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B Pfohl

Publications and source records attributed to B Pfohl.

At least 55 records · Page 3Linked to original sources
PubMed1985

The treatment validity of DSM-III melancholic subtyping.

Because melancholic subtyping is associated with pretreatment symptom severity, the type of data-analytic technique used in examining treatment validity may affect one's conclusions. We examined the relationship between the presence or absence of melancholia and the response to electroconvulsive therapy (ECT) in 87 depressed inpatients. Depending on the definition of improvement used, melancholic subtyping was either not associated with ECT response, or non-melancholics had a better outcome than melancholics. We suggest that standard methods of outcome evaluation be required in therapy outcome studies.

Adult↗
PubMed1985

The validity of DSM-III axis IV (severity of psychosocial stressors).

One hundred thirty depressed inpatients were rated on DSM-III axis IV on the basis of information collected from a comprehensive life events interview. Axis IV scores were more highly correlated with undesirable than desirable events, with exits than entrances, and with time-limited than chronic events. Higher axis IV scores were associated with a lower rate of abnormal dexamethasone suppression test results, a higher morbid risk for alcoholism, a greater frequency of personality disorders, and a greater likelihood of attempted suicide during the index episode.

Adolescent↗
PubMed1985

Age-related changes in the circadian rhythm of plasma cortisol in man.

We studied the effect of age on the circadian rhythm of plasma cortisol in 34 normal subjects, aged 18-75 yr. Blood was sampled at 20-min intervals beginning at 2000 h, and the data were analyzed using the PULSAR program and the cosinor method. There was a negative correlation between age and the time of the maximum cortisol concentration (r = -0.548; P = 0.001), the time of the nadir cortisol concentration (r = -0.543; P = 0.001), and the acrophase (r = 0.528; P = 0.001). When the subjects were divided into those 39 yr of age and younger and 40 yr of age and older, the times of the cortisol nadir, maximum, and acrophase were significantly earlier in the older group. The interval between the nadir and peak cortisol levels was not significantly different, consistent with an age-related phase advance of the cortisol circadian rhythm. Quantitative indices of adrenal function, including the 24-h mean cortisol concentration and the number of cortisol peaks as well as their amplitude and duration, were not different in the two groups. There was a significant negative correlation between age and customary bedtime (r = -0.686; P = 0.001) that may explain, in part, the phase advance in the older subjects. This observation strengthens the evidence that sleep onset is a major factor contributing to synchronization of the cortisol rhythm. Alternative explanations are that age-related changes in the control of hormonal and other rhythms have important influences on sleep and activity schedules, or that sleep and cortisol variables do not influence each other, but are both the final expression of some central change.

Adolescent↗
PubMed1984

Circadian analysis of plasma cortisol levels before and after dexamethasone administration in depressed patients.

Pituitary-adrenal regulation in healthy subjects and in depressed patients is very dynamic. Interpretation of results of the 1-mg dexamethasone suppression test has usually depended on the result of a single blood cortisol level measurement obtained in the morning or afternoon. We analyzed circulating cortisol concentrations by obtaining blood samples at 20-minute intervals for 24 hours before and after dexamethasone administration in depressed patients. The results illustrate the variability in patterns of escape from the effects of dexamethasone among depressed patients; they also indicate the influence of the sampling time on the test results and thus on the relationship of the test result to various clinical classifications. Finally, these results provide the basis for understanding the consequences of alternative sampling strategies.

Circadian Rhythm↗
PubMed1984

The implications of DSM-III personality disorders for patients with major depression.

We studied 78 inpatients with DSM-III major depression. Forty-one (53%) had a concurrent personality disorder (PD) according to a detailed structured interview for DSM-III personality disorders. The patients with depression plus PD differed from patients with depression alone on numerous measures. The PD patients had earlier onset; higher HRS scores; poorer social support; more life stressors; more frequent separation and divorce; more frequent nonserious suicide attempts, less frequent dexamethasone nonsuppression; poorer response to antidepressant medication; and higher risk for depression, alcoholism and antisocial personality among first-degree relatives. The PD subgroup shares many attributes with Winokur's subtype of depression spectrum disorder and Akiskal's character spectrum disorder. An attempt to identify a subgroup of personality disorders which might be an atypical affective disorder was inconclusive. However, patients in DSM-III cluster III were similar to the patients with no-PD on the dexamethasone suppression test, response to treatment, and familial risk for depression and antisocial personality.

Adult↗
PubMed1984

Affective disorder not linked to HLA in a large bipolar kindred.

Recent studies have suggested genetic linkage between the major histocompatibility complex and affective disorder. We tested this hypothesis in a large pedigree of bipolar affective disorder in which 22 of 37 relatives were interviewed and HLA typing was carried out on 20. The findings provided no evidence for linkage between affective disorder and HLA antigens. Our findings are discussed along with those of other linkage studies bearing on this question.

Adolescent↗
PubMed1984

Influence of age on the cortisol response to dexamethasone.

