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Biomedical subjects

I W Miller

Publications and source records attributed to I W Miller.

At least 37 records · Page 2Linked to original sources
PubMed1995

Course of illness and maintenance treatments for patients with bipolar disorder.

BACKGROUND: Both naturalistic studies and treatment research on bipolar disorder are reviewed to describe its clinical course, the need for maintenance therapy, the efficacy of current pharmacologic prophylaxis, and the empirical basis for more comprehensive approaches to treatment. METHOD: Articles were identified through computerized literature searches and from bibliographies of published studies, review articles, and textbooks. RESULTS: Bipolar disorder is marked by multiple relapses and recurrences, as well as significant interepisode psychopathology. Within 1 year of recovery from a mood episode, half of all patients will have suffered a second episode. Various clinical and demographic variables have been investigated as risk factors for recurrence. Although lithium represents the single greatest advance in the treatment of this disease, it is clear that a substantial number of patients fail lithium prophylaxis, including those with a high frequency of prior episodes, mixed (dysphoric) mania, comorbid personality disturbance, and rapid cycling. The foremost pharmacologic alternatives to lithium are the anticonvulsants carbamazepine and valproate. Increased recognition of the psychosocial sequelae of bipolar disorder and the limitations of pharmacotherapy alone have led to the investigation of psychosocial interventions. These preliminary studies are small in number and of poor quality for the most part, but have nevertheless yielded positive findings. CONCLUSION: Although lithium often fails to meet the clearly established need for prophylactic treatment, there is little evidence from rigorous clinical trials to support the wide-spread use of anticonvulsants in maintenance therapy. Treatment research should further examine these medications and the use of psychosocial treatments as adjuvants to pharmacotherapy.

Adult↗
PubMed1994

The development of a clinical rating scale for the McMaster model of family functioning.

This article describes the development and validation of the McMaster Clinical Rating Scale (MCRS). The MCRS is a 7-item scale designed to be completed by a trained rater after completion of an in-depth interview of the family. We present data from four new studies and review previously published articles concerning the reliability, validity, and clinical utility of the MCRS. Adequate interrater reliability and rater stability were obtained. The MCRS was found to correlate significantly with the self-report Family Assessment Device and to discriminate between families in different phases of a depressive disorder.

Adolescent↗
PubMed1992

Age and the dexamethasone suppression test: results from a broad unselected patient population.

We examined the relationship between age and postdexamethasone serum cortisol concentration in 676 psychiatric inpatients with a variety of DSM-III diagnoses. Regardless of diagnosis, patients 65 years and older had significantly higher nonsuppression rates than those below age 65 (64% vs. 34%). The correlation between age and cortisol level was moderate, but significant. Aging is associated with increasing nonsuppression rates to dexamethasone, and this change is augmented by an affective disorder diagnosis. Levels of nonsuppression and age-cortisol correlations vary depending on dose of dexamethasone, diagnosis, and gender.

Adolescent↗
PubMed1992

Depressed patients with dysfunctional families: description and course of illness.

Sixty-eight depressed patients were subdivided according to their family's level of family functioning into functional and dysfunctional groups. Patients from dysfunctional families did not differ from those from functional families on measures of severity of depression, chronicity of depression, depression subtypes, other nonaffective psychiatric diagnoses, history of depression, or neuroendocrine functioning. Patients from dysfunctional families did have significantly higher levels of neuroticism. A 12-month follow-up of these patients indicated that depressed patients with dysfunctional families had a significantly poorer course of illness, as manifested by higher levels of depression, lower levels of overall adjustment, and a lower proportion of recovered patients. Thus, impaired family functioning appears to be an important prognostic factor in major depression.

Adult↗
PubMed1992

Recovery and major depression: factors associated with twelve-month outcome.

OBJECTIVE: In spite of the prevalence and chronicity of major depression, there is no consensus regarding which clinical and psychosocial variables are associated with recovery. The authors examined the probability of recovery from a major depressive episode 12 months after hospital discharge, the factors most closely associated with recovery, and the patterns of improvement distinguishing patients who recovered from those who did not. METHOD: Seventy-eight inpatients with a DSM-III diagnosis of major depression were assessed at hospitalization and at monthly intervals for 12 months after discharge on a variety of clinical and psychosocial factors. Recovery status at 12-month follow-up was then used as a basis for comparing acute-phase patient characteristics and change in symptoms over time. RESULTS: By the 12th month of follow-up, 34 (48.6%) of 70 patients met criteria for recovery. The five most important factors related to recovery were shorter length of hospital stay, older age at onset of depression, better family functioning, fewer than two previous hospitalizations, and absence of comorbid illness. The majority of patients who had recovered by 12 months had done so within 6 months of discharge; the average length of time to recovery was 4.9 months. CONCLUSIONS: Patients hospitalized for major depression have less than a 50-50 chance of recovering by 1 year. Some variables associated with nonrecovery (e.g., comorbid illness, poor family functioning) are amenable to clinical intervention; however, findings also suggest that there may be two distinct types of depressive illness with respect to recovery, one that remits quickly and the other with a more prolonged course of illness.

