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K W Sax

Publications and source records attributed to K W Sax.

35 records · Page 2Linked to original sources
PubMed1998

Twelve-month outcome after a first hospitalization for affective psychosis.

BACKGROUND: We studied the 12-month course of illness after a first hospitalization for affective psychosis to identify potential outcome predictors in this rarely studied patient population. METHODS: For this study, 109 patients consecutively admitted for their first psychiatric hospitalization for treatment of affective psychosis were recruited. Diagnostic, symptomatic, and functional evaluations were obtained at the index hospitalization and at 2, 6, and 12 months after discharge to assess syndromic, symptomatic, and functional outcome predictors. Factors associated with outcome were identified by means of multivariate analyses. RESULTS: Fifty-six percent of the patients achieved syndromic recovery during the 12-month follow-up. Full treatment compliance was associated with more frequent and rapid syndromic recovery. Full compliance was more common in white patients and in patients without substance abuse. Only 35% of these patients achieved symptomatic recovery during this same 12-month interval, and, similarly, only 35% achieved functional recovery. Symptomatic recovery was delayed in patients with substance abuse and was associated with higher socioeconomic status. Higher socioeconomic status was also associated with functional recovery, as was good premorbid function. CONCLUSIONS: Few patients achieved a favorable outcome in the year after a first hospitalization for an affective psychosis. Low socioeconomic status, poor premorbid function, treatment noncompliance, and substance abuse were associated with lower rates or delayed onset of recovery.

Adult↗
PubMed1998

Attentional performance in patients with psychotic and nonpsychotic major depression and schizophrenia.

OBJECTIVE: The authors examined Continuous Performance Test scores of patients with major depression with or without psychosis and schizophrenia. METHOD: Patients with major depression with psychosis (N = 13), major depression without psychosis (N = 14), and schizophrenia (N = 15) and normal volunteers (N = 14) completed the degraded-stimulus version of the Continuous Performance Test. Patients were rated with the Hamilton Depression Rating Scale and measures of positive formal thought disorder. RESULTS: Continuous Performance Test scores of patients with major depression with psychosis and schizophrenia were significantly worse than those of patients with major depression without psychosis and of normal volunteers. Positive formal thought disorder was correlated with performance on this test in patients with schizophrenia. CONCLUSIONS: These findings suggest that attentional impairment on the Continuous Performance Test is associated with psychosis in general and may be specifically associated with positive formal thought disorder in patients with schizophrenia.

Adolescent↗
PubMed1998

12-month outcome of patients with bipolar disorder following hospitalization for a manic or mixed episode.

OBJECTIVE: The authors studied the 12-month course of illness following hospitalization for a manic or mixed episode of bipolar disorder to identify potential outcome predictors. METHOD: They recruited 134 patients with DSM-III-R bipolar disorder who were consecutively admitted for the treatment of a manic or mixed episode. Diagnostic, symptomatic, and functional evaluations were obtained at the index hospitalization. Patients were reevaluated at 2, 6, and 12 months after discharge to assess syndromic, symptomatic, and functional outcome. Factors associated with outcome were identified by using multivariate analyses. RESULTS: During the 12-month follow-up period, there were no significant differences in outcome between patients with manic compared with mixed bipolar disorder. Although syndromic recovery occurred in 48% of the overall group, symptomatic recovery occurred in only 26% and functional recovery in only 24%. Predictors of syndromic recovery included shorter duration of illness and full treatment compliance. Medication treatment compliance was inversely associated with the presence of comorbid substance use disorders. Symptomatic and functional recovery occurred more rapidly and in a greater percentage of patients from higher social classes. CONCLUSIONS: A minority of patients with bipolar disorder achieved a favorable outcome in the year following hospitalization for a manic or mixed episode. Shorter duration of illness, higher social class, and treatment compliance were associated with higher rates of recovery and more rapid recovery.

Adolescent↗
PubMed1998

Course of psychiatric and substance abuse syndromes co-occurring with bipolar disorder after a first psychiatric hospitalization.

