American Journal of Psychiatry

Published by American Psychiatric Publishing
Online ISSN: 1535-7228
Print ISSN: 0002-953X
Publications
A method for decreasing the liquid content of radioactive concentrates ; from nuclear power plants is described. Concentrates from a resin-bed ion ; exchange filter system and from at least one other concentrating stage ; (mechanical filters, settling basin, etc.) are combined and fed to a filter-cake-; producing filter for dewatering and drying. The concentrates from the other ; concentrating stage must have a smaller particle size than that from the resinbed ; ion exchange filter and a lower salt content than that from the evaporation ; concentrator. The concentrates from the evaporation concentrator bypass the ; filter-cake-producing filter and goes directly into transport and storage ; containers where it is dewatered and dried to the desired water content for ; storage. Solidification of these radioactive wastes makes storage more ; economical. (LK);
 
1. RO-5-0831/1 is a sufficiently potent anti-depressant to require further study; 2. It should be tried in instances where other anti-depressants have failed; 3. It brings into the therapeutic arsenal of depression the possibility of choice according to the patient responsivity.
 
The case records of 1,000 consecutive rape victims seen at a crisis center were analyzed to identify important categories of rape victimization. The most noteworthy finding was a replication and extension of the blitz rape and confidence rape typology. The distinction between these two types of rape corresponded to a series of significant differences in the victims' characteristics, the rape settings, the victims' activities before they were raped, the assailants' characteristics, and the victims' immediate responses to the assaults. The authors discuss the implications of these differences with respect to specific strategies of outreach and treatment for victims of different types of rape.
 
The literature pertinent to the problem of whether or not schizophrenics are more likely to show "abnormal" or poorly organized records is briefly reviewed. Data collected from 1,000 schizophrenic patients with an average age of 20.4 years are contrasted with a "control" group consisting of 474 patients without discernible neurological disease, who are nonpsychotic and in a comparable age group. This reveals that 5.0% of the schizophrenic records are "abnormal" by virtue of the presence of significant amounts of slow wave activity; 8.3% of the control group also have such abnormal records. It is concluded that changes in the EEG can result from emotional perturbation and do not necessarily indicate support for an organic genetically oriented concept of schizophrenia. There appears to be no more significant abnormality in the EEG's of schizophrenics than in those of any other patients with nonorganic disturbance in the brain.
 
It is well established that until age 40 years, delinquent individuals have roughly twice the mortality of nondelinquent individuals and that the excess deaths are largely due to accidents, violence, and substance abuse. The present study examined if the increased mortality of delinquent subjects continues until age 65 years and, if so, why. The authors followed 475 delinquent and 456 matched nondelinquent comparison boys from age 14 years until age 65 years. Thirteen percent (N=62) of the delinquent and only 6% (N=28) of the nondelinquent subjects died unnatural deaths. By age 65 years, 29% (N=139) of the delinquent and 21% (N=95) of the nondelinquent subjects had died from natural causes. In a univariate analysis, frequency of delinquency, abuse of alcohol, adult crime, dysfunctional home environment, and poor education were significantly related to death, especially to unnatural death. However, when delinquency and alcohol abuse were controlled by logistic regression, education, dysfunctional upbringing, and adult criminality made no further contributions to mortality. Although delinquency is strongly associated with premature mortality, the etiological links remain unclear. Alcohol abuse and poor self-care in adulthood (e.g., infections or accidents) account for most of the modest variance in mortality that could be accounted for.
 
The authors present a format that organizes DMS-III diagnoses according to its five axes. For each axis, it provides an ordered listing of several diagnostic categories, their qualification as principal or provisional diagnoses, and alternative categories to be ruled out. For each dimensional axis, the terms and codes of the scale are specified and arranged linearly. This format was used with 1,111 new patients who consecutively applied for care at a comprehensive psychiatric facility during a 6-month period. The authors report on the frequency of use of specific diagnostic categories and dimensional levels along provisional, and rule-out diagnoses were noted.
 