Adult↗
PubMed1991

Cognitive therapy with depressed inpatients: specific effects on dysfunctional cognitions.

Specificity of cognitive change following cognitive therapy for depression was assessed in 39 depressed inpatients who completed either a standard inpatient treatment (pharmacotherapy and milieu management) or the standard treatment plus cognitive therapy. Following treatment, patients in both groups endorsed fewer dysfunctional cognitions on 2 of 4 measures of cognitive distortion. Compared with patients receiving only the standard treatment, patients also receiving cognitive therapy reported less hopelessness and fewer cognitive biases at posttreatment and 6- and 12-month follow-up assessments and fewer dysfunctional attitudes at the 6-month follow-up. Treatment effects for dysfunctional cognitions were found even though the treatment groups did not differ in depression severity, suggesting that results did not reflect state-dependent differences between treatments secondary to difference in depression.

Adaptation, Psychological↗
PubMed1991

12-month outcome of patients with major depression and comorbid psychiatric or medical illness (compound depression).

OBJECTIVE: Inpatients with major depressive illness often have coexistent nonaffective psychiatric and/or medical conditions. The authors' objective is to address the following questions: 1) What is the effect of comorbid illness on the severity of major depression and associated psychosocial factors? 2) How does the course of depression differ for patients with and without concurrent illness? 3) Do patients with compound depression differ in rate of recovery and time to recovery from patients with pure depression? METHOD: The subjects were 78 patients with a DSM-III diagnosis of major depression who were consecutively admitted to an acute care university-affiliated psychiatric hospital; 37 of these patients had major depression only and 41 had major depression compounded by a coexisting axis I, II, or III condition. The patients were studied while hospitalized and for 12 months after hospital discharge. Instruments used included the Modified Hamilton Rating Scale for Depression, the Global Assessment Scale, and the Social Readjustment Rating Scale. RESULTS: Patients with compound depression reported significantly poorer functioning over the 12-month follow-up period and had lower recovery rates than the patients with pure depression. There were no differences in recovery rates between men and women with compound depression, but significantly more men than women with pure depression recovered. CONCLUSIONS: Compound depression is a common clinical occurrence, the course of illness is more difficult for patients with compound depression than for patients with pure depression, and the recovery rate of patients with compound depression is lower than that of patients with pure depression.

Adult↗
PubMed1991

A cross-cultural study of major depression and family functioning.

Patterns of family functioning in families with a depressed member from two cultures (North America and Hungary) were compared. In both cultural settings, families with a depressed member reported poorer family functioning than the control families. Comparisons between the two depressed groups, however, showed that the response to family dysfunction by the two cultures differed. While depressed families in Hungary reported difficulties in setting family rules and boundaries, those in North America experienced impaired functioning in solving problems, communicating, being involved with each other, and in overall functioning. These results are discussed in terms of the interplay between culture, depression and family functioning.

Adult↗
PubMed1990

Family functioning, social adjustment, and recurrence of suicidality.

We examined suicidal and nonsuicidal patients with major depression during and subsequent to their hospitalization. Factors associated with suicidality at the index episode included psychosocial variables as well as measures of family functioning. Previous suicidality, inter-episodic adjustment, changes in family constellation, and perception of family functioning were instrumental in separating nonsuicidal patients at follow-up from patients exhibiting recurrent suicidal behavior. These results indicate that when assessing patients with major depression for suicidality, particular attention should be paid both to the social environment and to family functioning as perceived by the patient.

Adult↗
PubMed1990

Life stress and social supports in depressed inpatients.

The presence of adequate social supports has been associated with a reduced incidence of psychological symptoms. It is unclear, however, whether the protective influence of social supports is because of a direct positive effect on psychological functioning or a stress-buffering effect. Furthermore, most research on life stress and social supports has focused on community-based rather than clinical samples. The present study attempts to clarify the relationship between life stress and social supports related to psychological symptoms in 84 adult, nonpsychotic, depressed inpatients. Subjects were categorized according to their responses on the Life Experiences Survey and the Social Supports Inventory. Subjects were then assessed using both structured interviews and self-report measures of depression and suicide potential, as well as other psychological symptoms. Although both life stress and social supports were significantly related to a variety of psychological symptoms, the interaction between these variables was not significantly related to psychological symptomatology. Life events and social supports were found to exert their effects independently. This argues against the stress-buffering theory in favor of the direct-effects theory of social supports, at least when applied to inpatient samples.

Adaptation, Psychological↗
PubMed1990

The dexamethasone suppression test and completed suicide.

