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Biomedical subjects

P R Joyce

Publications and source records attributed to P R Joyce.

At least 91 records · Page 5Linked to original sources
PubMed1994

Total cholesterol and suicidality in depression.

There exists considerable controversy regarding an association between low total cholesterol and increased mortality from suicide. As suicide mortality is a crude marker for suicidal ideation and behavior, we investigated the association between total cholesterol and suicidality in a depressed sample. Ninety men and women meeting structured criteria for a major depressive episode of at least moderate severity participated in a study of predictors of treatment response. A three level variable codified the degree of suicidality in the previous month: no suicidal thoughts (39/90), suicidal ideation or plan (38/90), and a suicide attempt (13/90). There was a significant univariate association between lower cholesterol levels and increasing degrees of suicidality. In a multivariate analysis, this association was the only one that neared statistical significance (p = 0.068). Although it is premature to conclude that these variables are causally associated, data from a number of sources suggest that this association is worthy of further study.

Adult↗
PubMed1994

Effects of exclusion criteria in depression treatment studies.

We investigated the effects of exclusion criteria in depression treatment studies by applying simulated exclusion criteria to a relatively unselected sample. The criteria were borderline personality disorder, drug/alcohol dependence, and exclusion criteria from the Treatment of Depression Collaborative Research Program and the Maintenance Therapies for Recurrent Depression Protocol. Each set of criteria substantially distorted demographic characteristics and Axis I and II comorbidity but did not yield higher rates of study completion or, in general, response to tricyclics. Excessive exclusion criteria in depression treatment studies have many adverse effects and should be applied only when overwhelmingly compelling reasons exist.

Adult↗
PubMed1994

Temperament predicts clomipramine and desipramine response in major depression.

Clinical predictors of drug response in major depression have been weak and inconsistent. Eighty-four patients suffering from a current major depressive episode completed a 6-week double-blind trial of either clomipramine or desipramine. Temperament, as measured by the Tridimensional Personality Questionnaire, accounted for 35% of the variance in treatment outcome, compared with less than 5% predicted by clinical variables. In the more severely depressed patients, temperament predicted nearly 50% of the variance in treatment outcome, which is the first time that such a substantial predictor of drug response has been identified. Within depressed women, temperament also predicted response to different antidepressant drugs. The potential importance of temperament, and the need for replication of these findings is discussed.

Adult↗
PubMed1994

Direction of weight change in depression.

Direction of weight change in depression has recently been reported to be mediated by Body Mass Index (BMI). The present study examined the relation between direction of weight change in unipolar depression, BMI, and clinical variables such as severity of depression, melancholia, chronicity and recurrence in 89 patients with major depression. While the BMIs of individuals who gained weight when depressed were significantly higher than individuals with no weight change, the BMIs of individuals who lost weight were not significantly lower than those with no weight change. Direction of weight change was not predicted by severity of depression, melancholia, chronicity or recurrence. Concerns regarding conceptual and methodological difficulties in research on predictors of direction of weight change in depression are discussed.

Adult↗
PubMed1994

Bulimia comorbidity in the general population and in the clinic.

This study compares rates of comorbidity of lifetime psychiatric disorder in a clinical sample of women with bulimia, with general population base rates, and with rates of comorbidity among bulimic women in the general population. Eighty-four per cent of the clinical sample of bulimic women had a lifetime affective disorder, and 44% a lifetime alcohol or drug disorder. These rates of disorder were significantly higher than the base rates in the general population. Bulimic women in the general population also had more affective and substance-use disorders than the general population base rates, but the rates of these disorders were lower than found in the clinical sample. In the general population, quite similar rates of other disorders including generalized anxiety, panic, phobia and obsessive-compulsive disorder, are found among those with bulimia, substance-use disorder and depression. Furthermore, among those with depression and substance-use disorder in the general population, rates of eating disorder are comparable. Rather than suggesting a specific relationship between bulimia and either depression or substance-use disorder, the data from this study suggest that the presence of any disorder is associated with a non-specific increase in the likelihood of other psychiatric disorder.

Adolescent↗
PubMed1994

Borderline personality disorder in major depression.

