Intake diagnoses: how representative?
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Bipolar Disorder↗
Biomedical subjects
J Endicott
Publications and source records attributed to J Endicott.
Primary and secondary affective disorders: unipolar patients compared on familial aggregation.
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Bipolar Disorder↗
Alcohol problems in psychiatric patients: 5-year course.
Little is known about the occurrence and course of alcohol problems in patients with affective syndromes treated in psychiatric facilities. We have shown previously that a high proportion of such patients abused alcohol. In a 5-year follow-up of patients in the initial study, a large majority had a remission of their alcohol problems lasting at least 6 months, although many of these patients had subsequent relapses. Using survival analyses, we found that alcohol dependence indicators, previous chronicity of alcohol problems, and a diagnosis of schizoaffective disorder predicted poor outcome (specifically, longer time to remission of the alcohol problems). However, these factors were unrelated to receiving alcohol-specific treatment during the 5 years. Severity of social/occupational alcohol problems did not predict poor outcome, but did predict alcohol-specific treatment (detoxification, rehabilitation, Alcoholics Anonymous [AA], or Antabuse).
Adult↗
Bipolar II. Combine or keep separate?
Data on prior course, characteristics of index episode, and familial aggregation of patients with bipolar II disorder is discussed. The data supports the separation of this condition from both bipolar I and recurrent unipolar disorder.
Adult↗
Premenstrual changes: patterns and correlates of daily ratings.
Daily ratings of 20 measures of mood, behavior, and physical condition made by 64 women for one menstrual cycle were analysed to determine patterns of covariance between the pre- and postmenstrual periods. Five discriminantly different dimensions of premenstrual change were identified. They were found to be differentially related to a lifetime diagnosis of affective disorder. These results, and others, support the recommendation that research should be focused upon diversified premenstrual changes rather than a single premenstrual syndrome.
Adult↗
Lack of stability of the RDC endogenous subtype in consecutive episodes of major depression.
The stability of the endogenous subtype of major depressive disorder was examined within individuals across consecutive episodes. The subjects were 119 probands from the NIMH Collaborative Depression Study who experienced at least two episodes of unipolar major depressive disorder within a two-year period of biannual evaluations. Structured data collection methods and Research Diagnostic Criteria were employed. The inter-episode stability of subtype diagnosis was low, never producing a kappa of greater than 0.25. This result was not attributable to threshold for diagnosis, time between episodes, differences in severity, or changes in raters.
Adult↗
Reliability and relationship of various ages of onset criteria for major affective disorder.
This paper presents data on six different clinical definitions (indices) of age of onset for major affective disorders. The inter-rater reliability for each index and the relationships among these indices are discussed. Age of onset for impairment with affective symptoms was found to be a reliable and useful index of early onset. It discriminated between unipolar depressed subjects and both bipolar I and bipolar II subjects.
Adolescent↗
Schizo-affective disorders: bipolar-unipolar subtyping. Natural history variables: a discriminant analysis approach.
In view of tackling the problem of heterogeneity among the schizo-affectives, methods of univariate and multivariate statistical analysis (canonical discriminant analysis) were applied to the sociodemographic and natural history variables of four groups of affective disorder patients from the NIMH Collaborative Study on the Psychobiology of Depression Clinical section: the schizo-bipolar (SBP, n = 45), the schizo-unipolar (SUP, n = 30), the bipolar I (BP, n = 159) and the primary unipolar depressed (UP, n = 387) defined by Research Diagnostic Criteria. Two dimensions were identified among the four groups of 'affective' patients: the 'bipolar' and the 'schizophrenic' dimensions. They provided highly significant discrimination among the means of the four groups but were not very accurate in predicting group membership. The 'bipolar' dimension separates the UP from the BP and SBP, the SUP taking some intermediate value. The 'schizophrenic' dimension separates the BP and UP from the SUP, the SBP being intermediate. The two groups with the most similarities were the SBP and BP. The group with the most heterogeneity was the SUP, sharing similarities with the UP and SBP mostly. These conclusions are supported by results of familial aggregation on the same group of patients.