Logistic Regression Analysis of Baseline Charac- teristics Predicting Suicide Attempts Among 1,237 Alcohol- Dependent Subjects During a 5-Year Follow-Up Period a 
In previous studies, factors related to a history of suicide attempts in persons with alcohol dependence have included sociodemographic variables, a more severe course of alcoholism, additional substance use disorders, and psychiatric comorbidity. This 5-year prospective study evaluated attributes associated with suicide attempts in a group of treatment-seeking persons with alcohol dependence. Psychiatric comorbidity was examined in terms of a distinction between substance-induced and independent psychiatric disorders. Semistructured interviews were conducted with 1,237 alcohol-dependent subjects from the Collaborative Study on the Genetics of Alcoholism both at an initial evaluation and at a 5-year follow-up. Clinically relevant information was gathered at baseline, and suicidal behavior, aspects of alcohol dependence, and drug use were evaluated at the follow-up interview. Alcohol-dependent subjects (N=56) with suicide attempts during the follow-up period were more likely than subjects with no suicide attempts (N=1,181) to have made prior attempts. Other factors related to future suicide attempts in univariate analyses included younger age, being separated or divorced, other drug dependence, substance-induced psychiatric disorders, and indicators of a more severe course of alcoholism. Gender did not predict future attempts. A 5-year prospective evaluation of attributes associated with suicide attempts among alcohol-dependent persons identified factors that contributed to a small but significant proportion of the variance for future suicidal behavior.
 
Number of DSM-IV Manic Symptoms During an Index Episode of Bipolar Depression in STEP-BD (N=1,380) 
Specific DSM-IV Manic Symptoms During an Index Episode of Bipolar Depression in STEP-BD 
Naturalistic Pharmacotherapy Among STEP-BD Entrants With Pure Depressed Versus Mixed Presentations of Bi- polar Depression 
Little is known about how often bipolar depressive episodes are accompanied by subsyndromal manic symptoms in bipolar I and II disorders. The authors sought to determine the frequency and clinical correlates of manic symptoms during episodes of bipolar depression. From among 4,107 enrollees in the National Institute of Mental Health's Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD), 1,380 individuals met criteria for bipolar I or II depressive syndromes at the time of enrollment and were assessed for concomitant manic symptoms. Illness characteristics were compared in patients with pure bipolar depressed episodes and those with mixed depressive presentations. Two-thirds of the subjects with bipolar depressed episodes had concomitant manic symptoms, most often distractibility, flight of ideas or racing thoughts, and psychomotor agitation. Patients with any mixed features were significantly more likely than those with pure bipolar depressed episodes to have early age at illness onset, rapid cycling in the past year, bipolar I subtype, history of suicide attempts, and more days in the preceding year with irritability or mood elevation. Manic symptoms often accompany bipolar depressive episodes but may easily be overlooked when they appear less prominent than depressive features. Subsyndromal manic symptoms during bipolar I or II depression demarcate a more common, severe, and psychopathologically complex clinical state than pure bipolar depression and merit recognition as a distinct nosologic entity.
 
The purpose of this study was to examine the presence and severity of eating disorder pathology in students representing South Africa's ethnically and culturally diverse population. A questionnaire survey, which involved the Eating Attitude Test and the Bulimic Investigatory Test, was administered to 1,435 South African college students (739 Caucasian and 696 non-Caucasian) from six universities in two urban centers. Black students scored significantly higher than the other ethnic groups on these measures. In addition, a comparable percentage of black and Caucasian female students had scores within the clinical range on these scales. Male students scored consistently lower than female students. This study's findings challenge the notion that eating disorders are primarily a Western, Caucasian phenomenon and raise the possibility that the risk of eating disorders may increase in developing societies.
 
1. Of 1, 523 patients treated with chlorpromazine from 1-15 months, 81.8% showed improvement. 2. Problems concerning dose, side-effects, and clinical results have been considered. 3. Female patients used higher doses, had a proportionately larger number of sideeffects, and showed a better discharge rate than males. 4. Some theoretical considerations of these findings have been reviewed.
 
The authors report suicide risk among 1,593 patients with major depression or bipolar disorder, 443 (27.8%) of whom were psychotic (260 bipolar and 183 unipolar). The subjects were followed for 0-14 years, and their suicide experience was compared with that of the state population. Eight (19.5%) of the 41 suicide victims were from the psychotic group. The psychotic and nonpsychotic subjects in each diagnostic group had similar risks for suicide. A higher risk for suicide was not found in the bipolar subjects. The authors conclude that among patients with major affective disorder psychosis per se does not predispose to suicide.
 
