disorder was investigated, using 81 women presenting to a Neurology Clinic with functional headache. Premenstrual affective syndrome was significantly associated with a history of depressive syndrome in the population studied. Patients judged to have a non-affective psychiatric disorder reported no greater frequency of definite or probable premenstrual affective syndrome than patients considered psychiatrically normal. The premenstrual occurrence or exacerbation of affective symptoms has been noted. This symptom exacerbation maybe sufficient to require hospitalization. Data presented by Coppen indicate that women with affective disorder are more likely to report the premenstrual symptom of depression than women with other psychiatric disorders. These findings suggest that there may be some relationship between depressive disorder and premenstrual affective symptoms. As part of a larger study on the personality and psychiatric correlates of functional headache, data on the relationship between depressive syndrome and premenstrual affective symptoms were obtained.
Fifty patients attending a neurological outpatient clinic for Parkinson's disease were assessed by standardized methods for both physical and psychiatric symptoms. The patients then received treatment with L-dopa with carbidopa or anticholinergic drugs and/or amantadine. During the following six-month period the subjects were assessed at intervals, both physically and psychiatrically. Forty patients were followed up for the full six-month period. The severity of physical signs and affective symptoms was shown to be significantly related at several stages of the investigation. Initially, the patients showed a high psychiatric morbidity. During treatment, 22 patients developed a depressive disorder, 12 or which had a history of previous depressive episodes. By contrast, of the 11 patients who showed very few affective symptoms during follow-up, none had a history of depression. Of the 22 patients with a depressive disorder, only two were in the anticholinergic/amantadine group, compared with nine and 11 in the other groups. L-dopa was not an effective antidepressant agent. The probable relevance of the findings of the study to the management of patients with Parkinson's disease is outlined.
An imbalance between central cholinergic and adrenergic influences may affect mood disorders. Of 38 patients taking high doses of deanol, a putative acetylcholine precursor, eight developed changes in mood: five became depressed and three became hypomanic. A predisposition is suggested as seven of these eight patients had histories of affective symptoms. There was no relationship between the changes in dyskinesias and mood. These observations have both practical and heuristic implications for the management of patients and for further research into the pharmacology of affective disorders and deanol.
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.
Lithium carbonate alone has been shown to be inferior to neuroleptics alone in the treatment of excited schizo-affective illness. However, in clinical practice, lithium carbonate and neuroleptics are often combined in this disorder. We report a double-blind five-week controlled trial of lithium carbonate plus haloperidol vs placebo plus haloperidol in the treatment of excited schizo-affective patients. Eighteen patients were studied in each treatment group. Modest but statistically significant differences in favor of lithium carbonate plus haloperidol were found by week 5, using the Brief Psychiatric Rating Scale. Lithium carbonate plus haloperidol was favored both for affective schizo-affectives and for schizophrenic schizo-affectives. Lithium carbonate benefit did not seem to be restricted to affective symptoms only. In the clinical treatment of acute schizo-affective illness, the modest benefits of added lithium carbonate must be weighed against the risks of the drug's toxicity.
The present research introduced standardized psychological measurement into the clinical assessment of the male transsexual. Thirty-one males with a presenting complaint of gender dysphoria were carefully screened as to their correspondence with current nosological conceptions of transsexualism, and administered the Derogatis Sexual Functioning Inventory (DSFI) as part of their clinical psychometric work-up. The DSFI is an omnibus self-report scale providing measurement in the primary domains of sexual information, sexual experiences, sexual drive, sexual attitudes, psychological symptoms, affects, gender role definition, and sexual fantasy. Transsexual profiles were contrasted with those of a comparison group of 57 normal heterosexual males. Results of the comparisons revealed the transsexuals to show a significant decrement in accurate sexual information, and a marked reduction in the variety of sexual experiences they have been involved in. They also revealed a reduction in drive levels; however, this was qualified by which indicator of drive was used. Significant elevations in psychological symptoms and dysphoric affect were also noted, particularly of a depressive nature. Gender role definitions were markedly polarized in the feminine direction for male transsexuals, and their fantasy endorsements revealed some of the classic transsexual themes. The ability to develop this quantified and standardized psychological profile is viewed as an important step in accurately assessing the nature of these complex individuals, and developing a more accurate understanding of their condition.
Unpredictable and uncontrollable events are associated with a variety of illnesses. It was hypothesized that unpredictable aversive events are causally linked to physical symptom reporting and that the Type A coronary-prone behavior pattern affects symptom reporting, such that Type A individuals fail to report symptoms when they expect to continue working on a task as compared to when they believe they have completed it. In the present research, Type A and Type B women reported symptoms either at the end or in the middle of listening to unpredictable, predictable or ambient noise in the laboratory. Results showed that unpredictable noise produced more symptom reporting than predictable noise, which in turn produced more symptom reporting than the ambient noise; Type A individuals reported fewer symptoms in the middle of the task than at the end, whereas Type B's did not show this differential effect. Thus, both hypotheses were confirmed. Several possible explanations of the results are offered, and implications of the findings are discussed.