The precise interrelationship between borderline personality disorder (BPD) and major depression (MD) remains unclear. To elucidate this further, we studied the characteristics of BPD in an unselected sample of 103 depressed subjects. All subjects were evaluated with structured diagnostic instruments. We contrasted three groups (MD plus BPD, MD plus a non-BPD, and MD plus no personality disorder) across several domains (characteristics of the depressive disorder, psychometric scales, axes I and II comorbidity, early environmental indices, family psychiatric history, and treatment response). Depressed subjects with BPD had significantly earlier onset of depression, dense axes I and II comorbidity, and higher prevalence of conduct disorder, and were characterized by elevated psychoticism and anger-hostility scores. In most other respects, however, depressed subjects with BPD were not strikingly distinct from other groups of depressed subjects.

Adult↗
PubMed1994

Temperament and hypercortisolemia in depression.

OBJECTIVE: The authors examined the relationships among depression severity, melancholia, and cortisol level and the relationship between temperament, as measured with the Tridimensional Personality Questionnaire, and cortisol level. METHOD: Morning and afternoon cortisol levels of 40 healthy comparison subjects and 96 patients with major depression were measured. The depressed patients were rated for depression severity and melancholia, and they completed the Tridimensional Personality Questionnaire. RESULTS: Temperament, especially dependence and extravagance, but not depressive symptoms, was the major determinant of the hypercortisolemia observed in the depressed patients. CONCLUSIONS: For research in biological psychiatry to advance, more attention needs to be paid to the individual differences in biology that underlie any state-dependent biologic dysfunction.

Adult↗
PubMed1994

Relationships of the Tridimensional Personality Questionnaire to mood and personality measures for depressed patients.

The relationships of Tridimensional Personality Questionnaire dimensions to mood and to the Eysenck personality dimensions and Barratt's impulsivity scores are presented. Some aspects of temperament appear to be mood related, but most are not. Correlations with the other personality measures were largely as predicted. However, Exploratory Excitability correlated negatively with Harm Avoidance rather than with Novelty Seeking. Factor analysis supported this relationship. Reward Dependence was weakly represented by the other personality measures and may be tapping unique behaviours.

Adolescent↗
PubMed1994

Parental bonding in men with alcohol disorders: a relationship with conduct disorder.

Men from a clinical treatment setting suffering from alcohol dependence, and randomly selected men from the community diagnosed as having alcohol abuse and/or dependence, completed the Parental Bonding Instrument. The men from the alcohol treatment setting perceived both parents as having been uncaring and overprotective. In the general population sample, an uncaring and overprotective parental style was strongly associated with childhood conduct disorder, but not with alcohol disorder symptoms. This discrepancy in perceived parenting highlights the difficulties in extrapolating findings about aetiological factors for alcohol disorders from clinical samples. It also suggests that childhood conduct disorder and adult antisocial behaviour could influence which men with alcohol disorders receive inpatient treatment.

Adolescent↗
PubMed1993

One hundred years of suicide in New Zealand.

Suicide rates were obtained for New Zealand from 1889 to 1988. The overall rate for women has been stable since the 1930s, and the male rate showed marked peaks in the early 1930s and in the 1980s. Analysis of rates by age group revealed that the 1930 male peak was due to increases among the middle-aged and elderly men, and the current peak is due to increases among young men. Possible explanations for fluctuations in suicide rates over the last century are discussed.

Adolescent↗
PubMed1993

Stability of psychiatric diagnoses in New Zealand psychiatric hospitals.

This study examines the stability over a five year follow-up of first admission psychiatric diagnoses assigned in New Zealand psychiatric hospitals in 1980 and 1981. Diagnostic stability is a measure of the degree to which psychiatric diagnoses remained unchanged at a later hospital admission. Reasonably high levels of stability were found for the initial diagnoses of substance abuse disorders (86% stable), anorexia nervosa (70%), schizophrenia (67%), and affective disorder (67%). Poor levels of stability were noted for the initial diagnoses of personality disorder (36%), other psychosis (excluding schizophrenia and affective psychosis) (22%), and other neurosis (excluding neurotic depression) (20%). The major trends in diagnostic change are described. Factors influencing diagnostic instability are also examined. For patients with an initial diagnosis of schizophrenia, a change in hospital is found to be the strongest factor causing diagnostic instability, with time between admissions and age at first admission also having a significant influence. The implications of these findings are discussed.