The psychiatric and medical characteristics of victims of homicide have not been systematically studied and are often confounded by race. This study was undertaken to determine health and social factors contributing to the risk of being murdered in the Swedish, predominantly Caucasian population. All 1,739 homicides between 1978 and 1994 in Sweden were studied in terms of variables in national case registers regarding health, crimes, immigration, and marital status. The same data were extracted for matched comparison persons in the general population, with controls for time of exposure. The data were analyzed by conditional logistic regression on matched pairs. Traumatic brain injury, physical abuse, alcohol dependence, and criminal recidivism conferred risk of being murdered. To the authors' knowledge, this is the first report of traumatic brain injury, in both men and women, as a risk factor for being murdered. Brain injury may mark risk-taking behavior in general or may cause provocative behavior.
 
Previous reports of side effects from light therapy were mostly based on administration of 2,500-lux treatments. It has become common practice to use brighter, 10,000-lux exposure when treating seasonal affective disorder. The authors studied side effects produced by short-term 10,000-lux light therapy. Seventy subjects with seasonal affective disorder who underwent brief 10,000-lux light therapy were asked to report side effects. Of the 70 subjects, 32 (45.7%) experienced side effects, and nine (12.9%) reported two or more apiece. Headaches and eye or vision problems were the most common. Almost all were mild, were transient, and did not interfere with treatment. Short-term 10,000-lux light therapy often produces side effects early in treatment. These are not serious or prolonged, however, confirming findings from earlier studies that used dimmer light.
 
This study examined whether extrapyramidal symptoms predict incidence of tardive dyskinesia 1 year later. Simple, global measures were used to rate extrapyramidal symptoms and tardive dyskinesia in a prospective, observational health outcomes study. Baseline and 3-, 6-, and 12-month data on 9,298 patients were analyzed by using a Cox proportional-hazard model. Onset of tardive dyskinesia was examined in two groups: 1) no tardive dyskinesia at baseline (broad risk set) and 2) no tardive dyskinesia at baseline and 3 months (narrow risk set). Baseline extrapyramidal symptoms predicted later onset of tardive dyskinesia (broad risk set: hazard ratio=2.0, narrow risk set: hazard ratio=1.6). In analyses adjusted for age, gender, and medication exposure, this effect size was not reduced. About half of patients who developed tardive dyskinesia had earlier extrapyramidal symptoms. Although the association of tardive dyskinesia and extrapyramidal symptoms is significant, extrapyramidal symptoms do not robustly identify individuals at high risk for tardive dyskinesia. However, drug regimens and disease processes that increase extrapyramidal symptoms are likely to result in increased risk of tardive dyskinesia.
 
The authors examined the prevalence of and risk factors for homelessness among all patients treated for serious mental illnesses in a large public mental health system in a 1-year period. The use of public mental health services among homeless persons was also examined. The study included 10,340 persons treated for schizophrenia, bipolar disorder, or major depression in the San Diego County Adult Mental Health Services over a 1-year period (1999-2000). Analytic methods that adjusted for potentially confounding variables were used. Multivariate logistic regression analyses were used to calculate odds ratios for the factors associated with homelessness, including age, gender, ethnicity, substance use disorder, Medicaid insurance, psychiatric diagnosis, and level of functioning. Similarly, odds ratios were computed for utilization of mental health services by homeless versus not-homeless patients. The prevalence of homelessness was 15%. Homelessness was associated with male gender, African American ethnicity, presence of a substance use disorder, lack of Medicaid, a diagnosis of schizophrenia or bipolar disorder, and poorer functioning. Latinos and Asian Americans were less likely to be homeless. Homeless patients used more inpatient and emergency-type services and fewer outpatient-type services. Homelessness is a serious problem among patients with severe mental illness. Interventions focusing on potentially modifiable factors such as substance use disorders and a lack of Medicaid need to be studied in this population.
 
