Some comments on the question "Does ECT permanently alter seizure threshold?".
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Electroconvulsive Therapy↗
Biomedical subjects
G Winokur
Publications and source records attributed to G Winokur.
The time course of nonchronic major depressive disorder. Uniformity across episodes and samples. National Institute of Mental Health Collaborative Program on the Psychobiology of Depression--Clinical Studies.
BACKGROUND: Most natural history studies of affective disorders have emphasized the prediction of eventual recovery. Little is known of changes over time in the immediate probability of recovery. METHODS: To identify regularities in the timing of recovery from nonbipolar major depressive disorders, we considered only episodes that began during follow-up to increase the accuracy with which onsets were timed and to limit the study sample to individuals who had a demonstrably episodic course. Five participating centers conducted baseline assessments and followed probands (N = 605) and nonclinical subjects (relatives, controls, and spouses, N = 826) up for 6 years. During that time, 359 probands had at least one prospectively observed episode, and 181 had two episodes; corresponding numbers for the nonclinical subjects were 216 and 78, respectively. Our analyses considered the distribution of episode lengths across ascertainment source (probands vs nonclinical subjects), center, and episode number (first vs second prospectively observed episode). RESULTS: Distribution was remarkably uniform. Regardless of ascertainment source, center, or episode number, recovery occurred within 3 months in 40% of episodes, within 6 months in 60%, and within 1 year in 80%; 20% had more protracted courses. CONCLUSIONS: Once triggered, the immediate likelihood of recovery changes over time in a predictable fashion. This has practical implications for the study of antidepressant efficacy and theoretical implications for factors involved in affective dysregulation.
Adolescent↗
Recurrently situational (reactive) depression: a study of course, phenomenology and familial psychopathology.
Probands with non-bipolar major depressive disorder (MDD) were grouped according to the consistency across episodes with which depression appeared to arise from situational factors. Situational depression showed significant diagnostic stability across the second and third recurrences in a 10-year follow-up. The relatives of recurrently situational probands had higher neuroticism scores, higher lifetime rates of MDD and, when depressed, fewer endogenous symptoms than did the relatives of non-situational probands. This study joins two others in finding an association between stress-related depression and high familial loadings for MDD. It also illustrates the value of diagnostic consistency across episodes as a means of refining groups for the study of diagnostic subtypes.
Adjustment Disorders↗
Manic-depressive (bipolar) disorder: the course in light of a prospective ten-year follow-up of 131 patients.
For a five-year period, 131 bipolar patients were followed every 6 months; for the next 5 years, they were followed yearly. Each patient was interviewed in a systematic way that gave information about episodes, hospitalizations, cycle lengths and the presence of alcoholism. Women and men were not significantly different in the number of follow-up manic or depressive episodes or hospitalizations. Chronicity from index episode to the end of the 10-year follow-up was uncommon (4%). Alcoholism, which was common in these patients, showed a great diminution at the end of 10 years. Contrary to expectation, cycle lengths showed no systematic decrease in length over the follow-up. In this naturalistic study, treatment intensity was not related to decreasing episodes or to changes in cycle length. The number of episodes in the first 5 years of follow-up was not correlated with the number of episodes in the last 5 years. Cycle lengths in the first 5 years of follow-up were similar in length to the last 5 years of follow-up. A family history of mania in these bipolar patients was associated with more episodes in follow-up than if such a family history were absent. The patients whose alcoholism predated the onset of their affective illness were less likely to have episodes in the follow-up than the patients in whom affective illness predated the onset of the alcoholism.
Adult↗
The long-term stability of depressive subtypes.
OBJECTIVE: This study used the concept of diagnostic stability to examine the validity of three subtypes of major depression. METHOD: Patients with major depressive disorder (N = 424) were assigned baseline diagnoses according to structured interviews and the Research Diagnostic Criteria. Follow-up evaluations took place at 6-month intervals over the next 5 years and annually for an additional 3 years. During this period 424, 246, 163, and 96 of the patients who had recovered from the index episode had one, two, three, and four recurrences, respectively, of major depressive disorder. The kappa statistic was used to quantify the likelihood that patients with the psychotic, agitated/retarded, or endogenous subtype of depression in a given episode would again manifest that subtype in subsequent episodes. RESULTS: The psychotic subtype showed the most enduring diagnostic stability across multiple subsequent episodes. Even after three intervening episodes, patients with baseline psychotic major depression were five times more likely to develop a psychotic depression than were other depressed patients. For all three subtypes, diagnostic stability was greater for contiguous episodes than for noncontiguous episodes. Psychotic, agitated/retarded, and endogenous subtypes showed significant stability after control for the bipolar/unipolar and primary/secondary distinctions. The endogenous subtype was stable among patients with primary depression but not among those with secondary depression. CONCLUSIONS: The psychotic subtype was the most valid of the subtypes tested from the perspective of diagnostic stability. The fact that stability across adjacent episodes exceeded stability across more distantly spaced episodes may reflect state-dependent determinants, and these are likely to vary by subtype.
