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Biomedical subjects

G Winokur

Publications and source records attributed to G Winokur.

At least 73 records · Page 4Linked to original sources
PubMed1988

Complicated mania. Comorbidity and immediate outcome in the treatment of mania.

In a case-control study, 57 manics with antecedent or coexisting nonaffective psychiatric disorders (n = 38) or serious medical illnesses (n = 19) ("complicated mania") were compared with 114 age-, sex-, and year-of-admission-matched controls with no other disorder ("uncomplicated mania"). Significant differences emerged between the three groups in age, marital status, age at onset, number of prior hospitalizations and prior suicide attempts, organic features, and outcome measures (recovery and death rates). Patients were divided into four treatment groups based on primary mode of therapy during index admission; the groups included electroconvulsive therapy, adequate lithium carbonate, inadequate lithium carbonate, and neither treatment. Uncomplicated manics were significantly more likely to receive adequate lithium carbonate and less likely to receive inadequate lithium carbonate than were complicated manics. The latter patients had a significantly poorer immediate response to treatment overall, and to adequate lithium carbonate specifically. Seventy-eight (68.4%) uncomplicated manics had recovered ad discharge, compared with 26 (45.6%) complicated manics. Logistic regression suggested that the influence of comorbidity on outcome was more important for women than men. We conclude that complicated mania is a useful clinical construct.

Adult↗
PubMed1988

Familial syndrome patterns in schizophrenia, schizoaffective disorder, mania, and depression.

A major problem with studies in the field of quantitative genetics is that of phenotypical heterogeneity. In particular, such heterogeneities show up in psychiatric investigations: index cases often tend to display more severe forms of disorders than the respective affected relatives. The principal goal of the present investigation was to test the phenotypical equivalence of the two populations of index cases and their affected relatives. Our analyses were based on 269 hospitalized patients with functional psychoses and 350 affected first degree relatives. As opposed to the majority of earlier investigations in which phenotypes were uniquely defined by diagnoses, phenotypes were represented in this study by a list of 22 psychiatric syndromes. Accordingly, multivariate statistical procedures were applied to analyze the intrinsic properties of the empirical lists. The results showed that typical syndrome patterns clearly appeared in both populations and that the phenotypical equivalence of the corresponding population sample sets lay between satisfactory and good. Furthermore, it was possible to select phenotypically homogeneous and reproducible subsets on the basis of the 22 syndromes. These subgroups can be used as basic material to study the genetic modes via current models from quantitative genetics. Nevertheless, our analyses revealed no clear breeding true of either affective disorders or schizophrenia.

Bipolar Disorder↗
PubMed1988

Evidence for possible linkage between genetic markers and affective disorders.

Studies of the underlying components of affective disorders are particularly difficult because of the confounding effects of both genetic and environmental factors. Linkage analysis is a useful tool in delineating the etiology of affective disorders, as it is unlikely that linkage between behavioral traits and blood group polymorphisms could result from environmental effects. The present study used the robust Haseman and Elston sibpair method to analyze linkage between 24 genetic markers and affective disorder in 34 nuclear families from 25 pedigrees (195 people). The probands were ascertained as part of the ongoing NIMH Collaborative Depression Study. Indications of linkage between familial pure depressive disease and MNS and depression spectrum disease and ORM were found, as had been previously suggested. There was also suggestive evidence for linkage between the latter and GC. Results are discussed in terms of methodological differences with previous studies.

Bipolar Disorder↗
PubMed1988

Predictors of immediate response in the treatment of mania: the importance of comorbidity.

Four hundred thirty-eight bipolar manics were admitted to an acute care psychiatric inpatient ward over a 12-year period. Eighty percent had good and 20% poor immediate outcome. Good outcome patients were characterized by short episode duration, older age of onset, a longer hospitalization, fewer suicide thoughts, and less psychiatric and medical comorbidity than the poor outcome group. Patients were divided into four treatment groups based on primary mode of therapy during index hospitalization: electroconvulsive therapy (ECT), adequate lithium, inadequate lithium, and neither treatment. Patients experiencing good outcome were more likely to be in the adequate lithium group and less likely to receive neither treatment. Regression analysis identified the absence of comorbidity, duration of lithium treatment more than 2 weeks, and duration of episode of less than 1 month as predictors of good outcome at hospital discharge.