Clinical. 1. Two hundred psychiatric patients were treated with chlorpromazine from the start of an initial trial of the drug in 1953 and followed until they had a remission, discontinued, or continued in maintenance therapy. Efficacy in the series attained the level generally reported by other investigators, countering the findings of those reporting only minimal response. Half of the schizophrenics had a lasting remission, including those who discontinued and 35 who still take the drug. More than % of the schizophrenics were markedly improved, in an average of 5 years of treatment. Chlorpromazine clearly had an anti-psychotic activity, consisting of anti-delusional and anti-hallucinatory activity, in addition to its anti-agitation activity. Of the psychoneurotics 2/3 were significantly improved in an average of 2½ years' treatment. 2. Chlorpromazine, although less effective in psychoneurotic patients than in psychotics, nevertheless had anti-phobic activity and anti-obsessional-compulsive activity, in a...
 
A previous positron emission tomography (PET) study reported increased serotonin 5-HT(2A) receptor binding in unmedicated depressed patients with high scores on the Dysfunctional Attitudes Scale. The purpose of the present study was to use the highly selective 5-HT(2A) receptor ligand [(11)C]MDL 100,907 in a PET imaging paradigm to assess 1) 5-HT(2A) receptor binding potential in euthymic subjects with a history of recurrent depression and 2) the relationship between receptor binding and scores on the Dysfunctional Attitudes Scale. Cortical 5-HT(2A) receptor binding was measured in 20 unmedicated, fully recovered unipolar depressed patients and 20 age- and gender-matched comparison subjects. Regional estimates of binding potential were obtained using a reversible plasma input function compartmental model and the cerebellum as a reference region to estimate the free and non-specifically bound [(11)C]MDL 100,907 in brain tissue. Relative to the comparison subjects, the recovered depressed patients demonstrated significantly higher 5-HT(2A) receptor binding potential in the frontal cortex (mean increase: 19%), parietal cortex (mean increase: 25%), and occipital cortex (mean increase: 19%). 5-HT(2A) receptor binding potential correlated negatively with age in both patients and comparison subjects and positively with the Dysfunctional Attitudes Scale in the recovered patients. These findings should be considered preliminary but suggest that recovered subjects with a history of recurrent major depression have elevated binding potential of cortical 5-HT(2A) receptors. The correlation of increased 5-HT(2A) receptor binding potential with increased scores on Dysfunctional Attitudes Scale supports earlier work suggesting that increased 5-HT(2A) receptor availability characterizes a group of depressed patients with high levels of dysfunctional attitudes.
 
The authors investigated the relationship between anxiety--a facet of the Revised NEO Personality Inventory dimension of neuroticism--and serotonin 5-HT(1A) receptor binding potential. Positron emission tomography with [(11)C]WAY-100635 was used to estimate regional 5-HT(1A) binding potential in 19 healthy volunteers who completed the Revised NEO Personality Inventory. Correlation coefficients were calculated to determine the degree of association between 5-HT(1A) binding potential and personality inventory measures. There was a significant negative correlation between 5-HT(1A) binding potential and anxiety in four regions: the dorsolateral prefrontal cortex, anterior cingulate cortex, parietal cortex, and occipital cortex. The inverse relationship between 5-HT(1A) receptor binding potential and anxiety is consistent with 1) animal models that have shown higher anxiety in mice lacking 5-HT(1A) receptors and 2) clinical trial data that have demonstrated antianxiety properties of partial 5-HT(1A) agonists.
 
How physicians approach patients and the problems they present is much influenced by the conceptual models around which their knowledge is organized. In this paper the implications of the biopsychosocial model for the study and care of a patient with an acute myocardial infarction are presented and contrasted with approaches used by adherents of the more traditional biomedical model. A medical rather than psychiatric patient was selected to emphasize the unity of medicine and to help define the place of psychiatrists in the education of physicians of the future.
 
Early clinical observations and recent systematic studies overwhelmingly document a greater role for psychosocial stressors in association with the first episode of major affective disorder than with subsequent episodes. The author postulates that both sensitization to stressors and episode sensitization occur and become encoded at the level of gene expression. In particular, stressors and the biochemical concomitants of the episodes themselves can induce the protooncogene c-fos and related transcription factors, which then affect the expression of transmitters, receptors, and neuropeptides that alter responsivity in a long-lasting fashion. Thus, both stressors and episodes may leave residual traces and vulnerabilities to further occurrences of affective illness. These data and concepts suggest that the biochemical and anatomical substrates underlying the affective disorders evolve over time as a function of recurrences, as does pharmacological responsivity. This formulation highlights the critical importance of early intervention in the illness in order to prevent malignant transformation to rapid cycling, spontaneous episodes, and refractoriness to drug treatment.
 