Bipolar Disorder↗
The contribution of clinical genetics to molecular genetics in psychiatry.
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Bipolar Disorder↗
A prospective follow-up of patients with bipolar and primary unipolar affective disorder.
OBJECTIVE: As part of the National Institute of Mental Health Collaborative Study of the Psychobiology of Depression, the comparative course of manic depressive (bipolar) and primary unipolar patients was assessed. DESIGN: Systematic evaluation using structured instruments every 6 months for a period of 5 years with the recording of remissions, new episodes, and subsequent hospitalizations. PATIENTS: The number of subjects varied somewhat depending on the analyses conducted. For a comparison of course in bipolar patients and unipolar patients, 148 bipolars were compared with 172 unipolar patients. RESULTS: Both unipolar and bipolar patients were more likely to have episodes if they had episodes prior to index admission. Likewise, prior hospitalizations predicted multiple hospitalizations in follow-up. Chronicity was significantly more prevalent among unipolar depressives but in both unipolar and bipolar patients, chronicity diminished over time. Bipolar patients were more likely than unipolar patients to have multiple episodes at the 2-year and 5-year follow-ups. In bipolar patients, there was no difference in the number of episodes in follow-up between males and females but in unipolar patients, females were significantly more likely to have subsequent hospitalizations and episodes than males. Treatment variables did not relate to these differences. A family history of mania or schizoaffective mania predicted multiple episodes in bipolar patients but not in primary unipolar depressives. A family history of all affective illness (mania, schizoaffective mania, bipolar II illness, and depression) did not predict a multiple-episode course in either bipolar or unipolar illness. In unipolar patients, the independent variables leading to multiple-episode course in follow-up are being female, an early age of onset, and prior episodes. CONCLUSIONS: As a result of this systematic follow-up study, new data add to the distinction between bipolar and primary unipolar patients both as regards number of episodes in follow-up and also as regards risk factors that are associated with the multiple-episode course.
Adult↗
Further distinctions between manic-depressive illness (bipolar disorder) and primary depressive disorder (unipolar depression)
OBJECTIVE: Patients with bipolar disorder differ from patients with unipolar depression by having family histories of mania with an earlier onset and by having more episodes over a lifetime. This study was designed to determine whether additional aspects of course of illness, the presence of medical diseases, childhood traits, and other familial illnesses separate the two groups. METHOD: In a large collaborative study, consecutively admitted bipolar and unipolar patients were systematically given clinical interviews. Data were collected on medical diseases and childhood behavioral traits. Systematic family history and family study data were also obtained. The patients were studied every 6 months for 5 years. RESULTS: The group of bipolar patients had an earlier onset, a more acute onset, more total episodes, and more familial mania and were more likely to be male. These differences were relatively independent of each other. The bipolar patients were also more likely to have shown traits of hyperactivity as children. The unipolar patients had a significantly greater number of lifetime medical/surgical interventions than the bipolar patients, even when age was controlled. Alcoholism was more frequently found in the families of the bipolar patients, even when alcoholism in the probands was controlled; however, this difference was not significant. CONCLUSIONS: This study supports the usefulness of distinguishing between bipolar and unipolar patients in treatment and research studies.
Adult↗
A comparative study of paranoid and schizoid personality disorders.
OBJECTIVE: Family studies have demonstrated a higher rate of schizoid personality in the families of probands with schizophrenia and a higher rate of paranoid personality in the families of probands with delusional disorder. The authors sought to investigate the familial characteristics of probands with schizoid and paranoid personality disorders and to delineate the clinical characteristics of the two groups. METHOD: Records of 351 inpatients with discharge diagnoses that included the term "schizoid personality" or "paranoid personality" were examined to identify patients who met DSM-III-R criteria for schizoid personality disorder (N = 34) or paranoid personality disorder (N = 19). Comparisons were made between the two groups with respect to clinical symptoms, familial characteristics, and longitudinal course. RESULTS: The authors found that probands with schizoid personality disorder were hospitalized at an earlier age than probands with paranoid personality disorder, had more intervention before the index admission, and had greater morbidity following the index admission. They also found that descriptors of the two syndromes tended to congregate in the respective family material, but the differences were not statistically significant. Differences in the familial prevalence of schizophrenia were also not statistically significant. CONCLUSIONS: These familial data do not support the hypothesis that schizophrenia congregates in the families of probands with schizoid personality disorder. Possible explanations for this finding are discussed.
Adult↗
Alcoholism in manic depressive (bipolar) patients.
Bipolar patients with alcoholism were compared to nonalcoholic bipolar patients on clinical and family history variables. All patients were systematically examined using a structured interview. There was no increase in the family history of alcoholism in the alcoholic/bipolar. This argues against separate transmission of alcoholism and bipolar illness in bipolar patients who meet diagnostic criteria for both bipolar illness and alcoholism. The possibility remains that alcoholism is secondary to the bipolar illness in some cases. Likewise, there is a possibility that preexisting alcoholism may, by a sequence of events, produce an induced "organic" bipolar picture.
