Biomedical subjects
Publications and source records attributed to M M Weissman.
The authors evaluated the usefulness of the Michigan Alcoholism Screening Test in detecting alcoholism (as defined by the Research Diagnostic Criteria) in opiate addicts. The test was found to be adequately sensitive and specific in detecting current cases of alcoholism but inadequate for detecting alcoholic opiate addicts whose drinking was currently under control.
The authors report data from a case-control family study of lifetime psychiatric diagnoses among the relatives of individuals with major depression. Specifically, they address the relationship between anxiety disorders and major depression. The findings indicate that relatives of individuals with major depression plus an anxiety disorder are at greater risk for major depression, as well as anxiety disorders; than are the relatives of individuals with major depression without an anxiety disorder. This increased risk appears to be present whether or not the anxiety disorder occurs solely in association with episodes of major depression or is temporally separate. The nosological implications of these findings are discussed.
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Evaluations of diagnosis and symptoms of depression were undertaken in 157 opiate addicts at entrance to a multimodality drug treatment program and six months later. While 17% were having an episode of major depression (defined by Research Diagnostic Criteria) and 60% had at least mildly elevated depressive symptoms at entrance to treatment, substantial improvement was noted at the six-month reevaluation, with the rates of major depression and elevated symptoms dropping to 12% and 31%, respectively. Symptomatic improvement, although related to retention in treatment, was not the result of specific antidepressant pharmacotherapy and did not differ across treatment modalities. Starting treatment during a major or minor depressive episode was predictive of poorer outcome in the areas of illicit drug use and psychological symptoms, but unrelated to the areas of occupational functioning, legal problems, and program retention.
A survey evaluated current and lifetime rates of psychiatric disorders in 533 opiate addicts in treatment at a multimodality program. Information was gathered using a structured interview format, the Schedule for Affective Disorders and Schizophrenia-Lifetime version, and the criteria were the Research Diagnostic Criteria. Most were give the diagnosis of at least one psychiatric disorder in addition to opiate addiction. The most common diagnoses were major depressive disorder, alcoholism, and antisocial personality, and rates of chronic minor mood disorders and anxiety disorders also were found to be elevated in comparison with those found in a community population. In contrast, rates of schizophrenia and mania were very low and did not exceed those reported for the general population. The findings are interpreted as suggesting the importance of detecting and attending to psychopathology associated with opiate addiction.
It is important for genetic, epidemiologic, and nosological studies to determine accurate rates of lifetime psychiatric diagnoses in patient and nonpatient populations. As part of a case-control family study of major depression, lifetime psychiatric diagnoses were made for 1,878 individuals. Sources of information used in making diagnostic estimates included direct interview, medical records, and family history data systematically obtained from relatives. Diagnostic estimates were made by trained interviewers, experienced clinicians, and by computer program. The results indicate that it is possible to make lifetime best estimate diagnoses reliably among both interviewed and noninterviewed individuals for most diagnostic categories and that diagnoses based on interview data alone are an adequate substitute for best estimate diagnoses based on all available information in a limited number of diagnostic categories.
Discrepancies between the symptoms of depression, as found in a self-report questionnaire (Center for Epidemiologic Studies--Depression Scale [CED-D]), and the diagnosis of major depression as made by the Research Diagnostic Criteria (RDC) occurred in a community survey. The discrepancies can be explained by the subject's psychiatric or medical disorders other than depression, by nay saying during the interview, or by the exclusion criteria of the RDC (duration of symptoms, role impairment, or help seeking) that are not part of the CES-D. Results show that the discrepancies can be readily explained.
Familial studies of depressed probands vary in the absolute rates of affective disorders in relatives. In a study of 215 mild and severely depressed nonbipolar major depressives and normal probands and 1,331 adult first-degree relatives, attempts were made to account for the sources of variance. The results demonstrated familial aggregation, although degree of aggregation of absolute rates of affective disorders varied among relatives according to the definition of depression used for the relatives, the source of data, and the composition of the relative sample. Despite this variability, the magnitude of the difference in rates between relatives of the normal persons and of the depressed probands remained constant. The rates of affective disorders were always higher in the relatives of the depressed than in the relatives of the normal probands. The magnitude of the difference in rates of depression between the relatives of the depressed subjects and the relatives of the normal probands ranged approximately between twofold and fivefold.
