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Biomedical subjects

G Winokur

Publications and source records attributed to G Winokur.

At least 127 records · Page 7Linked to original sources
PubMed1983

Alcoholism and depression.

There are a variety of ways in which depression and alcoholism are related. These include the possibility of a person suffering from two relatively frequent diseases by chance alone. Secondly, on withdrawal from alcoholism depressive symptoms occur; these are rather short lived. Third, a secondary depression is seen in a large number of chronic alcoholics. Secondary depression is an ordinary depressive illness which manifests itself in the course of another primary illness, in this case alcoholism. There is no evidence that secondary mania exists to alcoholism. Finally, another type of relationship is familial. In a large number of alcoholics, such people come from families where depression also exists. This depression is called a depression spectrum disease. Depression spectrum disease is a depressive illness which occurs in an individual who comes from a family where alcoholism exists. Such a family may also contain other depressives but no manics. Depression spectrum disease patients are likely to have a relatively early onset, and are likely to show many problems in living and unstable personality characteristics. They are likely to be normal suppressors on the dexamethasone suppression test.

Adult↗
PubMed1982

The induction of mania. A natural history study with controls.

Previous reports have indicated that tricyclic antidepressants (TCAs) induce mania, but the studies suffer from lack of control groups. This study included 137 unipolar and 157 bipolar patients, all having two or more admissions to the same hospital. In many cases, the same patients were treated at one time with TCAs and at another time with no somatic therapy at all. Most patients who switched (20/23) were bipolar. Twenty-seven bipolar patients receiving no treatment had a 41% switch rate (rate/person). They had 32 admissions, and the rate of switch while receiving no treatment was 34% (rate/admission). Twenty-six patients receiving tricyclics had a 28% switch rate; for these, there were 30 admissions and the switch rate was 23%. Thus, it appears that the rate of induction of mania by TCAs is not greater than what one would expect from the natural history of the illness itself. Validity of these findings is attested to by the fact that lithium carbonate and neuroleptic treatment, as expected, significantly prevented the induction of mania.

Adult↗
PubMed1982

An efficacy study of electroconvulsive therapy and antidepressants in the treatment of primary depression.

At discharge, a significantly larger percentage of unipolar patients treated with electroconvulsive therapy (ECT) respond with marked improvement as compared with those receiving antidepressants or other treatment. No treatment appears to be more efficacious in the bipolar group. In studying the covariables related to the length of time between hospitalizations, we found that the type of treatment is not important for the unipolar patient, whereas a combination of ECT and antidepressants lengthens the time to rehospitalization of the bipolar patient. Previous hospitalization is an important predictor variable for all patients.

Adolescent↗
PubMed1982

The Iowa 500: affective disorder in relatives of manic and depressed patients.

About 10% of hospitalized unipolar depressed patients ultimately became bipolar. Using a blind protocol to assess data from patient (N = 485) and first-degree relative (N = 2,803) interviews and hospital records, the authors found that bipolar probands and unipolar probands had more affective illness in their families than did control subjects. Although more relatives of bipolar probands than of unipolar probands had bipolar illness, the difference in risk for affective illness between relatives of bipolar probands and of unipolar probands was not significant. In general there were more female than male depressed relatives, bit the equal numbers of men and women among bipolar relatives suggest heterogeneity of illness within the families of bipolar probands.

Adult↗
PubMed1981

Stability of psychiatric diagnosis. Schizophrenia and affective disorders followed up over a 30- to 40-year period.

Stability of diagnosis in schizophrenia and affective disorders is high. Patients selected according to research criteria for schizophrenia and affective disorders were followed up in a historical prospective study to evaluate their diagnostic stability over a 30- to 40-year period. Our follow-up, lifetime diagnosis, based on blind diagnostic assessment, showed that 92.5% of the personally interviewed schizophrenics were given the follow-up diagnosis of schizophrenia, which was significantly higher than the 78.3% found in affective disorders. However, no significant difference exists when assessment was made on available records of those who died or refused to be interviewed. These stability coefficients are discussed in light of the methodological assumptions involved in a long-term follow-up study. We concluded that the diagnostic stability in schizophrenia and affective disorders were very high and that rigorous diagnostic criteria should be maintained.

Adult↗
PubMed1981

Clinical overlap among familial subtypes of unipolar depression.

Unipolar depressives (n = 288) were subclassified according to family history. Depression spectrum patients (DSD; n = 104) were defined as those with first-degree relatives suffering from alcoholism. Familial pure depression patients (FPDD; n = 86) were those with only depression in the immediate family, and sporadic depressive patients (SDD; n= 98) had negative family histories. An analysis was performed using index symptoms, precipitating events, and premorbid personality features. A positive family history was associated with greater premorbid personality difficulties. This pattern was highlighted when each was compared to SDD. DSD and FPDD could not be differentiated from each other. The differences between them and SDD could not be explained by the differing age distribution. Overall, the premorbid and index symptom differences were not striking enough to be clinically useful.

Age Factors↗
PubMed1981

Effect of case definition on affective disorder rates.