The present study was undertaken to further explore the relationship between the dexamethasone suppression test (DST) and suicide. Depressed inpatients who had undergone the DST at index admission and later committed suicide (n = 13) were matched for age, gender, diagnosis, and type of DST (1 mg, 2 mg) with depressed inpatients from the same hospital and study time period to form 2 groups: a suicide attempter group (n = 25) and a nonattempter group (n = 28). The suicide completers group had significantly higher 1600 postdexamethasone cortisol levels than the suicide attempters group and a significantly higher 1600 rate of DST nonsuppression compared with the suicide attempter + nonattempter combined group. Although the rate of DST nonsuppression did not differ between the suicide attempter and nonattempter groups, serious attempters had significantly higher 1600 cortisol levels and a statistically higher proportion of patients who completed suicide than nonserious attempters.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Family functioning and major depression: an overview.

The authors review the evidence supporting the idea that the family plays a major role in the development and course of major depression. They find that the family pathology evident during an acute depressive episode continues after the patient's remission; that the course of depressive illness, relapse rates, and suicidal behavior are all affected by family functioning; and that children of depressed parents are at high risk for psychopathology. The authors explore unresolved issues regarding our understanding of the factors mediating the interaction between major depression and family functioning, concluding that there is evidence to support family and marital interventions, particularly in the treatment of depressed women.

Acute Disease↗
PubMed1989

Cognitive-behavioral treatment of depressed inpatients: six- and twelve-month follow-up.

The authors report 6- and 12-month follow-up data for 45 depressed inpatients who were randomly assigned to either standard treatment (hospital milieu therapy, pharmacotherapy, clinical management sessions), cognitive therapy plus standard treatment, or social skills training plus standard treatment. All treatments began in the hospital and continued for 4 months after discharge on an outpatient basis. Significantly higher proportions of the patients who received additional cognitive-behavioral treatment (cognitive therapy or social skills) had responded by the end of the formal treatment period and did not relapse for the remainder of the 1-year follow-up period.

Adult↗
PubMed1989

The effect of anticonvulsants on the dexamethasone suppression test.

Rates of non-suppression on the DST were compared in 19 psychiatric inpatients and anticonvulsants and 38 psychiatric inpatients not on anticonvulsants who were matched for age, sex, and diagnosis. Patients on anticonvulsants had a significantly higher rate of nonsuppression.

Adult↗
PubMed1987

Family functioning and suicidal behavior in psychiatric inpatients with major depression.

Family functioning was compared between suicide-attempting and nonsuicidal depressed inpatients in order to further understand psychosocial determinants of suicidal behavior. Suicidal behavior was strongly associated with a discrepancy between the patient's perception of his/her family and the perception held by other family members. Suicide-attempting depressed inpatients perceived their family functioning to be worse than did their families. Suicidal patients also viewed their families more negatively than did depressed nonsuicidal inpatients, who actually viewed their family functioning more positively than did their family members. The clinical implications of these findings are discussed.

Adolescent↗
PubMed1987

The course of depressive symptoms in suicidal vs. nonsuicidal depressed inpatients.

The present study attempts to delineate the course of depressive illness in suicidal, depressed inpatients as compared with a matched group of nonsuicidal, depressed inpatients. Thirty adult nonpsychotic psychiatric inpatients presenting with symptoms of a major depressive episode participated in the present study. Two subject groups were identified, one suicidal and the other nonsuicidal according to their responses on the Modified Scale for Suicidal Ideation. Subjects were assessed on a variety of self-report measures and several clinical interviews during hospitalization and follow-ups at 4, 10 and 16 months after discharge. Results supported the hypothesis that, although displaying similar levels of depression during hospitalization as well as at long-term follow-up, the two groups differed in the speed of their recovery. Approximately 4 months after discharge virtually all of the nonsuicidal patients had recovered, whereas a majority of the suicidal group remained quite depressed. These results suggest that more time is needed for the recovery process to occur in suicidal patients. Future research in the area of depression and suicide should take into account the different courses seen in these two groups of subjects. Furthermore, those who treat suicidally depressed patients should be cautions of the slow recovery of these patients.

Adult↗
PubMed1987

Relationship between dysfunctional cognitions and depressive subtypes.

The results of this study suggest that the relationship between cognitions and severity of depression hypothesized by cognitive theorists may be relevant only to a subgroup of depressives. In a sample of 40 inpatients with major depression who received the Dexamethasone Suppression Test (DST), scores on the Dysfunctional Attitude Scale were equivalent in suppressor and nonsuppressor groups, as well as in melancholic and nonmelancholic depressive groups. Neither was there a difference between suppressors and nonsuppressors on measures of depression. However, in the nonmelancholic group, there was a significant relationship between dysfunctional cognitions and severity of depression. This relationship was not found in the melancholic group. Finally, independent of diagnostic and biological subtype, patients with elevated levels of dysfunctional cognitions when compared with the remaining sample revealed greater severity of depression, more days in hospital and more readmissions to hospital.

Adolescent↗