Adult↗
PubMed1988

Depressions secondary to other psychiatric disorders and medical illnesses.

The authors studied 401 patients with depressions secondary to psychiatric illnesses (substance abuse disorders or somatoform, anxiety, or personality disorders) or depressions secondary to medical illnesses. They found that the patients with depressions secondary to psychiatric illnesses had an earlier age at onset, were more likely to have suicidal thoughts or to have made suicide attempts, were less likely to have memory problems, were less improved with treatment and more likely to relapse on follow-up, and had more alcoholism in their families than patients with depressions secondary to medical illnesses. Depressions secondary to medical illnesses seem to fit the category of reactive depression, and depressions secondary to psychiatric illnesses fit the definition of neurotic depression.

Adjustment Disorders↗
PubMed1988

Depression and panic attacks: the significance of overlap as reflected in follow-up and family study data.

Ninety-one patients with panic attacks limited historically to depressive episodes had more severe depressive symptoms and were less likely to recover during a 2-year follow-up than 417 depressed patients who did not have panic attacks. Family study data clearly distinguished another 15 patients with panic disorder and secondary depression; interviewed relatives of panic disorder patients were significantly less likely to have primary depression and significantly more likely to have various anxiety disorders. These data support the hierarchical system by which many of the contemporary diagnostic systems separate panic disorder and major depression.

Anxiety Disorders↗
PubMed1988

Effect of psychosis on suicide risk in 1,593 patients with unipolar and bipolar affective disorders.

The authors report suicide risk among 1,593 patients with major depression or bipolar disorder, 443 (27.8%) of whom were psychotic (260 bipolar and 183 unipolar). The subjects were followed for 0-14 years, and their suicide experience was compared with that of the state population. Eight (19.5%) of the 41 suicide victims were from the psychotic group. The psychotic and nonpsychotic subjects in each diagnostic group had similar risks for suicide. A higher risk for suicide was not found in the bipolar subjects. The authors conclude that among patients with major affective disorder psychosis per se does not predispose to suicide.

Affective Disorders, Psychotic↗
PubMed1988

Postpartum mania.

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Bipolar Disorder↗
PubMed1988

Possible linkage between alcoholism and esterase-D.

Association and linkage relationships between alcoholism and 30 polymorphic marker loci were studied in a total of 42 families: 27 families originally collected as part of a study on depression spectrum disease, 14 previously reported families with depression spectrum disease, and 1 family with familial alcoholism. Since heterogeneity within a sample can confound genetic linkage analysis, obscuring linkage relationships, alcoholism was studied in these families as a disorder unrelated to depression or antisocial personality. No allelic associations were found to be significant after allowing for the multiple tests. In a sib-pair linkage analysis, significant differences between the mean proportion of genes identical by descent in concordant and discordant sib pairs were found for the esterase-D (ESD) marker locus (p less than or equal to .01). This suggested that a linkage may exist between a gene for alcoholism and the ESD locus on chromosome 13q. Lod score linkage analysis yielded odds in favor of linkage to ESD of 44 to 1, most of the information relevant to linkage residing in a single family in which three offspring were classified as alcoholic and five were not.

Adult↗
PubMed1988

Anxiety disorders. Relationships to other psychiatric illness.

Considerable evidence suggests that patients with anxiety disorders have secondary depression, and somewhat less evidence suggests that secondary alcoholism is seen in anxiety disorder. Such illnesses as manic-depressive disorder, schizophrenia, and hysteria are likely to be associated with secondary anxiety syndromes. Considerable data support the idea that within families of anxiety disorder patients alcoholism is seen more frequently than would be expected by chance and that within families of alcoholics anxiety disorders are seen more frequently than would be expected by chance. These findings suggest a difference in expressivity for the same familial propensity.

Anxiety Disorders↗
PubMed1987

Suicide in subtypes of major affective disorder. A comparison with general population suicide mortality.

