Clinical prediction of ECT response in depressed patients.
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Depressive Disorder↗
Biomedical subjects
R Abrams
Publications and source records attributed to R Abrams.
ECT and tricyclic antidepressants in the treatment of endogenous depression.
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Antidepressive Agents, Tricyclic↗
Early- and late-onset bipolar illness.
We categorized a sample of 134 bipolar probands into early- and late-onset groups; age 30 years was the cutting point. Early-onset probands had three times the morbidity risk /MR) for affective disorder in first-degree relatives as late-onset probands and a greater proportion of relatives with the more severe, bipolar form. Early-onset patients also exhibited more neuropsychological dysfunction, less frequently had a unipolar manic course, and had a greater MR for alcoholism in first-degree relatives. The two groups did not differ in other clinical or historical characteristics or in the proportion of EEG abnormalities. Age at illness onset is useful in clarifying the genetic basis of affective disorder. The data are consistent with a polygenic or multifactorial model of illness in which the more severe genotype is expressed earlier in life and through the course of illness.
Adult↗
Prediction of treatment response in mania.
We evaluated the relation of responsivity of somatic treatment and heterogeneity in a sample of III manics (diagnosed by Feighner criteria) by assessing demographic, clinical, and family illness variables-historical variables potentially related to abnormal brain function and cortical function as measured by neuropsychological and EEG techniques. Except for a positive, perhaps unimportant, relationship between an abnormal EEG and improvement, we could find little evidence for biological differences between responders and nonresponders to treatment. However, 30% of the nonresponders and only 4% of the responders prematurely terminated treatment, suggesting a strong nonbiological mechanism underlying treatment failure. We conclude that there are as yet no adequate predictors of short-term treatment response in mania and that evidence for heterogeneity in mania must be sought elsewhere.
Adult↗
Gender differences in bipolar affective disorder.
We report a study of gender differences in a sample of 111 manic patients. Female manics (N = 78) exhibited fewer manic and more depressive symptoms than males (N = 33). Although male manics had a more frequent history of delayed landmarks, the two groups did not differ in cortical function as measured by EEG and neuropsychological testing. There were no significant differences between male and female relatives of male and female probands for unipolar or bipolar affective disorder, alcoholism or sociopathy. Female relatives of both groups were at greater risk for total affective disorder and male relatives were at greater risk for alcoholism. Familial illness patterns indicated that male and female manics shared the same genetic liability for affective disorder and that X-linked transmission was unlikely.
Affective Disorders, Psychotic↗
Importance of schizophrenic symptoms in the diagnosis of mania.
The authors examined a sample of 111 consecutively admitted patients who satisfied inclusion criteria for mania and further characterized them as exhibiting none, one, or two or more of five clinical features often believed to be associated with a diagnosis of schizophrenia: formal thought disorder, first-rank symptoms, auditory hallucinations, persecutory delusions, and catatonia. The presence and number of such symptoms were unrelated to any of the major demographic, clinical, historical, laboratory, or familial variables studied. The authors conclude that schizophrenic symptoms do not play an important role in patients who satisfy modern criteria for the diagnosis of mania.
Affective Disorders, Psychotic↗
Cognitive dysfunction in schizophrenia, affective disorder and organic brain disease.
We used the Wechsler Adult Intelligence Scale (WAIS) to study a sample of patients with affective disorder (N = 52), schizophrenia (N = 17) and organic brain disease (N = 8). Schizophrenic patients had lower verbal, performance and full-scale IQs than patients with affective disorder, but were no different from those with organic brain disease. An individual WAIS subscale analysis showed that, compared with affectives, schizophrenics had relatively poorer performance on language than non-language tasks. These differences were independent of age, sex, handedness, educational level or drug administration and are consistent with a variety of studies demonstrating significant cerebral dysfunction in carefully diagnosed schizophrenic patients.
Adult↗
Neuropsychological dysfunction in schizophrenia and affective disease.
