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Biomedical subjects

D N Klein

Publications and source records attributed to D N Klein.

At least 73 records · Page 4Linked to original sources
PubMed1990

The genetics of neurotic-reactive depression: a reanalysis of Shapiro's (1970) twin study using diagnostic criteria.

The present study explored the role of genetic factors in the development of neurotic depression. Case studies of 16 monozygotic (MZ) and 14 same-sex dizygotic (DZ) twins from Robert Shapiro's 1970 study of non-endogenous depression were rediagnosed by two raters blind to the zygosity and identity of each twin. Diagnoses were made using Research Diagnostic Criteria (RDC) and George Winokur's 1985 criteria for neurotic-reactive depression. When neurotic depression was operationally defined using Winokur's criteria plus RDC major or definite minor depression, the concordance rate for MZ twins was significantly greater than that for DZ twins. Our results contrast with Shapiro's negative findings, probably due to our use of formal diagnostic criteria and Shapiro's requirement that cotwins be hospitalized to be considered concordant. The present results suggest that genetic factors play a role in the etiology of at least some forms of neurotic depression.

Adjustment Disorders↗
PubMed1990

Depressive personality: reliability, validity, and relation to dysthymia.

The reliability and validity of Schneider's (1958) construct of depressive personality was evaluated in a sample of 177 outpatients, who were administered structured diagnostic and family history interviews, an extensive battery of inventories, and a 6-month follow-up assessment. The criteria for depressive personality had moderate to good interrater reliability, internal consistency, and test-retest stability, and the assessment of depressive personality traits was not influenced by patients' clinical states. In addition, preliminary support for the convergent and discriminant validity of the depressive personality construct was obtained. Although there were significant relations between the depressive personality and Diagnostic and Statistical Manual of Mental Disorders (3rd ed. and rev. 3rd ed.; American Psychiatric Association, 1980, 1987) diagnoses of dysthymia, the depressive personality was not entirely subsumed by existing mood disorders.

Anxiety Disorders↗
PubMed1990

The unipolar-bipolar distinction in the characterological mood disorders.

The present study explored the validity of the unipolar-bipolar distinction in the characterological mood disorders. Thirteen cyclothymic and 32 primary early-onset dysthymic outpatients, diagnosed according to DSM-III-R, were compared on demographic, clinical, personality, and family history variables. The cyclothymics exhibited significantly higher levels of depressive symptomatology and extraversion and had a higher rate of bipolar I disorder in their first-degree relatives than the dysthymics. In addition, a significantly greater proportion of cyclothymics than dysthymics had a family history of drug abuse. The groups did not differ significantly on gender, overall rates of affective disorders in relatives, or a number of symptoms which have been reported to distinguish unipolar and bipolar depressives. Although these data require replication due to the small sample and large number of analyses conducted, they provide at least partial support for extending the unipolar-bipolar distinction to the characterological mood disorders.

Bipolar Disorder↗
PubMed1990

Symptom criteria and family history in major depression.

The author examined the relationship between symptom criteria for major depression and family history of mood disorders in 82 outpatients with major depression and 27 outpatients with nonaffective disorders. The family members of depressed patients with six or more groups of DSM-III symptoms of major depression exhibited substantially higher rates of mood disorders than the family members of depressed patients with fewer than six groups of symptoms and the family members of patients with nonaffective disorders. These data suggest that stricter symptom criteria for major depression may define a more homogeneous phenotype, at least from the standpoint of familial aggregation.

Adult↗
PubMed1989

Identifying chronic affective disorders in outpatients: validation of the General Behavior Inventory.

The validity of the General Behavior Inventory (GBI) in screening outpatients for chronic unipolar and bipolar affective conditions was evaluated. The GBI was administered to 492 consecutive patients at a university clinic and a community mental health center. Using a stratified random sampling plan, 167 patients were selected and administered blind structured diagnostic interviews. In addition, unipolar depressives were followed up 6 months after the initial evaluation. Overall, the GBI exhibited fair-to-good positive predictive power and good-to-excellent negative predictive power. In addition, GBI scores in the case range were consistently associated with poor outcome at the 6-month follow-up. These findings suggest that the GBI may provide an economical means of screening for chronic unipolar and bipolar affective conditions in outpatient settings.

Adult↗
PubMed1989

Cyclothymic mood swings in the course of affective disorders and schizophrenia.

The authors assessed cyclothymic mood swings and psychosocial adjustment in 38 unipolar depressed, 27 bipolar, 35 schizophrenic, and 27 other psychiatric patients 4 years after hospital discharge and in 153 normal control subjects. The patients were significantly more cyclothymic at follow-up than the control subjects, but there were no differences in cyclothymia between the diagnostic groups. Cyclothymic patients showed significantly poorer posthospital functioning than noncyclothymic patients. These findings raise questions concerning the scope of the hypothesized cyclothymic-bipolar spectrum. Minor mood swings in a variety of patients with poor posthospital adjustment may reflect persistent vulnerability to psychopathology.

Adaptation, Psychological↗
PubMed1989

The Depressive Experiences Questionnaire: a further evaluation.

