Recent developments and controversies in depression.
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Biomedical subjects
Publications and source records attributed to C V Haldipur.
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This article considers the nosology and taxonomy of psychiatric disorders in Sushruta Samhita, an ancient Indian treatise on medicine. Some implications of this treatise for modern psychiatry are discussed.
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Based on clinical similarities with schizophrenics and previous computed tomography (CT) studies that found distinct structural abnormalities in the brains of bipolar patients, we evaluated 26 DSM-III bipolar patients and 22 controls by CT, using quantitative measures of ventricular and sulcal size and of cerebral parenchymal density. Third ventricle size was increased, as was periventricular and cortical density. Comparison is made with results found in other psychotic conditions and the possible etiopathological significance discussed.
Since the clinical significance of CT abnormalities found in bipolar patients remains obscure, we studied 26 DSM-III bipolar patients who had specific CT abnormalities (third ventricle enlargement, and hyperdensity of the caudate, thalamus, anterior frontal white matter, and right temporal lobe) on numerous parameters such as EEG, the Halstead-Reitan Neuropsychological Battery, premorbid personality adjustment, family history of affective disorder, positive and negative symptoms, employment history, and response to lithium carbonate treatment. None of these measures could differentiate between the CT abnormal and CT normal subgroups. The implications of these findings are discussed.
Reversal of normal cerebral asymmetry has been reported to be more frequent in children with higher cortical dysfunction and in schizophrenics, in whom it has clinical significance as well. As there are few studies of bipolar patients, we attempted to determine if significant reversal would be found in a clearly diagnosed sample of bipolar patients. As technical differences may account for varying results, we used two previously reported methods and a modified technique. Correlations of computed tomography (CT) findings with neuropsychological variables (Halstead Reitan Battery and WAIS subtests) were also studied. Bipolars and controls did not differ on any CT measure, nor were there meaningful correlations between asymmetry and neuropsychological variables. If if is confirmed that schizophrenics have increased reversed cerebral asymmetry but bipolars do not, it may point to an important difference, as all other CT abnormalities initially described in schizophrenics are now also noted in bipolar patients.
The authors compared the type and number of life events experienced by 19 mentally retarded patients and 19 nonretarded control subjects in the month before their admission to the same unit of a state mental hospital. The retarded patients had exhibited fewer changes in eating and other personal habits. On admission they presented fewer signs of intrapsychic disturbance but more of self-destruction or aggression. These results imply that clinicians need specific training to diagnose and treat psychiatric disorders in the mentally retarded patients who now use community mental health facilities, because their presentations may be atypical.
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A 4-year study of 48 bipolar subjects and matched controls looked closely at the psychosocial histories of an early-onset subsample. A significant majority of these biographies include five distinct features: treatment as the special child of the family, high achievement in school, evidence of symptomatology in childhood, first episode soon after leaving home, and characteristic content in later symptomatology. The authors suggest that the findings provide a replication of a well-known study and that they further specify the increasingly evident differences between early- and late-onset bipolar patients.
Forty-six subjects with bipolar disorder and their relatives and friends were interviewed in depth about life events preceding the first and the latest episode of the subject's affective illness. Twenty years of age was the cutting point for dividing the sample into early- and late-onset groups. The late-onset group reported the occurrence of significantly more stressful life events before the first and before the latest episode of affective illness than the early-onset group did.
The authors evaluated six acute short-stay admission wards in a community mental health center using the sociometric Ward Atmosphere Scale. There was an attempt to run three of the six wards as therapeutic communities. No differences were found on Ward Atmosphere Scale dimensions between the therapeutic communities and other types of programs, nor did the therapeutic communities conform to an empirically derived therapeutic community program dimension profile. Possible reasons for this failure and its implications for community mental health centers are discussed.
The rational and irrational aspects of fear in the countertransference will be discussed. Arguments are presented for the potent force of fear in personality development and psychotherapy hitherto underemphasized in the literature. Manifestations of unacknowledged fear in clinical settings are identified and discussed. Recommendations are made for dealing with rational and irrational fears. These include supervision and interpretation in the case of irrational fear and effective security in the case of rational fear.
This first part of a multiphase longitudinal study looks at life events implicated in manic depression among an American working class, bipolar sample. Three turning points are identified. a) Stressful life events occurred that resulted in loss of significant social roles. b) Attempts to regain or replace the roles or otherwise "fight back" proved ineffective. c) Retreat via depression, and rebellion via mania, ensued. These turning points were well verified for 75 per cent of the subjects prior to first onset, and for 56 per cent prior to most recent onset. Special methodological issues are raised, and the need for a biopsychosocial etiology of manic depression is suggested.
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