Adult↗
Evaluation of suicidality during pharmacologic treatment of mood and nonmood disorders.
Double-blind, controlled clinical trial data were evaluated to assess a hypothetical relationship between fluoxetine and suicidality (suicidal acts and ideation) in patients with mood (n = 5,655) and nonmood disorders (n = 4,959) (Mantel-Haenszel incidence difference method). In mood disorders, act rates (suicide attempts/completions) were low (treatment differences nonsignificant). Substantial suicidal ideation emerged less frequently with fluoxetine than placebo and was comparable with fluoxetine and tricyclic antidepressants. Improvement in ideation was greater with fluoxetine than placebo; it was comparable with fluoxetine and tricyclic antidepressants (United States trials) and greater with tricyclic antidepressants than fluoxetine (international trials). In nonmood disorders, no suicides occurred. Act and emergent ideation rates were low (treatment differences nonsignificant). Results do not suggest a causal relationship between pharmacotherapy and emergence of suicidality. Fluoxetine or tricyclic antidepressants reduce suicidal ideation and may protect against the emergence of substantial suicidal ideation.
Antidepressive Agents, Tricyclic↗
Familial subtypes of unipolar depression: a prospective study of familial pure depressive disease compared to depression spectrum disease.
In a large multicenter effort, major depressives were systematically studied at index admission and prospectively followed up for 5 years. Primary unipolar depressives with a family history of alcoholism (depression spectrum disease) differ from depressives with a family history of depression only (familial pure depressive disease) in having more familial anxiety and somatization disorder, more divorce, more suicide attempts, more negative life events, and needed more time to recover from the index episode. In the 5-year follow-up they are more likely to develop alcoholism and drug abuse. Depressive spectrum disease patients are more likely to meet systematic criteria for neurotic depression. The data suggest that major depression is a syndrome that is heterogeneous, and may be a final common pathway of more than one familial illnesses.
Adult↗
Failed and short seizures associated with prior electroconvulsive therapy.
Electroconvulsive therapy (ECT) has not been associated with many long-lasting effects that are associated with the treatments itself. The impact of having prior ECT to determine if the increased seizure threshold that is noticed during the treatment course is long-lasting was studied. If so, more failed and short seizures should occur among those patients who have had prior electroconvulsive treatments. A review of the treatments of 114 males and 220 females indicated a strong association of prior ECT with failed as well as short seizures for men but not for women.
Adult↗
Alpha 2 adrenergic receptor subtypes in depression: a candidate gene study.
Alpha 2 adrenergic receptors play an important role in regulating the neuronal release of norepinephrine through presynaptic feedback inhibition in the locus ceruleus. Therefore, alpha 2 adrenergic autoreceptors may underlie some aspects of the pathogenesis and symptomatic expression of depressive illness. We studied two brain-expressed alpha 2 adrenergic receptor genes as genetic markers in linkage analyses in 17 multiplex pedigrees of unipolar depression. Neither of the genes was supportive of linkage to depression. Lod scores of less than -2 were found in both familial pure depressive disease pedigrees and in depression spectrum disease pedigrees. Therefore, we conclude that depression in our pedigrees is not related to mutations in the two alpha 2 adrenergic receptor genes tested.
Adult↗
Alcoholism and primary major depression: a family study approach to co-existing disorders.
Alcoholism and major depression appear together at much higher than chance rates, but reasons for this are obscure. We used the direct diagnostic assessment of 177 probands with primary, unipolar depression and 619 of their first degree relatives to explore the significance of concomitant alcoholism. The male relatives of alcoholic probands of both sexes had substantially higher rates of alcoholism than did the male relatives of non-alcoholic probands. Among female probands, but not among male probands, alcoholism was associated with markedly higher familial rates of primary depression, particularly among female relatives. These data contained no evidence that comorbidity itself was familial. The appearance of alcoholism in depressed women may indicate depression spectrum disease, a disorder which manifests as depression in women and alcoholism in men. In contrast, men with both primary depression and alcoholism may be exhibiting two distinct illnesses.
Adolescent↗
A familial ("genetic") methodology for determining valid types of affective illnesses.
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Family↗
Testing the validity of the neurotic depression concept.
We applied an operational definition of neurotic depression to 185 hospitalized patients who met Feighner and DSM-III-R criteria for unipolar depression. Based on a systematic chart review, 37 patients met the criteria for neurotic depression. As a group, these patients differed from nonneurotics in symptoms, clinical course, outcome, and family history. The neurotic depressives were younger and more likely to identify precipitating factors. They were less likely to meet criteria for melancholia and to have delusions. They were more likely to be ill 3 years later and more likely to have familial alcoholism. These differences help to confirm the validity of the neurotic depression concept.
Adult↗