Relative Density and Laminar Distribution of Parvalbumin-Immunoreactive Neurons in 15 Matched Pairs of Schizophrenic and Normal Comparison Subjects 
Photomicrographs Illustrating the Distribution of Parvalbumin Immunoreactivity in Area 46 From a Normal Comparison Subject and a Matched Schizophrenic Subject a 
The purpose of this study was to test the hypothesis that abnormalities in the parvalbumin-containing subclass of local circuit neurons contribute to altered gamma-aminobutyric acid (GABA) neurotransmission in the prefrontal cortex of schizophrenic subjects. Profile counts and somal size measures were made of parvalbumin-immunoreactive neurons in areas 9, 46, and 17 from 15 matched pairs of schizophrenic and normal comparison subjects. No differences in relative density, laminar distribution, or somal size of labeled neurons were found in any region. These findings suggest that altered GABA neurotransmission in schizophrenia is due to either abnormalities in other sub-populations of prefrontal cortical GABA neurons or abnormalities in the parvalbumin-containing subclass that could not be detected in the present study.
 
The authors compared serotonin receptor binding in patients with schizophrenia and healthy comparison subjects. They used positron emission tomography with [(18)F]setoperone to examine six patients with schizophrenia who had never been given neuroleptics and seven age-matched subjects who did not have schizophrenia. A nondirected voxel-based analysis of the subjects' entire search volume found that serotonin 2A binding potential in the frontal cortex index was significantly smaller (by 16.3%) in patients with schizophrenia than in healthy subjects. The authors conclude that the decrease in serotonin receptor densities previously reported in postmortem studies of subjects with schizophrenia are present at the onset of the illness, before exposure to neuroleptics.
 
1. One hundred and two long-term schizophrenics were treated with ECT during a period of 15 months. 2. Eight were released from the hospital; 8 are expected to be released; 35 showed marked improvement; 20 showed improvement in attitude and behavior; and 31 are considered unimproved. 3. ECT is considered a useful method in long-term schizophrenics, provided it is given in sufficient amount for a long enough period of time. Although the percentage of those discharged from the hospital is small, a large percentage of these patients have become much better adjusted to hospital life. An important result is marked improvement in the morale of patients and personnel. 4. Long duration of illness should not be a reason for denying ECT to schizophrenic patients, nor should the diagnostic subtype be considered a contraindication to treatment. 5. The possible value of maintenance treatment is pointed out by the fact that 66 of the 102 patients are continuing on maintenance treatment successfully to date. Further inv...
 
Patients with multiple personality disorder (N = 102) at four different centers were interviewed with the Dissociative Disorders Interview Schedule. The presenting characteristics of the patients at all four centers were very similar. The clinical profile that emerged included a history of childhood physical and/or sexual abuse in 97 (95.1%) of the cases. The subjects reported an average of 15.2 somatic symptoms, 6.4 Schneiderian symptoms, 10.2 secondary features of the disorder, 5.2 borderline personality disorder criteria, and 5.6 extrasensory experiences; their average score on the Dissociative Experiences Scale was 41.4. The results indicate that multiple personality disorder has a stable, consistent set of features.
 
In this study of 101 patients who met DSM-III criteria for major depression, those with extreme anhedonia (N = 23) were younger, more depressed, and less neurotic than the patients with a normal-range capacity for pleasurable experiences (N = 78). The anhedonic depressed patients recovered more rapidly; at discharge they consequently had levels of symptom severity equal to those of the hedonic patients, yet they remained significantly more anhedonic. The anhedonic patients exhibited loss of pleasure in appetite, sex, social contacts, and work, which suggests a global dulling of the capacity for pleasure.
 
The authors describe a 24-year-old woman with borderline personality disorder and prolonged fever of unknown origin. After an extensive search for a fever source, they noted that her temperature responded to pseudoseizures and to phenobarbital.
 