BACKGROUND: Patients with bipolar disorder frequently meet criteria for other psychiatric and substance abuse diagnoses. To clarify relationships among these disorders, the authors examined the course of syndromes co-occurring with bipolar disorder for 12 months after a first hospitalization. METHOD: Seventy-seven patients were recruited from consecutive inpatient admissions who met DSM-III-R criteria for bipolar disorder, manic or mixed with psychosis. The 12-month syndromal course of co-occurring DSM-III-R alcohol and drug abuse disorders, posttraumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), and other anxiety disorders were longitudinally recorded. RESULTS: The rates of all syndromes, except other anxiety disorders, were elevated. OCD demonstrated an interval course that frequently mirrored the course of the bipolar disorder. The courses of PTSD and substance abuse syndromes were separate from that of the bipolar disorder in many of those with both syndromes. Alcohol and drug abuse syndromes were strongly correlated. CONCLUSION: The obsessive-compulsive syndrome may represent an alternative expression of bipolar disorder in some patients. In contrast, PTSD appears to represent a truly separate disorder, which is possibly more prevalent in bipolar patients due to a shared risk factor. Substance abuse does not appear to simply result from attempts at self-medication or from the impulsivity of mania. These results suggest that future studies examining the course of syndromes co-occurring with bipolar disorder are warranted.

Adult↗
PubMed1997

Lack of enhanced response to repeated d-amphetamine challenge in first-episode psychosis: implications for a sensitization model of psychosis in humans.

Behavioral sensitization is the process whereby intermittent stimulant exposure produces a time-dependent, enduring, and progressively more robust behavioral response. This process serves as a model for the development of psychosis, but has been little studied in humans. The authors report results from a double-blind, placebo-controlled study of repeated d-amphetamine challenges in 13 patients with first-episode manic or schizophrenic psychosis. Each patient received two daily doses of d-amphetamine (0.25 mg/kg) separated by 48 hours that alternated with two daily doses of matched placebo. Symptoms (activity/energy level, mood, rate and amount of speech, and severity of psychosis) and eye-blink rates were measured hourly for 5 hours following drug administration. In contrast to results from previous work in normal volunteers, none of the measures demonstrated the progressive increase following the second amphetamine dose as compared to the first dose that characterizes sensitization. These results suggest that patients with psychosis are already maximally sensitized, so cannot exhibit progressive behavioral enhancement following repeated stimulant challenges, or that patients with psychosis do not sensitize.

Adult↗
PubMed1997

Comparison of patients with early-, typical-, and late-onset affective psychosis.

OBJECTIVE: The authors compared the clinical characteristics and family history of patients with early-onset (before age 18), typical-onset (at 20-25 years), and late-onset (after age 35) affective psychosis at the time of first hospitalization. METHOD: Diagnostic, symptom, and family history information was obtained from 88 consecutively hospitalized patients. RESULTS: Major depression was more common in the late-onset group, and a family history of affective and substance abuse disorders was more common among the early-onset patients. Affective symptoms differed significantly among groups; specifically, early-onset patients had more energy, minimal sleep disruption, and greater suicidality, while typical-onset patients had more severe abnormal thought content. CONCLUSIONS: Among patients with affective psychosis, there may be heterogeneity of symptoms and family history associated with age at first hospitalization.

Adolescent↗
PubMed1997

The effects of race and information variance on disagreement between psychiatric emergency service and research diagnoses in first-episode psychosis.

BACKGROUND: Previously, we reported that patient race was associated with disagreement between research and clinical diagnoses. To extend this work, we studied whether disagreement was specifically due to associations of patient race with information or criterion variance. METHOD: Ninety-nine patients consecutively admitted through the University of Cincinnati Psychiatric Emergency Service (PES) for a first hospitalization for psychosis were evaluated using the Structured Clinical Interview for DSM-III-R. Diagnoses made in the PES were compared with those obtained from the structured interview. We examined the contributions of information variance and criterion variance to the association between race and diagnostic agreement of PES and research diagnoses. RESULTS: Agreement in PES and research diagnoses was present in only 42% of patients. Diagnostic agreement was less common in non-white patients than white patients, even after controlling for other sociodemographic and clinical variables. Information variance was the cause of diagnostic disagreement in 58% of cases and was associated with patient race. Criterion variance, occurring in 42% of cases, was not associated with race. CONCLUSION: Patient race may contribute to the diagnostic process in the psychiatric emergency service by influencing the information obtained from patients during clinical evaluations.

