Biomedical subjects
Publications and source records attributed to G Parker.
A questionnaire examining structural and basic process characteristics of psychiatric practice was prepared by the RANZCP Quality Assurance Committee and circulated to all Fellows of the College in 1991. There were 830 replies (48%). A one in two sample of the replies was analysed and forms the basis of the descriptive report presented in this paper.
We report a consensus conference on psychotic depression that addressed historic, classification, phenomenologic, epidemiologic, aetiologic, management and outcome issues. We were able to detail the impact of the information offered by having audience members complete questionnaires before and after the conference. The respondents indicated that the status of psychotic depression (as a separate type or as a more severe expression of depression) remains unclear; that delusions, hallucinations and severe psychomotor disturbance have high cross-sectional diagnostic weighting (while longitudinal information is of importance); that determinants include both genetic and organic factors; that most patients with this condition require admission to hospital; and that bilateral ECT is the most effective treatment. The answers to the questionnaires established areas where the audience did not modify their responses because they were already well-informed, others where their views were considerably changed (e.g. "psychotic" episodes in those with a borderline personality disorder) and others where they modified their clinical reasoning (e.g. "if a "psychotic" feature is mood-congruent then the condition must be an affective disorder" became "if the patient has an affective disorder, the psychotic feature must be mood-congruent"). Finally, we make some recommendations for future consensus conferences.
Implementation of the Community Care Act makes it essential that clients' needs for services are accurately assessed. A study was undertaken by a general practice to identify whether clients with physical disabilities were satisfied with the service they received.
Female rats, with and without maternal experience, received limbic seizure-inducing (SC) injections of lithium and pilocarpine. Following the subsequent parturitions, these rats displayed a complete absence of maternal behavior. Rats that did not display seizures after receiving the lithium/pilocarpine injections displayed behaviors that were comparable to normal controls. Although the multifocal limbic, thalamic, and cingulate damage abolished maternal care, there was no evidence of aberrant effects upon fecundity, litter size, or mammary function; infanticide was negligible. The pattern of brain damage involves the evolutionarily more recent thalamocingulate system of mammals and supports MacLean's theory that these pathways are required for normal mother-offspring interaction.
Literature reviews have suggested that combination antidepressant/antipsychotic drug therapy and electroconvulsive therapy (ECT) are of comparable efficacy in treating psychotic depression, and distinctly superior to antidepressant alone or antipsychotic alone. We undertook a meta-analysis of 44 studies, and focussed on those three principal treatment options. There was a trend for ECT to be superior to combination drug therapy, with bilateral ECT being suggested as distinctly more effective than unilateral, and ECT was demonstrated to be significantly superior to tricyclic drug alone. Combination drug therapy ranked as more effective than antipsychotic alone and than antidepressant alone, but that greater efficacy was not significant.
There appear to be few published studies that have examined the levels of agreement between ratings of features of depression as assessed by clinicians and by corroborative witnesses. We therefore report a study of 141 depressed patients assessed by a clinical psychiatrist at a semi-structured interview, reviewing family and historical data as well as depressive symptoms, and rated on a series of designated mental state signs. A family member completed questionnaire data assessing the same features. Moderate agreement was obtained only for several historical items (e.g., previous depressive episode, response to ECT). Agreement was minimal or non-existent on numerous clinical symptoms and signs of depression. A number of sources of disagreement are considered, and it is suggested that discordance may have emerged principally from the contrasting domains and training experiences of the clinicians and the corroborative witnesses.
Although it is now more than 30 years since Leohard originally proposed the distinction between bipolar and monopolar (unipolar) forms of affective disorder, there have been relatively few studies which have investigated clinical features which may differentiate the depressed phase of bipolar disorder from unipolar depression. In this study we examined the value of a new scale for rating depressive mental state signs (the 'core' score system), and a large series of symptoms and risk factors, in distinguishing between 27 age and sex-matched pairs of bipolar and unipolar patients diagnosed as melancholic on several diagnostic criteria. In general, we found a marked similarity between the groups on clinical features of the depressive episode when allowance was made for multiple tests. Bipolar patients, however, had shorter episodes of depression and were less likely to demonstrate 'slowed movements' than unipolar subjects. There were also consistent trends on other items for psychomotor retardation to be less common and agitation to be more likely in the bipolar patients. At the least, these findings suggest that the widely-held belief that bipolar depressed patients typically have psychomotor retardation is not as clear-cut as has been previously described.
Interpersonal characteristics of the intimate partners of patients with non-melancholic depressive disorders were evaluated as potential predictors of outcome in an eighteen-month, longitudinal study. The short-term reduction in depressive symptoms was predicted most significantly by the patient's perception of the partner's care (as measured by the Intimate Bond Measure). The longer-term reduction in depressive symptoms was predicted by two components of the intimate relationship (the perceived care of the intimate and a briefer relationship) and was more likely in younger patients. Those who separated from an uncaring partner reported a distinct improvement in depressive symptoms. The patterns of improvement for patients who separated from uncaring partners and for patients who remained in caring relationships were similar, and distinctly superior to the pattern for those who remained with a partner who was perceived as uncaring.