The effects of yohimbine, an alpha 2-adrenergic receptor antagonist, on anxiety, blood pressure, heart rate, and plasma levels of the norepinephrine metabolite 3-methoxy-4-hydroxyphenylglycol (MHPG) and cortisol were determined in 20 healthy subjects and 68 patients who had agoraphobia with panic attacks or panic disorder. Yohimbine produced panic attacks meeting DSM-III criteria in 37 patients and one healthy subject. The patients reporting yohimbine-induced panic attacks had significantly larger increases in plasma MHPG, cortisol, systolic blood pressure, and heart rate than the healthy subjects. These findings support the hypothesis relating high noradrenergic neuronal activity to the pathophysiology of panic attacks in a subgroup of panic disorder patients.
 
Adjunctive pharmacological agents are extensively used in the treatment of patients with schizophrenia. This cross-sectional study examined the prevalence of the use of adjunctive agents, the extent to which their use conforms with Schizophrenia Patient Outcomes Research Team (PORT) recommendations for adjunctive pharmacological treatment and the relationship of conformance with treatment recommendations to demographic and clinical variables and to symptoms and level of function. Outpatients with schizophrenia (N=344) underwent an extensive interview, and their medical records were reviewed. Data on demographic and clinical characteristics, medications, and role functioning were collected. More than two-thirds of the outpatients received antiparkinsonian agents, and 50% received an adjunctive agent other than an antiparkinsonian agent. Fifty-four (15.7%) outpatients received two or more non-anti-parkinsonian adjunctive agents. Rates of conformance with the PORT treatment recommendations for the use of adjunctive agents ranged from 49% to 65%, depending on the type of agent. Ethnicity and diagnosis were the only two patient characteristics that were consistently related to conformance with PORT treatment recommendations. The treatment recommendation for adjunctive mood stabilizers was the only recommendation for which conformance was related to multiple measures of patients' symptoms and level of function. Adjunctive agents are widely used in the pharmacological treatment of patients with schizophrenia, but there is a limited relationship between use of these agents in conformance with treatment recommendations and measures of symptoms and level of function. Longitudinal, prospective studies are needed to demonstrate the clinical utility of adjunctive agents.
 
Major Motivational Brain Circuitry Putatively Involved in Impulsivity, Decision Making, and Drug Addiction a  
Cortical-Striatal-Thalamic-Cortical Loops Within Primary Motivation Circuitry Involved in the Representation of Motivated Drives and the Neurocomputational Events of Motivational Decision Making and Behavioral Instigation a
Epidemiological studies indicate that experimentation with addictive drugs and onset of addictive disorders is primarily concentrated in adolescence and young adulthood. The authors describe basic and clinical data supporting adolescent neurodevelopment as a biologically critical period of greater vulnerability for experimentation with substances and acquisition of substance use disorders. The authors reviewed recent literature regarding neurocircuitry underlying motivation, impulsivity, and addiction, with a focus on studies investigating adolescent neurodevelopment. Adolescent neurodevelopment occurs in brain regions associated with motivation, impulsivity, and addiction. Adolescent impulsivity and/or novelty seeking as a transitional trait behavior can be explained in part by maturational changes in frontal cortical and subcortical monoaminergic systems. These developmental processes may advantageously promote learning drives for adaptation to adult roles but may also confer greater vulnerability to the addictive actions of drugs. An exploration of developmental changes in neurocircuitry involved in impulse control has significant implications for understanding adolescent behavior, addiction vulnerability, and the prevention of addiction in adolescence and adulthood.
 
The authors compared 105 patients who met DSM-III criteria for bulimia with 86 control subjects on measures of family environment and presence of eating disorders. Bulimic patients' perceptions of their families included low cohesiveness, a lack of emphasis on independent and assertive behavior, and a high level of conflict coupled with a low emphasis on open expression of feelings. Families of bulimic subjects had achievement expectations comparable to those of control families, but the former placed less emphasis on intellectual and recreational activities. The high disorganization of the families of bulimic subjects was associated with severity of symptoms.
 
Top-cited authors
Daniel S Pine
  • National Institutes of Health
Robert Heinssen
  • National Institute of Mental Health (NIMH)
Philip Wang
  • Brigham and Women's Hospital
Thomas R Insel
  • U.S. Department of Health and Human Services
Charles Sanislow
  • Wesleyan University