Bipolar Disorder↗
Outcome in RDC schizo-affective depression: the importance of diagnostic subtyping.
A 2-year semiannual follow-up of 40 patients with RDC schizo-affective disorder, depressed type revealed poorer outcomes among those who were subtyped as chronic or mainly schizophrenic patients than among their counterparts with nonchronic or mainly affective schizo-affective depression. Outcomes for these latter groups, in turn, were no worse than those for patients with psychotic major depression. Among a variety of predictors entered into step-wise regression analyses, diagnosis was most important in predicting recovery overall and outcome at 6 months, while demographic variables, particularly sex, predicted outcome at 2 years.
Adult↗
Bipolar versus unipolar and primary versus secondary affective disorder: which diagnosis takes precedence?
The primary versus secondary distinction is often used as a way of subtyping depression. Its applicability to bipolar disorders has been unclear. This report examines the relative primacy of the bipolar versus unipolar distinction as compared to the primary versus secondary distinction in a sample of 955 patients in the NIMH Collaborative Study of the Psychobiology of Depression. These patients are divided into nine groups of the basis of whether they are bipolar I, bipolar II, or unipolar, and whether they are primary, 'pure' secondary, or 'complicated' secondary (i.e. bipolar I primary, bipolar I pure secondary, bipolar I complicated, etc.). Three sets of variables are used to determine the predictive validity of these various subtypes: data concerning age of onset and phenomenology of current episode, outcome, and familial prevalence. In general, data from these three sets of validators suggest that the bipolar distinction takes precedence over the primary versus secondary distinction. Within bipolars, there is little value in further subtyping into primary versus secondary.
Adult↗
The influence of alcoholism on the course of depression.
The clinical course of 289 patients with primary non-bipolar major depression without concurrent alcoholism was compared with that of 79 patients with non-bipolar major depression with concurrent alcoholism. Neither patient group suffered from dysthymia or current drug abuse. Contrary to expectations, the two groups did not differ on time to recovery from the major depression, time to relapse into a subsequent major depression, or various cross-sectional clinical ratings at 2 years. The two groups did differ on psychosocial status. Although they were equally impaired at index, the alcoholism group maintained significantly lower levels of psychosocial functioning throughout the 2-year follow-up period. Interpersonal relation with spouse was particularly worse among the alcoholic group.
Adult↗
The menstrual cycle and mood disorders.
Greater attention to the possible effects of the menstrual cycle on the course of mood disorders in women has revealed that, at least for a subset of women with mood disorders, the premenstrual phase of the cycle may be a period of increased vulnerability for the appearance of a period of severe depression or for the worsening of an ongoing period of depression. The data supporting this conclusion and the implications for future research is summarized and discussed.
Bipolar Disorder↗
Panic-agoraphobic spectrum: reliability and validity of assessment instruments.
DSM IV is a simple, reliable diagnostic system with many advantages. However, DSM diagnostic criteria may not provide sufficient characterization of clinically significant symptoms. We have undertaken a project to assess an array (spectrum) of clinical features associated with different DSM Disorders. The purpose of this paper is to report on reliability of assessment instruments for Panic-Agoraphobic Spectrum (PAS), to document convergent validity of PAS symptom groupings, and to confirm the relationship between PAS and DSM IV Panic Disorder (PD). We studied 22 normal controls and 95 outpatients who met criteria for Panic Disorder with and without lifetime Major Depression, and Major Depression or Obsessive Compulsive Disorder without lifetime Panic Disorder. Assessment instruments had excellent reliability and there was good concordance between interview and self-report formats. PAS scores were highest in subjects with PD, followed by outpatients without PD, and were lowest in normal controls. PAS scores varied among PD patients, and a subgroup of patients without PD scored high on PAS. We conclude that PAS can be reliably assessed, and that it describes a valid, coherent constellation of features associated with DSM IV Panic Disorder, but providing additional important clinical information.
Agoraphobia↗
Course of treatment received by depressed patients.