Beck Depression Inventory scores were obtained from 48 elderly who had been residing in homes for the aged for more than one year, 31 elderly residing in the community and waiting to enter an old-age home, and 424 young adults enrolled in a fist-year psychology course. The residents of old-age homes reported no more symptoms of depression than the waiting-list controls, a finding that provides no support for the hypothesis that the institional nature of old-age homes increases depression in the elderly. Both the institutionalized and noninstitutionalized aged reported more somatic symptoms of depression than the young adults, but no greater cognitive or affective symptoms of depression. These results were interpreted as providing no support for the widely belief that the aged are more depressed than any other age group. Finally, it was argued that somatic complaints can be valid indicators of depression in the elderly if normative differences between young and old are taken into account.
Proven allergic contact dermatitis from carbon paper is an exceptional rarity; the reported causes are dyes and plasticisers. But carbon paper is gradually being replaced by pressure-sensitive or carbonless copy paper, particularly for business forms. The method depends on mechanical pressure or chemical transfer. For the latter, colour formers are held in microcapsules, which rupture under pressure, and released when they produce the colour. Some office workers have claimed that the handling of used carbonless papers are responsible for symptoms affecting the skin, eyes, and upper respiratory tract, as well as systemic symptoms including headaches, drowsiness and fatigue. Patch tests are negative. If the symptoms are attributable to carbonless paper it is suggested that the colour former solvents are most likely to be responsible.
The antidepressants desipramine and imipramine were compared within the framework of a multiclinical study performed under the conditions of a controlled clinical experiment. There has been found a time-different remission of affective symptoms, which was not detectable for the inhibition of drive. The tachythymoleptic action of desipramine is discussed with reference to these results. Evaluation of the possibility of controlling affects shows different ranges of activity of desipramine and imipramine, with desipramine influencing especially negative psychoenergetic symptoms in the area of drives and emotions and imipramine, restrictive symptoms in addition to differential phenomena of the psychomotor expression.
BACKGROUND: Depressive symptoms are a common and disabling comorbidity in temporal lobe epilepsy (TLE), yet the neural mechanisms linking seizure networks to affective symptoms remain unclear. Although limbic network dysfunction has been implicated in both epilepsy and depressive disorders, it is unknown whether the time-varying dynamics of large-scale electrophysiological brain states reflect depressive symptom severity in TLE. In this study, we examined whether EEG microstate dynamics capture network alterations associated with depressive symptoms in individuals with unilateral TLE. METHODS: We analyzed resting-state, visually normal scalp EEG from 26 individuals with unilateral TLE. EEG microstates were identified by clustering global field power peaks into four canonical classes, with electrode positions mirrored to align the ictal hemisphere across subjects. Microstate dwell time, fractional occupancy, global transition entropy, and Markov transition probabilities were quantified and related to Beck Depression Inventory-II (BDI) scores. RESULTS: Individuals with high depressive symptoms (BDI ≥ 13; N = 12) exhibited longer mean dwell time in the ictal hemisphere-aligned microstate compared with individuals with low depressive symptom burden (BDI < 13; N = 14). Across subjects, dwell time in this microstate correlated with depressive symptom severity (r = 0.57, p = 0.002). TLE individuals with higher depressive symptoms exhibited reduced global transition entropy (p = 0.02), which also correlated with depressive symptom severity (r = -0.54, p = 0.004), indicating decreased flexibility of microstate transitions. Despite similar fractional occupancy of this state between groups, individuals with higher depressive symptoms were less likely to transition into the ictal hemisphere-aligned microstate from non-ictal or posterior configurations. Once engaged, however, the ictal-aligned microstate showed increased persistence, indicating prolonged stabilization of this network configuration. CONCLUSION: Higher depressive symptom burden in unilateral TLE is associated with increased temporal rigidity of the ictal hemisphere-aligned brain microstate, reflecting impaired disengagement of epileptogenic network configurations. These findings suggest that depressive symptoms in TLE may be associated with epilepsy-related disruptions in large-scale neural dynamics.
All patients with a discharged diagnosis of schizo-affective disorder (53 cases) admitted to the University of Iowa Department of Psychiatry during 1971-73, were selected for the present study. Schizophrenia (chronic psychotic disorders) and affective disorders (episodic remitting disorders with affective symptoms) were diagnosed among parents and sibs on the basis of chart material. The frequency of schizophrenia was 0.9%; the frequency of affective disorders, 11.8%. These results were compared to data for the relatives of cases of schizophrenia and affective disorders. There were no significant differences for the rates of schizophrenia among the relatives. The rate of affective disorder among the relatives of the schizo-affectives was significantly higher than for the relatives of schizophrenics (3.2%), and not significantly different from the relatives of affective disorder cases (8.3%). An analysis of outcome, precipitants, and age of admission also support the view that schizo-affective disorder should not be routinely classified as schizophrenia for research purposes.