Search PubMed⌕ Search

Biomedical subjects

G Winokur

Publications and source records attributed to G Winokur.

At least 91 records · Page 5Linked to original sources
PubMed1987

Psychiatric and medical diagnoses as risk factors for mortality in psychiatric patients: a case-control study.

On the basis of a case-control study, the authors conclude that former psychiatric inpatients are more likely than control subjects to die of both natural and unnatural causes within 2 years of discharge. Patients who committed suicide were more likely to have had a diagnosis of affective disorder (unipolar depression) or alcoholism. Those who died of natural causes were more likely to have been admitted with medical diagnoses; no specific psychiatric diagnoses were associated with these deaths. It is doubtful that medical illnesses caused psychiatric syndromes such as depression in these inpatients. Psychiatric and medical illnesses combined may increase a patient's likelihood of seeking psychiatric help and entering the hospital.

Adolescent↗
PubMed1987

Mortality in patients with primary unipolar depression, secondary unipolar depression, and bipolar affective disorder: a comparison with general population mortality.

Mortality data are presented from a two to fourteen year follow-up of 705 primary unipolar depressives, 302 secondary unipolar depressives, and 586 patients with bipolar affective disorder (BAD) hospitalized at a tertiary care facility. Death ascertainment was made through a record-linkage process. Using sex- and age-standardized mortality ratios (SMRs), the mortality experience of the study population was compared with that of Iowa, the geographical area served by the admitting medical facility for this study group. Results show that risk for all-cause mortality was most pronounced during the first two years following hospital discharge, although secondary unipolar depressives continued to show a significant excess of deaths throughout the entire follow-up period. Deaths occurring from natural causes were significantly excessive only during the initial portion of the follow-up. Deaths from unnatural causes were significantly excessive throughout follow-up except for patients with bipolar affective disorder.

Bipolar Disorder↗
PubMed1987

Treatment of mania: a naturalistic study of electroconvulsive therapy versus lithium in 438 patients.

The efficacy of electroconvulsive therapy (ECT), adequate lithium therapy, inadequate lithium therapy, and neither ECT nor lithium therapy was compared by reviewing the charts of 438 patients hospitalized because of mania over a 12-year period. A significantly (p less than .05) greater percentage (78%) of patients who received ECT had "marked improvement" than did those who received either adequate or inadequate lithium treatment (62% and 56%, respectively) or neither treatment (37%). Of the patients with schizoaffective disorder, manic type, 87.5% who received ECT showed "marked improvement"; almost 70% of patients who failed to respond to adequate lithium had "marked improvement" with ECT. Unilateral and bilateral ECTs were equally effective. Psychosis was not useful in predicting treatment response. ECT was demonstrated to be an effective treatment for mania.

Adult↗
PubMed1987

Treatment and outcome in secondary depression: a naturalistic study of 1087 patients.

In a naturalistic study, the treatment response and outcome of 1087 patients with nonbipolar primary (N = 763) and secondary (N = 324) depression were compared by a chart review. The patients were divided into four treatment groups, based on the primary mode of therapy received during the index hospitalization: ECT, adequate antidepressant, inadequate antidepressant, and neither treatment. Primary depressives were more likely to have received ECT, and secondary depressives were more likely to have received inadequate antidepressant or neither treatment. A total of 436 (57.1%) primary depressives received adequate therapy, but only 113 (34.9%) secondary depressives did (p less than .001). Overall, primary depressives responded better to treatment (both ECT and antidepressants) than did secondary depressives. A total of 470 (61.6%) primary depressives but only 140 (43.2%) secondary depressives were recovered at discharge (p less than .001). The conclusion is that secondary depressives are more likely to receive inadequate treatment and are less likely to respond to adequate treatment than are primary depressives.

Adult↗
PubMed1986

Prospective studies of suicide and mortality in psychiatric patients.

Mortality in a psychiatric population was studied. During the first two years following hospital discharge, natural deaths, accidental deaths, and suicide were excessive. After two years, suicide and accidental deaths continued to be excessive, but not natural deaths. Diagnostic categories were linked to cause-specific deaths. Clinical implications were discussed.

Accidents↗
PubMed1986

Classification of chronic psychoses including delusional disorders and schizophrenias.

A classification of chronic psychoses including nonparanoid schizophrenia, paranoid schizophrenia, paranoid state and paranoia (delusional disorder) is presented. This classification is dependent on a systematic increase in number of symptoms with each group. In particular, delusional disorder is examined with regard to family history. It is clear from the data which are presented that delusional disorder is more likely to be associated with a family history of such traits as suspiciousness, jealousy, secretiveness, and the presence of paranoid behavior or delusions. There is evidence that such familial traits are not seen in schizophrenia, only in delusional disorder.