In a preliminary analysis by the NIMH-Clinical Research Branch Collaborative Program on the Psychobiology of Depression the lifetime rate of affective illness among 1,090 interviewed relatives of depressed and manic probands was considerably lower in Iowa than in the other four centers. Among various affective disorder diagnoses, only primary unipolar depression was significantly less frequent in Iowa. This rate difference decreased with increasingly restrictive case definitions. Possible determinants of the low depression rate in Iowa will be investigated; the present data illustrate the importance of case definition in the interpretation of future findings.

Bipolar Disorder↗
PubMed1980

Hypothalamic-pituitary-adrenal axis activity in depressive illness. Its relationship to classification.

Serum cortisol response to the 1-mg overnight dexamethasone suppression test was studied in 221 depressed patients and 109 nondepressed psychiatric controls. Nonsuppression distinguished patients with primary unipolar depression (65/146) from patients with secondary unipolar depression (0/42) and nondepressed controls (0/109). Furthermore, nonsuppression distinguished the three familial subtypes of primary unipolar depressive illness: familial pure depressive disease (FPDD; 38/50 patients), sporadic depressive disease (SDD; 24/55 patients), and depression spectrum disease (3/41 patients). Moderate elevations in baseline serum cortisol levels were found in FPDD, SDD, and bipolar depression. Medication did not affect the results. The data suggest that the depressive syndrome is composed of separate illnesses, each of which has a distinctive pattern of hypothalamic-pituitary-adrenal axis activity during the depressed state as well as a specific clinical and familial psychiatric history.

Adolescent↗
PubMed1980

Morbidity risks of schizophrenia and affective disorders among first degree relatives of patients with schizophrenia, mania, depression and surgical conditions.

One thousand five hundred and seventy eight first degree relatives of schizophrenics, manics, depressives and controls were personally interviewed using the Iowa Structured Psychiatric Interview Form without knowledge of the probands' diagnoses. Our data, based on blind diagnostic assessment of the relatives, support the distinction between schizophrenia and affective disorders, although the distinction between schizophrenia and mania was not clear-cut. Our data could not support familial subtyping of paranoid and non-paranoid schizophrenia, and unipolar and bipolar affective disorders. Future studies attempting to develop research criteria for subtyping schizophrenia and effective disorders should utilize not only clinical and familial data but also biological markers and other non-familial variables.

Adolescent↗
PubMed1980

Familial subtypes of depression: a clinical view.

The clinical workup of 238 unipolar depressives were subdivided according to immediate family history. Pure depressives (with only depression in the family) typically have an illness involving more endogenous features and chronicity. Depression spectrum patients (with only alcoholism or sociopathy in first-degree relatives) have the mildest illness. Sporadic depression (with a negative family history) is associated with an intermediate severity. Premorbid unstable personality characteristics are more common to the spectrum patients. Sporadic patients have the least personality difficulties. While these differences are definite, they are not large enough to justify separation of unipolar depression into subsyndromes dependent on symptom differences. Rather, family history seems to exert its effect most strongly on the distinctive premorbid personality characteristics of the 3 groups.

Adult↗
PubMed1979

Genetic subtypes of unipolar primary depressive illness distinguished by hypothalamic-pituitary-adrenal axis activity.

Serum-cortisol response to the 1 mg overnight dexamethasone suppression test was investigated in 86 patients with unipolar primary depressive illness and 80 non-depressed controls (45 with mania and 35 with schizophrenia). The depressed patients were assigned to one of three genetic subtypes according to the family psychiatric history. Resistance to suppression of serum-cortisol by dexamethasone was found in 37 of 86 (43%) depressives and none of the 80 controls. Non-suppression distinguished the three genetic subtypes of depression, being found in 23 of 28 (82%) patients with familial pure depressive disease (F.P.D.D.), 13 of 35 (37%) patients with sporadic depressive disease (S.D.D.), and 1 of 23 (4%) patients with depression spectrum disease (D.S.D.). The three genetic subtypes were further distinguished by the age of onset, with S.D.D. the oldest, and by the number of previous depressive episodes, with F.P.D.D. the most. Severity of depression did not separate the three subtypes. This is the first report of a distinct neuroendocrine abnormality which supports an objectively defined classification of unipolar primary depressive illness. It is suggested that unipolar primary depressive illness is three or more separate illnesses, each with a potentially distinctive mode of inheritance, pathophysiology, neurochemistry, clinical course, and treatment response.

Adolescent↗
PubMed1979

Unipolar depression: is it divisible into autonomous subtypes?

Depression spectrum disease has been defined as an illness in which a first-degree family member has alcoholism and/or antisocial personality. Pure depressive disease may be considered as the remainder of the depressive illnesses or more rigorously as depression in a person who has a family history of depression but no alcoholism. Evidence is presented that the course of the illness is different in the two groups. Depression spectrum disease is more variable, with more personality problems and interpersonal conflict. Preliminary data indicate that depression spectrum disease may be linked to such genetic markers as C3 or alpha-haptoglobin.

Age Factors↗