We used Smith's neuropsychological test battery to study the cortical functioning of 52 patients with affective disorders, 17 schizophrenics, and 8 patients with coarse brain disease (CBD), all diagnosed according to research criteria. Testing and diagnoses were made independently and blindly. After accounting for the variance due to age, sex, handedness, educational level, and psychotropic drugs, we found that on tests of dominant hemisphere function schizophrenics performed significantly worse than patients with affective disorder but were no different from patients with CBD. On tests of nondominant hemisphere function the performance of the schizophrenics was similar to that of the other two groups, which were different from each other in that patients with CBD had poorer performance than affectives. A discriminant function analysis of the test scores applied to a jackknifed classification matrix successfully predicted research diagnosis in 86.5% of the affectively ill patients and 76.5% of the schizophrenics, for an overall hit rate of 84.1%. A canonical plot of the discriminant scores further showed distinct groups, with manics and depressives most alike but quite different from schizophrenics and patients with CBD. These findings are consistent with those derived from other neuropsychological studies, as well as EEG and CT scan studies.
Adult↗
Brain uptake of meperidine in the fetal lamb.
The uptake of meperidine by the brain of the fetal lamb was investigated by determining the concentration of meperidine in the fetal brachiocephalic artery and sagittal vein after intravenous and intramuscular administration to the mother. A positive arteriovenous gradient across the fetal brain existed for 10 minutes after intravenous administration, and for 20 to 25 minutes after intramuscular administration, thus indicating the uptake of meperidine by the fetal brain. The peak concentration of unbound meperidine in the fetal brain, as estimated from the plasma concentration of free meperidine at equilibrium, was three to four times greater after intravenous administration than after intramuscular administration. The findings suggest that, during labor, the route of administration of meperidine will determine the time course of meperidine in the fetal brain and, consequently, the time action of effects seen in the neonate. The lag time required for plasma-brain equilibration may explain the lack of correlation between the incidence of neonatal respiratory depression and the levels of meperidine in the cord after intramuscular administration.
Animals↗
Physiologic variability and fetal electrocortical activity.
The relationship between fetal electrocortical activity and multiple fetal parameters was examined in chronically instrumented fetal lambs. Consistent small but significant changes in fetal heart rate, mean arterial pressure, umbilical blood flow, and the cerebral uptake of glucose relative to oxygen were observed as fetal electrocortical activity cyclically shifted between high-voltage slow activity and low-voltage fast activity. Cardiovascular parameters were higher and the cerebral uptake of glucose relative to oxygen was lower during high-voltage slow activity than during low-voltage fast activity. The implication of these observations is discussed.
Animals↗
Reassessing the bipolar-unipolar dichotomy.
This paper is a critical review of the literature on the dichotomous classification of affective disorders into unipolar and bipolar types. The majority of genetic studies show significant overlap in the liability to develop two forms of illness, and the majority of lithium studies show a similar clinical responsiveness of both groups to both acute and maintenance treatment. Biological studies comparing the two groups are difficult to interpret as most have compared manics to depressives without controlling for motor activity, excitement, and other state-dependent clinical variables. Viewed in light of our research findings in a recent genetic study of affective states, we believe these data suggest that the separation of affective disorders by polarity may have been premature, and that the search for heterogeneity should now be carried out using alternative strategies.
Bipolar Disorder↗
The classification of affective disorders--a reassessment of the bipolar-unipolar dichotomy. A clinical, laboratory, and family study.
We studied a sample of 26 unipolar and 134 bipolar probands for a selection of familial, demographic, clinical and laboratory variables. We found a high proportion of unipolar illness in the relatives of bipolar probands and bipolar illness in the relatives of unipolar probands, inconsistent with the present dichotomous classification of affective disorders. The two groups were also similar on a number of clinical and demographic variables, and displayed equal amounts of cortical dysfunction as measured by electroencephalographic and neuropsychological techniques. The groups differed significantly on only 2 variables, with unipolars having a greater proportion of females and a later onset age than bipolars. We interpret these findings to be suggestive of homogeneity rather than heterogeneity for the more severe forms of affective disorders and offer several alternatives to the present unipolar/bipolar dichotomy which require further testing.
Adult↗
Familial and non-familial mania.