This paper presents an evaluation of clinical characteristics of opiate addicts who also have a current or past history of alcoholism diagnosed according to Research Diagnostic Criteria. Based on data derived from a survey of 533 treated opiate addicts, the following findings were obtained. First, alcoholism in treated opiate addicts was found to be a common problem occurring at rates far exceeding those in the surrounding community in all demographic groups. Second, regarding the sequence of alcoholism and opiate addiction, most alcoholic addicts in this sample had alcohol problems before developing a drug use disorder or seeking treatment for opiate addiction. Third, entrance into treatment did not appear to lead to either increased or decreased alcohol abuse, and alcohol abuse while in treatment usually took place in those who had a history of alcohol problems. Fourth, when compared with nonalcoholic addicts, alcoholic addicts had fewer assets and more liabilities including a more disruptive childhood history, heavier history of legal problems and polydrug abuse, more severe problems with social functioning, and higher rates of psychiatric disorders. Fifth, despite these liabilities follow-up findings 6 months after seeking treatment indicate that alcoholism was of little prognostic significance in relationship to treatment outcome.
The authors describe the issues involved in training experienced psychotherapists to participate in outcome studies. Potential areas of conflict among research goals, clinical goals, and therapists' expectations include the restrictions imposed by the research protocol, the therapists' feelings about being evaluated, and the restrictions of a defined psychotherapy. A training program that addresses these issues and an appropriate administrative structure can reduce these conflicts.
This paper defines and tests a typology of addicts defined through assessment of the sequence of three types of key events: (a) traumatic childhood events such as death of a parent or child abuse; (b) onset of regular delinquent activity; and (c) initiation of illicit drug use. By evaluating the sequence of these events three groups are defined: (a) an initial childhood trauma group; (b) an early delinquency group; and (c) an initial drug use group. Data derived from a sample of treated opiate addicts are used to define and differentiate these three groups.
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Although pharmacotherapy and psychotherapy are frequently used in combination as treatment for depression, speculations about possible negative interactions of the two treatments remain. This occurs despite growing research evidence demonstrating the greater efficacy of combined treatment. In this report six hypotheses about negative interactions between pharmacotherapy and psychotherapy are evaluated on the basis of data derived from a clinical trial of psychotherapy and tricyclic antidepressants alone and in combination as treatment for ambulatory depression. None of the hypotheses was supported by the data.
A one-year follow-up was conducted on ambulatory nonbipolar, nonpsychotic, acutely depressed patients who received amitriptyline hydrochloride and/or interpersonal psychotherapy (IPT), each alone and in combination, as part of a four-month clinical trial. There were no differential long-term effects of the initially randomized treatment on clinical symptoms one year later since most of the patients were asymptomatic. While most patients were functioning reasonably well, there were some main effects of IPT on social functioning at the one-year follow-up. Patients who received IPT with or without pharmacotherapy were doing significantly better on some measures of social functioning.
Data on the current prevalence of depression and its treatment derive from a longitudinal community survey conducted in 1975-1976 in New Haven, Conn. The results show the high prevalence of depression based on the Research Diagnostic Criteria. While persons with a depression use the psychiatric and general medical health care systems more frequently than those without a depression, the overall number of those who see a psychiatrist, receive a tricyclic antidepressant, or receive any treatment for their emotional problems from any source is low. Persons with a depression who do not receive treatment especially for their emotional problems make relatively frequent visits to nonpsychiatric physicians. Men and older persons who are depressed receive the least treatment.
Epidemiologic studies of depression have been difficult to interpret because of differing case definitions and variation in diagnostic procedures between studies. We review data from recent epidemiologic studies in which the new research diagnostic techniques were used. We have divided the data into studies of depressive symptoms, bipolar disorder, and nonbipolar depression. An effort is made to integrate the findings of older studies in light of this new classification. Using this classification, there is less variation in epidemiologic rates (point prevalence, incidence, and lifetime risk) than has been noted in previous reviews. Future directions of research are also discussed.
Since a review of 15 social adjustment scales appeared six years ago in the ARCHIVES, a number of new scales have been developed and tested. Twelve new scales, three written self-administered and nine interviewer-administered scales, are considered to be useful in clinical and epidemiologic research in psychiatry. Future research in this area should include development of scales for use with children, adolescents, and the elderly; revision of scales to reflect changes in traditional roles, especially among women; clarification of the concepts underlying social functioning; and systematic explication and measurement of these concepts.
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