Emergency Services, Psychiatric↗
PubMed1996

Enhanced response to repeated d-amphetamine challenge: evidence for behavioral sensitization in humans.

Behavioral sensitization is the process whereby intermittent stimulant exposure produces a time-dependent, enduring, and progressively more robust behavioral response. This process serves as an important model of neural plasticity and has also been proposed as a model for a variety of psychiatric syndromes; however, there are no published controlled studies of behavioral sensitization in human subjects. The authors report results from a double-blind, placebo-controlled study of repeated d-amphetamine challenges in a sample of normal human volunteers. Eleven consecutively recruited normal volunteers participated in this 4-day protocol. Each subject received two daily doses of d-amphetamine (0.25 mg/kg) separated by 48 hours that alternated with two daily doses of matched placebo. Symptoms (activity/energy level, mood, rate, and amount of speech) and eye-blink rates were measured hourly for 5 hours following drug administration. All four measures demonstrated significantly enhanced increases following the second amphetamine dose as compared to the first amphetamine dose and both placebo conditions. These findings suggest that behavioral sensitization is measurable in human subjects.

Administration, Oral↗
PubMed1996

Personality disorders in first- and multiple-episode mania.

We compared rates of DSM-III-R personality disorders in 33 first-episode and 26 multiple-episode bipolar patients. Patients were evaluated with the patient and personality disorders versions of the Structured Clinical Interview for DSM-III-R. Significantly more multiple-episode patients (65%) met DSM-III-R criteria for a personality disorder than did first-episode patients (33%). Race was also associated with a diagnosis of a personality disorder. Personality disorders may be associated with multiple affective episodes in bipolar patients.

Adult↗
PubMed1996

Relationships among negative, positive, and depressive symptoms in schizophrenia and psychotic depression.

BACKGROUND: We examined relationships among positive, negative, and depressive symptoms in schizophrenia and major depression with psychosis. METHOD: Patients with schizophrenia (n = 17) and major depression and psychotic features (n = 25), with no prior psychopharmacologic treatment were assessed on scales measuring positive psychotic, negative, and depressive symptoms. RESULTS: Analyses revealed the depressive symptoms positively correlated with anhedonia/asociality and avolition/apathy in both patient groups. Positive psychotic symptoms significantly correlated with depressive symptoms in the schizophrenic group. CONCLUSIONS: Several specific symptoms used in defining both depressive and negative syndrome constructs appear to be shared. The relationship between positive symptoms and depression in schizophrenia and not psychotic depression suggests the severity of depression may be involved in this relationship.

Adolescent↗
PubMed1996

Differences in thyroid function studies in acutely manic adolescents with and without attention deficity hyperactivity disorder (ADHD).

The purpose of this study was to compare basal thyroid indices in adolescent (ages 12 to 18) bipolar patients with and without attention deficit hyperactivity disorder (ADHD). On the basis of earlier studies, the authors hypothesized that bipolar patients with comorbid ADHD would have lower serum triiodothyronine (T3) and thyroxine (T4) concentrations and higher serum thyroid stimulating hormone (TSH) concentrations compared with patients with bipolar disorder alone. Thirty adolescents who met DSM-III-R criteria for bipolar disorder and were hospitalized for the treatment of acute mania were assessed. Twenty patients (66%) had comorbid ADHD. The mean serum T4 concentration in this group was significantly lower than it was for patients with bipolar disorder alone. There were no significant differences between groups in serum T3 or TSH concentrations. Although, these data are preliminary and require further investigation, this may have important implications regarding the potential benefits of thyroid supplementation in adolescents with bipolar disorder and comorbid ADHD who do not respond to mood stabilizers alone.

Adolescent↗
PubMed1995

The comorbidity of attention-deficit hyperactivity disorder in adolescent mania: potential diagnostic and treatment implications.

The frequency of attention-deficit hyperactivity disorder (ADHD) was assessed in 20 adolescents with DSM-III-R bipolar disorder hospitalized for the treatment of acute mania. Thirteen (65%) patients met DSM-III-R criteria for ADHD. Patients who met criteria for both disorders were more likely to be Caucasian and male, and to have mixed rather than pure mania. Patients with ADHD also had a higher mean total Young Mania Rating Scale score and lower serum thyroxine concentrations than patients with bipolar disorder alone. These results suggest that prior histories of ADHD or ADHD symptoms may be common in adolescents hospitalized for mania, and that patients with both disorders may have more severe manic symptoms than patients with mania alone. These findings may have important implications, especially in determining the optimal pharmacologic treatment of patients who meet criteria for both disorders, because standard treatments for ADHD and bipolar disorder have been assumed to exert opposing effects.