Chronic Disease↗
PubMed1986

Genetic approach to heterogeneity in psychoses: relationship of a family history of mania or depression to course in bipolar illness.

A specific family history or genetic background may be used to distinguish valid subgroups in patients who show similar symptoms. Also, a familial background may predict differences in other characteristics, i.e. course of illness, response to treatment or biological characteristics. Two hundred and fifty-one bipolar patients were separated according to their family history, 20 with a family history of mania with or without depression, 86 with a family history of depression only, and 145 with a family history of neither mania nor depression. The group that had a family history of mania was notable in that it showed more episodes of affective illness and was more likely to be readmitted to hospital. This difference in course suggests a familial association with multiple episodes and mania. In other respects than in course of illness, the groups separated by family history were similar.

Adult↗
PubMed1986

The psychiatric inpatient unit in the general hospital: clinical demography.

Data from the University of Iowa Psychiatric Hospital are consistent with national trends. Inpatients tend to be young, female, and have psychotic rather than non-psychotic disorders. Women were significantly older than men at admission for most psychiatric disorders. During the past 20 years, length of stay has dropped by over 50%, while admissions have almost trebled and re-admissions doubled. Historic trends are reviewed and clinical implications are discussed.

Adult↗
PubMed1986

Elevated blood neutrophil concentration in mania.

Total, differential, and absolute blood cell counts were compared in 66 untreated manics and 178 untreated schizophrenics. Mania was associated with significantly higher total leukocyte counts (p less than .001), accounted for by a significant increase (p less than .0001) in the number of neutrophils. There were no significant differences between the two groups in any other blood cell elements. Using normative values, manic patients had significantly higher frequencies of both leukocytosis (25.8% vs. 12.4%) and neutrophilia (34.8% vs. 12.4%) than the schizophrenic group. These data suggest a significant association between leukocytosis, neutrophilia, and mania.

Adult↗
PubMed1985

Excess mortality among psychiatric patients. The Iowa Record-Linkage Study.

Of 5,412 patients admitted to the University of Iowa Psychiatric Hospital between Jan 1, 1972, and Dec 31, 1981, three hundred thirty-one died during the follow-up period, significantly more than expected. The risk for premature death was greatest among women and the young, especially those between the ages of 30 and 39 years. Risk was associated with all psychiatric diagnoses and was significantly higher among patients of either sex with an organic mental disorder or schizophrenia; women with acute schizophrenia, depressive neuroses, alcoholism, drug abuse, and psycho-physiologic disorders and special symptoms; and men with neuroses. Suicide and accidental death were more frequent than expected and were responsible for two thirds of the excess deaths. During the total time of follow-up, women were at risk for natural deaths but men were not. Our most important finding was that 99% of the excess deaths occurred within two years of discharge. During this period there were undue numbers of both "natural" and "unnatural" deaths. The first two years after discharge are a time of great risk for psychiatric patients, particularly women.

Accidents↗
PubMed1985

The Iowa record-linkage study. I. Suicides and accidental deaths among psychiatric patients.

In a prospective investigation of 5,412 formerly hospitalized psychiatric patients, 68 committed suicide and 38 died from accidental causes. Both figures are significantly in excess of expectations based on a relevant control population. Those at significant risk included men and women of all ages, except those older than 69 years. Comparison of standardized mortality ratios suggests relatively greater risk for women and young persons. Risk for suicide was significant for patients of both sexes with acute schizophrenia, schizophrenia, affective disorders, and alcohol and other drug abuse, for men with neuroses, and for women with depressive neuroses. Risk for accidental death was greatest for those aged from 30 to 49 years and for those with personality disorders.

Accidents↗
PubMed1985

The Iowa record-linkage study. II. Excess mortality among patients with organic mental disorders.

Of 543 patients with organic mental disorders hospitalized at the University of Iowa Psychiatric Hospital, Iowa City, during a ten-year period, 87 died. This mortality was significant based on a control population. Patients of all ages were at risk for early death, especially those younger than 40 years. Risk was greatest during the first two years of follow-up; thereafter the observed death rate approached the expected rate. Patients were at special risk for death from "natural" causes, particularly cancer and heart disease among women, and influenza or pneumonia or "other" natural causes among men. During the first two years of follow-up, men were also at risk for death from accidents or suicide. Women with alcohol- and drug-related psychoses were at risk for death early in follow-up, but the diagnosis was not associated with risk from "unnatural death" in either sex.

Accidents↗
PubMed1985

The Iowa record-linkage study. III. Excess mortality among patients with 'functional' disorders.