We compared 34 manics with a positive family history of affective disorder (familial mania) and 84 manics with a negative family history of affective disorder (non-familial mania) for clinical, demographic and historical variables related to abnormal brain function and for cortical functioning measured by neuropsychological and electroencephalographic techniques. Proband and relative research diagnosis, neuropsychological and electroencephalographic interpretations were made blindly and independently of each other. Except for index admission severity of illness being greater in familial manics, we could find no significant differences for any of the variables studied. We conclude that differences in family illness patterns do not identify subgroups of manics and if it exists, heterogeneity, must be sought by studying other biologic correlates of psychopathology.
Adult↗
Cognitive taska in the mental status examination.
We evaluated the reliability of 20 cognitive tasks as part of a clinical mental status examination. Twenty-five adult psychiatric inpatients were selected at random and inter viewed before three board-certified psychiatrists who, without any knowledge of each other's ratings, completed a form determining the presence or absence of abnormal responses. We found 19 of the 20 items to yield R values of greater than .50, with 14 of these having R values of .80 or better. All correlations were significant at the less than .01 level. We suggest that these cognitive tasks with demonstrated reliability be included in the standard mental status examination. As a group, the tasks are easily and rapidly administered and should provide more accurate clinical screening of patients suspected of cortical dysfunction. These tasks will enable clinicians to make more precise and cost-effective referrals for elaborate, time-consuming, and expensive neuropsychological testing.
Adult↗
A comparison of unipolar and bipolar depressive illness.
In a study of 40 consecutively hospitalized patients with research diagnoses of endogenous depression, the authors found no difference between unipolar and bipolar depressive patients in the risk for affective disorder in first-degree relatives, proportion of EEG or neuropsychological abnormalities, clinical evidence of the depressive syndrome, or response to doctor's choice of treatment. Bipolar patients had an earlier age of onset and displayed more manic symptoms that did unipolar patients. The authors conclude that the two forms of depressive illness are clinically and genetically homogeneous, are without identifying EEG or cognitive differences, and have an equally good response to somatic treatments.
Adult↗
Psychopathology and the electroencephalogram.
We investigated the relationship between EEG abnormalities and clinical psychopathological features in a consecutive sample of 159 patients who satisfied our research criteria for schizophrenia or affective disorder and in whom an EEG was obtained. In the 44 patients with abnormal EEGs, we found significant correlations between left-sided EEG abnormality and the clinical features of formal thought-disorder and emotional blunting, correlations which were independent of the variance associated with age, sex, past or present drug administration, or research diagnosis. The correlation for formal thought-disorder was specifically related to the left temporal lobe, a finding which we discuss in terms of the similarity between formal thought-disorder defined as a language dysfunction and fluent posterior aphasia. Because of the small sample size these results, although statistically significant, should be interpreted with caution and require confirmation by other workers.
Affective Disorders, Psychotic↗
Differential EEG patterns in affective disorder and schizophrenia.
We analyzed the EEGs of 27 schizophrenic patients and 132 patients with affective disorder who received diagnoses according to rigorous research criteria. The proportion of abnormal EEGs was twice as great among schizophrenics as among affectives, and when the groups were compared for localized cortical differences, schizophrenics had more temporal abnormalities and affectives more parieto/occipital abnormalities. There was also a trend toward different hemispheric lateralization for the two groups, with a reversal of the relative proportions of left- and right-sided abnormalities. These differences were unrelated to age, sex, severity of illness, or past or present drug administration. These findings are complementary to those of other workers, lend support to the validity of our diagnostic research criteria, and provide additional evidence for neurophysiological differences between schizophrenics and patients with affective disorder.
Adult↗
Unipolar mania revisited.
In a more sophisticated replication of an earlier study (Abrams and Taylor 1974), we examined 77 manic patients, of whom 29 had never suffered a depressive illness, and had two or more manic attacks. These unipolar manics were similar to the 48 bipolar manics for a wide variety of clinical, phenomenological, historical, laboratory and demographic variables, generally supporting our earlier findings. However, the present sample showed a striking excess of males among the unipolar manics, as well as an increased morbid risk for unipolar depression in first-degree relatives. Although not readily explainable, these differences suggest that it is premature to equate unipolar mania with classical bipolar illness. Further studies of unipolar mania are in progress.
Adult↗