Adolescent↗
PubMed1995

The effects of race on diagnosis and disposition from a psychiatric emergency service.

BACKGROUND: Previous studies have reported that racial differences exist in patterns of clinical psychiatric diagnoses as well as the distribution of mental health services resources. The psychiatric emergency service serves as an entry point into the mental health system, so it plays a potentially important role in addressing racial disparities in diagnosis and disposition. To address this disparity, the authors studied two specific questions: (1) are there racial differences in diagnosis and (2) are there racial differences in disposition of patients visiting a psychiatric emergency service? METHOD: Demographic and clinical data were obtained by retrospective chart review of 490 patients randomly selected from 9500 visits to a large psychiatric emergency service during a 1-year period. All clinical information had been recorded by the primary treaters who had no knowledge of this study. RESULTS: Black patients were significantly more likely to be diagnosed with schizophrenia and substance abuse than similar white patients, although less likely to be diagnosed with a personality disorder. Black patients were significantly more likely to be hospitalized, particularly at a public hospital, although there were no significant differences in insurance coverage or measures of suicidal or homicidal ideation. CONCLUSION: Despite the availability of DSM-III-R criteria, black patients continue to be disproportionately diagnosed with schizophrenia. In this sample, this diagnosis may have been given in lieu of a personality disorder or affective illness diagnosis. Black patients are also more likely to be hospitalized. These observations suggest that further research is needed to clarify the effects of race on the decision-making process in diagnosis and disposition from the psychiatric emergency service.

Adult↗
PubMed1994

Sustained attention and positive formal thought disorder in schizophrenia.

Deficits in sustained attention and formal thought disorder (FTD) are two characteristics of schizophrenia that might be expressions of a common pathology. This study examined whether a measure of enduring (post-treatment, stabilized) deficits in sustained attention, the Continuous Performance Test (CPT) could predict FTD. In addition, a comparison was made of CPT performance between subjects with schizophrenia (n = 41) and healthy controls (n = 28). Results replicated previous findings of significantly poorer performance by individuals with schizophrenia compared to normal controls. Within the schizophrenia group, significant correlations were found between FTD and CPT measures. In order to assess predictability of FTD, a hierarchical multiple regression analysis was used. CPT errors and gender both significantly predicted FTD. The most robust prediction was of residual FTD (post-treatment, stabilized) by CPT commission errors. These results lend support to the proposition that a subsyndrome within schizophrenia exists that is characterized by deficits in sustained attention and positive formal thought disorder. Furthermore, this subsyndrome might be more common in males than females.

Adult↗
PubMedDate not supplied

fMRI of neuronal activation with symptom provocation in unmedicated patients with obsessive compulsive disorder.

BACKGROUND: Previous studies suggest that a neural circuit involving over-activation of cortical, paralimbic, limbic, and striatal structures may underlie OCD symptomatology, but results may have been limited by medication use in those studies. To address this, we examined the effects of symptom induction on fMRI neural activation in medication-free patients with OCD. METHODS: Seven outpatients with OCD were exposed to individually tailored provocative and innocuous stimuli during fMRI scans. Self-ratings of OCD symptoms were performed prior to each scan and after exposure to stimuli. Images were analyzed as composite data sets and individually. RESULTS: Stimulus presentation was associated with significant increases in OCD self-ratings. Significant activation was demonstrated in several regions of the frontal cortex (orbitofrontal, superior frontal, and the dorsolateral prefrontal); the anterior, medial and lateral temporal cortex; and the right anterior cingulate. Right superior frontal activation inversely correlated with baseline compulsion symptomatology and left orbitofrontal cortical activation was inversely associated with changes in OCD self-ratings following provocative stimuli. CONCLUSIONS: These results in unmedicated patients are consistent with those from previous studies with medicated patients and suggest that OCD symptomatology is mediated by multiple brain regions including the anterior cingulate as well as frontal and temporal brain regions.

Adult↗