Using data from an observational study of affective disorders, we describe the rates of transition among levels of antidepressant treatment for subjects with Major Depressive Disorder (MDD), and relate these changes to changes in clinical status. We report on the treatment received during the first 10 years of follow-up in the Collaborative Depression Study by 555 patients with a diagnosis of MDD of at least one month's duration. This work extends the initial examination of treatment received during the first eight weeks after entry into this study that showed depressed patients to be on low levels of treatment. Multiplicative intensity models which generalize survival analysis models were used to analyse these data. Description of the course of treatment of these depressed patients shows that low levels of treatment persist for these patients across subsequent episodes, and that these episodes, like the index one, are characterized by extended time in a symptomatic subcriterion state after acute symptoms have improved. These long-term descriptions of treatment support the initial hypothesis that these CDS patients were undertreated. The long-term tendency toward undertreatment seems to persist even as newer treatments become available and widely accepted in practice.
Acute Disease↗
Psychopathology in prenatally DES-exposed females: current and lifetime adjustment.
This report concerns the long-term effects of prenatal exposure to diethylstilbestrol (DES) on overall psychologic functioning in females. Thirty DES-exposed women aged 17-30 years and 30 control women with a history of abnormal Pap smear findings were interviewed with the SADS-L and completed the SCL-90-R and the PRI-Q. Both DES and PAP women showed elevated symptoms on the SCL-90-R in comparison to published norms and were similar to women with cancer, but their rates of psychiatric disorders (SADS-L/RDC) at the time of the evaluation did not differ from community norms. However, both groups met criteria for Major Depressive Disorder (lifetime) significantly above expectancy, and the DES women reported slightly more episodes than the control group. The DES women also had significantly more problems than the PAP control group in social relations with spouses and other significant persons.
Adolescent↗
The return of the case report to Psychosomatic medicine.
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Affect↗
Persistence of depressive symptoms and cardiovascular death among patients with affective disorder.
OBJECTIVE: Studies of both community and clinical samples have associated depressive symptoms with risks for subsequent cardiovascular morbidity and mortality. Because the physiological mechanisms thought to underlie this link would be cumulative in their effects, the following analyses tested the prediction that risks for cardiovascular death would increase in proportion to the persistence of depressive symptoms in a long-term follow-up. METHODS: Baseline assessment was performed as patients sought treatment for major depressive disorder, mania, or schizo-affective disorder. Follow-up evaluations occurred semiannually for the next 5 years and annually thereafter. The 903 patients described, observed for a mean of 11.0 years (SD = 5.2 years), were divided into thirds according to the proportion of follow-up weeks in episodes of major depressive disorder, schizoaffective disorder, or intermittent depressive disorder. The resulting groups were then compared by cumulative risks of cardiovascular death. RESULTS: Patients whose depressive symptoms were the most persistent were no more likely to die of cardiovascular causes than were those with the fewest weeks ill. A regression analysis showed that older age and the presence of cardiovascular disease at baseline, but not the subsequent chronicity of depressive symptoms, predicted cardiovascular death. CONCLUSIONS: The physiological concomitants of depressive illness apparently do not promote cardiovascular mortality in a cumulative manner. Efforts should be directed toward identification of risk factors common to both lifetime depressive symptoms and cardiovascular morbidity.
Adult↗
Treatment of premenstrual dysphoric symptoms in depressed women.
Although research has established a strong association between premenstrual dysphoric symptoms and depression, there is little data on the effect of antidepressents on premenstrual symptoms. This study compared the efficacy of three treatments--imipramine, phenelzine, and placebo--on the premenstrual symptoms of women with atypical depression who had responded to treatment for their depressive symptoms. The Premenstrual Assessment Form (PAF) was used to rate the type and degree of premenstrual symptomatology. After 12 weeks, at least two-thirds of the women on active medication showed improvement on most measures of premenstrual symptoms to the degree that they had essentially no premenstrual problems after treatment. By comparison, only half of a group of women who had responded to placebo treatment of 6 weeks duration showed such improvement.
Adolescent↗