Our investigation of the pattern of mortality among former inpatients in nine diagnostic groups was based on deaths found among 4,869 former inpatients of the University of Iowa Psychiatric Hospital, Iowa City, during a ten-year period. Comparisons were made with expected values based on a relevant Iowa control population. The first two years of follow-up was a period of great risk but not after. Excessive mortality from "unnatural" causes was found among patients of either sex with an affective disorder, schizophrenia, alcohol or other drug abuse, and personality disorders, among men with acute schizophrenia or neuroses, and among women with depressive neuroses. Women with acute schizophrenia or a psychophysiologic disorder or special symptom were at risk for a "natural" death. These findings confirm the risk of reduced life span that patients in all nine categories share.

Adult↗
PubMed1985

The validity of neurotic-reactive depression. New data and reappraisal.

A family history of alcoholism can be used as a validating factor in the diagnosis of reactive-neurotic depression. Not only is this true but there are clear data that indicate the presence of positive symptoms that can be used to make the diagnosis. A set of criteria based on previous research is presented for the diagnosis of neurotic-reactive depression. These criteria are based on a clustering of certain symptoms, events, and traits in patients with neurotic-reactive depression. The patients showed stormy life-styles, some specific symptoms, personality abnormalities, presence of life events before the onset of depression, and a family history of alcoholism. They had relatively few hospitalizations for depression and responded poorly to specific antidepressant treatment.

Adjustment Disorders↗
PubMed1985

A family study of psychotic symptomatology in schizophrenia, schizoaffective disorder, unipolar depression, and bipolar disorder.

An evaluation was made of schizophrenics (140), schizoaffectives (40), unipolar depressives (59), and bipolars (30), and their relatives who had a chart diagnosis of psychosis or depressive neurosis. The purpose was to determine whether the psychosis (delusions and hallucinations) was transmitted independently of the illness itself. If this were true, there would be an excess of pairs of probands and relatives both positive for psychosis and pairs of relatives and probands both negative for psychosis when compared to relatives and probands who were not concordant for the variable. This was found to be true in schizophrenia and schizoaffective disorder and is probably the result of the simple transmission of an illness which includes the presence of psychotic symptoms in the definition. Thus, this would be a manifestation of the genetic propensity in schizophrenia. For the affective disorders there was no evidence that psychotic probands were more likely than the nonpsychotic to have psychotic relatives. So far the reason why some patients have psychosis and others not in the affective disorders remains unexplained.

Bipolar Disorder↗
PubMed1985

The diagnostic value in assessing mood congruence in delusions and hallucinations and their relationship to the affective state.

An examination was carried out on 140 schizophrenics, 34 schizoaffective manics, 6 schizoaffective depressives, 59 unipolars, and 30 bipolars to determine the variables of affective states and mood-congruent and mood-incongruent psychotic symptoms. These patients had been admitted to a hospital in Zürich and were systematically diagnosed, using both clinical and computer-derived systems. Forty-eight patients (18%) had both mood-congruent and incongruent psychotic symptoms. However, the affective disorders usually showed mood-congruent symptoms and the schizophrenics the mood-incongruent types. The schizoaffectives were likely to show both types. There was a marked dissociation between affective states and mood congruence in the schizophrenics. Though the majority of these patients showed depressive syndromes, they were quite unlikely to have mood-congruent symptoms. Likewise, 25% of the schizophrenics had manic-like syndromes, which contrasted with the fact that they rarely had mood-congruent psychotic delusions and hallucinations.

Adult↗
PubMed1985

Stability of psychotic symptomatology (delusions, hallucinations), affective syndromes, and schizophrenic symptoms (thought disorder, incongruent affect) over episodes in remitting psychoses.

A study was made on 140 schizophrenics, 40 schizoaffectives, 59 unipolar depressives, and 30 bipolar affective disorder patients in order to determine the quality of psychopathology over multiple episodes. The schizoaffectives were the most likely to have multiple episodes. Among the schizophrenics, there were few episodes that lacked psychotic symptoms, but almost half of the episodes for the schizoaffectives were associated with an absence of psychotic symptoms. Three-quarters of the patients with unipolar depression and bipolar illness showed no psychotic symptoms either congruent or noncongruent. There was a striking finding that all diagnoses were associated with a decrease in psychotic symptoms over time. These psychotic symptoms (delusions and hallucinations) became particularly more scarce among the schizoaffectives, unipolars, and bipolars. There was a 50% to 67% decrease of episodes with psychotic symptoms as more episodes occurred. For schizophrenia and schizoaffective disorder the first ten episodes were very similar to each other for affective syndromes, formal thought disorder and/or incongruent affect, and delusions and hallucinations. It was not until much time had passed that the symptom pictures changed.

Adult↗