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Biomedical subjects

M Zimmerman

Publications and source records attributed to M Zimmerman.

At least 145 records · Page 8Linked to original sources
PubMed1987

Prognostic validity of self-report and interview measures of personality disorder in depressed inpatients.

Presence of personality disorders was assessed with the Structured Interview for the DSM-III Personality Disorders (SIDP) in a series of 78 nonpsychotic inpatients with major depression. Measures of severity of depression were administered at admission, at discharge, and 6 months after admission. Outcome for the depression was especially poor in patients meeting criteria for multiple personality disorders from multiple DSM-III clusters. A subgroup of 38 patients received both the SIDP interview and a self-report measure of personality disorder, the Personality Diagnostic Questionnaire. Depressed inpatients who met more than the median number of personality disorder criteria by either measure were approximately half as likely to show improvement at discharge and at 6-month follow-up than were patients with less than the median number of criteria.

Adult↗
PubMed1986

The validity of four definitions of endogenous depression. II. Clinical, demographic, familial, and psychosocial correlates.

Based on a survey of the classic literature and studies examining the correlates of a clinical diagnosis of endogenous or nonendogenous depression, we found 14 variables that should discriminate endogenous and nonendogenous depressives. We applied four definitions of endogenous depression (Feinberg and Carroll, DSM-III, Research Diagnostic Criteria, and Newcastle) to a consecutive series of 152 unipolar major depressive inpatients. We examined the concordance between the definitions and the relationship between each definition and clinical, demographic, family history, and psychosocial factors. The DSM-III and Newcastle definitions were less inclusive than the other two definitions. We found some support for the validity of each of the four definitions. The validity of the Newcastle scale was the most frequently supported, with the endogenous depressives having a lower rate of personality disorder, marital separations and divorces, familial alcoholism, life events, and nonserious suicide attempts.

Adult↗
PubMed1986

The validity of the dexamethasone suppression test as a marker for endogenous depression.

The validity of the dexamethasone suppression test (DST) as an indicator of endogenous depression has been most frequently tested by examining its relationship to operational criteria of endogenous depression. However, these criteria sets themselves have not been empirically validated. We examined the DST in terms of a series of hypotheses and predictions that are consistent with the theoretical construct of endogenous depression. In a consecutively admitted sample of 187 primary unipolar depressed inpatients, the DST nonsuppressors were older, had less premobid personality disorder, better social support, less frequent marital separations or divorces, fewer nonindependent stressful life events during the year prior to admission, made fewer nonserious suicide attempts during the index episode, had fewer dysfunctional attitudes, and had a lower rate of treated alcoholism and antisocial personality in their first-degree relatives. The only clearly negative finding was the lack of association between DST results and family history of depression. Our results strongly support the construct validity of the DST as a marker of endogenous depression.

Adult↗
PubMed1986

Reliability of follow-up assessments of depressed inpatients.

Twenty-one depressed inpatients were followed up for six months after hospital admission. One rater assessed the patients at monthly intervals, and an independent rater assessed symptoms and treatment for the same period at the end of the six-month follow-up. Ratings of audiotapes of the monthly interviews by a third rater achieved excellent reliability. Fair to excellent agreement was also found between the monthly and six-month interviews. Reliability was lowest during the first month of the follow-up period. Unexpectedly, at the six-month interview more rather than fewer symptoms were reported for the most remote part of the follow-up interval. Our results suggest that at the six-month interview patients had reevaluated their functioning for the immediate postdischarge period.

Adult↗
PubMed1986

A self-report scale to diagnose major depressive disorder.

The Inventory to Diagnose Depression (IDD) is a self-report scale designed to diagnose DSM-III major depressive disorder (MDD). In our analysis, its test-retest reliability and internal consistency were high. The IDD was significantly associated with other self-report and interviewer rated depression scales and was sensitive to clinical change. Diagnostic agreement between the IDD and clinician's diagnosis of MDD was as high as that found in studies examining the interrater reliability of the diagnosis of MDD. Moreover, our results suggested that the IDD may aid clinicians in detecting secondary depression and distinguishing psychotic depression from nonaffective psychoses. The IDD may be particularly useful in light of the recent evidence that American psychiatrists continue to underdiagnose depression and overdiagnose schizophrenia.

Adult↗
PubMed1986

Validity of familial subtypes of primary unipolar depression. Clinical, demographic, and psychosocial correlates.