The Depressive Experiences Questionnaire (DEQ; Blatt, D'Afflitti, & Quinlan, 1976b) was designed to assess the introjective and anaclitic personality dimensions hypothesized by Blatt (1974) to underlie different forms of depression. Welkowitz, Lish, and Bond (1985) revised the DEQ (RDEQ) in order to simplify its scoring and facilitate cross-gender comparisons. The study described herein explored the relation between the original and revised forms of the DEQ and assessed the reliability and validity of the Welkowitz et al. (1985) version of the inventory. Two samples were employed: (a) 163 psychiatric outpatients; and (b) 144 adolescent and young-adult offspring of patients with major affective disorders, chronic physical diseases, and normal controls. The results indicated that the three scales comprising the RDEQ were highly correlated with the corresponding scales from the original DEQ, however, the original and revised forms of the inventory exhibited different patterns of intercorrelations between scales. The RDEQ was internally consistent and stable over a 6-month period. In addition, it exhibited the predicted patterns of relationships with interview and self-report measures of depression and depressive personality traits and cognitive styles. Finally, the RDEQ was significantly associated with the course of depression in a 6-month follow-up study. The findings were generally similar across samples and genders. Overall, these results support the reliability and validity of the RDEQ, but indicate that there are important structural differences between the original and revised forms of the inventory.

Adolescent↗
PubMed1988

Schizotypal personality disorder in an outpatient population: incidence and clinical characteristics.

The incidence and clinical characteristics of DSM-III Schizotypal Personality Disorder (SPD) were explored in a series of 76 consecutive outpatients. Ten patients (13.2%) met DSM-III criteria for SPD. Patients with SPD were significantly more likely to receive a diagnosis of drug abuse or dependence and tended to exhibit a higher rate of major affective disorders than did the non-SPD group. Patients with SPD were rated as significantly more severely disturbed than non-SPD patients on the Global Assessment Scale for the current episode and the worst lifetime episode of disorder. In addition, SPD patients were significantly more likely to have histories of psychiatric hospitalization and attempted suicide and first received treatment at a significantly younger age than did non-SPD patients. These results indicate that SPD is relatively common in outpatient settings and is associated with particularly severe psychopathology.

Adolescent↗
PubMed1988

Double depression and episodic major depression: demographic, clinical, familial, personality, and socioenvironmental characteristics and short-term outcome.

The authors compared 31 outpatients with double depression to 50 outpatients with episodic major depression. Patients with double depression exhibited significantly greater impairment, more severe depressive symptoms, greater comorbidity, more personality disturbance, lower levels of social support, more chronic strains, and higher rates of bipolar II and nonbipolar affective disorders in first-degree relatives. In addition, in a 6-month follow-up, the patients with double depression were significantly less likely to recover, and a higher proportion experienced hypomanic episodes than did patients with episodic major depression. These data provide strong support for the clinical significance of double depression.

Adult↗
PubMed1987

The reliability of subjects' reports on stressful life events inventories: a longitudinal study.

Previous studies of the reliability of stressful life events inventories employing test-retest, informant report, and fall-off designs have all suffered from significant methodological limitations. In order to provide a more rigorous test of the reliability of subjects' reports on life events inventories, the present study employed a longitudinal design with multiple, frequent assessments. Fifty-three subjects completed life events questionnaires every 5 weeks for 5 months. At the end of this time, subjects were asked to report all events occurring during the entire study period. The intraclass correlation between the number of events reported in the four 5-week assessments and the final, 5-month assessment was .63. There was a 26% decline in the number of events reported between the 5-week assessments and the 20-week assessment. Agreement on specific inventory items was only 52%. These data are consistent with previous, less methodologically rigorous studies in raising serious questions about the reliability of stressful life events questionnaires.

Adult↗
PubMed1986

Inventory identification of cyclothymia. IX. Validation in offspring of bipolar I patients.

We present the ninth in a series of validation studies that support the effectiveness of the General Behavior Inventory (GBI) in identifying cyclothymia. This study assessed the potential utility of the GBI in family and offspring studies by evaluating its ability to satisfy three prerequisites for use in such research: (1) identification of cyclothymia familially related to bipolar I disorder, (2) use with young adolescents, and (3) "insensitivity" to the effects of nonaffective psychopathology and parental nonaffective disorder in the offspring of control probands. The GBI and a blind, structured diagnostic interview were administered to 37 offspring of bipolar I patients and 21 offspring of psychiatric control patients, Twenty-seven percent of the offspring of bipolar patients, but none of the control offspring, were found to have bipolar forms of affective disorder, primarily cyclothymia (24%). Concordance between the GBI and interview-derived diagnoses was 95% to 97%, with 98% specificity and 80% to 90% sensitivity, depending on cutting score location. Together with the results of previous studies, the findings suggest that the GBI holds promise for the identification of cyclothymia in several research and clinical contexts.

Adolescent↗
PubMed1986

Discriminant validity of the General Behavior Inventory: an outpatient study.

Recent studies have provided strong support for the convergent validity of the General Behavior Inventory (GBI), a case identification inventory for chronic subsyndromal affective disorders (cyclothymia and dysthymia). Fewer data are available, however, on the ability of the GBI to distinguish chronic subsyndromal affective disorders from other forms of psychopathology. In order to address this issue, outpatients with cyclothymia (n = 9), dysthymia (n = 26), nonchronic major depression (n = 16), and nonaffective psychiatric disorders (n = 30) were compared on the GBI. Diagnoses were derived blind to GBI scores using structured diagnostic interviews and DSM-III criteria. The inventory significantly discriminated cyclothymes and dysthymes from patients with nonchronic major depressions and nonaffective disorders. Using the cutoff score that maximized GBI-diagnosis concordance, the inventory correctly classified 88% of the sample. All of the cyclothymes, 92% of the dysthymes, 87% of the patients with nonaffective psychiatric disorders, and 75% of the nonchronic major depressives were correctly classified by the inventory. These data provide strong support for the discriminant validity of the GBI.

Adult↗