Controversy exists regarding the association of age with postdexamethasone serum cortisol levels. We evaluated this relationship in 95 patients with major depressive disorder and 49 healthy controls. Age and 8 a.m. postdexamethasone cortisol levels were not correlated among the healthy controls, but were positively associated among the depressives. There was also a trend for age and 4 p.m. postdexamethasone cortisol levels to be positively associated in depressives. Multiple linear regression analyses revealed that these associations could not be explained by other variables such as sex, psychotic features, or familial subtype of depression. Several hypotheses that might account for these associations are examined.

Adult↗
PubMed1984

Clinical significance of large cerebral ventricles in manic males.

Consecutively admitted manic males (n = 24) who consented to participate in a computed tomographic (CT) study of the brain were studied. Those with a ventricle-to-brain ratio (VBR) 2 standard deviations above the mean VBR of a matched control group comprised the large VBR group; the remainder comprised the small VBR group. A controlled comparison of a series of clinical variables was conducted between the larger and smaller VBR groups. There were no differences in age of onset, duration of illness, substance abuse, electroconvulsive therapy, abnormal electroencephalogram, delusions, hallucinations, suicidal attempts, irritable or grandiose affect, family history, cognitive test scores, or response to drug treatment. However, manic males with larger VBRs were found to have a significantly lower frequency of hospitalization than those in the smaller VBR group.

Adult↗
PubMed1984

The clinical and neuroendocrine features of psychotic depression.

The authors compared 65 patients with major depression and psychotic features to 192 patients with major depression and no psychotic features in terms of clinical features, family history, and hypothalamic-pituitary-adrenocortical axis function. In accord with other studies, patients with psychotic depression were more likely to have bipolar depression, psychomotor disturbance, a family history of schizophrenia, and a more severely disordered hypothalamic-pituitary-adrenocortical axis. Whether psychotic depression is best considered apart from nonpsychotic depression or as simply a more severe form of depression remains unsettled. Nevertheless, research to date does give the diagnosis of psychotic depression a practical significance which is enhanced by its simplicity.

Adolescent↗
PubMed1983

The association between early parental loss and diagnosis in the Iowa 500.

While a number of studies have found an association between the experience of death of a parent during childhood and the later development of depression as an adult, few of these studies have controlled for possible confounders such as social class, sibship size, parental age at birth, and the patient's age at admission. The results of several studies that do control for such confounders have been negative. The authors investigated the frequency of parental loss and parental death among 129 depressives, 155 schizophrenics, and 63 manics from the Iowa 500 data base. Using a logistic regression to control for confounders, depressives are found to experience early maternal death 3.4 times more frequently than the schizophrenics and 2.1 times more frequently than the bipolars. The failure to confirm other hypotheses and possible implications are discussed.

Adult↗
PubMed1983

The micropsychopathology of hebephrenic/catatonic schizophrenia.

All hospital records, interviews, and notes are reviewed on a group of 52 chronic hebephrenic/catatonic schizophrenics who were institutionalized before the era of antipsychotic medications. The authors catalog the presence or absence of individual symptoms of schizophrenia on a year by year basis over a span of 25 years and present this data in a series of bar graphs. Symptoms such as avolition, impaired social interaction, and flat affect become more frequent over the 25 years of follow-up. Hallucinations and delusions become less frequent. Eighteen of the patients are noted to have had a DSM-III personality disorder premorbidly and eight of these are characterized as schizoid personality disorder. Level of insight is found to be poor at the onset of schizophrenia and deteriorates further over the next 5 years. Although the study design contains a sampling bias in favor of chronically institutionalized cases, several lines of evidence suggest that the trends reported here are not artifacts of institutionalization but are due to schizophrenia.

Adult↗
PubMed1982

Unipolar vs. bipolar mania: a review of 247 patients.

Previous studies attempting to support unipolar mania as an entity distinct from bipolar disorder, have produced conflicting results. The present study reports on a chart review of 247 patients admitted to the University of Iowa with a history of at least one manic episode; 87 of these had apparently never experienced a depression. A subgroup of 92 patients, who met DSM III diagnostic criteria and had a history of at least two episodes of affective disorder, were also examined. There were few clinically meaningful differences between patients with unipolar mania and bipolar disorder on demographic, symptomatic, or familial variables. An earlier report that unipolar manics were more likely to be male and have a family history of unipolar depression was not confirmed. Unipolar mania is not supported as a separate entity from bipolar disorder.

Adult↗
PubMed1981

The mathematical case against unipolar mania.

A mathematical model is developed based on several assumptions to predict frequency of admission for apparent unipolar mania given that such patients have the same illness as bipolars. The model is compared with data from previous studies of unipolar mania and with data from the author's own study of 77 unipolar manic patients. The observations generally supported the model. It is concluded that the DSM III convention of classifying unipolar manics under the heading "Bipolar disorder" is upheld.

Affective Disorders, Psychotic↗
PubMed1981

A learning aid for DSM-III: computerized prompting of diagnostic criteria.

To help overcome many of the difficulties of learning and using the new Diagnostic and Statistical Manual of Psychiatry, a system was developed for reviewing its contents as appropriate to individual clinical cases. It is faithful in format and contents to this Manual. This system is now being regularly used by medical students, residents, and psychiatrists on a voluntary basis, as a teaching aid. It also allows measurement of how the interpretation of DSM-III criteria differs among these groups. This system can be used on relatively inexpensive microcomputers.

Diagnosis, Computer-Assisted↗