We examined the psychosocial, demographic, and clinical correlates of familial subtypes of primary unipolar depression. Our findings supported the hypothesis that depression spectrum disease is a variant of neurotic depression, whereas familial pure depressive disease overlaps with endogenous depression. Patients with depressive spectrum disease experienced more life events, had more marital separations and divorces, had poorer social support, more frequently made a nonserious suicide attempt, and had a less characteristic endogenous symptom profile than patients with familial pure depressive disease. Consistent with our previous report on the relationship between dexamethasone suppression test results and familial subtyping, the broadness of the criteria used to diagnose the patients' first-degree relatives affected the strength of the association between the familial subtypes and the dependent variables.

Adult↗
PubMed1986

Body weight and reported versus measured weight loss as confounders of the dexamethasone suppression test.

We examined the association between post-dexamethasone suppression test (DST) serum cortisol and body weight, self-report of weight loss during the episode, and measured weight loss during the first week of admission in a series of 245 depressed inpatients. Data on measured weight loss between two successive admissions was available in a group of 57 depressed inpatients. Reported weight loss during the episode and measured weight loss during the first week of admission were not related to DST nonsuppression. In contrast, DST nonsuppression was significantly more frequent in patients with measured weight loss between two successive admissions. This association was particularly strong in patients with below-average body weight and was practically nonexistent in patients with above-average body weight. Multivariate analysis indicates that a significant association between DST results and weight loss may be missed if self-report is substituted for direct measurement of weight loss and if potential confounders, such as total body weight, age, and sex, are ignored.

Adult↗
PubMed1986

Quantitation of the relationship between aortic endothelial intercellular cleft morphology and permeability to albumin.

The aortic endothelial intercellular cleft (AEC) is a determinant of permeability to macromolecules. This study compared the surface density and frequency of AEC profile types between areas of rat aorta that were permeable/impermeable to albumin-bound Evans Blue dye (EBD). Five adult male Wistar rats were given saturating i.v. doses of EBD and 30 min later were perfusion, fixed and their aortae excised. Samples of impermeable (White) and permeable (Blue) areas were prepared for EM. Sections were coded randomly and all AEC profiles observed were assigned to 4 different morphological classes. Ten to 15 micrographs per sectioned sample, per area, per rat were taken to determine the surface density of AEC's relative to the endothelial cell layer. The frequency distribution of AEC profile types from Blue areas was significantly (P less than 0.01) different from that of the White areas. The Blue regions had relatively more AEC profiles of a less complex structure than did the White areas. The majority of cleft profiles in the Blue areas were of the simple 'overlap' type, whereas the commonest in the White areas were the 'mortise' type. The mean surface density of the AEC's in Blue areas was 0.066 +/- 0.002 micron-1, which was significantly (P less than 0.05) less than in White areas (0.11 +/- 0.002 micron-1). These findings confirm earlier qualitative observations and indicate that AEC's in areas permeable to macromolecules, such as albumin, are less complex in structure and of lower surface area than those in areas relatively impermeable to such macromolecules.

Albumins↗
PubMed1986

Validity of the Hamilton Endogenous Subscale: an independent replication.

We calculated scores on the Hamilton Endogenous Subscale (HES) (Thase et al., 1983) for 252 depressed inpatients. The HES scores were bimodally distributed, and HES classification was significantly associated with endogenous (Research Diagnostic Criteria) and melancholic (DSM-III) subtyping. Based on a cutoff score of 8, HES classification was not associated with either family history of specific psychiatric illness or abnormal dexamethasone suppression test (DST) results. When the cutoff was raised to 10, DST nonsuppression was more frequent in HES endogenous depressives, although we again failed to find an association with a family history of psychiatric disorders.

Adult↗
PubMed1986

Life events assessment of depressed patients: a comparison of self-report and interview formats.

Both self-report questionnaires and semi-structured interviews have been employed in past research on the association between life events and psychiatric disorder. We examined the comparability of these two approaches by giving both a self-report life events scale and semi-structured life events interview to 38 depressed patients. About 40% of the items noted on the interview were missed when using the questionnaire. Approximately 15% of the items noted on the questionnaire were errors since the events did not meet the definition or time criteria specified in the questionnaire. Twenty percent of the items noted on the questionnaire were not noted on the interview and may represent underinclusiveness on the part of the interview. The implications of these differences were examined by comparing the association between a variety of demographic and clinical variables and life events under each methodology. There were no significant differences between the two methods except when examining the association between life events and other subjective self-report measures.

Depressive Disorder↗
PubMed1986

Outcome at discharge and six months in major depression. The significance of psychotic features.