Several studies have suggested that 'anomalous parenting', as measured by the Parental Bonding Instrument (PBI), may be a differential risk factor to subsequent depression in adulthood--being irrelevant to melancholia but over-represented in non-melancholic depressive disorders. Such a 'specificity' effect is confirmed in our current sample of 65 melancholic and 84 non-melancholic depressed patients. Secondly, we examine the risk to depression effected by exposure to one parent with an anomalous parental style, and the extent to which that risk is modified by characteristics of the other parent. We find clear evidence of additive effects with the risk to non-melancholic depression being raised by exposure to 'anomalous parenting' from two parents. Of the varying parental styles measured by the PBI, low parental care from both parents provided the highest risk to non-melancholic depression (being 4-7 time higher in one sample and 13-27 times higher in the other).
We assessed improvement patterns and predictors of outcome over a 1-year period, in a sample of depressed patients receiving treatment from a specialized mood disorders unit. Patients with melancholia had a differential improvement pattern from the nonmelancholics in the first 20 weeks, but case rates and severity levels were comparable at 20 weeks and at 1 year. Only three variables (older age at first episode, less severe depression and extraversion) were predictors of improvement in both groups. Improvement was predicted by less psychomotor disturbance, absence of personality disorder, and higher social functioning in the melancholic patients. A reported absence of timidity and shyness in childhood, a briefer duration of depression, and receipt of individual psychotherapy predicted a better outcome in the nonmelancholic patients. Although significant predictors were few overall, the suggested differential relevance for most of the isolated predictors argues for outcome studies that examine melancholic and nonmelancholic depressive disorders separately.
Psychomotor disturbance has generally been viewed as a feature of all depressive disorders, merely varying in severity as a consequence of the mood state. As we have elsewhere argued for psychomotor change being specific to melancholia, its definition, measurement and capacity to sub-type depressive disorders may benefit from close consideration. Here we overview historical views and contemporary measures of psychomotor change, noting variable interest in behavioural manifestations of depression, as against symptoms, over time.
Previous studies have demonstrated that abnormalities of personality can contribute to a poor prognosis following a depressive episode. In this study the relevance of a specific personality trait, interpersonal sensitivity, to poor outcome was examined. One hundred and eleven depressives completed the Interpersonal Sensitivity Measure (IPSM) twenty weeks after a baseline assessment. High scores on the IPSM were associated with a poor outcome at one year following the baseline assessment, judged according to whether they had remitted clinically or not and by the degree of change in depression severity measured using the Hamilton and Zung Depression Rating Scales. The relevance of this personality trait to the course and treatment of depression is discussed.
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OBJECTIVE: To determine if personality and coping style are central determinants of drinking and smoking at risk to fetal health during pregnancy. DESIGN, SETTING AND PARTICIPANTS: A sample of 99 women recently confined at a Sydney obstetric hospital received a semi-structured interview and completed a number of questionnaires. MEASURES: Alcohol and cigarette consumption over designated intervals since conception were assessed by interview. Questionnaires assessed maternal anxiety and postnatal depression, as well as coping strategies and personality characteristics such as impulsiveness. RESULTS: After confirmation of pregnancy, two-thirds of those previously drinking ceased while only one-third of those who had been smokers then abstained, with intake levels showing a similar pattern of a relatively greater decrease in alcohol than cigarette consumption over the course of the pregnancy. Personality and coping style differences were not demonstrated between the following contrasting groups: (a) smokers v. non-smokers prior to confirmation of pregnancy; (b) on-going drinkers v. relative abstainers during pregnancy; and (c) excessive smokers and drinkers before pregnancy v. all other subjects. Comparison of drinkers and non-drinkers before pregnancy suggested less "mature" coping styles for the latter, an unexpected finding. CONCLUSION: There was little support for the hypothesis that drinking and smoking at risk to health (before and during pregnancy) are determined by the individual's personality and general coping repertoires.
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The reliability of long-term recall of physical activity participation was examined in 322 women and 129 men in a worksite health study conducted at the Liberty Corporation, Greenville, South Carolina during 1976-1987. Leisure time physical activity was assessed at baseline; and energy expenditure in total, light, moderate, and vigorous activities was calculated. The long-term recall of baseline activities was determined 1-10 years after the examination. The relation between actual baseline and recalled activity was positive and in most cases the coefficients were statistically significant at p less than 0.05. The correlations were modest, most in the range of 0.20 to 0.50. Percent agreement between baseline and recalled activity generally ranged from 60 to 75%. Multiple regression analyses suggested that recalled activity was a significant predictor of baseline activity, but recall interval and age were not important contributors to the regression model. R2 values for the model were 0.10 for light activity and 0.26 for vigorous activity. Questionnaire assessment of long-term physical activity recall appeared to be reliable, length of recall interval up to 10 years was not an important factor, and recall of vigorous activity was more accurate than for less intensive activities.
The relevance of three different interpersonal risk factors to post-natal depression was examined. One hundred and forty-nine non-depressed women completed the Parental Bonding Instrument (PBI), the Intimate Bond Measure (IBM) and the Interpersonal Sensitivity Measure (IPSM) antenatally. Post-natal depression was identified using the Edinburgh Post-natal Depression Scale (EPDS) at 1, 3 and 6 months post partum. Significantly increased risks for post-natal depression were found for the women whose spouses provided low care or were overcontrolling and for women with high interpersonal sensitivity. Low maternal care and paternal overprotection were additional predictors when multiple regression analyses were used. Importantly, the different risk factors had their impact at different times post partum. The implication of these findings is discussed.