We investigated the risk of suicide among 705 patients with primary unipolar depression, 302 patients with secondary unipolar depression, and 586 patients with bipolar affective disorder (BAD). The suicide rates among the study subjects were compared with that of the general population of Iowa, the area from which the subjects were selected. An increased risk of suicide was found in all psychiatric groups, except the group of female patients with BAD, which was associated with a lower risk of suicide than unipolar disorders. Thirty suicides (73.2%) occurred during the first two years of follow-up; this trend was particularly pronounced in female patients with primary unipolar depression and male patients with BAD.

Bipolar Disorder↗
PubMed1987

Neurotic depression: a diagnosis based on preexisting characteristics.

A neurotic depression is a depression in an emotionally unstable person. Secondary depressions to major personality disorders, neuroses, and drug use disorders fit the above definition. Likewise, primary depressions with a family history of alcohol (depression spectrum disease) are characterized by a long history of stormy life problems and, therefore, would fit the definition. Using these two preexisting characteristics, we examined a group of 401 neurotic depressives and compared them to 536 nonneurotic (endogenous) depressives. The neurotic depressives were younger and the neurotic patients had made more previous suicide attempts. They were less likely to show memory deficits or delusions and less likely to show symptom criteria of melancholia. They were more likely to have suicide thoughts at index. Treatment was more effective in the nonneurotic patients and such patients made fewer suicide attempts in follow-up. These differences confirm the validity of the distinction between neurotic and nonneurotic depression.

Adult↗
PubMed1987

DST nonsuppressor status: relationship to specific aspects of the depressive syndrome.

Using a conservative definition of suppressor status in hospitalized depressives, we found a relationship between abnormal endocrine function and certain kinds of depressive symptoms, i.e., melancholic symptoms, delusions, and memory deficit. Normal suppressor status is related to an early age of onset, absence of delusions, absence of memory deficit, absence of melancholia symptoms, and a presence of a diagnosis of secondary depression or a family history of alcoholism in depressives. The data suggest the distinction between neurotic-reactive depression and endogenous depression. It is equally important to note that these specific symptoms and characteristics possibly are associated with suppressor status independently of each other.

Delusions↗
PubMed1987

Family (genetic) studies in neurotic depression.

Neurotic depression may be defined as a depression that occurs in the context of a long standing history of personality difficulties or neurotic symptoms. Two types of conditions fit this definition: (1) depressions secondary to personality disorder, neuroses or substance abuse; and (2) primary depressions with a family history of alcoholism. Depressions so defined show familial relationships with secondary depression, anxiety disorders, alcoholism, and depressions with personality disorders. The data suggest that these cluster in the same family and are related to the definition of neurotic depression given above. Whether these familial relationships are genetic awaits further research.

Adjustment Disorders↗
PubMed1987

Is death from natural causes still excessive in psychiatric patients? A follow-up of 1593 patients with major affective disorder.

A follow-up of 1593 Iowans with major affective disorder showed excessive mortality from unnatural causes in primary and secondary depression, and bipolar depression, but not mania, compared with age- and sex-matched controls from the general population. Excessive death from natural causes was found in women with secondary unipolar depression and bipolar depression and in manics (men and women combined) who had concurrent organic mental disorders or serious medical illnesses. Natural death was not excessive in the absence of these conditions. We conclude that excessive natural death reported in psychiatric patients is due to complicating physical disorders and not to the primary psychiatric disorder per se, whereas excessive unnatural death is due to the psychiatric disorder. Also, psychiatrically ill persons are probably referred for hospitalization more frequently when complicating physical disorders are present. Finally, we conclude that mortality patterns were similar in patients with primary and secondary unipolar depression, but bipolar patients were at lower risk for unnatural death than were unipolar patients.

Bipolar Disorder↗
PubMed1987

From unipolar depression to bipolar illness: 29 who changed.

We studied 29 patients who were admitted to a psychiatric hospital for depression, never had had a previous mania, and developed the mania in follow-up. When compared to patients who were stable unipolars, the potential bipolars had a history of more episodes prior to their onset of mania, more hospital admissions, more marked self-reproach and guilt; in follow-up, they had more hospitalizations.

Adult↗