Adult↗
PubMed1992

Elevated levels of acute phase plasma proteins in major depression.

Levels of acute phase and other plasma proteins were measured in 21 men with major depression, 28 men with alcohol dependence, and 12 men who acted as controls. The depressed men had significantly elevated levels of the acute phase proteins, haptoglobin and alpha-1-antichymotrypsin, and of immunoglobulin G. The elevations in haptoglobin and alpha-1-antichymotrypsin were highly correlated with each other, and were correlated with the severity of depression and negatively correlated with the thyroid stimulating hormone response to thyrotropin. The alcoholic men had elevated haptoglobin levels, but significantly decreased levels of immunoglobulin G. These findings provide further evidence for an inflammatory response during depression.

Acute-Phase Proteins↗
PubMed1992

Diurnal profiles of thyroid hormones are altered in depression.

Free thyroxine index (FT4I), serum thyroxine (T4) and thyrotrophin concentrations were measured in 45 depressed subjects and 23 controls. The FT4I am/pm ratio was significantly higher in depressed subjects than in controls. This elevated diurnal ratio of thyroid hormones in depression adds to the literature on the chronobiology of affective disorders, and may help to explain differences in thyroid hormone levels in depressed patients in other studies, where time of sampling has seldom been reported.

Adolescent↗
PubMed1992

The clinical significance of the thyrotropin-releasing hormone test in alcoholic men.

Sixty-six alcoholic men who had been abstinent from alcohol for at least four weeks were assessed clinically and then investigated in terms of Thyroid-Stimulating Hormone (TSH) and prolactin responses to a Thyrotropin-Releasing Hormone (TRH) challenge. Consistent with other studies, a third of the subjects had a blunted TSH response to TRH. This blunted response was not associated with a family history of alcoholism, or current depressive symptoms, past history of depression or family history of depression. However, subjects with a blunted TSH response were more likely to have had an earlier onset of alcoholism and to have had shorter alcoholic remissions in the past.

Adult↗
PubMed1991

The prognostic significance of thyroid function in mania.

Free thyroxine index (FT4I) and thyroxine (T4) levels were measured in 31 manic patients shortly after admission to a psychiatric hospital. Over one-third had elevated thyroid hormone levels, and this was largely due to increases in FT4I. Increased FT4I levels were associated with greater sleep disturbance and with being male, and were negatively associated with having had hospital admissions in the past six months. More interestingly, however, low FT4I levels prospectively predicted more hospital admissions in the 12 months from index admission, and this was not due to past admissions predicting future admissions. This adds to the growing literature on important relationships between thyroid hormones and treatment outcome in patients with affective disorders.

Adolescent↗
PubMed1991

Preventing alcohol problems: the implications of a case-finding study in Christchurch, New Zealand.

In 1986 the Christchurch Psychiatric Epidemiology Study obtained 1498 interviews using the Diagnostic Interview Schedule. Respondents were from a probability sample of adults aged 18-64 years. This article reports results relevant to preventing alcohol problems. The symptoms most likely ever to be experienced were types of heavy drinking (7-22%) and their consequences such as blackouts (13%). Thirty-two percent of men and 6% of women had met criteria for alcohol disorder prior to interview. The predictors of alcohol disorder were gender, childhood conduct disorder symptoms, early drunkenness, family breakdown and age of leaving school. Cohort effects were clear for onset of drunkenness and alcohol problems. The median duration of alcohol problems was at least 10 years, indicating scope for secondary prevention. General practice and hospitals appeared to be the most suitable places for intervention.

Adolescent↗
PubMed1990

Christchurch psychiatric epidemiology study: use of mental health services.

Use of health and mental health services by the 1498 adults in the Christchurch psychiatric epidemiology study is reported. Fourteen percent of the sample had visited a health service for help with mental health problems over the preceding six months. Of those with identified psychiatric disorder during the last six months, only 29% had over that period visited a health service or professional for a mental health consultation though 75% had sought health care. Mental health consultations were more commonly with general practitioners than with mental health specialists, the latter seeing only one in seven of those with recent disorder. Those who at some point in their lives had not sought help, even though they or others had considered it necessary, reported the reasons to be attitudinal rather than to do with practical concerns such as finance, time or access to care.

Adolescent↗