Inpatients with nonbipolar psychotic major depression (N = 46) had significantly lower Hamilton Rating Scale scores at discharge and a significantly greater number of weeks back to their "normal selves" during a 6-month follow-up than did patients with nonpsychotic major depression (N = 159). While both baseline severity and the receipt of electroconvulsive therapy distinguished these groups, neither accounted for the outcome differences noted. Severity ratings at discharge were clearly more predictive of follow-up course in psychotic patients than they were in nonpsychotic patients. Moreover, patients with psychotic depression had clearer outcomes in that their average follow-up weeks were more likely to involve either full syndromes or a complete absence of depressive symptoms. This finding, if replicated, may account in part for the lack of consensus on the prognostic significance of psychotic depression.

Delusions↗
PubMed1986

Evaluation of symptoms of major depressive disorder. Self-report vs. clinician ratings.

The authors examine the relationship between self-reported and interviewer ratings of individual symptoms of major depressive disorder. The overall rate of agreement between the self-reported and clinician ratings was about 80% for 14 of the 18 symptoms, and the median Kappa for determining the presence or absence of the symptoms was .62. Disagreement was greatest for psychomotor disturbance, decreased concentration, and indecisiveness. The authors discuss how the unreliability of interviewer assessments limits the amount of agreement between self-reported and clinician ratings.

Adult↗
PubMed1986

Demographic, historical, and symptomatic features of the nonmanic psychoses.

Consecutively admitted patients with nonmanic psychosis were more likely to meet Research Diagnostic Criteria (RDC) for schizoaffective disorder, depressed type (N = 47), than for psychotic major depression (N = 29) or schizophrenia (N = 21). Although the RDC duration requirements for these three disorders are quite similar, schizophrenics had already experienced much more chronicity as reflected in episode duration, psychosocial impairment during the preceding 5 years, marital status, and low likelihood of prior remission. Schizoaffective patients took intermediate positions in these measures in accord with the majority of follow-up studies comparing these disorders. Although the RDC specify the same array of psychotic symptoms for schizoaffectives and for schizophrenics, these symptoms were significantly more prominent among the schizophrenics. Conversely, although this system also specifies the same list of depressive symptoms for major depression and schizoaffective depression, symptoms of endogenous depression were significantly more prominent in the major depression group. Thus, among functionally psychotic patients, those with schizophrenia-like symptoms have milder and less typical depressive symptoms whereas those with depressive syndromes have fewer and milder schizophrenia-like symptoms.

Adult↗
PubMed1986

An American validation study of the Newcastle scale. III. Course during index hospitalization and six-month prospective follow-up.

One hundred and fifty-two depressed inpatients were classified endogenous or neurotic according to the Newcastle Diagnostic Scale. Endogenous depressives were significantly more likely than neurotic depressives to be treated with electroconvulsive therapy (ECT). Newcastle subtyping was not associated with response to ECT; however, neurotic depressives not treated with ECT were more symptomatic at hospital discharge than endogenous depressives not treated with ECT. A prospective 6 month follow-up interview was completed with 85% of the patients. There was no association between Newcastle subtyping and follow-up outcome.

Depressive Disorder↗
PubMed1986

Melancholic subtyping: a qualitative or quantitative distinction?

Melancholic depressed subjects scored significantly higher than did nonmelancholic subjects both on the depressive symptoms used and those not used for melancholic subtyping. The results suggest that DSM-III's melancholic criteria do not identify a qualitatively distinct subgroup, but instead reflect illness severity.

Adolescent↗
PubMed1986

ECT response in depressed patients with and without a DSM-III personality disorder.

Twenty-five inpatients with DSM-III major depressive disorder received ECT and were interviewed with the Structured Interview for DSM-III Personality Disorders. Patients with and patients without a personality disorder had similar short-term responses to ECT. The results of a 6-month prospective follow-up showed that depressed patients with a personality disorder were significantly more symptomatic and eight times more likely to be rehospitalized.

Adult↗
PubMed1986

An American validation study of the Newcastle diagnostic scale. I. Relationship with the dexamethasone suppression test.

The Newcastle diagnostic index was completed on 159 depressed in-patients, who received the dexamethasone suppression test during their first week in hospital. Patients suffering from endogenous depression had a significantly higher rate of DST non-suppression, were older, were more frequently psychotic, and more frequently lost weight; even after controlling for these variables, DST non-suppression was significantly more frequent in the endogenous group. The relationship between Newcastle scores and the frequency of DST non-suppression was non-linear.

Adult↗